It was commonly believed that having many small meals per day increases satiety. Supporting this notion are cross-sectional studies suggesting an inverse association between eating frequency and body weight in adults(1). Meanwhile, data from the NHANES suggest a positive association between eating frequency and energy intake in the healthy US population, whereby each additional ‘eating episode' is estimated to contribute an additional ~200 kcal to overall energy intake potentially resulting in weight gain in the long-term (2). These findings, however, are greatly hindered as a result of underreporting of energy intake and meal frequency, particularly among nibblers (3).
The relationship between meal frequency and weight loss in overweight and obese individuals is also limited. A randomized, controlled trial in 2012 identified no differences in energy intake and BMI between participants randomized to either three or five meals per day (4). These findings were similar to other trials as well, which suggest no weight loss benefit from frequent meal intake (5). Meanwhile, in the healthy elderly, grazing may ensure adequate energy and micronutrient intake (6,7). While the contribution of small, frequent meals on energy balance remains equivocal, its influence should further be examined in the context of dietary quality and achieving adequate micronutrients intake.
Clinically, ‘small, frequent meals' is perhaps the most commonly used medical nutrition therapy. Clinical nutrition guidelines generally recommend six to ten meals per day for patients experiencing early satiety and anorexia as they battle various diseases, such as pancreatitis and gastroparesis, or undergoing appetite suppressive treatment, such as chemotherapy, as recommended by the American Cancer Society(8). This eating pattern promises to decrease bloating, overcome early satiety and other symptoms, to help achieve adequate caloric intake (9). Grazing is also indicated post surgery for many gastrointestinal procedures including bariatric surgery and Whipple, to accommodate calories without abdominal distention and discomfort or dumping syndrome. Despite its short-term benefits, prolonging this dietary pattern post surgery may result in adverse health outcomes, such as less weight loss and eventual weight regain following bariatric surgery (10). These findings support the notion that this eating pattern more likely than not contributes to positive energy balance in the long-term. Yet this remains under examined, and whether the provision of small, frequent meals does indeed result in increased caloric intake in nutritionally at-risk individuals, such as those with pancreatitis, has yet to be elucidated.
An often-overlooked consequence of grazing is curtailed fasting duration. Clinical indications of small, frequent meals also include avoiding prolonged fasting, which is critical for cirrhotic patients, for example, to overcome the onset of endogenous protein breakdown for gluconeogenesis particularly during nocturnal fasting. However in healthy individuals, nocturnal fasting has been shown to provide various health benefits .
Several hurdles remain to be overcome in advancing our understanding of the relationships between grazing pattern and health. Among the most pressing limitations is the consistent use of a single definition for ‘meals' for meaningful comparisons among studies. In addition, appropriate assessment tools, such as multiple food diaries –capturing meal size and time – in addition to nutrient intake, instead of food-frequency questionnaires should be adopted moving forward to accurately assess frequency.
The 2010 Dietary Guidelines of Americans concludes that there seems to be inadequate evidence to accurately evaluate the relationship between meal frequency and nutrient intakes. The current evidence does seem to suggest that unless clinically indicated, perhaps the general population should follow a more structured, 3 nutritious meals at regular times per day because of difficulty related to achieving energy balance without proper portion control. In addition, small, frequent meals often tend to be in the form of convenient snacks, which contribute refined carbohydrates, rather than fats and proteins, to the diet, and therefore add minimal nutrition to the diet for the most part. Thus, if necessary, provision of this dietary pattern should also be supplemented by an education focused on healthy meals/snacks and portion control.
1.Kant AK. Evidence for efficacy and effectiveness of changes in eating frequency for body weight management. Adv Nutr. 2014 Nov;5(6):822–8.
2.Kant AK, Schatzkin A, Graubard BI, Ballard-Barbash R. Frequency of eating occasions and weight change in the NHANES I Epidemiologic Follow-up Study. Int J Obes Relat Metab Disord. 1995 Jul;19(7):468–74.
