Physiology & Behavior 119 (2013) 9–16

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Physiology & Behavior

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Effect of skipping breakfast on subsequent energy intake

David A. Levitsky ⁎, Carly R. PacanowskiDivision of Nutritional Sciences, Cornell University, Ithaca, NY 14853, United States

H I G H L I G H T S

• Two experimental studies examined skipping breakfast on subsequent energy intake.• Skipping breakfast was not compensated by an increase in intake at lunch.• Consequently, total daily energy intake was reduced by skipping breakfast.• Effect was confirmed in a cross-sectional study of non-breakfast eaters.• Humans do not compensate for variation in energy consumed at previous meals.

⁎ Corresponding author at: 112 Savage Hall.E-mail address: dal4@cornell.edu (D.A. Levitsky).

0031-9384/$ – see front matter © 2013 Elsevier Inc. Allhttp://dx.doi.org/10.1016/j.physbeh.2013.05.006

a b s t r a c t

a r t i c l e i n f o

Article history:Received 14 November 2012Accepted 3 May 2013

Keywords:Skipping breakfastControl of energy intakeEnergetic compensationWeight controlObesity

The objective was to examine the effect of consuming breakfast on subsequent energy intake.Participants who habitually ate breakfast and those who skipped breakfast were recruited for two studies.Using a randomized crossover design, the first study examined the effect of having participants consumeeither (a) no breakfast, (b) a high carbohydrate breakfast (335 kcals), or (c) a high fiber breakfast (360 kcals)on three occasions and measured ad libitum intake at lunch. The second study again used a randomized cross-over design but with a larger, normal carbohydrate breakfast consumed ad libtum. Intake averaged 624 kcalsand subsequent food intake was measured throughout the day. Participants ate only foods served from theCornell Human Metabolic Research Unit where all foods were weighed before and after consumption.In the first study, neither eating breakfast nor the kind of breakfast consumed had an effect on the amountconsumed at lunch despite a reduction in hunger ratings. In the second study, intake at lunch aswell as hungerratings were significantly increased after skipping breakfast (by 144 kcal), leaving a net caloric deficit of408 kcal by the end of the day. These data are consistent with published literature demonstrating that skip-ping a meal does not result in accurate energy compensation at subsequent meals and suggests that skippingbreakfast may be an effective means to reduce daily energy intake in some adults.

© 2013 Elsevier Inc. All rights reserved.

1. Introduction

Despite many scientific publications demonstrating nutritionalbenefits of eating breakfast [1,34,55,58,64,65,69,73,80,81,85], skip-ping breakfast is one of the first changes in feeding habits peoplemake when they want to lose weight [8,12–14,101,104]. About 25%of American adults report regularly not eating breakfast, a statisticthat has increased from 14% observed in 1965 [37]. The major reasongiven for skipping breakfast is to control body weight [78,104].

Skipping breakfast as a means of losing weight appears to contra-dict the scientific literature. Wyatt and colleagues found that one ofthe most consistent characteristics of people who were part of theNational Weight Control Registry, a group of successful dieters whohave maintained at least a 13.6 kg (30 lb) weight loss for one year

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or more, is that only 4% of the nearly 3000 participants reportedthat they skipped breakfast, [102] a frequency considerably lowerthan the 25% observed in the population [37].

Scientific evidence supporting the contention that skipping break-fast is ineffective as a means of restricting energy intake is inferredfrom the frequently published observation that people who skipbreakfast either have a higher Body Mass Index (BMI) or gain weightat a greater rate than people who regularly eat breakfast [2–4,6,7,9,10,12,13,15,16,18,22–26,30,35,40,42,46,47,52,53,56,59,68,70,79,80,82,87,89,90,93–97,100], although there are reports where such rela-tionships were not observed [1,30,31,54,76,83,86,98,99]. Despitethe preponderance of studies demonstrating the inverse relationshipbetween BMI and the frequency of eating breakfast, these observationshave been correlational. It is equally plausible to interpret these asso-ciations as indicating that a high BMI causes one to skip breakfast asit is to suggest that skipping breakfast causes an increased BMI. It isalso possible that breakfast eaters engage in other healthy behaviors,such as reduced snacking, lower total fat intake and engaging in regular

Table 2Composition of foods offered at lunch for Study 1.

Lunch Study 1 Weight Calories Protein Carbohydrate Fat Fiber

Fruit cocktail 248 181 1.0 46.9 1 2.5Plain yogurt 245 149 8.5 11.4 8 0Tuna sandwich 121.8 322 14.2 31.6 0.4 2.3Turkey sandwich 255 476 23 39 15.6 5Cheese sandwich 119 399 17.2 30 23.2 1.3Pasta & marinara sauce 226.8 168 7.2 34 3.2 3.2Iced tea 226.8 0 0 0 0 0

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exercise, all of whichwill lead to a reduced BMI [38,102]. From this cor-relational evidence alone, we cannot conclude that eating breakfast re-sults in a reduced BMI or that skipping breakfast results in a higherBMI.

To establish whether skipping breakfast results in an increase inenergy intake at succeeding meals to compensate for the lost energyconsumed at breakfast requires breakfast consumption to be experi-mentally manipulated and its effects on resulting intake measured.In one of the few studies that directly tests this idea, Kral and col-leagues [57] demonstrated that when children skip breakfast, despiteincreased hunger ratings, they do not compensate for the caloric def-icit by eating more later in the day. To further investigate whetherskipping breakfast results in subsequent energetic compensation inadults, the following two experimental studies were performed. Thefirst study examined the effect of skipping breakfast on the amountconsumed at lunch. The second study examined the effect of eatinga larger breakfast on the amount consumed at lunch and during therest of the day.

2. Study I

2.1. Material and methods

Participants were recruited from the undergraduate studentpopulation at Cornell University through posters and class announce-ments. The participants were told that the researchers were studyingthe cognitive effects of breakfast consumption. Volunteers werescreened using a health questionnaire and the Stunkard Three FactorEating Questionnaire. From this pool, twenty-four participants wereselected on the basis that (a) they exhibited low restraint scores(b15), (b) they did not have any aversions to the foods that wouldbe served, (c) they were in good physical health (self-report), and(d) they did not take any medications. All participants were between18 and 23 years old (mean age of 21) with BMIs greater than 20 andless than 25. The study was approved by the Cornell InstitutionalReview Board.

