By Amin - Own work, CC BY-SA 4.0, LinkThe fight over "breakfast" among diet gurus and social media warriors is so tiresome. Firstly it's tiresome because "breakfast" means different things to different people, and yet conclusions about the utility of ...


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Does When You Eat Affect Your Circadian Rhythm, Metabolism, Appetite, Physical Activity, And More? A "Big Breakfast" Study Aims To Explore.

By Amin - Own work, CC BY-SA 4.0, Link
The fight over "breakfast" among diet gurus and social media warriors is so tiresome.

Firstly it's tiresome because "breakfast" means different things to different people, and yet conclusions about the utility of the meal as a whole are regularly made despite the fact that a bowl of Froot Loops is likely to have a very different impact on fullness than a couple of eggs and a piece of toast.

Secondly it's tiresome because what works for one person, may well not work for another, and no doubt when it comes to weight and dietary control, for some, breakfast will be crucial, while for others, it'll be inconsequential, and others still, potentially problematic.

In my clinical experience, though clearly coloured by my own confirmation biases, a protein rich breakfast with minimal liquid calories benefits more people than not, and whether that applies to you is easily tested on your own.

With all that out of the way, I wanted to talk a bit about an upcoming study coming out of the UK. The Big Breakfast Study: Chrono‐nutrition influence on energy expenditure and bodyweight aims to explore the impact of breakfast by way of a randomized controlled trial comparing morning-loaded vs. evening-loaded weight loss diets on people with excess weight, and where all components of energy intake and energy expenditure will be monitored throughout.

That researchers' hypothesis is that breakfast will make a positive difference, and their thinking is that part of the reason why may be the effect of breakfast on circadian rhythm, which in turn effects changes to metabolism, hormonal and metabolite regulation, appetite, ingestive behaviour, and physical activity.

The researchers second study, the Mealtime Study, which over 10 weeks, will compare front loaded morning calorie dieting with bottom loaded end of day calorie dieting in a crossover design where all food will be provided to participants.

And finally their third study will be looking at 5 hour "phase shifts", analogous perhaps to what shift workers regularly experience (and who have been shown to have higher rates of obesity), and the shifts' impact on "the patterns of energy expenditure, metabolism and gastric empty-ing and related endocrine pathways"

Very much looking forward to these studies' results, but that said, I won't be holding out hope that their findings will stop people from extrapolating their personal breakfast biases as applicable, without exception, to everyone, when the fact remains, different strokes will work for different folks.

New Intermittent Fasting Study: No Magic Weight Loss Benefits. Hungry Making.

If you even remotely follow dieting zeitgeist, there's no doubt you've come across intermittent fasting.

Briefly, intermittent fasting involves, yes, intermittently fasting. Sometimes for 8 hours a day. Sometimes for 24 hours. Sometimes even more.

And if you're wondering if it's for you, the simple answer is, if you find it helps you to control calories and weight, and you enjoy it enough to keep doing it, then go for it.

But putting aside the needing to enjoy living with it part for a moment, and assuming everyone could happily follow this strategy forever, would intermittent fasting lead to a greater weight loss than plain old old-fashioned dieting?

That was the question researchers in Norway recently took on, and their paper, Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial, has some answers.

The style of intermittent fasting they chose to study was the 5:2 style, whereby 5 days a week you eat normally, and then 2 days a week you eat no more than 400 calories if you're a woman, or 600 calories if you're a man. They compared a year worth of this approach to a year worth of reducing total daily calories by the same theoretical amount as the 5:2 fasting would provide but spread out evenly over 7 days rather than the 2. In all, 112 middle aged people with obesity were randomly assigned to one of the two treatments and then followed for a year - the first 6 months being a weight loss effort, and the next 6 months weight maintenance. All participants received individualized counselling, were trained in cognitive behavioural methods to help with adherence, and encouraged to follow, whether fasting or not, a Mediterranean style diet. The outcomes studied were weight loss, waist circumference, blood pressure. lipids (including ApoB), glucose, HbA1C, CRP, and RMR.

Participants were also asked to rate their degrees of hunger, well-being, and overeating quarterly.

Follow up was terrific, with only 4 lost in the intermittent fasting group, and 3 in the continuous.

Outcomes wise, at a year, weight loss (and the spread of weight loss with identical percentages of participants achieving 5-10% and >10% weight loss) and weight circumference were the same. There was also no difference to the various measured metabolic parameters.