3.McCrory MA, Campbell WW. Effects of eating frequency, snacking, and breakfast skipping on energy regulation: symposium overview. J Nutr. 2011 Jan;141(1):144–7.
4.Bachman JL, Raynor HA. Effects of manipulating eating frequency during a behavioral weight loss intervention: a pilot randomized controlled trial. Obesity (Silver Spring). 2012 May;20(5):985–92.
5.Kulovitz MG, Kravitz LR, Mermier C, Gibson AL, Conn CA, Kolkmeyer D, et al. Potential role of meal frequency as a strategy for weight loss and health in overweight or obese adults. Nutrition. 2014 Apr;30(4):386–92.
6.Zizza CA, Tayie FA, Lino M. Benefits of snacking in older Americans. J Am Diet Assoc. 2007 May;107(5):800–6.
7.Zizza CA, Arsiwalla DD, Ellison KJ. Contribution of snacking to older adults' vitamin, carotenoid, and mineral intakes. J Am Diet Assoc. 2010 May;110(5):768–72.
10.ConceiÇão EM, Mitchell JE, Engel SG, Machado PPP, Lancaster K, Wonderlich SA. What is “grazing?” Reviewing its definition, frequency, clinical characteristics, and impact on bariatric surgery outcomes, and proposing a standardized definition. Surg Obes Relat Dis. 2014 Sep;10(5):973–82.
11.Marinac CR, Natarajan L, Sears DD, Gallo LC, Hartman SJ, Arredondo E, et al. Prolonged Nightly Fasting and Breast Cancer Risk: Findings from NHANES (2009-2010). Cancer Epidemiol Biomarkers Prev. 2015 May;24(5):783–9.
By: R. Alex Coots
The field of nutrition is diverse. Some nutrition researchers pursue their work to better understand human metabolism, while others seek to help people build healthy eating habits. Despite the different approaches in their research programs, nutrition researchersall aim to improve public health. But simply producing the information isn't enough. The entirety of scientific knowledge must be evaluated and used to create effective policies to fully realize the benefits of nutrition research.
Angela Tagtow, Executive Director of the Center for Nutrition Policy and Promotion at the USDA, continues an illustrious career in health promotion at the USDA. She's worked in nutrition, public health and food systems at levels ranging from local initiatives to international endeavors. She and I had a conversation about her career, her advice for students interested in policy, and her thoughts on the challenges of policy work.
How did you get your start in nutrition and policy?
Growing up, food and meals were very important in my family. We maintained a large garden which provided diverse foods for our day-to-day meals. In college I had an intense interest in health promotion, but clinical dietetics was focused on treatment rather than prevention of illness. Health promotion at the time was nascent but I saw the potential and oriented my life towards it.
After graduation from college I started work at the American Heart Association as a program director. This position helped build out my network and gave me my start in the health promotion world, however I quickly realized I'd need graduate-level training to take my career further. After graduate school I started work as a consultant in the WIC program at the Iowa Department of Public Health. Here I worked more broadly in the public health domain with a variety of groups such as the county boards of health and Title V Maternal and Child Health Services.
After 9 years, I decided to expand my areas of expertise to include food systems as well as public health and nutrition. I founded a consulting company where I provided education, informed policy, and developed communication tools around health, the environment, and food systems. After 9 years of consulting, I moved back to government to work at the CNPP.
What are the key lessons or skills that you took away from these endeavors?
Consulting work affords you a good deal of flexibility in the types of work that you take on. I was able to broaden my skillsets, increase my knowledge base, and diversify my network in ways that I wouldn't have been afforded in government. Consulting does have a bit more uncertainty with respect to job security. A career in government is a much different experience. The scope of the work is more defined and the position is more secure compared to consulting, but it may be difficult to advance upward.
The key skillsets that today's students should focus on are critical thinking, communication, and engagement. As dietitians and nutritionists, we need to feel comfortable being assertive and asking the difficult questions. Of these three skills, engagement and networking are the hardest to teach. Students should continually practice this skill throughout their careers. Networking is something that takes time and is an ongoing learning experience.
