The prevalence of type 2 diabetes has been dramatically increasing worldwide and is a major health concern. Many well-known lifestyle factors are associated with increased risk of type 2 diabetes; now, a recent study published in the January 2019 issue of The Journal of Nutrition suggests that skipping breakfast should be added to the list. Although previous studies have demonstrated an association between breakfast skipping and type 2 diabetes, this lifestyle choice was treated as a dichotomous variable.

A research team led by Dr. Aurélie Ballon from the German Diabetes Center hypothesized that not only is there an association between breakfast skipping and type 2 diabetes, but this relation presents in a consistent dose-response manner.

Data for this study were obtained by a systematic review and meta-analysis of 6 prospective cohort studies on breakfast skipping and risk of type 2 diabetes in adults. Breakfast skipping was analyzed as a continuous variable in order to determine whether the risk increased with increased frequency of breakfast skipping (i.e. a dose-response). The influence of body mass index on the association between breakfast skipping and risk of type 2 diabetes was also considered in the final analysis.

Nonlinear dose-response meta-analysis indicated that risk of type 2 diabetes increased with every additional day of breakfast skipping, reaching a plateau at 4‒5 days a week. No further increase in risk of type 2 diabetes was observed after 5 days of breakfast skipping per week. This association was partly mediated by obesity, but a positive association persisted after adjustment for obesity, suggesting that other factors might also influence this association. The researchers concluded, “future studies should also focus on breakfast quality.” In other words, would consuming an unhealthy breakfast be better than skipping breakfast altogether?

Reference Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Ballon A, Neuenschwander M, Schlesinger S. Journal of Nutrition. 2019; In Press. Breakfast Skipping and Type 2 Diabetes: Where Do We Stand? Mekary RA. Journal of Nutrition. 2019; In Press.


What is Breakfast?

Breakfast is unique because it breaks a time of fasting (after a night of sleep). You are considered a breakfast eater if you eat your first meal of the day following your longest period of sleep, within 2 to 3 hours of waking and if your meal contains food or beverage from at least one food group. Your breakfast should provide at least 15% of your total daily caloric needs.

Should You Eat Breakfast?

Approximately one in five Americans are “breakfast skippers”. Skipping breakfast, as part of time-restricted eating patterns, such as intermittent fasting, has become increasingly popular as a weight management strategy. However, scientific evidence to support this is lacking. Many scientific studies have shown that breakfast skippers are at an increased risk for weight gain (e.g., increased hunger driving hormones, increased hunger throughout the day) and chronic disease.

A study comparing breakfast eaters to breakfast skippers found that those who ate breakfast had a decrease in appetite, improvement in healthy food choices and improved sleep quality. In addition, a study published in 2018 compared the effects of breakfast and dinner skipping in adult men and women. The study revealed that breakfast skipping, but not dinner skipping, negatively impacted the body’s ability to control blood sugar and insulin.

Research suggests that breakfast is important, but simply eating breakfast may only be half the battle. The true victory comes when you eat a high-quality breakfast packed full of protein and nutrients.

A Balanced Breakfast with Protein

Unfortunately, the majority of Americans who eat breakfast consume too little protein at their breakfast meal and instead, eat the majority of their daily protein at dinner. The higher amount of protein (greatly exceeding 30g of protein) typically consumed at dinner time cannot be stored for later use and is either used for energy or stored as fat.

Figure 1: Protein Distribution between Meals. Adapted from Paddon-Jones and Rasmussen, 2009


A high protein breakfast has been shown to benefit muscle health and to support weight loss by increasing muscle mass, energy expenditure (calories burned), satiety hormones, glucose regulation and by decreasing the desire to snack at night .

High protein breakfasts have also been shown to improve the body’s response to a high carbohydrate food up to 4-hours after the breakfast meal. A recent study looked at the effect of a high protein breakfast compared to a high fat or high carbohydrate breakfast on the body’s ability to control glucose and insulin following the consumption of white bread four hours after the breakfast meal. Participants consuming a high protein breakfast (30% protein) had improved blood sugar control and insulin levels after consuming the white bread.


Although breakfast may be the most frequently skipped meal in America, it continues to live up to its reputation as the most important meal of the day. So, when making your next breakfast choice, consider how much protein you have on your plate. Your first meal of the day can have long lasting effects throughout your day and on your long-term health!