Participants were divided into three groups matched for age,restraint score, and gender. A randomized cross-over design wasused. They were instructed to eat breakfast and lunch in the CornellHuman Metabolic Research Unit (HMRU) on three consecutiveWednesdays. They were instructed not to eat any food after 11:00 pmthe night before and to arrive at the Unit between 7:45 and 9:20the next morning. Depending on which group the participants wereassigned, they were given either (a) no breakfast, (b) a high carbohy-drate breakfast consisting of a plain bagelwith 1½ tablespoons of straw-berry or grape jelly and 1 cup of orange or apple juice, or (c) a high fiberbreakfast consisting of 1 cup of Raisin Bran cereal with 1¼ cup of 1%milk. The energy content of the high carbohydrate breakfast was335 kcals and the high fiber breakfast was 338 kcals. The nutrient com-position of the two meals is provided in Table 1. The participants wereasked to eat all the food given to them. At each testing session one

Table 1Composition of foods consumed at breakfast for Study 1.

Breakfast Study 1 Weight Calories Protein Carbohydrate Fat Fiber

High carbohydrate breakfastPlain bagel 125 200 12 68 1 1.61½ tbs of strawberryor grape jelly

10 25 0 6.5 0 0

1 cup of orange orapple juice

249 110 1 30 0.5 0.3

Total 335 13 104.5 1.5 1.9

High fiber breakfast1 cup of raisin bran cereal 56 210 4 45 1.5 61¼ cup of 1% milk 305 128 10.3 15 3 0Total 338 14.3 0 0 6

third of the participants received each of the three breakfasts. For eachsucceeding week, each group was rotated through the remaining treat-ments according to a balanced Latin square design.

Participants were not permitted to eat anything between break-fast and lunch. One hour before lunch the participants completed a6-point hunger rating scale. Lunch was served in the HMRU between11:30 am and 12:30 pm. When the participants arrived for lunch, theywere given a 10 minute paper-and-pencil cognitive test to complete.

Lunch was served from a buffet table (nutrient composition ispresented in Table 2). The participants were instructed to eat asmuch or little as they wanted. After placing each food on separatepaper plates, the participants carried the food to a weighing stationwhere the investigators recorded the weight of each item. Data wererecorded to the nearest gram. Just before eating, participants complet-ed a second hunger rating scale. After finishing the meal, the amountof food remaining on the plate was recorded. Energy values of thefoods consumed were determined from standard food tables [50].

Amount consumed was the major dependent variable of interest.Statistical analyses were performed on both the amount consumed (g)and energy consumed (kcal). The results were identical.

Data were analyzed using a General Linear Model (GLM) with re-peated measures in SPSS version 14. Gender, body weight and BMIwere included in the model as subject variables. Amount consumedand hunger ratings were dependent variables and the kind of break-fast was entered as the independent variable. The Bonferroni correc-tion was used in the case of multiple comparisons and Tukey's HSDwere used to test differences between breakfast conditions.

2.2. Results

Characteristics of the participants are presented in Table 3. Eighteenof the 24 participants were regular breakfast eaters and 19 of the partic-ipants were female. Neither gender, body weight, BMI, nor whetheror not the participants were regular breakfast eaters had a statisticallysignificant effect on hunger ratings or energy consumption.

Fig. 1 displays the primary outcomes of Study 1. Panel A shows themean hunger ratings that were taken prior to eating lunch. Skippingbreakfast resulted in participants rating themselves significantlymore hungry (p b 0.01) than after eating either the high carbohydrateor the high fiber breakfast. Consuming either the high carbohydrate orthe high fiber breakfast had no significant effect on the participants'ratings of hunger just before lunch. The type of breakfast (high carbo-hydrate or high fiber) did not have a significant effect on any parame-ters measured.

Table 3Study 1 subject characteristics.

Mean age (years) 22.1 ± 2.7Mean height (m) 1.7 ± 0.08Mean weight (kg) 61 ± 17Mean BMI 21 ± 5.2Female/Male 19/5Mean restraint score 8.8 ± 0.89Number of regular breakfast eaters 18/24

Fig. 1. Panel A. Mean and standard error of hunger rating measured just prior to eating lunch. Groups designated by difference letters are significantly different (p b 0.001). Panel B.Mean and standard error of energy intake at lunch following no breakfast (NB), high carbohydrate breakfast (CB), and high fiber breakfast (FB). Panel C. Mean and standard errortotal energy intake (breakfast + lunch) following no breakfast (NB), high carbohydrate breakfast (CB), and high fiber breakfast (FB). Groups designated by different letters aresignificantly different (p b 0.001).

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Despite increased hunger ratings at lunch, the participants whoskipped breakfast did not have a statistically different energy intakeat lunch when compared to their energy intake at lunch on dayswhen they also ate breakfast, as shown in Panel B. The inability to de-tect an effect of skipping breakfast on lunch intake was not due to alack of statistical power. A power calculation of the sample indicatedthat a difference of 35 kcals could be statistically detected with analpha set at 0.05 and with a power of 0.8.

The energetic consequence of skipping breakfast on total dailyintake is depicted by Panel C. The accumulated energy consumed bythe end of lunch was significantly greater after having eaten thehigh carbohydrate 955 ± 42 kcal or the high fiber breakfast 930 ±65 kcal than when breakfast was skipped 600 ± 50 kcal. Energeticcompensation at lunch failed to balance the reduction in energyintake resulting from not eating breakfast.

Neither gender, body weight, BMI, nor the participants' habitualbreakfast eating pattern had any statistically significant effect oneither the amount consumed or hunger ratings.

2.3. Discussion

This study demonstrated that skipping breakfast did not result in asignificant increase in energy intake at the subsequent meal approxi-mately three hours later. This resulted in a caloric deficit on the occa-sions when breakfast was not eaten. However, the mean amount ofenergy consumed at breakfast was about 350 kcals. It is possible thatthe size of the breakfast used in this study was not sufficient to affectintake at lunch. It is also possible that energetic compensation forskipping breakfast may not occur at lunch, but later in the day.

Therefore, the following study was performed to examine the effectof skipping an ad libitum breakfast on the energy consumed through-out the rest of the day.

