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.
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.
Risks/Harms of Implementing This Recommendation
Conditions of Application
No conditions specified.
Potential Costs Associated with Application
- 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
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
In adults, how effective (in terms of client adherence and weight and loss maintenance) is a regular meal and snack pattern?
In adults, how effective (in terms of client adherence and weight loss and maintenance) is eating breakfast?
Andersson I, Rossner S. Meal patterns in obese and normal weight men: The Gustaf study. Eur J Clin Nutr 1996;50:639-46.
Basdevant A, Craplet C, Guy-Grand B. Snacking patterns in obese French women. Appetite. 1993;21:17-23.
de Castro JM. The time of day of food intake influences overall intake in humans. J Nutr. 2004;134:104-111.
Drummond SE, Crombie NE, Cursiter MC, Kirk TR. Evidence that eating frequency is inversely related to body weight status in male, but not female, non-obese adults reporting valid dietary intakes. Intl J Obes. 1998;22:105-12.
Forslund HB, Lindroos AK, Sjostrom L, Lissner L. Meal patterns and obesity in Swedish women - a simple instrument describing usual meal types. Eur J Clin Nutr 2002; 56:740-7.
Forslund HB, Torgerson JS, Sjostrom L, Lindroos AK. Snacking frequency in relation to energy intake and food choices in obese men and women compared to a reference population. Intl J Obes. 2005;29:711-9.
Kant AF, Schatzkin A, Graubard BI, Ballard-Barbash R. Frequency of eating occasions and weight change in the NHANES I Epidemiologic Follow-up Study. Intl J Obes. 1995;19:468-74.
Keim NL, Van Loan MD, Horn WF, Barbieri TF, Mayclin PL. Weight loss is greater with consumption of large morning meals and fat-free mass is preserved with large evening meals in women on a controlled weight reduction regimen. J Nutr. 1997;127:75-82.
Ma Y, Bertone ER, Stanek EJ, Reed GW, Hebert JR, Cohen NL, Merriam PA, Ockene IS. Association between eating patterns and obesity in a free-living US adult population. Am J Epidemiol. 2003; 158(1):85-92.
Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C. Relationship between feeding pattern and body mass index in 220 free-living people in four age groups. Eur J Clin Nutr. 1996;50:513-519.
Westerterp-Plantenga MS, Kovacs EMR, Melanson KJ. Habitual meal frequency and energy intake regulation in partially temporally isolated men. Intl J Obes 2002; 26: 102-110.
Cho S, Dietrich M, Brown CJP, Clark CA, Block G. The effect of breakfast type on total daily energy intake and body mass index: Results from the Third National Health and Nutrition Examination Survey (NHANES III). J Am Coll Nutr 2003; 22(4):296-302.
Martin A, Normand S, Sothier M, Peyrat J, Louche-Pelissier C, Laville M. Is advice for breakfast consumption justified? Results from a short-term dietary and metabolic experiment in young healthy men. Br J Nutr. 2000; 84:337-44.
Morgan KJ, Zabik ME, Stampley GL. The role of breakfast in diet adequacy of the U.S. adult population. J Am Coll Nutr 1986; 5: 551-563.
Ortega RM, Redondo MR, Lopez-Sobaler AM, Quintas ME, Zamora MJ, Andres P, Encinas-Sotillos A. Associations between obesity, breakfast-time food habits and intake of energy and nutrients in a group of elderly Madrid residents. J Am Coll Nutr 1996; 15(1):65-72.
Schlundt DG, Hill JO, Sbrocco T, Pope-Cordle J, Sharp T. The role of breakfast in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr 1992; 55:645-651.
Song WO, Chun OK, Obayashi S, Cho S, Chung CE. Is consumption of breakfast associated with body mass index in US adults? J Am Diet Assoc 2005;105:1373-82.
Wyatt HR, Grunwald GK, Mosca CL, Klem ML, Wing RR, Hill JO. Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obesity Research. 2002; 10(2):78-82.