When creating nutrition policy, are particular data or data types more useful than others?
All of the different data types must be considered, especially systematic reviews and randomly controlled trials. We need to be looking at the preponderance of data to reach a conclusion, not create policy based on one particular study or study type, as each type of study has strengths and weaknesses. After evaluation of the data, we have to be able to translate the body of research into appropriate policy or interventions. Policy is like a puzzle and data are the pieces.
Do you feel that there's siloing of academic fields, and that crosstalk can improve healthoutcomes?
There's still some siloing of research topics, but there has been improvement. Some land grant institutions with great agricultural research programs focus on food production or food processing issues, but this work is not necessarily connected to the greater picture of human health. Some schools have recognized this issue and have started interdisciplinary programs aimed towards interconnectivity – programs in food systems is a good example. People have recognized the value of an integrated approach, but it's a process that takes time to develop.
Part 2 of this interview will be posted in my next entry.
By: Mary Scourboutakos
In just a few weeks, New York will be the first city to introduce high sodium warning labels in restaurants. As a result, come December 1st 2015, any menu item that exceeds 2300 mg of sodium will be required to sport the new graphic [pictured here] illustrating a salt shaker inside of a triangle.
The policy, which is an amendment to the New York City Health Code, will affect any chain restaurant with at least fifteen locations, and will affect over 3000 restaurants, or one-third of all restaurant traffic in New York City.
Megan Lent, the Acting Director of Policy at the Bureau of Chronic Disease Prevention and Tobacco Control, who was involved in the background research and development of the policy, said the idea came from research which showed that people are eating more of their meals away from home. Furthermore, she said the rationale also comes from sodium's effect on blood pressure, and ultimately heart disease—which is the leading cause of death in New York City. Hence, she explained that this policy will “put information back into consumers hands” and thus hopefully foster healthier choices.
While some might argue that 1500 mg—the daily Adequate Intake level—would be a more conservative limit, Lent says they went with 2300 mg—the daily Upper Tolerable intake level—because “this clearly lets people know when they've reached that threshold, without making assumptions.”
As for the choice of a pictorial warning label, Lent explained that listing the number of milligrams of sodium is preempted by the federal calorie labeling law that was passed as part of the Patient Protection and Affordable Care Act, back in 2010. Hence, numerical information regarding sodium simply isn't allowed. Nevertheless, as Lent highlighted, one advantage of the graphic is that it provides an “actionable symbol.”
The implementation of policies such as this one, rarely come without backlash from critics. However, while this policy did receive some comments from the food industry during the public comment period, Lent explained that with regards to the media coverage “a lot has been fairly supportive.” And while some experts have criticized the whole notion of menu-labeling, citing a lack of evidence of effectiveness, Lent says polling has shown that “many New Yorkers think calorie labeling is useful and that these interventions are helpful.”
In a recent article posted on Nation's Nutrition News, Anita-Jones Mueller, the founder of Healthy Dining and Healthydiningfinder.com, told industry to “just say no” by stating “save money and time, and prevent the risk of disappointed guests, by saying NO to the icon and making sure that most — if not all — of your menu items contain under 2,300 mg of sodium. It's possible!”
But is it possible? In my own research, I've found that 56% of meals from chain, sit-down restaurants would qualify for the warning label, if it was implemented in Canada. However, when menu items are listed individually on the menu (ex. side dishes separate from entrÉes) only 9% would carry the label.
The New York Department of Health plans to evaluate the policy by monitoring changes in sodium levels over time using “Menu Stat”, their free online longitudinal nutrition database containing information for thousands of restaurant foods. But will the policy encourage decreases in sodium, as was seen in King County, Washington after the implementation of their sodium labelling policy? One can only hope!
The United States is able to utilize government assistance to support various programs to help improve the nutritional status of our nation. There is a safety net of several programs to improve public health via nutrition. Prolonged consequences of an unhealthy lifestyle including obesity, heart disease and type II diabetes are being seen in other countries as well. As I am currently residing in the south of France for seven months to teach English, I have the opportunity to discover how another country is tackling the public health problems associated with nutrition.