3. Study 2

3.1. Material and methods

Similar to Study 1, participants were undergraduate students atCornell University. Eighteen healthy volunteers who showed no aver-sions or allergies to foods that would be served were chosen. BMIsranged from 22 to 27 and the average age was 24. Eleven were regularbreakfast eaters, five regularly skipped breakfast, and two ate break-fast irregularly. This study differed from the first in that one breakfastwas served or not served and food intake was measured after lunch,after mid-afternoon snack, after dinner, and after late night snack.The study was approved by the University Institutional ReviewBoard. Participants consumed all breakfasts and lunches in the CornellHuman Metabolic Research Unit (HMRU), but could take snacks anddinners out from the unit. The snack and its weight were recordedbefore the subject left the HMRU and the subject was asked to returnthe wrapper along with any uneaten food. They were also asked to re-cord the time when they ate the snack. Because of time constraints,some participants ate their dinner meal outside the unit. They wereprovided with more than ample food and asked to return all uneatenfood to the unit the next day.

Participants were recruited and screened in a manner similar tothat of the previous study. They were divided into two groupsmatched on the basis of body weight. They were instructed to eat

Table 4Composition of foods offered at breakfast for Study 2.

Breakfast Study 2 Weight(g)

Calories(kcal)

Protein(g)

Carbohydrate(g)

Fat(g)

Fiber(g)

Kix cereal 22.6 85 1.4 19.4 0.5 0.7All bran cereal 60 156 7.9 44.5 2.9 17.6Corn flakes cereal ALC 28 101.1 1.9 24.4 0.2 0.7Frosted flakes cerealALC

41.3 151.7 1.4 37.3 0.2 1.3

Grape nuts cerealAFT.PC

116 416.4 12.5 94.3 2.2 10.1

Raisin bran cerealCMI.AR

56 210 4 45 1.5 6

Orange juice SHB.EF 236.4 120 0 29 0 0Apple juice HCG.WA. 248 110 0 29 0 0Plain bagel 125 330 12 68 1 3Cream cheese 85.1 296.8 6.4 2.3 29.7 0Jelly 6.3 16.9 0 4.4 0 0.7Skim milk 245 83.3 8.3 12.2 0.2 01%, milk 244 102.5 8.2 12.2 2.4 0Coffee 237 2.37 0.3 0 0 0

Table 6Study 2 subject characteristics.

Subject characteristics

Mean age (years) 24.0 ± 2.8Mean height (m) 1.7 ± 0.16Mean weight (kg) 69 ± 7.2Mean BMI 24.1 ± 2.2Female/male 13/3Mean restraint score 8.2 ± 0.93

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only food provided by the HMRU on two consecutive Mondays. Theywere asked not to eat anything after 11:00 pm the night before.Breakfast was served buffet style between 8:45 am and 10:00 am.Nutrient composition of the food offered is presented in Table 4.After participants placed their food on separate plastic dishes andbowls and took it to a weighing station, staff recorded the weightsof all their selected foods. At the end of the meal, plates were againweighed and weights were recorded by the staff. Lunch was servedbetween 11:00 am and 1:00 pm. Like breakfast, the food was servedbuffet style and weighed before and after eating. Dinner was servedbetween 5:00 and 7:00 pm. Nothing could be eaten between break-fast and lunch. The diet composition of the food offered at lunch,dinner and snacks is presented in Table 5.

All participants were tested twice, on the same day of the weekbut one week apart. At the first testing session, half the participantswere given breakfast while the other half were not given breakfastand asked not to eat until lunch. At the second testing session, the sit-uations were reversed.

Participants were asked to complete a 6-point hunger rating scaleat mid-morning, just prior to eating lunch, mid-afternoon, prior toeating dinner, and just before going to bed. Energy intake was calcu-lated by multiplying the amount of food removed from the partici-pants plate by the energetic value taken from the food item's label.Paired t-tests (one-tailed) were used to test the statistical significanceof the within participants difference in caloric intake on the day when

Table 5Composition of foods offered at lunch, snack, and dinner for Study 2.

Weight(g)

Calories(kcal)

Protein(g)

Carbohydrate(g)

Fat(g)

Fiber(g)

Lunch Study 2Plain yogurt 245 149.5 8.5 11.4 8 0Fruit cocktail 248 181 0.97 46.9 0.9 2.5Tuna sandwich 121.8 321.8 14.2 31.6 0.4 2.3Turkey sandwich 255 476 23 39 15.6 5Lemonade drink SBG 251.7 120 0 30 0 0

Snack study 2Plain yogurt 245 149.5 8.5 11.4 8 0Apple 110 57 0.3 15.2 0.2 2.6Animal crackers 85.1 379.3 5.9 63 11.7 0.9Pretzels 18 68.6 1.6 14.3 0.6 0.6Juice 250 130 0 34 0 0

Dinner Study 2Pasta & marinara sauce 226.8 168 7.2 34.4 3.2 0Dinner rolls 47 120 5 22 1.5 2Tossed Salad & dressing 99.2 80 3 6 5 1Lemonade drink SBG 251.7 120 0 30 0 0

participants ate breakfast compared with the day when breakfast wasskipped. Hunger ratings were also analyzed as a dependent variable.

3.2. Results

Eighteen participants began the study. One discontinued becauseof time conflicts, and one was removed for not following directions,leaving thirteen women and three men to complete the study. Partic-ipant characteristics are presented in Table 6. Similar to the previousstudy, neither gender, body weight, BMI, nor whether or not the par-ticipants were regular breakfast eaters had any statistically signifi-cant effect on either the amount consumed or hunger ratings. Onone occasion, three participants ate dinner outside the unit, butfood was prepared and measured in the laboratory under the sameconditions as the meals served in the HMRU. Because their intakeout of the unit at dinner was within the range of the intake of theother participants who ate dinner in the unit, their data was com-bined with the other intake values for statistical analysis.

Unlike in Study 1, participants were served breakfast ad libitum.Results of Study 2 are displayed in Fig. 2. The mean energy intakeat breakfast was 624 ± 72 kcal. Panel A shows the hunger ratingsthroughout the test day for both the day when participants ate break-fast and on the day when breakfast was skipped. Skipping breakfastproduced significantly higher hunger ratings mid-morning (p b 0.01)than when breakfast was consumed. This difference in hunger levelwas still evident at the beginning of lunch (p b 0.05) though smaller.By mid-afternoon, any difference in hunger ratings due to skippingbreakfast had disappeared.

Panel B of Fig. 2 displays the amount of food eaten throughoutthe rest of the day categorized into different eating occasions. Theamount of energy consumed at lunch was statistically greater (p =0.04) when breakfast was skipped than when it was eaten. However,no significant effect of eating breakfast could be detected at any othereating occasion.

