A recent review article in the New England Journal of Medicine (NEJM) aimed at debunking weight-loss myths (of which there are many, Dr. Oz, I’m looking at you) made the rounds in the popular press. The authors, Cassaza et. al., concluded that eating breakfast regularly is an unproven strategy in combating obesity, but I completely disagree and promptly sent a letter to the editors at the NEJM. Unfortunately, my letter was declined for publication (the old “too many letters and not enough space” brush off). However, fortunately for me I have a blog which is my fiefdom so I can not only expound on the benefits of breakfast, but also not be constrained by a pesky word limit.
The authors concluded that eating breakfast was an unproven strategy for weight loss based on a single randomized study from 1992 of breakfast consumption versus skipping breakfast among 45 women over 12 weeks (52 were enrolled, but only 46 completed the 12 weeks and 70% of the 42 followed up at 6 months). It is hard to based an entire dietary strategy on a single study. Over 12 weeks. Of 46 women.
To refute the NEJM article and support the strategy of eating breakfast I give you the following information
- The National Weight Control Registry, a longitudinal study of people who have lost at least 30 lbs and maintained that weight loss for over a year. In one study (Wyatt et al, 2002), 78% of National Weight Control Registry participants (over 2,000 adults) reported regular breakfast consumption. Only 4% of the participants reported always skipping breakfast. So, the vast minority of those who successfully lose and maintain their weight loss didn’t skip breakfast.
- Among a children and adolescents meal patterns that include breakfast are inversely associated with BMI in several prospective cohort studies including project EAT (Eating Among Teens), the HEIA study from Norway, and The Northern Finland Birth Cohort all tell us that adolescents who eat breakfast are less likely to become overweight or obese.
- Eating breakfast is one of the two markers that predicts sticking with an online web-based weight loss program at the 1-year mark (the other, interestingly enough, being drinking coffee or tea without sugar).
I agree that data supporting the association between breakfast consumption and a lower risk of obesity is observational so it is not possible to assign causality, however, it is hard to negate observational studies with thousands upon thousands of participants based on a single randomized trial of 46 women. These well-done studies, many with long-term follow-up, don’t relegate breakfast consumption to an “unproved yet commonly espoused proposition” (as touted by the NEJM).
The facts are regular breakfast is more common among successful long-term dieters than skipping breakfast, regular breakfast is associated with a lower body mass index for both adults and adolescents, and that breakfast predicts sticking with online.
I agree that none of these cohort studies tell us the mechanism by which breakfast is associated with successful weight loss and optimal body mass index. Breakfast eating may help metabolically or it may be a marker for another factor such as less disordered eating patterns, better shopping habits, commitment to healthier eating habits, less disordered family dynamics, or some socioeconomic factor that has yet to be elucidated.
All I know is it will take more than one study of 46 women with a 30% drop-our rate from 1992 to change my mind about breakfast. There is no proof that breakfast consumption is a weight loss myth and the NEJM editorial board should know better than to accept an article that ignores the wealth of observational data.
Eating breakfast to combat obesity isn’t myth, it’s sound dietary strategy.