Chronic Diseases in France
Worldwide we are seeing an increase rate of health disparities. Cardiovascular disease, obesity and type II diabetes are three main common ailments and are often preventable. Cardiovascular disease is the leading cause of death worldwide (1). Now in the 21st century over 30% of the world's population suffers from heart disease. Interestingly enough in France, heart disease mortality isn't as high as other 1st world countries (2). Despite a diet rich in saturated fats and cholesterol, the incidence of heart disease remains low (3). While heart disease may not been the main concern, circulatory disease remains an issue, being the second leading cause of death in 2012 after cancer (2). In 2014 25.7% of the French adult population was obese (4). Comparing this to the United States at 35% they aren't too far behind (5). Type II diabetes is drawing attention as well as a health issue. In 2009 7.0%- 7.5% of the French population had type II diabetes in comparison to about 10.41% of the United States Population (6,7). France is addressing currently addressing these problems and taking on tactics similar to the United States by promoting preventative methods.
Le Programme National Nutrition SantÉ (PNNS)
Manger Bouger translates to Eat and Move. It is supported by Programme National Nutrition SantÉ (PNNS) meaning a national nutrition and health program (8). PNNS began in 2001 with the objective to improve public health and reduce the incidence of chronic diseases by improving nutritional practices. The goals of PNNS assess different social, cultural, cognitive and economic disparities when trying to improve the nutritional status and the level of physical activity of France. Under the umbrella of PNNS there are a few specific programs. In 2010, the French government has implemented un plan obÉsitÉ (PO) (an obesity plan) and also un programme national pour l'alimentation (PNA) (a national food program).
Similar to the US's ChooseMyPlate, the Manger Bouger site offers a plethora of helpful nutritional information to the public (9,10). It stresses to regularly eat a diet mixed in fruits, vegetables, grains and fish; limit salts, sugars and fats and to participate in regular physical activity (10). It explains to the public how these healthy lifestyle choices can reduce your risk for many chronic ailments. The site also briefly mentions to read nutrition facts labels, but there is little assistance on how to understand this information. Furthermore, the format for Nutrition Facts in France is very different and hard to interpret given the main point that there are often no serving size portions and only 100g portion sizes. While, there is no software on the site similar to SuperTracker or any type of diet assessment tool, there is La Fabrique à Menus, which helps to plan out a daily menu of various healthy dishes. Manger Bouger also includes a blog titled “Le Mag” which includes tips on how to enjoy the many rich flavors of France or eating on a budget, while still eating healthy.
Living in France, I have witnessed how important cuisine is to the French population. A prime example is how each region has traditional dishes tied closely to their culture. In Nice a popular dish is socca, a chickpea pancake, and in SÈte you cannot walk a block without finding tielle, a savory fish tart. Manger Bouger embraces this by providing general nutritional practices like consuming smaller portions, while keeping the tradition of French cuisine alive. Manger Bouger only offers specific meal advice for lunch and dinner (11). This is most likely because a typical French breakfast or petit dÉjeuner is only a slice of bread or a croissant and a coffee. Snacking in France is also less common. While in America five small meals a day can be seen as a healthy eating habit, this would not be ideal for the French as they value their meal time as a time to relax and experience their food. Unfortunately, the French do not seem to draw much attention to the specific nutritional content of their food. Consequently the general public does not seem as well educated on their daily caloric intake and the nutritional makeup. This could be due to the fact that they seem to focus more on reducing portion sizes and over eating rather than changing the composition of their diet.
By Christopher Radlicz
Currently, only one-quarter of pregnant women in the United States are eating the amount of fish recommended for optimal maternal and child health (1). On the other end of the spectrum, about 10% of women of childbearing age have higher than recommended blood mercury concentrations (2).