The total daily energetic consequence of skipping breakfast can beseen in panel C of Fig. 2. This figure shows that, despite the small in-crease in consumption at lunch, total energy intake was significantlydepressed after skipping breakfast compared to when breakfast waseaten. By the end of the day, the participants had consumed about450 kcals fewer calories (p b 0.01) when they skipped breakfastthan when they ate it. Similar to the previous study, neither gender,body weight, BMI, nor the participants' regular breakfast eatingpattern had any statistically significant effect on either the amountconsumed or hunger ratings.

3.3. Discussion

The results from these two studies demonstrate that skippingbreakfast does not result in an increase in energy intake sufficient tocounterbalance the energy deficit by not eating breakfast. In Study 1,breakfast for all participants was limited to about 350 kcal and no in-crease in intake at lunch was observed despite the increase in hungerratings. In study 2, the breakfast ingested was increased to 624 kcaland skipping it resulted in a statistically significant increase in energyintake at lunch. However, energy intake at lunch increased by only

Fig. 2. Panel A. Mean and standard error of hunger ratings measured at mid-morning, just prior to lunch, mid-afternoon, just prior to dinner, and during the evening followingbreakfast and without breakfast. **p b 0.01; *p b 0.05. Panel B. Mean and standard error of energy intake at lunch, mid-afternoon snack, dinner, and at the evening snack followingbreakfast and without breakfast. *p = 0.04. Panel C. Mean and standard error to total energy intake following breakfast and without breakfast. *p b 0.01.

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174 kcal, leaving the participants with a net energy intake deficit of450 kcal by the end of the day.

It is unlikely that the lack of compensation of energy intake atlunch for skipping breakfast was due to the participants eating break-fast outside the unit. The hunger ratings, in both studies, confirmthat skipping breakfast resulted in a significant increase in feelingsof hunger, indicating that the participants had, indeed, refrainedfrom eating prior to eating lunch. Moreover, participant debriefingsaffirmed their high compliance with the protocol of the study.

Although this lack of energetic compensation after skipping break-fast may contradict our intuition, it is consistent with published liter-ature describing meals that were experimentally varied. In a studyclose in design to the present one (study 2), ten healthy men weregiven either a low-energy breakfast 100 kcal or high-energy breakfast700 kcal for a two week period and energy consumed was observedthroughout the day using self-reported diaries [66]. No effect of thesize of the breakfast was evident in the amount of energy consumedat lunch.1 In a study of the effects of skipping breakfast and of exer-cise on energy intake at lunch, Hubert et al. [48] found that reducingbreakfast by about 450 kcals increased intake at lunch by about120 kcals, compensating for only 25% of the energy lost by not eating

1 Unlike the present study, the participants in this study were allowed to eat amidmorning snack. After eating the smaller breakfast, participants ate an average of138 kcal whereas they ate only 28 kcal after eating the larger breakfast. This is a differ-ence of 110 kcal whereas the difference in energy consumed between the differentbreakfasts was 600 kcal. A suppression of midmorning snack intake following the con-sumption of a breakfast supplemented with carbohydrate was also observed byBlundell et al. [11].

breakfast. Interestingly, the compensation in energy intake at lunchobserved in the present study was very similar, about 20%.

Halsey et al. [41] examined the effect of feeding or not feedingbreakfast on young adults for a one week period. Although eatingbreakfast increased to total energy intake in both participants whoregularly did not eat breakfast and those that did, only the effect inregular breakfast eaters reached statistical significance in those whoregularly ate breakfast probably because of the small sample sizeand because intake was based on self-reported intake rather thanmeasured intake.

Although primarily concerned with fiber, Delargy et al. [21] exam-ined the effects of eating a small 390 kcal and large breakfast 555 kcalon subsequent intake at lunch. They, too, observed no significant effectof the amount consumed at breakfast on the amount eaten at lunch.De Graff et al. [20] and Hulshof et al. [49] examined the effects of feed-ing different levels of macronutrients at breakfast. Both studies failedto find a change in energy intake at lunch despite the fact that theamount of energy consumed at breakfast was 8 kcal, 100 kcal,250 kcal, and 400 kcal in the de Graaf et al. [19] study and 100 kcal,400 kcal, and 800 kcal in the Hulshof et al. [49] study. In a studydesigned to examine the similarities and differences between fat andcarbohydrate, sixteen healthy young men were given either a smallbreakfast (440 kcal) or the same breakfast supplemented with fat(803 kcal) or carbohydrate (803 kcal). Again, no statistical differencein the amount of energy consumed at lunchwas observed [17]. Similarfindings were reported by Blundell et al. [11]. Finally, Holt et al. [45]found no relationship between the energy consumed at breakfastcomposed of different foods and the energy consumed at lunch.

Fig. 3. Data from the NHANES 2003–2004. The mean and standard error of the amount of energy consumed at lunch, dinner, snacks, or drinks as function of whether breakfast wasconsumed as the first meal of the day (Breakfast Eater) or lunch was the first meal (Breakfast Skipper). Inset represents the total daily energy consumed by Breakfast Eaters orBreakfast Skippers. All differences between pairs of bars are significant, p b 0.001.

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Taylor and Garrow [91] performed one of themost intensive exam-inations of skipping breakfast on both subsequent ad libitum energyintake and energy expenditure in the whole body calorimeter. Similarto the studies cited above, skipping breakfast had no effect on subse-quent energy intake (or energy expenditure) through the remaining24 h in the calorimeter.

One of the few studies that tested the effects of skipping breakfastin a clinical weight loss trial was performed by Schlundt et al. [88].They divided a group of participants who wanted to lose weight intopeople who regularly ate breakfast and those who skipped breakfast.They further divided each of these two groups into a group that re-ceived two meals a day (lunch and dinner) and those who receivedthree meals a day (breakfast, lunch, and dinner) for 12 weeks. Thosewho regularly ate breakfast, who were then asked to skip breakfastdid not lose as much weight as those who ate breakfast, althoughthe differences were not statistically significant. Those who regularlyate breakfast, however, lost more weight (though not statistically sig-nificant) when switched to the skip breakfast condition than thosewho were asked to eat breakfast. The interaction was marginallysignificant (p = 0.06). If eating breakfast impairs weight loss, it wasnot evident in this study.

One exception to these findings is a recent study where Astburyet al. [5] observed an increase in energy intake at lunch that totallycompensated for skipping a 200 kcal breakfast. However, becausethe study was primarily concerned with gastrointestinal hormones,the protocol incorporated the consumption of a 250 kcal “pre-load”consisting of a liquid diet between the breakfast and the testingat lunch. Consequently, it is difficult to compare the results of thisstudy with the studies cited above because the increase in intake inthe breakfast skippers could have occurred because of a “counter-regulation” effect of the preload [44] or the unusual effects of con-suming liquid preloads [92].

