HOUSTON – A high-protein, high-carbohydrate breakfast that included a daily dessert such as cake or a cookie resulted in significantly greater weight loss through 32 weeks than an identically low-calorie weight loss diet featuring a low-carbohydrate breakfast.
That’s what Dr. Daniela Jakubowicz found in a randomized trial presented at the annual meeting of the Endocrine Society.
"To achieve long-term weight loss, meal timing and composition must counteract weight loss compensatory mechanisms that encourage weight regain after weight loss. A high-carbohydrate and protein breakfast may prevent weight regain by reducing diet-induced compensatory changes in hunger, craving, and ghrelin suppression," said Dr. Jakubowicz of the Wolfson Medical Center at Tel Aviv University.
She reported on 193 obese, sedentary, nondiabetic subjects with an average age of 47 years and a body mass index of 32 kg/m2 who were randomized to one of two weight-loss diets. Both incorporated 1,600 calories daily for men and 1,400 for women. The dessert-for-breakfast diet for women allotted 600 calories at breakfast, 500 at lunch, and 300 at dinner, while the low-carbohydrate breakfast comprised 300 calories in the morning, 500 at lunch, and 600 at dinner. The big-breakfast group consumed 60 g of carbohydrate at breakfast, compared with 15 g in the comparison group.
The two diets proved similarly effective through the first 16 weeks, with average weight losses of 15.1 kg in the low-carbohydrate breakfast group and 13.5 kg in the dessert-with-breakfast eaters. At that point, however, the trajectories diverged. Over the next 16 weeks, the low-calorie breakfast group regained an average of 11.6 kg, while the big-breakfast group lost a further 6.9 kg.
Thus, the net weight loss at 32 weeks was 20.4 kg (45 pounds) in the dessert-with-breakfast group, compared with a scant 3.5 kg (7.7 lb) in the low-carbohydrate group.
What’s the explanation?
"More important than the speed of weight loss is that patients feel satiety – less hunger – and that they prevent craving," the endocrinologist said. "Several studies have now shown that diets that avoid chocolates and cookies and carbohydrates increase the addiction to carbohydrates – they increase the craving. So instead, if you eat a snack in the morning every day, after a while you become less addicted to these foods. Also, protein in the morning increases satiety. We know that if you have enough protein in the morning you’re not hungry all day."
Indeed, these points were born out in patient self-assessments conducted using visual analog scales at weeks 16 and 32. Scores for hunger were significantly lower and satiety scores significantly higher in the dessert-for-breakfast group at both time points. In addition, this group had significantly lower craving scores for fatty foods, sweets, and fast food. Dietary compliance was significantly better in the big-breakfast group than in controls from week 8 on. At week 32, for example, the big-breakfast group averaged 5 episodes of noncompliance per week, compared with 15 in controls.
Moreover, levels of ghrelin – the so-called hunger hormone – were suppressed by 45% in the dessert-with-breakfast group 2 hours after breakfast at week 32, compared with a 30% reduction in controls. The insulin response to a standardized test meal was significantly lower in the big-breakfast group as well.
In a separate randomized trial Dr. Jakubowicz conducted in 93 obese, sedentary, nondiabetic women, placing the big meal of the day at breakfast resulted in significantly greater weight loss, waist circumference shrinkage, and salutary lipid changes than when dinner was the big meal.
Both groups were placed on a 1,400-calorie-per-day diet. One diet entailed 700 calories at breakfast and 200 at dinner, while the other featured 200 calories at breakfast and 700 at dinner. After 12 weeks, the big-breakfast group lost an average of 8.7 kg, while the big-dinner group lost 3.3 kg. Waist circumference decreased by 7 cm from a baseline of 110 cm in the big-breakfast group, compared with a 2-cm reduction in controls.
Triglyceride levels improved from 180 mg/dL at baseline to 129 mg/dL at 12 weeks in the big-breakfast group, while they worsened from a baseline of 178 mg/dL to 195 mg/dL in the big-dinner group.
"It’s important to note that triglycerides increased on the big-dinner diet even though the people lost weight. The management of lipids after eating carbohydrates at night is worse than with the same carbohydrates in the morning," she concluded.