July 2007
Reverse Nutrition: Saving the Best (and Biggest) for First
By Sharon B. Salomon, MS, RD
Today’s Dietitian
Vol. 9 No. 7 P. 48

Does eating the largest meal of the day in the morning promote weight loss?

What did you eat for breakfast this morning? Meatloaf? Enchiladas? If not, you’re out of step with one of the latest weight loss trends. Tricia Cunningham, who cowrote The Reverse Diet with Heidi Skolnik, MS, CDN, FACSM, recommends switching breakfast and dinner as part of a weight loss program. According to Cunningham, approximately 100,000 people across the country are eating their dinner for breakfast and losing weight.

Switching meals is not a new concept. Adelle Davis, 1960s nutrition guru, is credited with the suggestion that people “eat breakfast like a king, lunch like a prince, and dinner like a pauper.” John, a fit 75-year-old from the Midwest, heeded that advice more than 40 years ago when he noticed his “belt was getting too tight.” He and his wife continue to follow that pattern today because they feel more energetic and have managed to keep their weight stable all these years by eating their biggest meal at the start of the day.

Do most Americans heed mother’s advice to eat a good breakfast? In a 2006 study, the NPD Group found that 5% of consumers interviewed considered breakfast a “snack,” 45% viewed breakfast as a “mini-meal,” and 11% consumed only a beverage for breakfast.1 An ABC News Poll conducted in 2005 revealed that roughly 40% of Americans routinely skip breakfast.2 Most people cite time as a factor in determining whether they will eat breakfast. Others complain that they just aren’t hungry when they wake up. Many people skip breakfast to save on calories, but this dieting strategy often backfires. Research indicates that skipping breakfast is associated with a higher risk for obesity and is an ineffective way to manage weight.3,4

Cunningham used to count herself among those who skip breakfast. As her weight climbed to an all-time high, her health plummeted to an all-time low. After countless failed diet attempts, Cunningham had the idea to reverse the customary American diet pattern of eating the biggest meal at night. By eating three meals per day plus small snacks, choosing mostly whole foods, reducing sodium intake, and eating a “big breakfast, medium lunch, and small dinner,” Cunningham was able to lose more than 150 pounds and maintain that weight loss. She does indeed eat dinner foods at breakfast, although she also eats typical breakfast foods—just in amounts that are calorically equivalent to a traditional dinner portion of food.

Cunningham attributes her weight loss to switching her meal pattern. Most nutrition professionals, however, would surmise that her weight loss is most likely due to the caloric deficit that resulted from the change in the quality, quantity, and consistency of her diet rather than just the timing of her meals.

Elyse Resch, MS, RD, FADA, coauthor of Intuitive Eating, suggests that formulating a “diet” that allowed Cunningham to “listen to her own inner signals of when she was most hungry and what she felt like eating at the time was probably partly responsible for her success. By creating the ‘diet’ herself, it didn’t trigger any issues that would cause her to rebel as a way to assert her autonomy,” so she was able to stick to the regimen and lose weight just by listening to her own head and gut.

Why do we consider eggs an ideal breakfast food and steak an ideal dinner food? The designation of meals in our culture is somewhat arbitrary, having evolved over time after the Industrial Revolution. “Most Americans readily accept foods such as bacon and eggs or hot cereal as breakfast foods but consider them relatively undesirable in other meal contexts. Within any cuisine, there are many ‘rules’ about what goes with what and about the order of eating foods within a meal.”5

In earlier times, farmers may have started the day with a hot beverage for breakfast, followed by a substantial hot meal when they returned home from the fields at midday.6 As people moved to the cities and took jobs that required them to follow a more rigid schedule, mealtimes and food choices were adjusted to the workday timetable. Occupation, social class, gender, ethnicity, region of the country, and season all contribute to the typical American pattern of eating. Judith Matz, LCSW, coauthor of The Diet Survivor’s Handbook and Beyond a Shadow of a Diet, believes it is “helpful to encourage people to let go of rules about when they should eat certain types of food. Eating dinner foods for breakfast or lighter foods for dinner is fine if that’s what your body truly craves.” Tradition is the best explanation for our present meal pattern of small breakfast, medium lunch, and big dinner.