  1. Nas A, Mirza N, Hagele F, Kahlhofer J, Keller J, Rising R, Kufer TA and Bosy-Westphal A. Impact of breakfast skipping compared with dinner skipping on regulation of energy balance and metabolic risk. Am J Clin Nutr. 2017; 105(6):1351-1361.
  2. Astbury NM, Taylor MA and Macdonald IA. Breakfast Consumption Affects Appetite, Energy Intake, and the Metabolic and Endocrine Responses to Foods Consumed Later in the Day in Male Habitual Breakfast Eaters. The Journal of Nutrition. 2011; 141(7).
  3. Pereira MA, Erickson E, McKee P, Schrankler K, Raatz SK, Lytle LA and Pellegrini AD. Breakfast frequency and quality may affect glycemia and appetite in adults and children. J Nutr. 2011; 141(1):163-168.
  4. Baum JI, Gray M and Binns A. Breakfasts higher in protein increase postprandial energy expenditure, increase fat oxidation, and reduce hunger in overweight children from 8 to 12 years of age. The Journal of nutrition. 2015; 145(10):2229-2235.
  5. Mamerow MM, Mettler JA, English KL, Casperson SL, Arentson-Lantz E, Sheffield-Moore M, Layman DK and Paddon-Jones D. Dietary protein distribution positively influences 24-h muscle protein synthesis in healthy adults. J Nutr. 2014; 144(6):876-880.
  6. Gwin JA and Leidy HJ. Breakfast Consumption Augments Appetite, Eating Behavior, and Exploratory Markers of Sleep Quality Compared with Skipping Breakfast in Healthy Young Adults. Current Developments in Nutrition. 2018; 2(11).
  7. Leidy HJ, Ortinau LC, Douglas SM and Hoertel HA. Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping,” late-adolescent girls. Am J Clin Nutr. 2013; 97(4):677-688.
  8. Paddon-Jones D, Campbell WW, Jacques PF, Kritchevsky SB, Moore LL, Rodriguez NR and van Loon LJ. Protein and healthy aging. Am J Clin Nutr. 2015; 101(6):1339S-1345S.
  9. Chanet A, Verlaan S, Salles J, Giraudet C, Patrac V, Pidou V, Pouyet C, Hafnaoui N, Blot A, Cano N, Farigon N, Bongers A, Jourdan M, et al. Supplementing Breakfast with a Vitamin D and Leucine-Enriched Whey Protein Medical Nutrition Drink Enhances Postprandial Muscle Protein Synthesis and Muscle Mass in Healthy Older Men. J Nutr. 2017; 147(12):2262-2271.
  10. Megn H, Mathan NR, Ausman LM and Lichtenstein AH. Effect of prior meal macronutrient composition on postprandial glycemic responses and glycemic index and glycemic load value determinations. Am J Clin Nutr. 2017; 106:1246-1256.


By Caitlin Dow, PhD

Breakfast is often considered the “most important meal of the day,” and if you are looking to lose weight, you mustn’t skip breakfast… or so the story goes. This idea is widely believed in popular culture as well as by many nutrition scientists and government bodies and is repeated so often that many in the field consider it health dogma. Indeed, the Dietary Guidelines for Americans even recommend breakfast consumption as an important tool for weight loss. But what does the science say?

Observational studies indicate that breakfast consumption is linked to lower weight. Data from the National Weight Control Registry demonstrated that 78% of the nearly 3,000 subjects included in the analysis (adults who had lost at least 13 kg and kept the weight off for a year or more) reported eating breakfast everyday and only 4% reported never eating breakfast [1]. Further, a recent meta-analysis of observational studies that have evaluated the relation between weight and breakfast consumption found that skipping breakfast was associated with a 55% increased odds of having overweight or obesity [2]. These findings are likely the reason many tout breakfast consumption as an important weight loss modality, despite these studies not actually testing that outcome.

Observational studies can only describe associations, but are not appropriate to determine causation. Thus, randomized controlled trials (RCTs) have sought to test whether breakfast consumption directly impacts weight. In one of the first RCTs to evaluate the role of breakfast in weight loss, Schlundt et al. [3]studied women with obesity who were self-reported breakfast eaters or skippers.Within each group, women were randomized to eat or skip breakfast in addition to following a 1200 kcal/day diet for 12 weeks. All groups lost at least 6 kg, but interestingly, those who were randomized to switch their breakfast condition (e.g. ate breakfast at baseline, then started skipping) lost more weight than those who maintained their breakfast habit. These results suggest that changing an eating behavior in addition to following a reduced calorie diet may accelerate weight loss. However, the results from a study by Dhurandhar et al. did not corroborate those findings. Adults with overweight and obesity were randomized to one of three conditions in which all groups received a USDA pamphlet on healthy eating practices: the control group received no other information, one group received additional instructions to consume breakfast, and the third group was instructed to not eat breakfast [4]. After 16 weeks, there was no observed effect of treatment assignment on weight loss.Contrary to the results from the Schlundt study, baseline breakfast eating habit was not related to weight change, though this study didn’t evaluate breakfast consumption in conjunction with a reduced calorie diet.Finally, in a recently published 4-week study, adults with overweight and obesity were randomized to three different breakfast conditions: water (control), frosted flakes, or oatmeal [5].Interestingly, skipping breakfast resulted in an average weight loss of 1.2 kg, while those randomized to either breakfast condition demonstrated no significant weight change.However, total cholesterol also increased in the control group, suggesting that skipping breakfast may result in slight weight loss, but have detrimental effects on cardiometabolic health.

Thus, the results from the few RCTs completed in adults with overweight and obesity, to date, do not support the notion that breakfast consumption should be part of a weight loss regimen. Importantly, though, the results are also not compelling to suggest that eating breakfast hinders weight loss. This field is still young and many questions remain unanswered. I look forward to more RCTs evaluating breakfast consumption (and potentially, breakfast quality) on various facets of weight and metabolic health.


1.Wyatt, H.R., et al., Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obes Res, 2002. 10(2): p. 78-82.

2.Brown, A.W., M.M. Bohan Brown, and D.B. Allison, Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence. Am J Clin Nutr, 2013. 98(5): p. 1298-308.

3.Schlundt, D.G., et al., The role of breakfast in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr, 1992. 55(3): p. 645-51.

4.Dhurandhar, E.J., et al., The effectiveness of breakfast recommendations on weight loss: a randomized controlled trial. Am J Clin Nutr, 2014. 100(2): p. 507-13.

5.Geliebter, A., et al., Skipping breakfast leads to weight loss but also elevated cholesterol compared with consuming daily breakfasts of oat porridge or frosted cornflakes in overweight individuals: a randomised controlled trial. J Nutr Sci, 2014. 3: p. e56.