Data from Studies 1 and 2, though collected in the laboratory, areconsistent with 24-hour food recall data from the 2003–2004 NationalHealth and Nutrition Examination Survey [74]. NHANES is a multi-stage probability sample of the US non-institutionalized populationrepresenting a broader population than those of Studies 1 and 2. Theamount of energy consumed from lunch through the rest of the daywas calculated for cases where the first meal of the day was breakfastand compared to the caseswhere the firstmeal of the daywas “lunch”.The results are shown in Fig. 3. Breakfast eaters consumed signifi-cantly more energy at each succeeding eating occasion than breakfastskippers (p b 0.001). However, as indicated by the upper right insetin Fig. 3, despite the fact that the breakfast eaters ate less than thebreakfast skippers at each eating occasion, the cumulative daily intakeof breakfast skippers was significantly less than that of breakfasteaters (p = 0.025). Similar results were found in other epidemio-logical studies [16,22,51,71,72,75,77]. As in Studies 1 and 2, breakfastskippers in the NHANES dataset consumed more energy at lunchthan breakfast eaters.

If the results of the present studies can be confirmed in a more real-istic eating situation, skipping breakfast may be an effective way of re-ducing daily energy intake. However, skipping breakfast has beenfound to increase the risk of consuming an insufficient supply of dailynutrients important for health [1,33,36,55,58,64,65,69,80,81,85]. Thepublic's search for a clear answer as to whether or not to eat breakfastcan be expected to mount as the prevalence of overweight and obesityincreases [27–29,32]. Health practitioners have expressed concern thatbreakfast foods contain nutrients that are not consumed at eating occa-sions later in the day (e.g. fiber). However, there is no reasonwhy foodsthat are usually consumed at breakfast, particularly whole grain, fiberrich, cereals, and milk cannot be substituted for lunch or dinner. Infact, there is evidence that substituting a ready-to-eat cereal for lunchor dinner may result in a further decrease in total energy intake [67].

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These data are also consistent with recent research that showsthat a reduction in portion size at one meal does not result in an in-crease in energy intake at subsequent meals[63]. There appears tobe accumulating evidence that human feeding behavior is less drivenby internal regulatory mechanisms such as small energy deficitsor surfeits [60–62], but rather is vulnerable to external cues such asadvertising [39,43] or large portion sizes [84,103].

Although the data presented above are consistent with the scien-tific literature on the effects of skipping breakfast, they challenge thecommon belief that consumption of breakfast daily is essential forgood health and weight management. If skipping breakfast producesa chronic deficit in daily energy intake, then the health benefitsderived from consuming a lower daily energy intake may be substan-tially greater than consuming breakfast. Future research is needed toinvestigate the effects of skipping breakfast on energy intake overmultiple days.

4. Conclusion

The data collected from two experimental studies and an analysisof the NHANES epidemiological data set indicate that skipping break-fast does not lead to overconsumption at lunch or any other eating oc-casion later in the day. These findings suggest that occasionallyskipping breakfast may be an effective strategy to reduce total dailyenergy intake.

References

[1] Abalkhail B, Shawky S. Prevalence of daily breakfast intake, iron deficiency anae-mia and awareness of being anaemic among Saudi school students. Int J Food SciNutr 2002;53:519–28.

[2] Albertson AM, Anderson GH, Crockett SJ, Goebel MT. Ready-to-eat cereal con-sumption: its relationship with BMI and nutrient intake of children aged 4 to12 years. J Am Diet Assoc 2003;103:1613–9.

[3] Albertson AM, Franko DL, Thompson D, Eldridge AL, Holschuh N, Affenito SG,Bauserman R, Striegel-Moore RH. Longitudinal patterns of breakfast eating inblack and white adolescent girls. Obesity (Silver Spring) 2007;15:2282–92.

[4] Andersen LF, Lillegaard ITL, Overby N, Lytle L, Klepp KI, Johansson L. Overweightand obesity among Norwegian schoolchildren: changes from 1993 to 2000.Scand J Public Health 2005;33:99–106.

[5] Astbury NM, Taylor MA, Macdonald IA. Breakfast consumption affects appetite,energy intake, and the metabolic and endocrine responses to foods consumedlater in the day in male habitual breakfast eaters. J Nutr 2011;141:1381–9.

[6] Barton BA, Eldridge AL, Thompson D, Affenito SG, Striegel-Moore RH, Franko DL,et al. The relationship of breakfast and cereal consumption to nutrient intakeand body mass index: the National Heart, Lung, and Blood Institute Growthand Health study. J Am Diet Assoc 2005;105:1383–9.

[7] Bazzano LA, SongY, Bubes V, GoodCK,Manson JE, Liu S. Dietary intake ofwhole andrefined grain breakfast cereals andweight gain inmen. Obes Res 2005;13:1952–60.

[8] Bellisle F, Monneuse MO, Steptoe A, Wardle J. Weight concerns and eating pat-terns — a survey of university-students in Europe. Int J Obes 1995;19:723–30.

[9] Bellisle F, Rolland-Cachera MF, Deheeger M, Guilloud-Bataille M. Obesity andfood intake in children: evidence for a role of metabolic and/or behavioraldaily rhythms. Appetite 1988;11:111–8.

[10] Berkey CS, Rockett HR, Gillman MW, Field AE, Colditz GA. Longitudinal study ofskipping breakfast and weight change in adolescents. Int J Obes Relat MetabDisord 2003;27:1258–66.

[11] Blundell JE, Burley VJ, Cotton JR, Lawton CL. Dietary fat and the control of energyintake: evaluating the effects of fat on meal size and postmeal satiety. Am J ClinNutr 1993;57:772S–7S.

[12] Boutelle K, Neumari-Sztainer D, Story M, Resnick M. Weight control behaviorsamong obese, overweight, and nonoverweight adolescents. J Pediatr Psychol2002;27:531–40.

[13] Brugman E, Meulmeester JF, Spee-van der Wekke A, Beuker RJ, Zaadstra BM,Radder JJ, Verloove-Vanhorick PS. Dieting, weight and health in adolescents inthe Netherlands. Int J Obes Relat Metab Disord 1997;21:54–60.