The preponderance of data suggest that eating breakfast is important to losing and maintaining weight loss, and how much and what is eaten at breakfast may also contribute to weight loss and maintenance. Wyatt et al examined breakfast consumption patterns in subjects on the National Weight Control Registry and found that eating breakfast is a characteristic common to successful weight loss maintainers.7 Cho et al analyzed data from the National Health and Nutrition Examination Survey III to determine whether there was a relationship between breakfast category, energy intake, and body mass index (BMI).4 The breakfast categories included in the study were breakfast skippers and people who ate meat and/or eggs, ready-to-eat cereal (RTEC), cooked cereal, breads, quick breads, fruits/vegetables, dairy, fat/sweets, and beverages.

Their assumption was that not only is there a relationship between eating breakfast and BMI but also that the type of food eaten at breakfast affects BMI. The researchers adjusted for lifestyle factors such as smoking, alcohol intake, and physical activity. Subjects who ate RTEC, cooked cereal, or quick breads for breakfast had significantly lower BMI compared with the meat and egg group. The egg/meat eaters had one of the highest BMIs. Researchers surmise that the fat and calories in the egg/meat eaters’ meals may have accounted for the higher BMIs. They concluded that eating a fairly organized breakfast (ie, a meal) is associated with appropriate body mass regulation.

Additionally, in a study with obese females, Keim et al reported that when 70% of energy was ingested at breakfast and lunch vs. 70% at dinner and nighttime snack, weight loss and fat free mass loss were greater.8 In other words, big breakfasts and lunches resulted in greater weight loss than a big nighttime meal and snack. Free-living Americans tend to increase their intake over the day with peaks during lunch and dinner that occur as a result of increasingly larger meals during the day. De Castro et al suggest that intake in the morning of low-density foods is satiating and can reduce the amount ingested over the rest of the day to such an extent that the total amount ingested for the day is less overall.9 It appears that people who eat at least two thirds of their calories before dinner will consume less calories for the whole day than people who eat the majority of their calories at night.

The rationale offered by Cunningham and Skolnik for the apparent effectiveness of the diet is counterintuitive to the theories of energy balance. They contend that a body at rest overnight doesn’t need as many calories; hence, eating a big meal in the evening will result in fat storage. They recommend eating a big breakfast and medium lunch when a person is most active during the day so calories eaten will be used preferentially for energy. This recommendation, not unlike the familiar prohibition against eating past 6 pm, argues against the accepted wisdom of energy balance. Melinda Manore, PhD, of Oregon State University, says she doesn’t believe there is anything magical about the time issue. “I just think that if someone stops eating at a designated time, [he or she] will probably eat fewer calories overall.” In fact, Schlundt et al found that eating breakfast helped minimize impulsive snacking, and therefore may be an important part of a weight reduction program.10

Skolnik believes the diet pattern’s success is in part due to improved caloric distribution. Rather than eating the bulk of calories late in the day, caloric intake is spread out over the course of the day. She says that “reframing the approach to eating” is a valuable tool for someone who has trouble sticking to a diet. Skolnik isn’t ready to suggest any metabolic effects other than those that would be seen with a more uniform distribution of calories throughout the day. By eating three meals of fairly equal caloric density, people who follow the diet seem able to avoid the late-night munchies and extra calories that go along with eating after dinner.

Manore suggests that meal composition may have some effect on the success of the diet. Since typical dinner foods tend to be higher in protein, it is possible that either the satiety factors or dietary induced thermogenesis associated with protein foods may be somewhat responsible for greater satiety with a dinner-for-breakfast swap that could result in a reduced caloric intake for the day.

“Eating dinner for breakfast is an interesting concept,” says Suzie Solenberger, MS, RD, director of coaching for Eating Coach, Inc. Most clients Solenberger works with eat a smaller breakfast just because they are not that hungry in the morning or because they are in a hurry to get to work. “By eating ‘dinner’ in the morning, they might indeed eat fewer calories over the day. If the reverse diet puts dinner at a time when there isn’t a lot of time to eat and people are less hungry because they just woke up, people will probably eat less.” Anecdotally, John and his family found this to be true. Although they ate a hearty meal of meat and potatoes for breakfast, he found they rarely ate second helpings the way they often did when the family ate a traditional dinner at night. The family members also reported that they were not hungry at lunch and usually ate a light snack later in the afternoon rather than a full lunch at midday.

