To breakfast or not to breakfast? A doctor on why you shouldn't worry about it all that much

Breakfast has often been called the most important meal of the day, but if we're going by the facts, whether that's true or not is up for debate. Especially considering a new meta-analysis in the BMJ that suggests that skipping breakfast may not be as bad as we think.

The first thing to point out, though, is that breakfast means different things to different people, and people have different nutritional needs. For example, the people who promote breakfast rightly point to research suggesting that eating breakfast improves school performance in children. Compared to going hungry, it is not hard to see why having something to eat makes it easier to concentrate in class.

But this data may not translate into adults, and there is no real compelling evidence that eating or skipping breakfast will make you better at your job. The real push for eating breakfast came from the field of weight loss where recommendations were to not skip breakfast because eating smaller meals more frequently boosted your metabolism. Intermittent fasting though, seems to be challenging that assumption and has become very popular in recent years — but the actual evidence has not shown that it leads to any more weight loss than simply eating a bit less all day. Furthermore, since most 12 or 16 hour fasts involve skipping breakfast as part of the plan, we have to weigh any potential benefit against evidence that suggests skipping breakfast increases the risk of heart disease and is bad for blood sugar control if you are diabetic.

What about if you can't eat before noon — because you're asleep? For many people, either because they work long hours or work nights or work an irregular schedule, eating what might be considered breakfast (a meal in the early hours of the day) may not be possible. But if this is you, you'd still do well to eat whenever you rise. There is data suggesting that front loading your meals, i.e. having a large breakfast rather than a large diner, might be a better choice for managing weight.  

If all of this has you heading to the fridge when you wake up, remember that justifying a large breakfast because you're committed to that morning jog might be more an exercise in self-delusion than a healthy lifestyle choice. People generally overestimate how many calories they burn during exercise and it rarely leads to sustained weight loss on its own. In fact, many people engage in compensatory behaviours after exercise, such as overeating or moving less for the rest of the day, which negates any potential weight loss benefits.

If that sounds like a lot of competing information, you're not wrong. The truth is that for every study suggesting that breakfast has health benefits, there is another study suggesting that skipping meals might help with weight loss. There are sadly not many randomized trials on the subject and most are small studies and fairly short term; the BMJ meta-analysis, focused on the effect of breakfast and weight-loss, showed that most studies were of low quality and had short follow-up. As with most nutrition research, the data is equivocal and contradictory.

So in my opinion, the best rule of thumb is if you're hungry, eat a healthy breakfast. If you want to skip breakfast because you're not, that's probably OK too. And if you eat breakfast at noon because you work till midnight, that probably doesn't really matter all that much. The best way to look at breakfast is as something you shouldn't be worrying too much about.

Christopher Labos is a physician who writes about medicine and health issues. He co-hosts a podcast called The Body of Evidence and tweets at @drlabos.