The Importance of Breakfast

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The Importance of Breakfast

• EFNEP FNP Conference
• October 12, 2005
• OSU Extension

Karly Abbott, Dietetic Intern Sharron Coplin, MS,
RD, LD
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Topics Covered

• Why eat breakfast?
• Breakfast statistics
• What are people, institutions and communities
  doing to change breakfast patterns?
• What you can do.
• Resources

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Why Eat Breakfast?

• Improved Performance
• Cognitive and Physical
• Nutritional Adequacy
• Weight Management

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Improved Performance

• Improved cognitive function, improved physical
  endurance improvement in an overall feeling of
  wellness
• Several subjective studies have found a link
  between perceived feelings of health and
  wellbeing
• Reports of less depression, less perceived
  stress, less emotional distress, and higher
  energy levels

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Cognitive Function

• Numerous studies agree that breakfast is
  essential to learning and other cognitive
  functions among children
• Areas where significant improvements were found
  included
• Math, addition, number checking
• Creative thinking
• Processing of complex visual displays
• Memory, recognition, spatial memory tests, word
  list recall, story retention

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Other Improvements

• Besides cognition, positive correlation was found
  between breakfast and
• Ability to pay attention
• Behavior psychosocial functioning
• Physical endurance
• Attendance

RE Kleinman, Ann Nutr Metab, 2002 D Wyon, J Am
Diet Assoc, 1995 E Pollitt, Am J Clin Nutr, 1998
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Why Not Skip?

• Several studies found a correlation between NOT
  eating breakfast and
• Decline in cognitive performance
• Decline in memory and recall
• Increase in errors on tests
• Slower speeds in working on problems

AM Lopez-Sobaler, Eur J Clin Nutr, 2003 DP Wyon,
Int J Food Sci and Nutr, 1997 D Benton, Am J Clin
Nutr, 1997
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Evidence for Eating Breakfast

• Individuals who have reported food insecurity
  throughout childhood were more likely to have
• Repeated a grade in school
• Received special education and/or mental health
  counseling
• Lower scores on tests of psychological adjustment
• Lower grades in math
• Missed more days of school

RE Kleinman, Annal Nutrition Metabolism 2002
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Evidence Cont.

• One 2002 study of inner city children found that
  prior to intervention with a school breakfast
  program
• 33 were classified as at nutritional risk
• Had poorer attendance, punctuality grades
• Had more behavioral problems
• After intervention, the students demonstrated
• significant improvements in academic performance
  and psychosocial functioning/behavior
• Greater and continued participation in the program

AE Sampson, J National Medical Assoc., 1995
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Physiology

• Physiological explanations have been given for
  the breakfast/behavior link.
• Blood glucose concentrations
• Brains dependence on glucose
• Carbohydrate/micronutrient supply to improve mood
  and endurance.

D Benton, Am J Clin Nutr, 1998 AP Smith, Int J
Food Sci Nutr, 1998
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Nutritional Adequacy

• Another strong argument for regular breakfast
  consumption
• Especially in higher risk populations
• Children
• Adolescents
• Pregnant nursing women
• Elderly

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Nutrient Intake

• Breakfast consumers have much higher intake of
• Carbohydrate
• Fiber (33 more)
• Thiamin
• Riboflavin
• Niacin
• Folate (68 more)
• Calcium (37 more)
• Iron (49 more)
• Vitamins A, C E

JL Tietven, J Am Diet Assoc, 1995
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Dietary Intake of Breakfast Eaters vs.
Non-Breakfast Eaters
JL Tietven, J Am Diet Assoc, 1995
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Breakfast and Adolescents

• Young adults are two times more likely to skip
  breakfast than children
• In a study among young adults, 37 of those
  surveyed skip breakfast
• A significantly higher percentage of those who
  skipped breakfast did not meet even 66 of the
  RDA for most vitamins minerals

