The role of breakfast in promoting weight management

Dr Carrie Ruxton

Freelance Dietitian

More people are skipping breakfast

• Around 1/3 schoolchildren and adults

• Men more than women

• Younger adults and teenagers more than young children and older people

• Children from lower socio-economic groups more than better off children

Barriers to consumption

• Not hungry or don’t feel like eating

• Too busy

• Feeling pushed for time/sleeping in

• Dieting

• Growing trend of breakfast on the move impacting on food choice

Breakfast is marker of a better lifestyle

Ref: CARDIA study, Odegaard et al, 2013

Nutritional consequences of skipping breakfast

Breakfast skippers have lower intakes of:

• Fibre

• Certain vitamins and minerals

Higher intakes of:

• Fat

• Saturated fat

Could impact on weight

management

The impact of breakfast skipping on weight management

Increased risk of:

• Overweight and obesity

• Abdominal obesity and high waist circumference

• Faster weight gain in children

Evidence – observational 1

• Association with reduced body weight in adult men in regular breakfast consumers (Bazzano et al. 2005)

• US study of 10,000 children: breakfast skippers had higher BMI and waist circumference than breakfast consumers. Also, risk obesity higher in breakfast skippers vs. cereal consumers (Deshmukh-Taskar et al. 2010)

• BMI 0.24 points lower in high vs. low breakfast consumers (De la Huntley et al. 2013)

Evidence – observational 2

• Greek study 700 children: risk obesity 46% lower in boys and 59% lower in girls when cereal breakfast eaten regularly vs. skipping (Panagiotakos et al. 2008)

• US study of 625 low income children: signif lower BMI & higher intake of nutrients when cereal breakfast consumed over 3y period (Balvin Frantzen et al. 2013)

• US study of 660 children: higher breakfast cereal consumption associated with lower total and low-density lipoprotein cholesterol levels and lower BMI (Albertson et al. 2009).

Evidence – observational 3

• Polish study 1700 teenagers: risk obesity 83% higher when breakfast skipped. Intakes of sugary soft drinks were higher when breakfast skipped (Wüenstel et al. 2015)

• Iranian study 13,486 children 6-18 years; 20% skipped breakfast. Regular breakfast consumption was significantly associated with lower body fatness and healthier dietary habits (Ahadi et al. 2015)

Obesity risk higher when breakfast skipped

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Boys Girls

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Always

Sometimes

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N=4,326 English children 10-16y; Sandercock et al (2010) EJCN

More older men with BMI >25 when cereal breakfasts eaten 0-3 times weekly

N=1759; US 55 years+; Albertson et al (2012) J Ageing Res

Evidence – RCT cereal

• N=70 overweight adults asked to consume breakfast cereal at night for 6 weeks instead of usual snack

• Trend for lower body weight and waist circumference in intervention group vs. control but P>0.05

Matthews et al (2012) IJFSN

Evidence – RCT protein

• N=57 overweight adolescents who normally skipped breakfast consumed a normal or high protein breakfast for 12 weeks

• Body fat gain, voluntary reductions in daily calorie intake, and reductions in daily hunger were all improved when adolescents ate a high protein breakfast daily.

Leidy et al (2015) Obesity

Reasons for results

• Eating breakfast may help to prevent snacking later in the morning or the wrong choice of foods

• Cereal breakfasts boost fibre consumption and this may help to prolong satiety

• Protein at breakfast may also prolong satiety

• Breakfast has been linked with increased physical activity ?association or cause

• Breakfast may simply be a marker of healthier lifestyles in general which promote weight management.

Not all studies agree

• N=283 overweight adults completed 16-wk weight loss study where participants either skipped or ate breakfast while trying to lose weight by dieting

• No significant difference in weight loss between the two groups

• Suggests that dieting can over-ride any negative effects of skipping breakfast.

Dhurandhar et al (2014) AJCN

Other health consequences

Increased risk of:

• Higher blood pressure

• Higher or raised LDL and total cholesterol levels

• Higher blood glucose and insulin levels

Evidence

• 24% skipped breakfast

• Breakfast skippers more likely to have raised chol, LDL, BP, glucose

• Breakfast cereal consumers had the best cardiometabolic status

US study NHANES n=5,316 20-39 yrs Public Health Nutrition (2012) 16: 2073–2082.

Summary from key studies

Source: Ruxton (2014) NHD magazine

Is sugar an issue?

Source: NDNS (2014)

Breakfast cereal contribution 5-8%

Holistic approach needed

• Weigh up sugar content against:

– Calorie/fat content of alternatives e.g. croissant, fry up, muffin, toast & butter

– Micronutrient contribution of breakfast cereals; around 15% of B vitamins and iron

– New role of RTEC in providing vitamin D

– High fibre content of many varieties

– Sugar can come from dried fruit as well as free sugars e.g. in muesli

Conclusions

• Breakfast skipping is common, especially in teenagers and young adults

• Breakfast skipping is associated with:

– a lower micronutrient and fibre intake

– a greater risk of obesity and excess weight gain

– raised blood pressure, lipids and glucose

• In contrast, regular breakfast consumption associated with better weight management, especially cereal breakfasts. Reason unknown but could be less snacking/soft drinks later.

• For more information see www.breakfastcereal.org