Background: Breakfast is associated with lower body weight in observational studies. Public health authorities commonly recommend breakfast consumption to reduce obesity, but the effectiveness of adopting these recommendations for reducing body weight is unknown.
Objective: We tested the relative effectiveness of a recommendation to eat or skip breakfast on weight loss in adults trying to lose weight in a free-living setting.
Design: We conducted a multisite, 16-wk, 3-parallel-arm randomized controlled trial in otherwise healthy overweight and obese adults [body mass index (in kg/m2) between 25 and 40] aged 20–65 y. Our primary outcome was weight change. We compared weight change in a control group with weight loss in experimental groups told to eat breakfast or to skip breakfast [no breakfast (NB)]. Randomization was stratified by prerandomization breakfast eating habits. A total of 309 participants were randomly assigned.
Results: A total of 283 of the 309 participants who were randomly assigned completed the intervention. Treatment assignment did not have a significant effect on weight loss, and there was no interaction between initial breakfast eating status and treatment. Among skippers, mean (±SD) baseline weight-, age-, sex-, site-, and race-adjusted weight changes were −0.71 ± 1.16, −0.76 ± 1.26, and −0.61 ± 1.18 kg for the control, breakfast, and NB groups, respectively. Among breakfast consumers, mean (±SD) baseline weight-, age-, sex-, site-, and race-adjusted weight changes were −0.53 ± 1.16, −0.59 ± 1.06, and −0.71 ± 1.17 kg for the control, breakfast, and NB groups, respectively. Self-reported compliance with the recommendation was 93.6% for the breakfast group and 92.4% for the NB group.
Conclusions: A recommendation to eat or skip breakfast for weight loss was effective at changing self-reported breakfast eating habits, but contrary to widely espoused views this had no discernable effect on weight loss in free-living adults who were attempting to lose weight.
Alex’s Notes: Just last Tuesday (6/10/14) I wrote about a breakfast study examining causal links between breakfast habits and all components of energy balance in free-living, lean, and healthy adults. We discovered that lean and healthy people don’t overcompensate for skipped breakfast later in the day, and those who do eat breakfast expend more energy in the mornings doing “light-intensity” physical activity to help offset breakfast’s additional kcal (but not completely). Now at the other end of the spectrum, we have the current study.
This study also wanted to test the effectiveness of breakfast recommendations on weight loss, but with a few important differences. First and foremost, the participants (n=283) were middle-aged, overweight or obese with a group BMI average of 32, and interested in weight reduction. Half were regular breakfast eaters and half were breakfast skippers, and all were put into one of three groups: control, breakfast, or no breakfast. The control group received a health pamphlet on eating, while the breakfast and no-breakfast groups received the pamphlet in adjunct with advice to eat breakfast before 10am daily or to not consume any calories until 11am daily, respectively. Remember that the adults were free-living, so nothing was controlled for. The study coordinators reviewed the pamphlets with the participants and have follow-up phone calls during weeks 4, 8, & 12, but no other interventions were made. The study duration was 16 weeks, by the way.
And… nothing happened. Compliance was just over 90% for the breakfast and no-breakfast groups, and neither had any significant influence on weight loss. It didn’t matter if the participants in either group were regular breakfast eaters or skippers; advice regarding breakfast consumption had no significant influence on weight-loss. Moreover, looking at the overall weight-loss of the groups, not a single person broke 1 kg (2.2 lbs) of weight-loss during the entire study! Although, there was a trend for the no-breakfast group to lose more weight than the breakfast group. But still, normal weight-loss recommendations are 1-2 pounds per week, and these people didn’t do that in 16 weeks.
Which brings me back to the pamphlet regarding healthy eating. One would think that simply eating more healthy foods would lead to weight-loss in obese adults without the need for calorie tracking. Amusingly, the researchers butchered this approach by having the pamphlet they use be the USDA’s “Let’s Eat for the Health of It” pamphlet that is based on the 2010 dietary guidelines. Given this, I’m more surprised they didn’t gain weight.
Overall this study only really showed one thing: that giving free-living obese adults advice based on government recommendations does nothing to assist in weight-loss, regardless of eating pattern. The breakfast eaters likely consumed the standard “whole-grain” cereal and doughnuts, while the breakfast skippers compensated later in the day for the missed morning meal.