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Recommendations Summary

AWM: Eating Frequency and Meal Patterns 2014

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 Meal Patterns for Weight Loss and Weight Maintenance

    For weight loss and weight maintenance, the registered dietitian nutritionist (RDN) should individualize the meal pattern to distribute calories at meals and snacks throughout the day, including breakfast. Research reports inconsistent results regarding the association between eating frequency and body weight, which may be due to the role of portion size, energy density or compensation of energy intake at subsequent eating occasions. The majority of observational research reported that breakfast consumption is associated with a lower BMI and decreased obesity risk, while omitting breakfast is associated with a higher BMI and increased obesity risk. Several studies suggest that cereal-based breakfasts are associated with lower BMI, while breakfasts that are very high in energy are associated with higher BMI.

    Rating: Fair
    Imperative

    • Risks/Harms of Implementing This Recommendation

      None.

    • Conditions of Application

      None.

    • Potential Costs Associated with Application

      Costs of medical nutrition therapy (MNT) sessions vary; however, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      From the Adult Weight Management Project

      • Research reports inconsistent results regarding the association between eating frequency and body weight (Basdevant et al, 1993; Kant et al, 1995; Ma et al, 2003; Forslund et al, 2005; Kant and Graubard, 2006; Howarth et al, 2007; Keski-Rahkonen et al, 2007; Nonino-Borges et al, 2007; Piexoto Mdo et al, 2007; Uchigata et al, 2007; Whybrow et al, 2007; Carels et al, 2008; Marin-Guerrero et al, 2008; Kent and Worsley, 2009; Zaveri and Drummond, 2009; Al-Rethaiaa et al, 2010; Bes-Rastrollo et al, 2010; Holmback et al, 2010; Schusdziarra et al, 2010). This may be due to the role of portion size, energy density or compensation of energy intake at subsequent eating occasions. In addition, the majority of observational research reports an association between higher evening energy intake and increased body weight (Andersson and Rossner, 1996; Summerbell et al, 1996; Forslund et al, 2002; de Zwaan et al, 2006; Morse et al, 2006; Gluck et al, 2008; Berg et al, 2009; Tholin et al, 2009; Lundgren et al, 2010). However, this has not been confirmed in a limited number of intervention studies (Keim et al, 1997; Vander Wal et al, 2006). Further intervention studies are needed on the distribution of calories consumed at meals and snacks throughout the day and its effect on body weight.
      • The majority of observational research reported that breakfast consumption is associated with a lower BMI and decreased obesity risk, while omitting breakfast is associated with a higher BMI and increased obesity risk (Cho et al, 2003; Ma et al, 2003; Song et al, 2005; Crossman et al, 2006; Malinauskas et al, 2006; Niemeier et al, 2006; van der Heijden et al, 2007; Kant et al, 2008; Marin-Guerrero et al, 2008; Raynor et al, 2008; Berg et al, 2009; Grujic et al, 2009; Merten et al, 2009; Huang et al, 2010; Perusse-Lachance et al, 2010). Several studies suggest that cereal-based breakfasts are associated with lower BMI (Wyatt et al, 2002; Bazzano et al, 2005; Song et al, 2005), while breakfasts that are very high in energy are associated with higher BMI (Martin et al, 2000; Cho et al, 2003; Kant et al, 2008; Kent and Worsley, 2009). Further research is needed on the relative energy contribution and composition of breakfast.

      From the 2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library (NEL) Evidence-Based Systematic Reviews

      • What is the relationship between breakfast and body weight?
        • Moderate evidence suggests that children who do not eat breakfast are at increased risk of overweight and obesity. The evidence is stronger for adolescents. There is inconsistent evidence that adults who skip breakfast are at increased risk for overweight and obesity.
      • What is the relationship between snacking and body weight?
        • Limited and inconsistent evidence suggests that snacking is associated with increased body weight.
      • What is the relationship between eating frequency and body weight?
        • Evidence is insufficient to determine whether frequency of eating has an effect on overweight and obesity in children and adults.

    • Recommendation Strength Rationale

      The Conclusion Statements from the Adult Weight Management project in support of this recommendation received:

      • What is the relationship between eating frequency and weight change (weight loss, weight gain and weight maintenance)? Grade II.
      • What is the relationship between breakfast consumption and weight change (weight loss, weight gain and weight maintenance)? Grade II.

      The three Conclusion Statements for Energy Balance and Weight Management, Food Environment and Dietary Behaviors in support of this recommendation received grades of Moderate and Limited.

    • Minority Opinions

      Consensus reached.