Breakfast Eating and Weight Change in a Five-Year Prospective Analysis of Adolescents: Project EAT (Eating Among Teens)

By Mark Pereira, Ph.D.
Associate Professor
Division of Epidemiology & Community Health

Background

Over the past two decades, the prevalence of overweight has doubled in children and nearly tripled in adolescents.2  One intriguing line of research that may have broad public health application is the role of breakfast consumption on weight control.  In children and adolescents, it is estimated that 12 ¿ 34% regularly skip breakfast, and this percentage is found to increase with age.  Despite this finding, the relationship between breakfast consumption and body weight in children and adolescents has not been well established.

It has been suggested that breakfast frequency is inversely associated with obesity risk.  This association may be explained through a link between breakfast eating and dietary quality (food and nutrients) and appetite control (less likely to binge later in the day or evening). Weight-related concerns and perceptions among youth are likely related to breakfast intake and may play a role in the frequency with which breakfast is eaten in youth.  Our theoretical model is shown in Figure 1 below.

Figure 1. Theoretical Model

Study Design and Methods

The present study was conducted to examine the association between breakfast frequency and five-year body weight change in 2,216 adolescents.  Project EAT (Eating Among Teens) is a five-year longitudinal study of eating patterns and weight concerns among adolescents.  Surveys were completed at both Time 1 (1998-1999) and Time 2 (2003-2004).  Multivariable linear regression was used to examine the association between breakfast frequency and change in BMI, with adjustment for age, SES, race, physical activity, Time 1 BMI and breakfast category, and Time 1 dietary and weight-related variables.  We hypothesized that breakfast frequency would have an inverse association with body weight and with weight gain. 

Results

At Time 1, frequency of breakfast was directlyassociated with intake of carbohydrate and fiber, SES, Caucasian race, and physical activity, and inversely associated with smoking and alcohol consumption, and dieting and weight control behaviors.  In cross-sectional analyses at Time 1 and Time 2, inverse associations between breakfast frequency and BMI remained largely independent of all confounding (p<0.01) and dietary (p<0.05) factors.  Weight-related factors (concerns, behaviors, and pressures) explained little of the breakfast ¿ BMI association.  In prospective analyses, frequency of breakfast was inversely associated with BMI in a dose-response manner (p<0.01; Figure 2).  Further adjustment for confounding and dietary factors did not appear to explain the association, but adjustment for weight-related variables appeared to partly explain this finding. 

Figure 2.  Time 2 breakfast and BMI change (adjusted for baseline BMI and breakfast category, age, and gender)

Conclusion

While experimental studies are needed to verify whether the association between breakfast and body weight is of a causal nature, our findings support the importance of promoting regular breakfast consumption among adolescents.  Future studies should further examine the role of breakfast habits among youth who are particularly concerned about their weight. As rates of breakfast consumption decrease throughout adolescence and into adulthood, the impact of regular breakfast consumption on public health may be significant.  More emphasis should be placed on breakfast habits, especially among adolescents and young adults, when behavioral patterns are developing and stabilizing. 

One venue which may be appropriate for interventions is the school setting.  Interventions should be aimed at promoting a healthful breakfast (e.g., whole grain cereals, low-fat milk, and fresh fruit), as diets including nutrient- and fiber-rich carbohydrates have been shown to lead to weight loss and reduce disease risk.  Interventions could promote the ease and practicality of the breakfast meal, which can be eaten at home or at school or work.  Long-term studies including these types of interventions will be needed to evaluate the possibility of an important causal link between breakfast consumption and risk for obesity and chronic diseases, as well as for implementing generalizable community-based programs.