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in Africa

Medical News & Perspectives

Does Skipping Breakfast Lead to Weight Loss or Weight Gain?

Rita Rubin, MA

B
ack in 1917, the same year that she
cofounded the American Dietetic
Association (now the Academy of
Nutrition and Dietetics), Lenna Frances
Cooper authored an article in Good Health
magazine that noted “in many ways the
breakfast is the most important meal
of the day, because it is the meal that gets
the day started.” Good Health was pub-
lished by the Battle Creek Sanitarium,
a Michigan health resort run by Cooper’s
mentor, John Harvey Kellogg, MD, the coin-
ventor of corn flakes (his brother started
the cereal business that would become the
Kellogg Company).
More than a century after Cooper’s ar-
ticle appeared, scientists are debating
whether breakfast is important at all, let
alone the most important meal, at least as far
as weight management is concerned.
Although research into the health ben-
efits of intermittent fasting suggests break-
fast is the one meal that shouldn’t be
skipped, a recently published systematic
review and meta-analysis of randomized
clinical trials looking at breakfast’s effect on epidemiologist at King’s College London and What’s on the Menu?
weight and energy intake concluded that self-described breakfast eater, wrote in an A recently published study in JAMA Pediatrics
skipping it, rather than eating it, might help opinion piece accompanying the study. involving low-income fourth through
people lose weight. Spector noted that despite many national sixth graders in Philadelphia concluded
The finding by Australian researchers guidelines stressing the importance of eat- that providing breakfast in the classroom,
challenges the widely held notion that skip- ing breakfast, around a third of people in de- as opposed to in the cafeteria before
ping breakfast slows metabolism and leads veloped countries skip it. school started, had the unintended conse-
to overeating later in the day. One reason experts were misled, quence of increasing incident and preva-
“We are told that breakfast helps our Spector wrote, is “because multiple obser- lent obesity, although not the incidence of
metabolism and that skipping it will make us vational studies have shown that obese and overweight and obesity combined. The
much hungrier so we’ll overeat and put on diabetic people skipped meals more often authors suggested that some of the chil-
weight,” Tim Spector, MB, MD, a genetic than thin people.” dren might have eaten before coming to

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 News & Analysis
school, so they consumed excess calories
when offered breakfast in the classroom.
Of course, the goal of school breakfast
programs is not weight management,
and a study published in 2015 in JAMA
Pediatrics suggested that breakfast in the
classroom improves school attendance.
“We must remember that these programs
were designed to counter food insecurity,
not combat obesity, and offering students
subsidized meals at school is obviously
important if they would otherwise go
hungry,” wrote the authors of an editorial
accompanying the more recent JAMA
Pediatrics article.
Scientists skeptical of the research
linking breakfast to weight gain point out
that the problem might be what study par-
ticipants ate for breakfast, not simply that
they ate breakfast. Scarfing down a morn-
ing meal high in refined carbs and sugar,
such as doughnuts and many breakfast
cereals, isn’t likely to help people manage
their weight.
Reijo Laatikainen, PhD, MBA, a regis-
tered dietitian in Helsinki, Finland, noted
in a blog post that the recent meta-
analysis by the Australian researchers
included studies in which breakfast typi-
cally consisted of juice with cereal and/or
white bread. One study, Laatikainen
noted, described breakfast as “bran cereal
between 7 and 8 am, and a chocolate-
covered cookie between 10:30 and 11 am.”
Laatikainen then asked, “Does anyone
really assume that such a breakfast would
benefit weight management?”
A Day in the Life
Adventures of a Wilderness Medicine Physician
Dara Grennan, MD
I
t's 10 AM on a beautiful Monday in
January, and Scott McIntosh, MD, is
starting a shift on ski patrol in Little Cot-
tonwood Canyon near Salt Lake City after
finishing a conference call. He works about
10 ski patrol shifts a year as part of his
responsibilities as an associate professor in
the Division of Emergency Medicine at the
University of Utah Medical Center. Trained
in wilderness medicine—an emergency
medicine subspecialty—McIntosh is well
1858 JAMA May 21, 2019 Volume 321, Number 19 (Reprinted)
© 2019 American Medical Association. All rights reserved.
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In the Philadelphia school breakfast
study, those randomized to provide the
meal in the classroom chose not to offer
hot items such as egg sandwiches and
instead provided only cold items, such as
cereal and muffins.
The problem is that cereal and muf-
fins might not be filling enough, predis-
posing people to pig out over the course
of the day, suggests a recent review
article. The authors concluded that com-
pared with skipping breakfast, break-
fast meals consisting of solid food to-
taling at least 30 g of protein and 350
calories improved appetite control and
satiety response.
“Given the current evidence surround-
ing the consumption of increased dietary
protein at breakfast, it is appropriate to
recommend the consumption of protein in
the morning meal to improve appetite
control, eating behavior, and diet quality,”
said coauthor Heather Leidy, PhD, of
the Purdue University nutrition science
department. “In addition, higher-protein
breakfasts have also improved glucose
control throughout the day.”
In response to a question on Twitter
about whether the Philadelphia schools
served juice along with cereal or muffins,
Katherine Bauer, PhD, a coauthor of the
JAMA Pediatrics article and a pediatric
obesity researcher at the University of
Michigan School of Public Health, tweeted,
“I would love to do another trial varying
breakfast content, plus different meal deliv-
ery methods.”
equipped to support local organizations
that provide rescue and emergency medi-
cal services for skiers and snowboarders.
Having a wilderness medicine physi-
cian like McIntosh on the mountain is a clear
advantage. Wilderness medicine physi-
cians deal with altitude illness, frostbite, hy-
pothermia, avalanche injuries, and animal
attack wounds. Their specialty also encom-
passes search and rescue, plant toxicology,
dive and marine medicine, and space medi-
Too Short and Sweet?
Although Bauer’s study lasted 2.5 years,
most of those included in the article by
Australian researchers, who acknowledged
that the quality of the evidence was low,
were too brief to provide answers, said both
Laatikainen and Leidy.
“[T]he studies included were of such
short duration that even compiled together,
they simply cannot reliably conclude any-
thing about breakfast’s utility to long-term
weight management,” Laatikainen blogged.
Only 2 of the 12 studies lasted for at least
12 weeks—“the minimum duration to see
meaningful changes in body weight,” Leidy
said. Those that were only a few days to a
few weeks in length should have been ex-
cluded, she said.
Neither of the 2 studies that lasted 12
weeks or longer tightly controlled what
study participants ate for breakfast or var-
ied the meal’s energy or macronutrient con-
tent, Leidy said.
“We simply do not have enough evi-
dence to support or reject the idea as to
whether breakfast impacts body weight,” she
said. “With that said, there is increasing evi-
dence supporting the effects of breakfast on
weight management–related outcomes, in-
cluding things like appetite control, food crav-
ings, satiety, and snacking behavior.”
However, she said, more research is
needed to determine whether a high-
protein breakfast can prevent weight gain or
lead to weight loss.
Note: Source references are available through
embedded hyperlinks in the article text online.
cine. These physicians work in environmen-
tal extremes, where it may be difficult to
even reach their patients, and once they do,
resources are generally limited.
A Southern California native, McIntosh’s
enthusiasm for working in the wilds took off
after he joined a Duke University freshman
orientation program featuring wilderness ad-
venture. After college, he worked with the
outdoor education organization Outward
Bound in North Carolina and Colorado.
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