A qualitative study done in 2010 has helped explain why women may be consuming less than the recommended two-servings of fish per week (1). Pregnant women in the Boston area, who under-consumed fish according to these guidelines, were broken into focus groups and discussed what was keeping them from eating more fish. These groups revealed that many women knew that fish might contain mercury, but were naïve of the fact that fish contained beneficial fatty acids, such as docosahexaenoic acid (DHA), which is essential for optimal fetal brain development (3). The women admitted that they hadn't received advice to eat more fish or more specifically to eat fish that contain lower amounts of mercury and higher amounts of beneficial fatty acids. Instead, the women confessed that they were advised to limit fish intake due to possible mercury exposures.
Are these women misguided in keeping their fish consumption below the recommended two-servings per/week during pregnancy?
This past February, The 2015 Dietary Guidelines Advisory Committee reiterated that women who are pregnant, nursing, or are planning to become pregnant should still consume fish because neither the risk of mercury nor other organic pollutants outweigh the benefits (4). In a recent New York Times article on the issue, Dr. Steve Abrams, medical director of the Neonatal Nutrition Program at Baylor College of Medicine and panel member on the advisory committee commented on tuna consumption, explained, “The benefit of having (omega-3 fatty acids) in your diet really exceeds the likely risk of contamination. The point is that you should have a variety of types of seafood and not limit yourself to one type, and variety includes canned tuna.”(5).
The intake of fish during pregnancy is certainly more nuanced than simple elimination from the diet due to potential mercury exposure. Fish contains essential nutrients proven to have beneficial effects on brain neurodevelopment and may prevent cardiovascular disease (6). These benefits have been attributed in part to the long chain polyunsaturated fatty acids (LCPUFAs), DHA and eicosapentaenoic acid (EPA), but in addition seafood is a good source of protein, selenium, iron, iodine, choline, and vitamins E and D (4,7). These LCPUFAs are essential throughout pregnancy but are critical from the beginning of the third trimester until about 18 months after birth when the human brain is growing the fastest. Neglecting to supply LCPUFA among other nutrients during this period may result in deficits in brain development (9).
That being said, mercury exposure is a real possibility. Methylmercury is the organic form of mercury that we are exposed to when consuming fish in our diet. This form of mercury is relatively stable, mobile within the body, and exhibits a high potential to damage the brain (8). Mercury poisoning outbreaks in Japan are a testament to the wide spread damage that can occur from exposure to methylmercury, resulting in infants born with serious neurological damage, even when mothers were seemingly unaffected (10).
Extreme exposure to mercury in the food chain as in the case of Japan is a rather isolated instance though. But what is the balance? Do the beneficial effects of fish counteract the adverse effects of toxicants?
In the literature, detection of methylmercury exposure in infants is typically done by measuring levels in maternal hair, maternal toenails, cord blood, and maternal blood. These methods are variable in measuring biomarkers and on certain occasion, can be imprecise (5,7). Additionally, many observational studies do not statically control for negative confounders. This means that majority of the cohort studies done in this field have focused on either the risk of methylmercury or on nutrient benefits but not both (7).
All of the complications in study design and analysis show the complexity of establishing recommendations from these studies. Even with good study designs, clear-cut recommendations as to how much fish pregnant women should eat may still not be feasible, due to the variability of toxicants in seafood species. Empowering pregnant women by informing them of seafood that is lower in mercury levels and higher in LCPUFAs is a practical solution. A pertinent rule to apply when making seafood choices is that small sea creatures, which live shorter lives and are lower on the food chain, tend to be the lowest in methylmercury levels and exponentially higher in LCPUFAs. Larger seafood, on the other hand, tends to have higher levels of methylmercury due to a longer lifespan and their higher settlement on the food chain allowing for an accumulation of more methylmercury. The Dietary Guidelines Advisory Committee is in consensuses with the FDA and EPA in advising pregnant women to avoid eating these larger fish, such as swordfish, tilefish, shark, and king mackerel due to their high levels of methylmercury (4,7).
