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Is Skipping Breakfast Unhealthy?

A recent study in the Journal of the American College of Cardiology has received quite a bit of attention in the popular media in the past couple of months.  Check out these headlines:

  • “Skipping Breakfast Tied to Higher Risk of Heart Related Death”  CNN

  • “Eating Breakfast? Skipping a Morning Meal Has Higher Risk of Heart Related Death”  USA Today

  • “Study: Skipping Breakfast Increases Risk of Heart Disease Mortality by 87 Percent” FOX

But this study has received just as much attention from physicians and researchers who have been quick to point out the problems with studies like this, labeling it “bad science,” and even going as far as saying it should have been recalled or never published.

There are several problems with a study such as this.  Mainly, this is an observational study which means an observation or association was made, in this case between not eating breakfast and cardiovascular disease, but an actual experiment to test this observation or hypothesis was not done.  They basically pulled data from a nutrition survey done in the late 80’s and early 90’s, looked at who said they ate breakfast and who didn’t, and then followed up with them in 20 years on average to see who died from cardiovascular disease and who died from other causes.  

Was that the only difference between the 2 groups though?  It turns out that according to the study’s authors, those who didn’t eat breakfast were more likely to be former smokers, heavy drinkers, unmarried, physically inactive, obese, and diabetic.  They also had a lower family income, ate a poorer quality diet, and had higher cholesterol. So did they die of cardiovascular disease because they didn’t eat breakfast or because of one of these other reasons?  In these studies researchers always “adjust for” these other factors, but it is nearly impossible to accurately do that.

There are other problems with the study:

  • What did participants eat for breakfast?  The investigators did not collect information on what they ate or drank.

  • Did participants change their diet over the course of 20 years?  We don’t know since information was only collected at baseline.

  • What is the definition of not eating breakfast?  Investigators didn’t find out if they still ate 3 meals or ate more calories later in the day or simply just ate 2 meals after skipping breakfast.

The takeaway for most researchers that critically evaluated this study is that skipping breakfast was more likely a marker for a lifestyle and environment (other factors) that predisposed these people to cardiovascular disease, not that skipping breakfast itself caused cardiovascular disease.  

Interestingly, this article, looking at the association between eating breakfast and losing weight, came out 3 months before the above study.  This article questioned the science behind eating breakfast as a strategy for weight loss, and claimed it was propaganda manufactured by the cereal companies.  Studies cited in this article show that eating breakfast does not promote weight loss and skipping breakfast can be a useful strategy to lose weight.

My takeaway to you is this: take headlines and studies with a grain of salt and a critical eye.  Media outlets love titles and headlines like this because they know people will click on them to read further, and as long as there is a “study” quoted, they are not being journalistically inaccurate.  Ask us as your physicians for clarification or search for reviews or criticisms of studies. And if you want to eat breakfast eat it, if you want to skip it, skip it!