Janice shares her thoughts on the subject—
Maybe Jay and I are wrong about breakfast. Yes, we were aware that some — but not all (1,2) — scientific studies showed the benefits of breakfast for overall health and weight loss. However, each of us had independently become aware of something else: that we weren’t hungry in the morning and that when we did eat breakfast, we seemed to be hungrier for the rest of the day. During the time that each of us lost weight, neither of us were eating breakfast. By the way, this is the only time when intuitive eating was of any use to me — in any other situation, intuitive eating meant that I was eating grilled cheese sandwiches and unlimited Hershey Kisses pretty much all the time.
So why are we wrong, or at least maybe wrong, according to the science? Well, an article in last week’s New York Times got me thinking. The article talked about a recent study of Seventh Day Adventists that showed greater weight loss and healthier metabolic profiles in those people who ate a big breakfast, medium lunch, and smaller dinner rather than the other way around (3). “Not convincing,” I thought. This is a very narrow population whose members tend to live unusually healthy lifestyles to begin with.
The Times article also cited a recent statement by the American Heart Association (AHA) that more people who skip breakfast are obese and have increased risk for diabetes than those people who eat breakfast. “Not convincing,” I thought, since the AHA stressed that there is no proof that this is a cause-and-effect relationship. People who eat breakfast tend to have healthier lifestyles to begin with, so it might not be the breakfast at all.
But then I read two other studies mentioned in the Times article, and these piqued my interest. One study demonstrated that insulin seems to function more efficiently earlier in the day (4). This means that eating a meal in the morning might result in less fat deposit than an identical meal eaten in the evening. Now that was interesting. In the other study, the researchers gave two groups of women identical foods and calories. Those who ate most of their calories at breakfast lost 2 ½ times as much as those who ate most of the calories as their dinner meal. They also had lower triglyceride and glucose levels and lower abdominal fat. To top it all off, the breakfast people experienced less hunger throughout the day. The study author commented, “We observed that the time of the meal is more important than what you eat and how much you eat — it’s more important than anything else in regulating metabolism” (5).
“Hmm,” I thought. “Maybe there is something to this breakfast thing after all. I’m becoming convinced.” I started doing more research. Yet another recent study (Nas A) showed that skipping breakfast is associated with low-grade inflammation and impaired glucose metabolism. Importantly, all the studies recommend breakfast for children (7,8,9).
So as a physician, what does all this information tell me to recommend to my patients? Here's my best advice: eat some breakfast, preferably high in protein and very, very low in refined carbohydrates (no, Cocoa Puffs are not a suitable breakfast food, and cereal bars probably aren’t either — they’re more like rectangular oatmeal cookies). To be honest, though, I’m nervous about giving this advice to myself. After all, I lost 30 pounds more than four years ago and haven’t gained it back, and that was without eating breakfast. But I’m really convinced by the health benefits. I’ve decided to eat a couple of tablespoons of yogurt in the early in the morning, then eat my daily huge salad for an early lunch, and then have a small dinner. I’ll let you know how it works.
Jay — I do not eat breakfast because I’m not hungry in the morning. When I do find myself in a social situation where breakfast is encouraged, or if I’m in a situation where I cannot refuse a breakfast being served to me, I find that I’m hungrier for the rest of the day. This is difficult for me, as I find myself having a hard time making the healthier choice the rest of the day and often derail my efforts to make good decisions when it comes to my food choices. I do realize, though, that skipping breakfast doesn’t work for most people — and that’s okay! I know that this is what works for me, so it’s the strategy I stay with.
In summary, the scientific evidence is leaning in one direction, I’m not quite sure what to do, and Jay is staying with what works for her. In the end, your body is going to tell you which strategy works best for you.
I do have one major concern about the big breakfast/small dinner recommendation: I can’t overstate how much I believe in family dinners for their positive social and emotional effects.. If sitting around the dinner table with everyone eating just a small bowl of oatmeal isn’t conducive to family sharing and happiness, I get that. Figure out what works best for you in the life you’re living now.
Here’s a recipe suggestion for a dinner that also works well as a breakfast the next day:
Breakfast, Lunch, or Dinner Frittata
Preheat oven to 350 degrees.
8 large eggs, beaten until just combined
½ cup milk
Mix the eggs and milk together. Pour into an ovenproof 10” pan.
Now, here’s what makes frittatas great. Add any combination of the following or anything else that seems interesting to you:
Diced onions, which you’ve sautéed in a little extra virgin olive oil (save yourself work and do that in the pan before you use it for the egg mixture. Include any fresh or dried herbs that you like).
Chopped or sliced mushrooms, cooked as above
Chopped spinach or bell peppers, cooked or not
Cooked asparagus, broccoli, or zucchini
Chopped up tomatoes or avocado
pieces of cooked turkey sausage or fish
Put the toppings over the egg mixture, and cook on the stovetop on medium heat for five minutes.
Place the pan in the oven, and bake until the frittata stops wiggling, 15-18 minutes.
Slice up the frittata and eat warm, room temperature, or cold.
Enjoy! Let us know what you think.
(1) Lee JS et al. Combined eating behaviors and overweight: Eating quickly, late evening meals, and skipping breakfast. Eat Behav 2016; 21:84-8.
(2) Casazza, K et al. Myths, presumptions, and facts about obesity. N Engl J Med 2013; 368(23):2236-7.
(3)Kahleova H et al. J Nutr. Meal Frequency and Timing Are Associated with Changes in Body Mass Index in Adventist Health Study 2. 2017 pii: jn244749. doi: 10.3945/jn.116.244749.
(4) Sofer S et al. Greater Weight Loss and Hormonal Changes After 6 Months Diet With Carbohydrates Eaten Mostly at Dinner. Obesity 2011; 19(10):2006-14.
(5) Jakubowicz D et al. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obesity 2013; 21(12)2504-12.
(6) Nas, Alessa et al. Impact of breakfast skipping compared with dinner skipping on regulation of energy balance and metabolic risk. Am J Clin Nutr 2017; 105(6):1351-61.
(7) Karatzi, Kalliopi et al. Late-night-overeating is associated with smaller breakfast, breakfast skipping, and obesity in children: The Healthy Growth Study. Nutrition 2017; 33:141-144.
(8) Kranz S et al. High-protein and high-dietary fiber breakfasts result in equal feelings of fullness and better diet quality in low-income preschoolers compared with their usual breakfast. J Nutr 2017; 147(3):445-452.
(9)Rampersaud GC et al. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 2005; 105:743-60.