For years, we’ve held breakfast in high regard. “The most important meal of the day” for a slew of reasons such as improved focus and attention throughout the morning, reduced risk of heart disease, and most notably, managing hunger. However, a recent article in the New York Times suggests that breakfast may not be all that it’s cracked up to be, at least when it comes to managing hunger and body weight. What dented breakfast’s halo? Purportedly, a new paper published in the American Journal of Clinical Nutrition by a group of scientists from University of Alabama at Birmingham.1
As is so often the case with nutrition research, the headlines don’t quite match up with the evidence. In the case of this new paper, the authors were evaluating biased research reporting and over-replicating research, two factors that ultimately lead us to draw conclusions that are not really true. They acknowledge in the paper that other topics could have been explored to test for these factors, but the effect of breakfast skipping on obesity was selected because “it seems like a less politically charged topic” than others and the question of whether eating or skipping breakfast influences body weight can be easily addressed in a randomized controlled trial (RCT).
They conducted a very in-depth analysis of the available research, not only looking at the results of 92 unique articles, but also evaluating whether study results were accurately communicated in the abstract section of the article and whether other articles correctly described prior research results. Their evaluation of the observational research confirmed a positive association between breakfast skipping and indicators of adiposity. Unfortunately, they note that there were many cases where the data were mis-represented by the investigators, often being referred to as causal in the abstract section of the article, when observational studies merely generate associations that can be evaluated in RCTs (in most cases). The authors further question why so many studies were conducted, when the association was found very consistently time and time again. They refer to this as “unproductive use of scientific resources”. Why keep re-inventing the wheel when we could be diverting our brain power to something other than the wheel?
The authors also highlighted a lack of RCT evidence, with only one study long enough in duration to evaluate the influence of breakfast skipping on weight loss (12 wk).2 Results of that study showed that habitual breakfast skippers who switched to eating breakfast lost more weight than those continuing to skip breakfast. However, habitual breakfast eaters that switched to no breakfast lost more weight than those who continued to eat breakfast, resulting in the authors’ concluding that “those who had to make the most substantial changes in eating habits to comply with the program achieved better results”. It wasn’t about breakfast, but about changing food intake behaviors at breakfast time that produced more pronounced changes in weight.
What is probably the most alarming finding from the paper is the presence and magnitude of misrepresenting other investigators’ data. For example, there were 46 articles identified that cited the RCT mentioned above. Of those articles, 65% incorrectly reported the results, suggesting that eating breakfast led to greater weight loss. More than half of the papers got it wrong!
I applaud the authors of this analysis for bringing these issues forward. It is incumbent upon all of us as health professionals to fully understand the scientific underpinning of dietary advice to ensure we’re communicating the science accurately. Only time will tell whether breakfast causes changes in body weight. In the meantime, does this new paper suggest we should forget about breakfast all together? Not at all! There is RCT evidence showing that skipping breakfast negatively affects other outcomes, such as focus and attention, particularly in kids, and aspects of metabolic health, such as insulin sensitivity and the lipid profile in adults.3,4 The evidence does not exist to advise against eating breakfast. But I suspect we can all agree that we will be watching this area a lot more closely moving forward!
1Brown AW, Bohan Brown MM, Allison DB. Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence. Am J Clin Nutr. 2013 Sep 4. [Epub ahead of print].
2Schlundt DG, Hill JO, Sbrocco T, Pope-Cordle J, Sharp T. The role of breakfast in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr. 1992;55:645-51.
3Hoyland A, Dye L, Lawton CL. A systematic review of the effect of breakfast on the cognitive performance of children and adolescents. Nutr Res Rev. 2009;22:220-43.
4Farshchi HR, Taylor MA, Macdonald IA. Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. Am J Clin Nutr. 2005;81:388-96.