TA Nicklas, J Am Diet Assoc., 1998
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TA Nicklas, J Am Diet Assoc., 1998 981432-8
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TA Nicklas, J Am Diet Assoc., 1998 981432-8
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Breakfast and Impoverished Children

• Of black inner-city children, 12-26 go to school
  on any given day without breakfast.
• 33 of these consumed A, E, B6 folate
• Nearly 25 consumed vitamin C, calcium iron

AE Sampson, J Nat Med Assoc., 1995
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Breakfast and Girls

• Frequency of breakfast is directly associated
  with calcium and fiber intake
• The more frequent the breakfast, the more calcium
  and fiber in the diet
• Girls who ate breakfast on a regular basis
  consumed an average of 75.6 mg more calcium per
  day.
• Association is not simply a result of breakfast
  eaters consuming more food for that day

SG Affenito, J Am Diet Assoc., 2005 BA Barton, J
Am Diet Assoc., 2005
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Age and Race Differences

• The effect of race and age on breakfast
  consumption has also been tested
• The results showed that
• At 9 years old, 77 of white girls versus only
  57 of black girls ate breakfast regularly
• At 19, only 32 of white girls and only 22 of
  black girls ate breakfast regularly
• These statistics are alarming, considering the
  link between breakfast and calcium intake.

SG Affenito, J Am Diet Assoc., 2005
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SG Affenito, J Am Diet Assoc., 2005
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Breakfast and the Elderly

• Its not just the young who need breakfast
• Skipping breakfast has been linked to higher
  mortality in the elderly
• This is especially true for those who are
• Functionally limited
• Live alone
• Are low income
• Have difficulty shopping for and preparing food
• These individuals may participate in the Meals on
  Wheels program

EA Gollub, J Am Diet Assoc., 2004 GA Kaplan, Am J
Public health, 1987
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Breakfast and the Elderly Cont.

• A study of Meals on Wheels participants
  discovered great improvements when breakfast was
  delivered in addition to lunch.
• Breakfast receiving group
• Had greater energy and nutrient intakes
• Exhibited fewer depressive symptoms
• Worried less about whether they would get food,
  run out of food, or be able to eat a good meal

EA Gollub, J Am Diet Assoc., 2004
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Weight Management

• Argument for breakfast weight management is
  less clear
• Many studies have found a connection between
  eating breakfast and a lower BMI. This could be
  because
• Those who eat breakfast are more health
  conscious.
• Those who do not eat breakfast are overweight and
  are trying to lose weight.

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Weight Management Cont.

• Overweight children who skipped breakfast
  experienced a decrease in BMI
• Normal weight children who skipped breakfast
  experienced an increase in BMI
• The overweight who skip breakfast may be making
  more health conscious decisions throughout the
  day in an effort to reduce energy intake
• Those who skip for other reasons may more than
  make up for the missed calories through high fat
  snacking throughout the day

CS Berkey, Int J Obesity, 2003
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Replacing Breakfast with Snacks

• Some studies have found that children who skip
  breakfast consume a higher percentage of energy
  from fat with lower intakes of protein, vitamins
  minerals
• This indicates a pattern of unhealthy snack
  consumption throughout the day.
• higher in fat and saturated fat
• lower in essential nutrients

CS Berkey, Int J Obesity, 2003 BA Barton, J Am
Diet Assoc., 2005 WO Song, J Am Diet Assoc., 2005
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Cholesterol and Insulin

• Skipping breakfast has been implicated in higher
  total cholesterol and higher fasting LDL
  cholesterol concentrations
• It has also been linked to lower postprandial
  insulin sensitivity
• These three factors are known risk factors for
  cardiovascular disease

CS Berkey, Int J Obesity, 2003 HR Farshchi, Am J
Clin Nutr, 2005 K Sakata, Japanese J Pub Health,
2001
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Breakfast Statistics
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Breakfast Consumption Declining

• Breakfast has been associated with improved
  health among humans, yet is the most commonly
  skipped meal of the day
• Regular breakfast consumption has declined in
  past years
• especially among adolescents aged 15-18
• Surveys from 1965 to 1991 show a steady decline
  in breakfast eating behavior

AM Siega-Riz, Am J Clin Nutr, 1998 PS Haines, J
Am Diet Assoc, 1996
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AM Siega-Riz, Am J Clin Nutr, 1998
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Decline Cont.