[14] Brugman E, Meulmeester JF, Spee-Van der, Verloove-Vanhorick SP. Breakfast-skipping in children and young adolescents in the netherlands. Eur J PublicHealth 1998;8:325–8.

[15] Cartwright M, Wardle J, Steggles N, Simon AE, Croker H, Jarvis MJ. Stress anddietary practices in adolescents. Health Psychol 2003;22:362–9.

[16] Cho S, Dietrich M, Brown CJ, Clark CA, Block G. The effect of breakfast type on totaldaily energy intake and bodymass index: results from the third national health andnutrition examination survey (NHANES III). J Am Coll Nutr 2003;22:296–302.

[17] Cotton JR, Burley VJ, Weststrate JA, Blundell JE. Dietary fat and appetite — simi-larities and differences in the satiating effect of meals supplemented with eitherfat or carbohydrate. J Hum Nutr Diet 1994;7:11–24.

[18] Croezen S, Visscher TL, Ter Bogt NC, Veling ML, Haveman-Nies A. Skipping break-fast, alcohol consumption and physical inactivity as risk factors for overweightand obesity in adolescents: Results of the E-MOVO project. Eur J Clin Nutr2009;63:405–12.

[19] de Graaf C, Hulshof T. The effect of non-absorbable fat on energy and fat intake.Eur J Med Res 1995;1:72–7.

[20] de Graaf C, Hulshof T,Weststrate JA, Jas P. Short-term effects of different amountsof protein, fats, and carbohydrates on satiety. Am J Clin Nutr 1992;55:33–8.

[21] Delargy HJ, Burley VJ, O'Sullivan KR, Fletcher RJ, Blundell JE. Effects of differentsoluble: insoluble fibre ratios at breakfast on 24-h pattern of dietary intakeand satiety. Eur J Clin Nutr 1995;49:754–66.

[22] Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping andbreakfast type affect energy intake, nutrient intake, nutrient adequacy, and dietquality in young adults? NHANES 1999–2002. J Am Coll Nutr 2010;29:407–18.

[23] Dialektakou KD, Vranas PB. Breakfast skipping and body mass index among ad-olescents in Greece: whether an association exists depends on how breakfastskipping is defined. J Am Diet Assoc 2008;108:1517–25.

[24] Dubois L, Girard M, Potvin Kent M, Farmer A, Tatone-Tokuda F. Breakfast skip-ping is associated with differences in meal patterns, macronutrient intakes andoverweight among pre-school children. Public Health Nutr 2009;12:19–28.

[25] Dwyer JT, Evans M, Stone EJ, Feldman HA, Lytle L, Hoelscher D, Johnson C, ZiveM, Yang M. Child and Adolescent Trial for Cardiovascular Health (CATCH) Coop-erative Research Group. Adolescents' eating patterns influence their nutrient in-takes. J Am Diet Assoc 2001;101:798–802.

[26] Fabritius K, Rasmussen M. Breakfast habits and overweight in Danishschoolchildren. the role of socioeconomic positions. Ugeskr Laeger 2008;170:2559–63.

[27] Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in theUnited States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord1998;22:39–47.

[28] Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesityamong US adults, 1999–2008. JAMA 2010;303:235–41.

[29] Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesityamong US adults, 1999–2000. JAMA 2002;288:1723–7.

[30] Forslund HB, Lindroos AK, Sjostrom L, Lissner L. Meal patterns and obesity inSwedish women — a simple instrument describing usual meal types, frequencyand temporal distribution. Eur J Clin Nutr 2002;56:740–7.

[31] Fujiwara T. Skipping breakfast is associated with dysmenorrhea in youngwomen in Japan. Int J Food Sci Nutr 2003;54:505–9.

[32] Galuska DA, Serdula M, Pamuk E, Siegel PZ, Byers T. Trends in overweight amongUS adults from 1987 to 1993: a multistate telephone survey. Am J Public Health1996;86:1729–35.

[33] Gibson EL,Wainwright CJ, Booth DA. Disguised protein in lunch after low-proteinbreakfast conditions food-flavor preferences dependent on recent lack of proteinintake. Physiol Behav 1995;58:363–71.

[34] Gibson SA, O'Sullivan KR. Breakfast cereal consumption patterns and nutrientintakes of British schoolchildren. J R Soc Health 1995;115:366–70.

[35] Gikas A, Triantafillidis JK, Perdikaki P. Breakfast skipping and its associationwith other unhealthy food habiits among Greek high school adolescents. AnnGastroenterol 2003;16:321–7.

[36] Gittelsohn J, Wolever TM, Harris SB, Harris-Giraldo R, Hanley AJ, Zinman B. Spe-cific patterns of food consumption and preparation are associated with diabetesand obesity in a native Canadian community. J Nutr 1998;128:541–7.

[37] Haines PS, Guilkey DK, Popkin BM. Trends in breakfast consumption of US adultsbetween 1965 and 1991. J Am Diet Assoc 1996;96:464–70.

[38] Haire-Joshu D, Schwarz C, Budd E, Yount BW, Lapka C. Postpartum teens' break-fast consumption is associated with snack and beverage intake and body massindex. J Am Diet Assoc 2011;111:124–30.

[39] Halford JC, Boyland EJ, Hughes G, Oliveira LP, Dovey TM. Beyond-brand effect oftelevision (TV) food advertisements/commercials on caloric intake and foodchoice of 5–7-year-old children. Appetite 2007;49:263–7.

[40] Hallstrom L, Labayen I, Ruiz JR, Patterson E, Vereecken CA, Breidenassel C,Gottrand F, Huybrechts I, Manios Y, Mistura L, Widhalm K, Kondaki K, MorenoLA, SjostromM. Breakfast consumption and CVD risk factors in European adoles-cents: the HELENA (healthy lifestyle in Europe by nutrition in adolescence)study. Public Health Nutr 2012:1–10.

[41] Halsey LG, Huber JW, Low T, Ibeawuchi C, Woodruff P, Reeves S. Does consumingbreakfast influence activity levels? An experiment into the effect of breakfastconsumption on eating habits and energy expenditure. Public Health Nutr2012;15:238–45.

[42] Harding S, Teyhan A, Maynard MJ, Cruickshank JK. Ethnic differences in over-weight and obesity in early adolescence in the MRC DASH study: the role ofadolescent and parental lifestyle. Int J Epidemiol 2008;37:162–72.

[43] Harris JL, Bargh JA, Brownell KD. Priming effects of television food advertising oneating behavior. Health Psychol 2009;28:404–13.

