A reprisal from the breakfast club

Allison figure from AJCN

“Hypothetical model of how BRR [biased research reporting] and RLPV [research lacking probative value] may be involved in perpetuation presumptions” [or, an accurate representation of David’s thinking process]. Source: Brown, Bohan Brown, Allison. AJCN. 2013.

Breakfast is still the most important meal of the day. Excuse me if I’m a little biased. Apparently, I’m not alone. I like to eat breakfast. I’ve long told everyone they should eat breakfast. And I make sure my children eat breakfast every day, often cooking up their favorite sorts of breakfast meals on the weekends.

Breakfast is a great time to eat the types of foods (like yogurt and muesli, granola, cereal, or egg omelets) that can provide valuable nutrients like protein, calcium, iron, and a range of vitamins. For nutritionists, that’s a big deal. These nutrients are especially important in children and teens, who should be eating breakfast daily to better concentrate in school and who might not get these nutrients in other meals.

Besides, it’s useful to remind that eating breakfast can help you avoid weight gain by satisfying your appetite and keeping you from bingeing on high-sugar, high-fat foods later in the day. That’s a well-known fact. Everyone knows that, right?

So on that morning last September when well-respected researchers Andrew Brown, Michelle Bohan Brown, and David Allison of the University of Alabama at Birmingham dared to question breakfast’s sanctity in the American Journal of Clinical Nutrition (1), I just figured I’d ignore it. “Discarded information,” that’s all it was.

After all, Birmingham rhymes with “burning ham” and that reminded me that I had better things to do, like eat breakfast.

What these researchers were really after anyhow was just raised awareness about bias creeping into the scientific literature. It’s not like any had personal vendettas against eggs, pancakes, and sausage. And I already knew I was biased when it came to breakfast.

Still, I don’t get why they chose to pick on breakfast. They said it was because “it was a less politically charged topic” than, say, sugar-sweetened beverages or breastfeeding. That’s quite the assumption. Sugar-sweetened drinks? That’s for the birds. Breastfeeding? That’s for babies.

But breakfast is something I preach about daily. Didn’t Brown, Bohan Brown, and Allison get that the breakfast skipping trend was growing out of control? Around 20 percent of American adults and children (over age 2) and up to 32 percent of teens skip breakfast nowadays, according to National Health and Nutrition Examination Survey (NHANES) data.

Who are Brown, Bohan Brown, and Allison to challenge widely held presumptions about breakfast’s effect on obesity? Yet they did, in a cumulative meta-analysis, in which they explored study abstracts with “inappropriate use of causal language and biased interpretations,” and they offered these findings:

  • That the belief in the power of breakfast for protecting against obesity “exceeds the strength of scientific evidence”.
  • And that “the scientific record is distorted” by biased research reporting (BRR) and research lacking probative value (RLPV)—as in it does nothing to further prove that breakfast “causes” any better weight control.

That’s not to say that there was no indications whatsoever that breakfast can help you avoid weight gain. There are, in fact, but most of the evidence has come in the form of correlations between breakfast skipping and weight gain found in observational studies. It’s not enough to determine causation. As for randomized controlled trials, there were only a handful available and none that really provided any clear evidence that eating breakfast led to eating less. A few of the studies actually showed eating breakfast led to weight gain!

It just couldn’t be.

With my cognitive dissonance on overdrive, I was glad I could count on others to help set things straight about breakfast. I got to embellish in my breakfast confirmation bias a bit while writing my latest article for Food Technology magazine by researching and talking to several nutritionists, food scientists and technologists, and industry professionals about the topic. Unlike Allison and company, what these true experts shared with me was a pretty picture where breakfast has a bright future as becoming a major player in beating back the obesity epidemic in a “more portable, more satisfying, and more nutritious” fashion.

For instance, protein as a percentage of total energy can make a lot of difference in whether or not breakfast helps you eat fewer calories later. Heather Leidy of University of Missouri School of Medicine recently was involved in two recent trials showing that when breakfasts were higher in protein (30 to 39 g) they could help with better control of appetite, reduced feelings of hunger, greater satiety, and fewer calories eaten later in the day (2, 3).

In addition, Richard Mattes of Purdue University showed in the Journal of Nutrition and Metabolism that eating breakfast with nuts, specifically almonds, could help improve glycemic control and contribute more to satiety than one without (4). That would make sense given that a serving of almonds (28g) has a good content of fiber (4 g), monunsaturated fats (13 g), and protein (6 g), which are likely to provide quite a bit more satiety than typical cereal carbs.

Fortunately, as I report in my article, consumers are helping to fuel demand for healthier breakfast fare and food manufacturers are taking notice (it’s a $20 billion market with more than 25 percent of adults who consume breakfast away from home). What are consumers asking for? More convenience (to more consistently eat breakfast), more protein, more almonds and nuts (or satiety, in general), more whole grains and fiber, and fewer calories overall.

I was glad to hear all these reports, as you can imagine. So I say to Brown, Bohan Brown, and Allison, who probably truly thought they could hate on breakfast and get away with it unscathed—in the words of John Bender from that beloved ’80s classic, The Breakfast Club—you can just “eat my shorts!”

References

1. Brown AW, Bohan Brown MM, Allison DB. Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence. Am J Clin Nutr, 2013;98:1298–308. doi: 10.3945/ajcn.113.064410

2. Leidy HJ, et al. Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping,” late-adolescent girls. Am J Clin Nutr, 2013;97:677-88. doi: 10.3945/ajcn.112.053116

3. Maki KC, et al. Acute Satiety Effects of Sausage/Egg-based Convenience Breakfast Meals in Premenopausal Women. [Poster at Obesity Society’s annual scientific meeting]. Press release: http://www.eurekalert.org/pub_releases/2013-11/uom-pbh111413.php

4. Tan YT, Mattes RD. Appetitive, dietary and health effects of almonds consumed with meals or as snacks: a randomised, controlled trial. Eur J Clin Nutr, October 2, 2013, doi: 10.1038/ejcn.2013.184

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