By Chau Che MD
Faculty Peer Reviewed
In an age when two thirds of adults are either overweight or obese and obesity rates in children continue to rise, would an intervention such as consuming breakfast daily help combat this problem? Skipping breakfast has become increasingly common in adults and adolescents in the United States, with the proportion of adults and children skipping breakfast increasing from fourteen to twenty-five percent between 1965 and 1991 [1,3]. Additionally, skipping breakfast may be detrimental to other functions. To examine the role that breakfast plays, one must examine the relationship between breakfast in the reduction of body mass index (BMI) , improvement of cognition and reduction of fatigue.
Despite thoughts regarding the importance of breakfast, reasons cited for skipping breakfast include lack of time for breakfast preparation and consumption as well as a fear of weight gain. It has been shown that breakfast eaters tend to have a lower BMI than breakfast skippers [1,3]. While much of this evidence is cross-sectional and it is difficult to infer a causal relationship between skipping breakfast and weight gain, theories exist regarding the pathophysiology of weight gain in breakfast skippers. Eating breakfast is associated with increased eating frequency which results in a lower BMI [1-3]. This is believed to occur by increasing dietary induced thermogenesis and increasing the metabolic rate (1). Studies show that obese persons are prone to skip breakfast, leading to a high caloric intake at nighttime, while normal weight persons’ caloric intake is more evenly distributed throughout the day (1,2). Late night eating results in stored glycogen, and unless the glycogen is burned as fuel, it will be stored as fat causing weight gain . Breakfast skipping has also been linked to poorer eating habits including larger meal portions, impulsive snacking, a higher intake of dietary fat, and minimal fruit consumption [1,3]. Although there is no established causal relationship between skipping breakfast and weight gain, these various theories suggest an association.
The Third National Health and Nutrition Examination Survey (NHANES III) investigated further the inverse relationship between BMI and breakfast consumption by looking at the relationship between breakfast type, total daily energy intake, and BMI. The survey addressed 16,452 adults in a large, population based study that reiterated the ineffectiveness of skipping breakfast as a weight loss technique. Importantly, the study also noted that breakfast choice plays a role in lowering BMI. Individuals that ate cereal (hot or cold) or quick breads for breakfast as opposed to meat and eggs had a significantly lower BMI (1). Cross sectional data from a large prospective study, the Seasonal Variation of Blood Cholesterol Study (SEASONS), also evaluated the relation between obesity and eating patterns. The study showed that subjects who regularly skipped breakfast had 4.5 times the risk of obesity as those who consumed breakfast regularly (95% CI 1.57-12.90) .
Independent of other factors, a study in Japan published in Nutrition showed that skipping breakfast was associated with fatigue in medical students. The Chalder Fatigue Scale which has been confirmed as reliable and valid in previous studies was used to evaluate the severity of fatigue. Completely skipping breakfast everyday versus having breakfast every day was positively correlated with the prevalence of fatigue through an unknown mechanism (OR 5.62, 95% CI 1.28-24.76, P < 0.022). Limitations to the study included the small sample size and the lack of determination of a cause and effect relationship. Fatigue was associated with poor academic performance, decreased school attendance, displeasure in school, and poor lecture learning .
The beneficial effects of consuming breakfast are also apparent in the adolescent population. Adolescents who consume breakfast also have a lower BMI than their counterparts . The effect of breakfast consumption also extends into the classroom. Academic performance, problem solving skills, school attendance, and mood are all affected by breakfast consumption . A randomized intervention study of 569 students aged 11 to 13 years reported that breakfast consumed thirty minutes before testing was helpful in short term cognitive functions such as immediate recall, acquisition, and recognition using the Rey Auditory-Verbal Learning Test in which various trials involved recognizing, learning, and remembering lists of common nouns [6,8]. Although the mechanism is not clear, the effects may be due to glucose and insulin changes in non breakfast eaters, as well as other hormonal and neurotransmitter concentrations in the brain involved in cognitive function [5,6]. These effects have also been demonstrated in experimental studies in adults with similar results from an increased glucose concentration and nutrient supply to the central nervous system before or after learning, thus improving cognitive functions and memory skills [6,8].
A step in the right direction is to start off the morning by listening to the myth that breakfast is the most important meal of the day. It has been shown that there are several benefits to eating breakfast. With benefits of decreased body mass index, reduced fatigue, and improved cognition, we should all eat our Wheaties to start the day!
Reviewed by Michelle McMacken MD, Assistant Professor of Medicine, NYU Division of General Internal Medicine
Dr. Che is a 1st year internal medicine resident at NYU Medical Center
 Cho, S., Dietrich, M., Brown, C, et al. The Effect of Breakfast Type on Total Daily Energy Intake and Body Mass Index: Results from the Third National Health and Nutrition Examination Survey (NHANES III). Journal of the American College of Nutrition, 2003; 22(4): 296-302.
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