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Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials

BMJ 2019; 364 doi: (Published 30 January 2019) Cite this as: BMJ 2019;364:l42
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A GOfER diagram (Graphical Overview for Evidence Reviews) showing a visual summary of the included trials from this review.


Breakfast—the most important meal of the day?

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Re: Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials

On behalf of out team, I thank those who raised interesting discussion points regarding this paper. We agree that skipping breakfast is not for everyone. Indeed there are some populations eg diabetic patients on treatment, where distributing calories over the course of the day may be advisable. However, there is no doubt that one of the major medical and public health challenges facing us is the obesity epidemic. We are not winning. It is important that as part of dealing with this challenge we question our beliefs about obesity.

This study came about after I repeatedly saw patients with knee osteoarthritis who were obese, went to seek advice on what to do regarding their weight, and almost invariably were told they need to eat breakfast. A number would then complain that they were really struggling to eat breakfast, they just didn't feel hungry. It never made sense to me that we should be asking people to eat when they are not hungry.

There are some people who love eating breakfast. Others who just don't feel hungry at that time. The key message from this meta-analysis is there there is no evidence that in order to lose weight, we should advise people to change their eating patterns to include breakfast. We found that eating breakfast resulted in an average 260 extra calories per day, and the average weight gain mirrored this, 0.44kg over an average of 7 weeks.

People vary, their needs vary, their preferences vary. However the message that 'breakfast is the most important meal of the day' is very strongly believed in the community and among health porfessionals, to the point that many people are apologetic if they say they miss breakfast, on the assumption that they are not 'being healthy.'

One of the overwhelming responses to our study has been a relief among those who don't eat breakfast, that it is fine to skip it!

Competing interests: No competing interests

05 February 2019
Flavia M Cicuttini
Monash University/Alfred Health