Issue: 2015, Vol 1, No 4, Pages 124–167

Breakfast: Do we really know what advice to give?

Matt Capehorn

Matt Capehorn
Clinical Manager, Rotherham Institute for Obesity, and Clinical Director, National Obesity Forum

For many years the advice has been clear: if you have a decent breakfast, over the course of the day you are more likely to consume fewer calories overall and, therefore, it is better for weight management; in other words, “skipping breakfast can make you fat.” This has been based on findings from observational studies (van der Heijden et al, 2007).

A generation ago, “greasy fry-ups” fell out of favour because it was believed that the high saturated fat content automatically increased the risk of cardiovascular disease (CVD). Recent studies, however, call into question the role of dietary fat in CVD risk (Chowdhury et al, 2014). Perhaps the focus should have been on the excess number of calories being consumed, or on the high consumption of processed meats and the increased cancer risk this confers (Bouvard et al, 2015).

During this long period, cereal-based breakfasts, in particular those rich in whole grains and fibre, were marketed as being good for heart health. However, in reality, this led to a generation being brought up on a breakfast of ready-made cereals, often with a higher sugar content than a chocolate bar. This was then followed by the promotion of slow-release carbohydrates, such as porridge oats or, more recently, specially formulated and marketed breakfast biscuits. Have we ever really known how we should start the day?

In practice, we often see obese patients who report that once they “break the seal” on their eating, whether in the morning or at lunchtime, they find it difficult to control their eating for the rest of the day. Whether this is a psychological or hormonal effect remains to be proven. However, the study by Chowdhury and colleagues summarised alongside demonstrates for the very first time that, in obese adults, extending the morning fast period does NOT result in a compensatory increase in food/calorie intake at an ad libitum lunch and, furthermore, nor does it increase appetite in the afternoon. The effect on satiety and appetite-stimulating hormone levels was also fascinating.

So, what recommendations can we make to our patients regarding breakfast? Clearly, in order to establish a definitive answer, more work needs to be done, and it may be that we have to individualise advice. In the same way that one weight loss intervention will not suit or work for everyone, breakfast may have effects specific to the individual. We do, however, need to remember that the concept of breakfast is to “break the fast” of not having eaten overnight. Physiologically, if we wake up “empty” we may need to refuel in order to work efficiently. Unfortunately, these days too many of us eat more than the recommended three meals a day and end the night having snacked for hours even after a sufficient evening meal, or we are in the habit of having a late supper. I therefore suspect that it is much rarer for people to wake up with a fast to break. Perhaps, instead of focussing on breakfast, we should turn our attention to evening eating patterns and retrain society to “scupper the supper” and avoid filling our bodies with fuel just before going to sleep.

Click here to read the article summaries

References from commentary

Bouvard V, Loomis D, Guyton KZ et al (2015) Carcinogenicity of consumption of red and processed meat. Lancet Oncol 23 Oct [Epub ahead of print]

Chowdhury R, Warnakula S, Kunutsor S et al (2014) Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med 160: 398–406

van der Heijden AA, Hu FB, Rimm EB, van Dam RM (2007) A prospective study of breakfast consumption and weight gain among U.S. men. Obesity (Silver Spring) 15: 2463–9