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Recommendations Summary

Adult Weight Management (AWM) Eating Frequency and Patterns

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    AWM: Eating Frequency and Patterns

    Total caloric intake should be distributed throughout the day, with the consumption of 4 to 5 meals/snacks per day including breakfast. Consumption of greater energy intake during the day may be preferable to evening consumption.

    Rating: Fair
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      No conditions specified.

    • Potential Costs Associated with Application

      None.

    • Recommendation Narrative

      • One positive-quality RCT, one neutral-quality cohort study and five cross-sectional studies (3 positive-quality, 2 neutral-quality) show that 4 – 5 meals or snacks per day is associated with reduced or no obesity risk, while 3 or fewer and 6 or more meals per day may result in increased risk of obesity, depending on gender.  Higher eating frequency is related to lower total daily energy intake and body weights in men, but in women the data is less conclusive (Basdevant et al, 1993; Drummond et al, 1998; Forslund et al, 2002; Forslund et al, 2005; Kant et al, 1995; Ma et al, 2003; Westerterp-Plantenga et al, 2003) 
      • One neutral-quality cohort study, one positive-quality nonrandomized crossover trial and three cross-sectional studies (1 positive-quality and 2 neutral-quality) demonstrate that consumption of greater energy intake in the morning versus the evening is associated with lower body weights and results in greater weight loss (Andersson and Rossner, 1996; De Castro, 2004; Forslund et al, 2002; Keim et al, 1997; Summerbell et al, 1996) 
      • Three positive-quality cross-sectional studies show an association between skipping breakfast and increased prevalence and risk of obesity, despite lower reported daily energy intakes (Cho et al, 2003; Ma et al, 2003; Song et al, 2005)
      • Two RCTs (one positive-quality, one neutral-quality) show that breakfast eaters had a greater reduction in impulsive snacking and ate less at later meals (Martin et al, 2000; Schlundt et al, 1992)
      • Four cross-sectional studies (3 positive-quality, 1 neutral-quality) report that normal-weight subjects and people maintaining weight loss tend to eat breakfast regularly and generally consume a breakfast contributing approximately 20% of daily energy intake (Ortega et al, 1996; Song et al, 2005; Summerbell et al, 1996; Wyatt et al, 2002)   

    • Recommendation Strength Rationale

      • Conclusion statements both given a Grade II
      • Consistent findings among a variety of study designs

    • Minority Opinions

      Consensus reached.