[44] Herman CP, Polivy J, Esses VM. The illusion of counter-regulation. Appetite1987;9:161–9.

[45] Holt SHA, Delargy HJ, Lawton CL, Blundell JE. The effects of high-carbohydrate vshigh-fat breakfasts on feelings of fullness and alertness, and subsequent foodintake. Int J Food Sci Nutr 1999;50:13–28.

[46] Horikawa C, Kodama S, Yachi Y, Heianza Y, Hirasawa R, Ibe Y, et al. Skippingbreakfast and prevalence of overweight and obesity in Asian and Pacific regions:a meta-analysis. Prev Med 2011;53:260–7.

[47] Huang CJ, Hu HT, Fan YC, Liao YM, Tsai PS. Associations of breakfast skippingwith obesity and health-related quality of life: evidence from a national surveyin Taiwan. Int J Obes (Lond) 2010;34:720–5.

16 D.A. Levitsky, C.R. Pacanowski / Physiology & Behavior 119 (2013) 9–16

[48] Hubert P, King NA, Blundell JE. Uncoupling the effects of energy expenditure andenergy intake: appetite response to short-term energy deficit induced by mealomission and physical activity.Appetite Aug. 1998;vol. 31(1):9–19 [1998:199].

[49] Hulshof T, DeGraaf C, Weststrate JA. The effects of preloads varying in physicalstate and fat content on satiety and energy intake. Appetite 1993;21:273–86.

[50] EatRight analysis.Jones and Bartlett Publishers; 2002 [2].[51] Kant AK, Andon MB, Angelopoulos TJ, Rippe JM. Association of breakfast energy

density with diet quality and bodymass index in American adults: National HealthandNutrition Examination Surveys, 1999–2004. Am J ClinNutr 2008;88:1396–404.

[52] Kapantais E, Chala E, Kaklamanou D, Lanaras L, Kaklamanou M, Tzotzas T. Break-fast skipping and its relation to BMI and health-compromising behavioursamong Greek adolescents. Public Health Nutr 2011;14:101–8.

[53] Keski-Rahkonen A, Viken RJ, Kaprio J, Rissanen A, Rose RJ. Genet Environ FactorsEat Patterns 2004;34:503–14.

[54] Kim JH, So WY. Association between frequency of breakfast eating and obesity inKorean adolescents. Iran J Public Health 2012;41:50–7.

[55] Kleinman RE, Hall S, Green H, Korzec-Ramirez D, Patton K, Pagano ME, et al.Diet, breakfast, and academic performance in children. Ann Nutr Metab2002;46(Suppl. 1):24–30.

[56] Kovarova M, Vignerova J, Blaha P, Osancova K. Bodily characteristics and lifestyleof Czech children aged 7.00 to 10.99 years, incidence of childhood obesity. CentEur J Public Health 2002;10:169–73.

[57] Kral TV, Whiteford LM, Heo M, Faith MS. Effects of eating breakfast comparedwith skipping breakfast on ratings of appetite and intake at subsequent mealsin 8- to 10-y-old children. Am J Clin Nutr 2011;93:284–91.

[58] Kunimoto M, Nishi M, Sasaki K. The relation between irregular bowel movementand the lifestyle of working women. Hepatogastroenterology 1998;45:956–60.

[59] Lee CJ, Templeton S, Wang C. Meal skipping patterns and nutrient intakes ofrural southern elderly. J Nutr Elder 1996;15:1–14.

[60] Levitsky DA. The non-regulation of food intake in humans: hope for reversingthe epidemic of obesity. Physiol Behav 2005;86:623–32.

[61] Levitsky DA. The control of food intake and the regulation of body weight inhumans. In: Harris RBS, Mattes RD, editors. Appetite and food intake: behavioraland physiological considerations. Boca Raton: CRC Press; 2008. p. p21–42.

[62] Levitsky DA, Pacanowski C. Losing weight without dieting. use of commercialfoods as meal replacements for lunch produces an extended energy deficit.Appetite 2011;57:311–7.

[63] Levitsky DA, Pacanowski CR. Free will and the obesity epidemic. Public HealthNutr 2011:1–16.

[64] Liu S, Sesso HD, Manson JE,WillettWC, Buring JE. Is intake of breakfast cereals re-lated to total and cause-specificmortality inmen? Am J Clin Nutr 2003;77:594–9.

[65] Lloyd HM, Rogers PJ, Hedderley DI, Walker AF. Acute effects on mood and cogni-tive performance of breakfasts differing in fat and carbohydrate content. Appe-tite 1996;27:151–64.

[66] Martin A, Normand S, Sothier M, Peyrat J, Louche-Pelissier C, Laville M. Is advicefor breakfast consumption justified? Results from a short-term dietary andmetabolic experiment in young healthy men. Br J Nutr 2000;84:337–44.

[67] Mattes RD. Ready-to-eat cereal used as a meal replacement promotes weightloss in humans. J Am Coll Nutr 2002;21:570–7.

[68] Matthys C, De Henauw S, BellemansM, DeMaeyerM, De Backer G. Breakfast habitsaffect overall nutrient profiles in adolescents. Public Health Nutr 2007;10:413–21.

[69] McNeill G, Vyvyan J, Peace H, McKie L, Seymour G, Hendry J, et al. Predictors ofmicronutrient status in men and women over 75 years old living in the commu-nity. Br J Nutr 2002;88:555–61.

[70] Merten MJ, Williams AL, Shriver LH. Breakfast consumption in adolescenceand young adulthood: parental presence, community context, and obesity. J AmDiet Assoc 2009;109:1384–91.

[71] Morgan KJ, Zabik ME. The influence of ready-to-eat cereal consumption at break-fast on nutrient intakes of individuals 62 years and older. J Am Coll Nutr 1984;3:27–44.

[72] Morgan KJ, Zabik ME, Leveille GA. The role of breakfast in nutrient intake of 5- to12-year-old children. Am J Clin Nutr 1981;34:1418–27.

[73] Morgan KJ, Zabik ME, Stampley GL. The role of breakfast in diet adequacy of theU.S. adult population. J Am Coll Nutr 1986;5:551–63.

[74] NHANES. National health and nutrition examination survey. 2003–2004; 2007.[75] Nicklas TA, Bao W, Webber LS, Berenson GS. Breakfast consumption affects

adequacy of total daily intake in children. J Am Diet Assoc 1993;93:886–91.[76] Nicklas TA, Morales M, Linares A, Yang SJ, Baranowski T, De Moor C, et al.