In fact pretty much the only between group difference was hunger, whereby the intermittent fasters, when rating, "I have often felt hungry while on the diet", reported significantly more hunger (p=0.002).

Which brings me back to my wholly unsurprising tl:dr summary: Intermittent fasting provides no magical weight loss benefits, and is hungry making, but if you enjoy it, it'll probably work just as well, but not better, than anything else.

Registered Dietitian Christine McPhail Reviews The Picky Eater Project: 6 weeks to Happier, Healthier, Family Mealtimes

Today's guest post, a review of The Picky Eater Project 6 weeks to Happier, Healthier, Family Mealtimes, was written by Christine McPhail MSc RD. Full disclosure: I was given a review copy of the book by Dr. Muth.
I work with parents, and picky eating is a common issue. Fortunately, there are some general recommendations that I can review such as following the division of responsibility in feeding, where parents are responsible for the what, when and where of feeding and children are responsible for whether they eat and how much they eat out of what parents offer. Within this, I ask parents to focus on neutrality when offering different foods, bridging from foods their family already enjoys, involving children in grocery shopping, growing food and cooking for buy-in and avoiding pressure in general to eat more or less of certain foods.

The most important part of addressing picky eating with my clients is working on practical steps collaboratively with them. That’s where I have found the resources within The Picky Eater Project: 6 weeks to Happier, Healthier, Family Mealtimes by Natalie Digate Muth MD, MPH, RDN, FAAP and Sally Sampson from CHOPCHOP MAGAZINE to be very insightful and useful.

Here is what I liked about this book:
  • It is a project. The book is very interactive and includes goal setting, action planning strategies, and ways to measure your progress at each stage of the project. Each section also uses to do/check lists.
  • Picky eating is defined and explained and the book follows examples from real life families as they progress through the project. This shows families that it’s OK to stumble when they are trying to make changes and it allows them to see the recommendations translated into realistic outcomes.
  • The concept of picky-free parenting allows parents to review their current behaviours around food to see if there is anything they could change in their behaviour that may be influencing their child’s picky eating behaviours. This also aligns well with learning about the Division of Responsibility in Feeding.
  • There is a focus on changing your home food environment with sample pantry lists, snack lists, a how to use herbs and spices resource, recipes etc. which can be a useful tool for parents especially when they are tried and tested!
  • Involving kids in the kitchen has its own section with a focus on age-appropriate kitchen tasks, tips for beginner chefs, meal ideas and recipes. This is so important for families to review and understand as we know that kids who participate in meal preparation are more likely to WANT to try new foods.
  • Similarly, there is a section on involving kids in grocery shopping, growing foods, and visiting local farms with a focus on learning about food but also math and literacy skills too. It’s all buy-in and family involvement.
  • Family meals are a primary focus of the picky eating project with tips on how to make them a priority, meal planning, meal time rules, and even packed lunch mix and match ideas.
  • The project does not leave out all of the other factors and people that can either support or hinder your efforts to have your family eat a wider variety of foods. Those important people include peers, school staff, caregivers, grandparents etc. As the section is appropriately titled…it takes a village!
  • To finish up the project, there is a section that addresses that behaviour change is hard! I think this is important for parents to understand but it’s equally important to for them to have tips on how to make changes stick. The focus is on starting small, using SMART goals, having a plan, anticipating problems, and involving your kids the whole way!
  • The last section of the book discusses severe picky eating and when to seek more professional help. I was impressed with this because it identifies red flags for parents to watch out for so they know when they may need to incorporate health professionals into their journey.
The only issue I had about the picky eating project was the risk associated with labelling your child as picky i.e. they live up to the expectation. On the other hand, with the family-focussed nature of the book the journey is not simply for the “picky” child, it’s for the whole family to expand their palette in an open and honest way that includes all family members.

Christine McPhail MSc, RD is one of our Registered Dietitians at the Bariatric Medical Institute (though is moving on soon to work with the eating disorders team at Hopewell). Christine has worked in academic, clinical and public health nutrition settings and has been fortunate to have worked on projects relating to food sustainability, food security, food policy and politics, childhood nutrition, body image, and school nutrition programs. She believes in the power of connecting with your food from farm to table. She feels fortunate to share this passion with her clients, as she helps them strengthen their relationship with food and learn more about nutrition.