Monday, July 28, 2014
Eating breakfast neither helps nor hinders weight loss
It’s nearly impossible for us not to believe that what we eat has a profound effect on our health. But what we know about the link between food and health is much less than what we believe. A study published this week provides a perfect example.
An overweight person trying to lose weight is likely to hear advice about the importance of eating breakfast. We have some reasons to guess that skipping breakfast might hamper weight loss efforts. Skipping breakfast should increase hunger which might cause overeating at lunch. Hunger can also trigger hormonal changes that make weight loss more difficult. There have even been some observational studies showing that people who eat breakfast are thinner than those who don’t. (See here for a quick primer on the difference between an observational study and a randomized study and why observational studies should be largely ignored.)
Of course in the past we had very good reasons to guess that heavier objects fall faster than lighter objects, that light travels faster going west than north, and that estrogen prevents heart attacks. These guesses were all proven false as soon as someone actually tested them.
In the study, investigators enrolled about 300 overweight and obese adults and randomized them to three groups. One group in addition to receiving general weight loss advice was instructed to eat breakfast every day. The second group was instructed to skip breakfast every day. The third group received general nutrition advice that didn’t mention any advice about breakfast.
The groups were quite compliant with following their instructions. The group that was supposed to skip breakfast almost always did so, and the group that was supposed to eat breakfast almost always did so. The 3 groups lost equal amounts of weight. The senior investigator of the study, David Allison, summed it up well. “The field of obesity and weight loss is full of commonly held beliefs that have not been subjected to rigorous testing.”
There’s nothing wrong with educated guesses. They’re the seeds of discovery. But without testing we shouldn’t forget that they are not knowledge. We mistakenly keep guesses around for decades, grow comfortable with them, and forget that they’re untested. It seems that the field of nutrition is especially littered with these long-held assumptions. (The myth of the harms of saturated fats is another recent example.) I’m delighted that Dr. Allison is committed to either confirming or discarding them. I hope he gets some help.
Skipping Breakfast May Not Be Bad For Weight Loss After All (Forbes)
Eating breakfast may not matter for weight loss (CNN Health blog)
Passing on Breakfast OK for Weight Loss (Medpage Today)
The effectiveness of breakfast recommendations on weight loss: a randomized controlled trial (The American Journal of Clinical Nutrition)
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.
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Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Suneel Dhand, MD, ACP Member
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Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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