Confessions of a breakfast skipper

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As a doctor and a parent, I feel a certain obligation to model healthy behaviors. Even if I were neither, I'd do my best to make healthy choices. And, mostly, I do. I exercise regularly, I pay attention to what I eat and I try to eat reasonable portions of healthy foods. But I regularly break a cardinal rule of healthy living: I skip breakfast.

Is that so wrong? Apparently, most people think so. Ask anyone and my guess is that you'll hear this a lot: "Everyone knows that breakfast is the most important meal of the day." And it makes some sense. When you get up in the morning you've probably just endured the longest period of fasting for the day. And that's probably true even if you're a late night snacker (like me).

But, a new study suggests that skipping breakfast may not be as bad for you as commonly believed.

Researchers enrolled healthy kids, ages 8 to 10, and repeatedly measured attention, impulsiveness, memory, verbal learning, and speed of processing information. For each of these measures, the kids did no better (or worse) on the days they ate breakfast compared to the days they didn't. Of course, this study only assessed the short-term impact of breakfast on healthy school-age kids. The findings could have been quite different if it included "habitual breakfast skippers," adults, or people who don't get adequate nutrition.

What about past research?

Several past studies have demonstrated beneficial effects of eating breakfast on the academic performance, behavior, and psychological function of kids. But most of these studies were also short-term, small, and therefore not definitive. In fact, some of the largest and best studies showed no impact. The biggest benefits of breakfast have been noted among "nutritionally vulnerable" children — that is, kids with the poorest nutrition get the most from eating breakfast regularly.

Breakfast and weight: it's complicated

Studies on adults are far fewer and the findings are similarly inconsistent and inconclusive. Several have examined the impact of eating breakfast on weight. It might seem counterintuitive that skipping a meal might lead to weight gain, but that's just what a widely quoted 2007 study suggested: people who choose to skip breakfast tend to be overweight or obese significantly more often than those who eat breakfast. However, such studies have been criticized because of the real possibility that a factor other than breakfast habit might be responsible for the higher rates of obesity among breakfast skippers. Supporting this concern is a recent study finding that people who eat breakfast are more health conscious and exercise more regularly. While one of the largest studies to date found that eating breakfast had no consistent effect on rates of obesity or being overweight, a 2013 study found that adults who skipped breakfast actually consumed fewer calories by the end of the day.

The inconsistency noted in past research may be due to these recent observations:

• people who skip breakfast tend to eat more than breakfast eaters later in the day
• those who eat breakfast tend to be more physically active early in the day than breakfast skippers
• some people actually lose weight when skipping breakfast, because even if they eat more at lunch, it's often not enough to make up for the average breakfast.

So, what?

These latest studies suggest that eating breakfast may not be as essential as many believe — but they are also unlikely to be the last words on the subject. We need more and better research into how breakfast (and other meals) affect health and disease. But, from the available evidence, I'd say the idea that breakfast is the most important meal of the day may be a myth. In fact, we should probably be paying more attention to what and how much we eat rather than focusing on when.

If you're like me and you aren't particularly hungry first thing in the morning, feel free to buck the "must-eat-breakfast" trend. After reviewing the available research, I'm feeling less guilty about my breakfast skipping habit.