Big Breakfast Strikes Again

The breakfast cartel is back at it, trying to get us to eat more eggs, bacon, cereal, yogurt, or whatever. This time, big breakfast is telling us that if we skip breakfast, our arteries will surely harden.

In all seriousness, we don’t really believe in the big breakfast conspiracy. But two publications in the Journal of the American College of Cardiology are promoting an old meme. One is an observational study. The other is a commentary that comes right out and repeats the cliché: breakfast is the most important meal of the day.

Another Observational Study That Proves No Cause and Effect

This study by Irina Uzhova examined the association between different patterns of self-reported breakfast behaviors and atherosclerosis. And they found that skipping breakfast is associated with a higher risk of atherosclerosis. But because the study is cross-sectional and observational, it proves nothing about cause and effect.

In the companion commentary, Prakash Deedwania and Tushar Acharya admit it. “This cross-sectional
study evaluates for an association and not causality.” But nonetheless, they repeat the old tropes about how bad skipping breakfast is for your health.

Falling into the Trap of Familiarity Bias

Familiarity or mere exposure is a common and well-documented source of bias. And people have been repeating the claim that breakfast is essential for good health over and over again for more than a century. Study after study documents the same link. These studies reinforce our beliefs, but they provide no proof for cause and effect. Starting at slide 15 in this presentation, Andrew Brown explains the problem in detail.

Randomized, controlled trials provide good evidence that the association between skipping breakfast and health problems comes from other, confounding factors. For example, sometimes people who already have weight and health issues start skipping breakfast in order to lose weight. It doesn’t work, but they do it anyway.

And as a matter of fact, in the present study, breakfast skippers were more likely to report dieting to lose weight.

A Cliché Backed by Religious Fervor

Perhaps the big breakfast lobby seems so potent because it’s an old theme backed by religious fervor of the early 19th century. John Harvey Kellogg and others used moral rhetoric to sell the idea of a healthy breakfast. Adding in the virtue of equipping workers to be productive sealed the deal. Breakfast became the most important – and righteous – meal of the day.

Meal times probably do matter. Eating heavy meals late in the day and into the night is probably not a good idea. Research is still working this out. But one thing is already clear. Urging people who simply don’t want breakfast to eat it anyway probably does them no good.

Click here for the study and here for the commentary. For more on the origins of this myth, click here.

Breakfast with Heart, photograph © Allison Turrell / flickr

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November 5, 2017