1.Bloomingdale A, Guthrie LB, Price S, Wright RO, Platek D, Haines J, Oken E. A qualitative study of fish consumption during pregnancy. Am J Clin Nutr 2010; 92: 1234-40. doi:10.3945/ajcn.2010.30070
2.Mahaffey KR, Clickner RP, Bodurow CC. Blood organic mercury and
dietary mercury intake: National Health and Nutrition Examination
Survey, 1999 and 2000. Environ Health Perspect 2004 ;112:562–70.
3.Koletzko B, Cetin I, Thomas Brenna J. Dietary fat intakes for pregnant
and lactating women. Br J Nutr 2007;98:873–7.
4.United States Department of Agriculture. Scientific Report of the 2015 Dietary guidelines Advisory Committee. Washington, DC. 2015.
5.Parker-Pope T. (2015, March 2). Should Pregnant Women Eat More Tuna. The New York Times. Retrieved from http://www.nytimes.com. http://well.blogs.nytimes.com/2015/03/02/should-pregnant-women-eat-more-tuna/?r=0
6.Anon. The Madison Declaration on Mercury Pollution. Ambio 2007;36:62–65. [PubMed: 17408191]
7.Choi AL, Cordier S, Weihe P, Grandjean G. Negative Confounding in the Evaluation of Toxicity: The Case of Methylmercury in Fish and Seafood. Crit Rev Roxicol. 2008; 38: 877-893. doi:10.1080/10408440802273164.
8.Clarkson CW, Vyas JB, Ballatori N. Mechanisms of Mercury Disposition in the Body. American Journal of Industrial Medicine 2007;50:757-764.
9.Innis SM. Essential fatty acids in growth and development. Prog Lip Res 1991; 30: 39.
10.Harada M. Minamata Disease: Methylmercury Poisoning in Japan Caused by Environmental Pollution. Crit Rev Toxicol 1995;25:1–24.
11.Hibbeln JR, Davis JM, Steer C, Emmett P, Rogers I, Williams C, Golding J. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 2007;369:578–585.
By Marion Roche, PhD
Approximately162 million children are stunted.In the global nutrition community the human costs of stunting are well recognized: stunted children complete less school, have less learning and earning opportunities, and females who become moms in the future are more likely to give birth to stunted children. Intervening early in 1000-day window (from conception to the age of two) and even earlier, pre-pregnancy, is recognized as most cost-effective way to prevent, as in many settings it challenging to reverse the physical and cognitive deficits from chronic malnutrition. Beyond the human costs, there is also an economic case to be made for investing in stunting reduction.
Every four years, the world's leading economists and experts from diverse development fields come together to rank the best investments for development in what is called the Copenhagen Consensus. Nutrition is one such investment that is consistently ranked as a “best buy”. Specific interventions such as vitamin A supplementation, salt iodization, zinc & ORS for diarrhea treatment and support for breastfeeding and adequate complementary feeding have all been in the top 10 best investments in previous years. In addition, nutrition-sensitive approaches, such as keeping girls in school, improvements to agriculture yields and crop quality, enabling gender equity for women, and overall poverty reduction, are all necessary to sustainable long-term stunting reductions for communities and countries.
This month, world leaders and experts met in Addis Ababa, Ethiopia for the Third International Financing for Development conference. A presentation by Dr. Meera Shekar of the World Bank and Dr. Robert Hetch of Results for Development at an MI co-hosted side-event on nutrition at the conference laid out what it would take to achieve the World Health Assembly target of reducing stunting by 40% by 2025. They emphasized that strategic investing in improving the nutrition situation for 68 million children would offer a long-term $45 dollar return on each dollar invested. More specifically, every dollar invested in reducing stunting is estimated to generate an $18 return in the long run. However, although many nutrition interventions look affordable on an individual scale, a more detailed analysis has been done to show what it would cost to deliver these interventions and reduce stunting at a global scale.
The Financing for Development conference was centred on funding the Sustainable Development Goals, the set of targets relating to the of future international development post-2015. Looking at the return on investment (ROI) in nutrition and knowing that nutrition has such a profound effect on other areas of a person's life, I think there is no better investment the world can make to reach the SDGs more quickly and effectively than that in nutrition!
