Lately, I feel like I've become a target for people who like to tell me that I'm doing nutrition wrong. Evidently, some of you don't agree with my plea, "don't judge when it comes to what others eat."

One of the things that horrify people who know me closely is that I don't eat breakfast. I'm just not hungry in the morning. A cup of coffee and that's all I need until lunch. And, I've been that way for decades.

That means I'm subjected to periodic lectures on how breakfast is the most important meal of the day. Yeah, that's a myth. It's also the topic of this weeks Healthcare Triage.

[Intro]

Let's start with weight gain. There's any number of people out there who will be happy to tell you that if you skip breakfast not only will you not lose weight, you might gain weight. Undetered by the logic that forcing yourself to eat a meal you don't want might lead to weight gain, they come up with some interesting hypothesis.

They say that if you skip breakfast, you just eat more later. They say if you skip breakfast, you screw up your metabolism and store more fat somehow. They say if you eat calories in the morning, you have more time to burn them off.

Their backed up with a lot of observational data. For instance, a 2010 systematic review, published in Critical Reviews in Food Science and Nutrition, found that children and adolescents in Europe who skipped breakfast had a higher BMI. This is the kind of study that leads to headlines that say that eating breakfast makes you thinner.

But, as we've covered over and over and over and over and over again on Healthcare Triage, correlation does not equal causation. The University of York Centre for Reviews and Disseminations summarized that study, and this is what they said: "The authors' decision to statistically combine the results of the studies in a meta-analysis may not have been appropriate (results from cohort and cross-sectional studies are vulnerable to a large number of biases and confounding factors, and pooling may provide an overestimation of effect)... The authors correctly acknowledged the limitations of the review in terms of risk of publication bias, inclusion of observational studies and non-standard definitions of breakfast and breakfast skipping used in the review... The results should be interpreted with a substantial degree of caution because of poor reporting of the review process and a lack of information on the quality of the included studies."

So, how can so many sources be wrong? As Julia Bellux pointed out in a recent Vox article, many of the reviews of observational data are funded, wait for it, by the breakfast industry.

A 2003 review entitled The Effect of Breakfast Type on Total Daily Energy Intake and Body Mass Index had the following to say in its conclusion: "This analysis provides evidence that skipping breakfast is not an effective way to manage weight. Eating cereal (ready-to-eat or cooked cereal) or quick breads for breakfast is associated with significantly lower body mass index compared to skipping breakfast or eating meats and/or eggs for breakfast."

You know who funded that study? The Kellogg Company. Shocking.

A 2014 study entitled Skipping Breakfast Leads to Weight Loss, But Also Elevated Cholesterol Compared to Consuming Daily Breakfast of Oat Porridge or Frosted Cornflakes in Overweight Individuals: a randomised controlled trial had the following to say: "In conclusion, although skipping breakfast led to weight loss, it also resulted in increased total cholesterol concentrations compared with eating either oat porridge or frosted cornflakes for breakfast."

You know who funded that study? The Quaker Oats Center of Excellence. I'm serious.

None of this is to say I'm demonizing breakfast. First of all, it's delicious. Going out to a late morning breakfast with my family on a Sunday morning is pretty much my favorite meal of the week. Given the choice between breakfast food and lunch food at a brunch, I choose the eggs every time. But, that's because I like it, not 'cause I need it. I'm not hungry at 7 in the morning. I don't want to eat then. If you offered me breakfast at 11, I'm all in. But, that's pretty much lunch.

If you're hungry at 7 a.m., then you should eat. Enjoy your breakfast. Just don't force it on others. My wife, Amy, needs it. So do my kids, Noah and Sidney. But, my son, Jacob, doesn't. He's like me. He just wants to go to school, and we let him. I can't see the benefit of force-feeding him a meal he doesn't feel like he needs. Especially since his school feeds him lunch at like 10:30.

This is when breakfast proponents will start throwing research around that shows that kids who eat breakfast do better in school and are more able to pay attention. But, it's important to remember that a lot of those studies involved kids who are economically disadvantaged. They likely wanted breakfast and weren't getting it. No one denies that hungry kids should eat. I'm certainly not. I have not doubt that kids who are hungry will be less likely to pay attention and will not do as well. Hungry kids should be fed.

But, this is different from forcing kids to eat if they don't want to. Don't believe me? To the research!

From Nutrition Research Review, 2009, A Systematic Review of the Effect of Breakfast on the Cognitive Performance of Children and Adolescents, and I'm quoting here, "The evidence indicated that breakfast consumption is more beneficial than skipping breakfast, but this effect is more apparent in children whose nutritional status is compromised. There is a lack of research comparing breakfast type, precluding recommendations for the size and composition of an optimal breakfast for children's cognitive function. Few studies examined adolescents... Studies of school breakfast programs suggest that such interventions can have positive effects on academic performance, but this may be in part explained by the increased school attendance that programs encourage."

In other words, what I said. Here's the thing, if you're hungry in the morning, eat. If you feel like you need to eat breakfast in order to do well or be functional, eat. If you believe breakfast makes your eating over the course of the day more healthy, eat. But, for those of us who don't want to, leave us alone.

[Outro]

Healthcare Triage is supported in part by viewers like you through Patreon.com, a service that allows you to support the show through a monthly donation. Your support makes this show bigger and better. We'd especially like to thank our research associate, Joe Sevits, give a special shout-out to Jonathon Dunn, and thank our surgeon admiral, Sam. Thanks Joe and Jon! Thanks Sam! More information can be found at Patreon.com/HealthcareTriage.