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Asking if a Bad Breakfast is Better than No Breakfast is the Wrong Question

Posted December 8, 2014 by Yoni Freedhoff

Strangely, breakfast is a source of great contention.

There’s the camp that says breakfast is the most important meal of the day (be it for weight, health, attention, etc.), and then there’s the gleefully contrarian camp that relishes any and every opportunity to “bust the myth” of breakfast as being beneficial or essential to anything.

Now I don’t really have a horse in the breakfast race, though I do have some considerations. Personally, I’m a breakfast eater, and in my clinical experience with thousands of patients, it would seem that for many breakfast plays an important role in satiety and control (a phenomenon which at least associatively appears to be true with the thousands and thousands of the National Weight Control Registry’s weight loss masters of who nearly 80% report having breakfast). But I wouldn’t say I feel passionately about it. Meaning if there were good evidence for me to stop suggesting and consuming it, I’d have no issue doing so.

But there isn’t.

Sure there have been studies on breakfast skipping being no big thing, including this recent teeny tiny one (36 subjects split among 3 groups, 4 weeks duration, and only a 2lb difference in weight) which had more than one highly respected colleague of mine conclusively exclaiming breakfast to be officially dead and done. But here’s the thing, in this (and most) breakfast studies, the breakfasts themselves were crap.

The breakfasts that I recommend contain 300-500 calories (with liquid calories only as condiments) and a minimum of 20g of protein. For me and for my patients these sorts of breakfasts, when coupled with organized eating throughout the rest of the day, seem to help a great deal with whole day, and even evening, satiety and control. The study breakfasts? Well they’re the usually North American drek – highly processed sugary carbs washed down with liquid calories (milk and/or juice) – breakfasts which wouldn’t be expected to help with satiety in the short term, let alone long.

But even thoughtful breakfasts don’t help everyone. And go figure, there are lots of different people out there. To suggest that breakfast (or snacking, or any other meal or meal frequency prescription) will suit everyone is ridiculous. For some people certain styles and approaches to eating will be incredibly helpful while for others those same approaches will prove a hinderance.

Why researchers and clinicians seem to be stuck on suggesting there one right way to go is beyond me, but if you are aiming to weigh in conclusively on breakfast, at the very least make sure the breakfast in question isn’t a bowl of frickin’ Frosted Flakes like in the first arm of that study linked up above.

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General

You Can’t Talk to Customers. Really?

Posted December 2, 2014 by Anonymous

By Heather Searl Often when I suggest to a client that they talk to and observe customers, the suggestion is immediately met with a series of reasons why that is impossible. And yet if they are willing to try, we’ve always been able to work around the impossible road block. So here are some of […]

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Children

How Bad Do We Want Good News Regarding Childhood Obesity? This Bad

Posted November 26, 2014 by Yoni Freedhoff

So let me set the stage.

Researchers wanted to evaluate the impact of 6-8 months of motivational interviewing, self monitoring, text messaging and email support, had on the weights and behaviours of high school students with obesity. This intervention group was of course matched with a control group that didn’t receive all that great attention.

Retention was great with 94% of the intervention group completing their last visit (and 87% of controls).

The results? Well they were published last month in the journal Childhood Obesity.

While 54% of the intervention group either maintained or reduced their BMI scores, the control group did markedly better with 72% of the control kids seeing their BMI scores maintained or reduced.

The difference by the way, according to the authors’ statistical analysis, was likely real and significant with a p value of 0.025. And of course, there were confounders, and the authors did present some thoughts as to why they may have seen the results they did.

And yet what was the first of the authors’ conclusions about this study where their lengthy and involved intervention was shown to be statistically inferor to doing nothing?

This SBHC intervention showed successful recruitment and retention of participants and delivery of preventive services in both groups.

Shows you just how badly we want this particular glass to be half-full.

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General

Mere Access to Pots and Seafood Doesn’t Lead to Great Cioppino

Posted November 24, 2014 by Yoni Freedhoff

The study, which sounds quite promising, is titled, “Effectiveness of a Smartphone Application for Weight Loss Compared With Usual Care in Overweight Primary Care Patients: A Randomized, Controlled Trial“.

The application being studied for “effectiveness” was myfitnesspal – the world’s most popular food diary app. Now you might presume from the title that the study was in fact designed to determine whether or not the use of myfitnesspal in the pursuit of weight loss was effective. You would be wrong however.

Reuters’ journalist Andrew Seaman summed up the study’s conclusions in just 10 words, “Mere Access to Calorie-Counting App Doesn’t Lead to Weight Loss“. Yes that’s right, all the study looked at was whether or not having a research assistant in a physician’s office help a patient to download myfitnesspal to their smartphone and show them a youtube video highlighting its use (presumably this one) would lead that patient to lose weight. That’s right, patients who weren’t supported in app use, counselled in self-monitoring best practices, and other than one followup a week later for help with “technical problems“, had no other points of contact with the research team, didn’t lose any remarkable amount of weight. Shocker.

As to how this study was published (and publicized!), and not in the Journal of Duh but actually in Annals of Internal Medicine, speaks to the the fact that obesity and weight management sells, as I can’t fathom we would see studies or press coverages of studies that determined:

  • Mere access to dumbbells and barbells doesn’t lead to muscle growth.
  • Mere access to running shoes doesn’t lead to running.

More amazing to me was this statement made by the authors in the study’s discussion,

Given these results, it may not be worth a clinician’s time to prescribe myfitnesspal to every overweight patient with a smartphone.

In turn this leads me to offer the following advice – it may not be worth a patient’s time to stay on with any clinician who even remotely entertains the notion that the sole and simple act of recommending a smartphone application for the treatment of obesity could be construed as sufficiently helpful.

And lastly, two more “mere” statements.

Mere access to funding support doesn’t lead to useful studies or conclusions.

And sadly, no, mere access to pots and seafood doesn’t lead to great cioppino.

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