Michelle May, MD, author of Am I Hungry, believes that eating many small meals in response to hunger makes sense. In her practice, she teaches people to eat when they’re hungry—when their body tells them to eat—and stop when they are satisfied. “Instead of watching the clock and trying to eat before they get hungry or at a designated time, people can learn to tune in to their physical signs of hunger to let them know when it is time to eat.”

Donald Altman, MA, a former Buddhist monk, counselor at an eating clinic, and author of several books on mindful eating, cautions that hunger is a complex issue. “Many people who struggle with food issues have a fear of their hunger at some level. Hunger is something they can never seem to control. What mindfulness does is change the relationship someone has with the fear. Once the relationship has changed, there is nothing left to resist or fight against. Diets are based on the premise that we have to fight our urges.”

Rather than concentrate on how many meals a person eats or what foods are appropriate at different meals, most experts agree that learning the skills of mindfulness and intuitive eating are paramount to successful weight loss and maintenance.

One of the problems with diets like this one, according to Matz, is that they turn eating “into a new set of rules that tells you it’s better to eat dinner for breakfast and breakfast for dinner and that the purpose of doing so is to lose weight. Instead of a detailed food plan, teaching people to develop a healthy relationship with food by tuning into their own internal cues so that they learn to eat when they are hungry, eat exactly what they are hungry for—selecting from a wide variety of foods—and stop when satisfied is a good way to help them reach their goals.” May agrees that “a diet teaches rules about when and what people are allowed to eat and doesn’t address why they are eating in the first place. As a result, people follow the rules for as long as they can. Then when they cannot follow the rules any longer, they return to their previous eating pattern and regain the weight.”

Obesity is a complex multifactorial disorder that people try to resolve with the simple advice to eat less and exercise more. Because that simple advice has not resulted in positive long-term outcomes, there are approximately 200,000 diet books on the market and scores of supplements, prescription drugs, and other products purported to help people lose weight. None of them can claim that they are more effective than any other in the long term. There are many meal patterns and behaviors that promote weight loss but few that consistently support weight loss maintenance. As anyone who has dieted can tell you, all diets work if all you want to do is lose some weight. Keeping the weight off is the challenge. For people who are more successful with a structured approach, giving themselves permission to eat what they want when they want, like eating chicken for breakfast and cereal for dinner, may make it easier for them to stick to their diet. Any weight loss program can be tailored to fit into the reverse meal strategy by switching menus to meet the needs of the dieter, according to Cunningham.

Reversing meals is not so much about eating meatballs and spaghetti for breakfast and cereal for dinner as it is about freeing people from the constraints of traditional foods at breakfast, lunch, and dinner. Moreover, the pattern promotes breakfast, the most forgotten meal of the day.

— Sharon B. Salomon, MS, RD, has a Certificate in Adult Weight Management and culinary certificates from Greystone and La Varenne Cooking School. She is the coauthor of Eating Show and Tell for Dietitians and provides presentations on how to perform a successful cooking demonstration that teaches a nutrition message. She is also a freelance food and nutrition writer in Phoenix.

References
1. The NPD Group, Inc. “Americans are redefining how they eat breakfast.” December 12, 2006. Available here.

2. ABC News. “Poll: What Americans eat for breakfast.” May 17, 2005. Available here.

3. Ma Y, Bertone ER, Stanek EJ 3rd, et al. Associaion between eating patterns and obesity in free-living US adult population. Am J Epidemiol. 2003;158(1):85-92.

4. Cho S, Dietrich M, Brown CJ, et al. The effect of breakfast type on total daily energy intake and body mass index: Results from the Third National Health and Nutrition Examination Survey). J Am Coll Nutr. 2003;22(4):296-302.

5. Capaldi ED (ed). Why We Eat What We Eat: The Psychology of Eating. Washington, D.C.: American Psychological Association; 1996.

6. Food Timeline. Available here.

7. Wyatt HR, Grunwald G, Mosca C, et al. Long term weight loss and breakfast in subjects in the National Weight Control Registry. Obesity Res. 2002;(10):78-82.

8. Keim NL, Van Loan MD, Horn WF, et al. Weigth 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(1):75-82.

9. De Castro JM. The time of day of food intake influences overall intake in humans. J Nutr. 2004;134(1):104-111.

10. Schlundt DG, Hill JO, Sbrocco JP, et al. The role of breakfast in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr. 1992;55(3):645-651.