Children's meal patterns have changed over a 21-year period: the BogalusaHeart Study. J Am Diet Assoc 2004;104:753–61.

[77] Nicklas TA, Myers L, Berenson GS. Impact of ready-to-eat cereal consumption ontotal dietary intake of children: the Bogalusa Heart Study. J Am Diet Assoc1994;94:316–8.

[78] Nicklas TA, Myers L, Reger C, Beech B, Berenson GS. Impact of breakfast con-sumption on nutritional adequacy of the diets of young adults in Bogalusa,Louisiana: ethnic and gender contrasts. J Am Diet Assoc 1998;98:1432–8.

[79] Ortega RM, Redondo MR, Lopez-Sobaler AM, Quintas ME, Zamora MJ, Andres P,et al. Associations between obesity, breakfast-time food habits and intake ofenergy and nutrients in a group of elderly Madrid residents. J Am Coll Nutr1996;15:65–72.

[80] Ortega RM, Requejo AM, Lopez-Sobaler AM, Quintas ME, Andres P, Redondo MR,et al. Difference in the breakfast habits of overweight/obese and normal weightschoolchildren. Int J Vitam Nutr Res 1998;68:125–32.

[81] Preziosi P, Galan P, Deheeger M, Yacoub N, Drewnowski A, Hercberg S. Breakfasttype, daily nutrient intakes and vitamin and mineral status of French children,adolescents and adults. J Am Coll Nutr 1999;18:171–8.

[82] Purslow LR, Sandhu MS, Forouhi N, Young EH, Luben RN, Welch AA, et al. Energyintake at breakfast and weight change: prospective study of 6,764 middle-agedmen and women. Am J Epidemiol 2008;167:188–92.

[83] Resnicow K. The relationship between breakfast habits and plasma cholesterollevels in schoolchildren. J Sch Health 1991;61:81–5.

[84] Rolls BJ. The supersizing of America: portion size and the obesity epidemic. NutrToday 2003;38:42–53.

[85] Ruxton CH, Kirk TR. Breakfast: a review of associations with measures of dietaryintake, physiology and biochemistry. Br J Nutr 1997;78:199–213.

[86] Sampson AE, Dixit S, Meyers AF, Houser Jr R. The nutritional impact of breakfastconsumption on the diets of inner-city African-American elementary schoolchildren. J Natl Med Assoc 1995;87:195–202.

[87] Sanchez-Henriquez P, Doreste Alonso J, Lainez Sevillano P, Estevez Gonzalez MD,Iglesias Valle M, Lopez Martin G, Sosa Iglesias I, Serra Majem L. Prevalence ofobesity and overweight in adolescents from Canary Islands, Spain. Relationshipwith breakfast and physical activity. Med Clin (Barc) 2008;130:606–10.

[88] Schlundt DG, Hill JO, Sbrocco T, Pope-Cordle J, Sharp T. The role of breakfast in thetreatment of obesity: a randomized clinical trial. Am J Clin Nutr 1992;55:645–51.

[89] Schusdziarra V, Hausmann M, Wittke C, Mittermeier J, Kellner M, Naumann A,et al. Impact of breakfast on daily energy intake — an analysis of absolute versusrelative breakfast calories. Nutr J 2011;10:5–12.

[90] Song WO, Chun OK, Kerver J, Cho S, Chung CE, Chung SJ. Ready-to-eat breakfastcereal consumption enhances milk and calcium intake in the US population.J Am Diet Assoc 2006;106:1783–9.

[91] Taylor MA, Garrow JS. Compared with nibbling, neither gorging nor a morningfast affect short-term energy balance in obese patients in a chamber calorimeter.Int J Obes Relat Metab Disord 2001;25:519–28.

[92] Tieken SM, Leidy HJ, Stull AJ, Mattes RD, Schuster RA, Campbell WW. Effects ofsolid versus liquid meal-replacement products of similar energy content on hun-ger, satiety, and appetite-regulating hormones in older adults. Horm Metab Res2007;39:389–94.

[93] Timlin MT, Pereira MA, Story M, Neumark-Sztainer D. Breakfast eating and weightchange in a 5-year prospective analysis of adolescents: Project EAT (eating amongteens). Pediatrics 2008;121:e638–45.

[94] Tin SP, Ho SY, Mak KH, Wan KL, Lam TH. Breakfast skipping and change in bodymass index in young children. Int J Obes (Lond) 2011;35:899–906.

[95] van der Heijden AA, Hu FB, RimmEB, van DamRM. A prospective study of breakfastconsumption and weight gain among U.S. men. Obesity (Silver Spring) 2007;15:2463–9.

[96] Vanelli M, Iovane B, Bernardini A, Chiari G, Errico MK, Gelmetti C, et al. Breakfasthabits of 1,202 northern Italian children admitted to a summer sport school.Breakfast skipping is associated with overweight and obesity. Acta Biomed2005;76:79–85.

[97] Williams BM, O'Neil CE, Keast DR, Cho S, Nicklas TA. Are breakfast consumptionpatterns associated with weight status and nutrient adequacy in African-American children? Public Health Nutr 2009;12:489–96.

[98] Williams P. Breakfast and the diets of Australian adults: an analysis of data fromthe 1995 national nutrition survey. Int J Food Sci Nutr 2005;56:65–79.

[99] Williams P. Breakfast and the diets of Australian children and adolescents: ananalysis of data from the 1995 national nutrition survey. Int J Food Sci Nutr2007;58:201–16.

[100] Wolfe WS, Campbell CC, Frongillo Jr EA, Haas JD, Melnik TA. Overweightschoolchildren in New York state: prevalence and characteristics. Am J PublicHealth 1994;84:807–13.

[101] Wong YC, Chen SL, Chan YC, Wang MF, Yamamoto S. Weight satisfaction anddieting practices among college males in Taiwan. J Am Coll Nutr 1999;18:223–8.

[102] Wyatt HR, Grunwald GK, Mosca CL, KlemML, Wing RR, Hill JO. Long-termweightloss and breakfast in subjects in the national weight control registry. Obes Res2002;10:78–82.

[103] Young LR, Nestle M. The contribution of expanding portion sizes to the US obe-sity epidemic. Am J Public Health 2002;92:246–9.

[104] Zullig K, Ubbes VA, Pyle J, Valois RF. Self-reported weight perceptions, dietingbehavior, and breakfast eating among high school adolescents. J Sch Health2006;76:87–92.