September 12, 2017

One key to weight loss? A big breakfast and small dinner, study finds

Daily Briefing

While many people begin the day with a small meal and finish with a large dinner, a new study suggests the opposite approach—"breakfast like a king, lunch like a prince, and dinner like a pauper"—could help regulate your metabolism and aid weight loss, Roni Rabin writes for The New York Times' "Well."

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Study details

For the study, published last month in the Journal of Nutrition, researchers at Loma Linda University School of Public Health assessed the dietary habits of 50,000 adults over seven years. The study participants were Seventh Day Adventists, Rabin writes, an "unusually healthy" religious group who abstain from smoking and drinking, and who generally eat less meat than the general population.

The researchers found that participants who snacked during the day, in addition to eating three meals per day, tended to gain weight over time. In comparison, those who ate just one or two meals per day often lost weight—even when compared to those who ate three meals without snacks.

Further, the researchers found that those who ate their largest meal earlier in the day generally had a lower body mass index (BMI) than those who consumed larger quantities of calories at lunch or dinner. In fact, those with the lowest BMIs made up the smallest proportion of the study sample—just 8 percent—who finished lunch by early afternoon and fasted until the following morning, 18 or 19 hours later.

A growing body of research

According to Rabin, the study joins a limited but growing body of evidence suggesting there are benefits to intermittent fasting and frontloading your daily calorie intake.

For instance, another study—led by Satchidananda Panda, a professor at the Salk Institute for Biological Studies—found that mice given unlimited access to a high-fat diet grew obese in nine or 10 weeks, developed either insulin resistance or diabetes, and developed high cholesterol. In contrast, mice who were able to access the high-fat foods during only eight hours each day did not become obese or diabetic, even when eating the same overall number of calories.

And another study—led by Daniela Jakubowicz, a researcher at the Wolfson Medical Center in Tel Aviv—found that when dozens of obese and overweight women were put on identical 1,400-calorie-a-day diets, the group told to consume most of the calories for breakfast lost more than twice as much weight as the group told to consume most of the calories for dinner.

The benefits of feast and fast

Hana Kahleova, one of the authors of the latest study, said the findings indicate our bodies need "some regular cycling between having food intake and fasting. This seems to be hard-wired." In fact, according to Kahleova, someone who eats the same meal for breakfast and dinner might deposit more fat following the evening meal than the morning one.

Panda agreed, explaining that our insulin action is more efficient earlier in the day. "If you give a healthy individual a big bolus of glucose in the morning, the blood glucose might stay high one or two hours before coming back to normal," Panda said, adding, "You take that same normal healthy individual and give them the same bolus of glucose late at night, and now the pancreas is sleeping—literally—and cannot produce enough insulin, and blood glucose will stay high up to three hours."

Jakubowicz echoed Panda's sentiments, saying her research suggests that "the time of the meal is more important than what you eat and how much you eat—it's more important than anything else in regulating metabolism."

Mark Mattson, chief of the National Institute on Aging's laboratory of neurosciences, added that intermittent fasting could have other benefits as well.  "Twenty years of work on animals shows that compared to those that have constant access to food, those on intermittent fasting diets live longer, their brains function better as they get older and the nerve cells respond to the period of going without food by increasing their ability to cope with stress," he said. "From an evolutionary perspective, it makes sense that animals in the wild—especially predators—would have to function optimally in a fasted state when they haven't been able to obtain food."

Ultimately, Kahleova said, it's a simple message: "Make breakfast your largest meal of the day, and eat dinner as your lightest meal of the day" (Rabin, "Well," New York Times, 8/21).

From healthy food access to stable housing: The case for collaboration with community partners

Population health leaders know that health care delivery is incomplete without addressing the social determinants of health. But effective patient management cannot only include tasking care teams with addressing patients' social needs on top of their complex clinical needs.

Instead, providers should also partner with community-based organizations already providing quality non-clinical support for a range of needs, from healthy food access to stable housing, to scale patient management beyond traditional care settings.

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