Breakfast is often considered the “most important meal of the day,” and if you are looking to lose weight, you mustn't skip breakfast… or so the story goes. This idea is widely believed in popular culture as well as by many nutrition scientists and government bodies and is repeated so often that many in the field consider it health dogma. Indeed, the Dietary Guidelines for Americans even recommend breakfast consumption as an important tool for weight loss. But what does the science say?
Observational studies indicate that breakfast consumption is linked to lower weight. Data from the National Weight Control Registry demonstrated that 78% of the nearly 3,000 subjects included in the analysis (adults who had lost at least 13 kg and kept the weight off for a year or more) reported eating breakfast everyday and only 4% reported never eating breakfast . Further, a recent meta-analysis of observational studies that have evaluated the relation between weight and breakfast consumption found that skipping breakfast was associated with a 55% increased odds of having overweight or obesity . These findings are likely the reason many tout breakfast consumption as an important weight loss modality, despite these studies not actually testing that outcome.
Observational studies can only describe associations, but are not appropriate to determine causation. Thus, randomized controlled trials (RCTs) have sought to test whether breakfast consumption directly impacts weight. In one of the first RCTs to evaluate the role of breakfast in weight loss, Schlundt et al. studied women with obesity who were self-reported breakfast eaters or skippers.Within each group, women were randomized to eat or skip breakfast in addition to following a 1200 kcal/day diet for 12 weeks. All groups lost at least 6 kg, but interestingly, those who were randomized to switch their breakfast condition (e.g. ate breakfast at baseline, then started skipping) lost more weight than those who maintained their breakfast habit. These results suggest that changing an eating behavior in addition to following a reduced calorie diet may accelerate weight loss. However, the results from a study by Dhurandhar et al. did not corroborate those findings. Adults with overweight and obesity were randomized to one of three conditions in which all groups received a USDA pamphlet on healthy eating practices: the control group received no other information, one group received additional instructions to consume breakfast, and the third group was instructed to not eat breakfast . After 16 weeks, there was no observed effect of treatment assignment on weight loss.Contrary to the results from the Schlundt study, baseline breakfast eating habit was not related to weight change, though this study didn't evaluate breakfast consumption in conjunction with a reduced calorie diet.Finally, in a recently published 4-week study, adults with overweight and obesity were randomized to three different breakfast conditions: water (control), frosted flakes, or oatmeal .Interestingly, skipping breakfast resulted in an average weight loss of 1.2 kg, while those randomized to either breakfast condition demonstrated no significant weight change.However, total cholesterol also increased in the control group, suggesting that skipping breakfast may result in slight weight loss, but have detrimental effects on cardiometabolic health.
Thus, the results from the few RCTs completed in adults with overweight and obesity, to date, do not support the notion that breakfast consumption should be part of a weight loss regimen. Importantly, though, the results are also not compelling to suggest that eating breakfast hinders weight loss. This field is still young and many questions remain unanswered. I look forward to more RCTs evaluating breakfast consumption (and potentially, breakfast quality) on various facets of weight and metabolic health.
1.Wyatt, H.R., et al., Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obes Res, 2002. 10(2): p. 78-82.
2.Brown, A.W., M.M. Bohan Brown, and D.B. Allison, 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. 98(5): p. 1298-308.
3.Schlundt, D.G., et al., The role of breakfast in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr, 1992. 55(3): p. 645-51.
4.Dhurandhar, E.J., et al., The effectiveness of breakfast recommendations on weight loss: a randomized controlled trial. Am J Clin Nutr, 2014. 100(2): p. 507-13.
5.Geliebter, A., et al., Skipping breakfast leads to weight loss but also elevated cholesterol compared with consuming daily breakfasts of oat porridge or frosted cornflakes in overweight individuals: a randomised controlled trial. J Nutr Sci, 2014. 3: p. e56.