• On average, in 1965, over 85 of the population
  ate breakfast
• In 1977, 76 ate breakfast
• By 1991 the average percentage of the population
  who ate breakfast decreased by more than 10 to
  75
• Decline has been seen in all demographic and
  characteristic subcategories.

AM Siega-Riz, Am J Clin Nutr, 1998
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Decline Cont.

• Decline can be attributed to behavioral changes
  and not the changing socio-demographic patterns
  of the population.
• If we assume that this trend has continued, than
  we can assume that today more than 25 of the
  population skips breakfast
• Improvements have been made in the quality of
  breakfast but that success can be offset by the
  large percentage of individuals who do not eat
  breakfast.

AM Siega-Riz, Am J Clin Nutr, 1998 PS Haines, J
Am Diet Assoc, 1996
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Why the Decline?

• Shrinking families
• Decline in dual-parent households
• Rapid increase in the numbers of women and
  mothers who work outside the home
• Among adolescents, reasons given include
• Lack of a companion to share breakfast with
• Peer influence
• Lack of a desire to prepare breakfast themselves
• Lack of time

AM Siega-Riz, Am J Clin Nutr, 1998
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Parents Role

• Parental eating patterns were found to be the
  most statistically significant factor in
  adolescent eating patterns
• 81.7 of children whose parents eat breakfast
  also have breakfast regularly
• Only 47.8 of children whose parents do not eat
  breakfast have breakfast regularly
• Children of breakfast skippers also tend to be
  heavy coffee drinkers

A Keski-Rahkonen, Eur J Clin Nutr, 2003
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Food Insecurity

• Many families skip breakfast simply because food
  is not available
• In Franklin county, 11.6 of the population and
  14.2 of children live in poverty
• In southern counties of Ohio, around 19 of the
  population and over 25 of children live in
  poverty.
• These are the families who experience food
  insecurity regularly

http//www.ohtf.org/FACTS/profiles.html
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Hunger

• As defined by the USDA, hunger is a circum-stance
  in which an individual unwillingly goes without
  food for an intermittent or extended period of
  time.
• 1 in every 6 children in Ohio is hungry or at
  risk of developing hunger
• 129,000 children experience hunger
• An additional 366,000 children in Ohio are at risk

http//www.ohtf.org/FACTS/index.html
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What are people, institutions and communities
doing to change breakfast patterns?
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What Can be Done?

• School Breakfast Program
• Created in 1966 and made permanent in 1975
• Schools who participate receive cash subsidies
  from the USDA
• SBP must meet federal requirements
• Less than 30 calories from fat
• Less than 10 from saturated fat
• Provides one-fourth of the RDA for calories,
  protein, calcium, iron, Vitamins A C

USDA School Breakfast Program Fact Sheet, 2005
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School Breakfast Program

• Participation has grown steadily
• 0.5 million children served in 1970
• 3.6 million served in 1980
• 4.1 million served in 1990
• 7.6 million served in 2000
• 8.68 million were served in 2003-04, 7.1 million
  (or 82) received free or reduced-price breakfast
• Children from families with incomes at or below
  130 of the Federal poverty level are eligible
  for free meals

USDA School Breakfast Program Fact Sheet, 2005
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Food Research and Action Center, 2004 School
Breakfast Scorecard, www.frac.org
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SBP and Ohio Schools

• In 2004 only 53.8 offered breakfast at school,
  ranking Ohio 47th in the nation
• Nationally, almost 80 of schools that offer the
  SLP, also offer the SBP
• Fairly steady growth since made permanent in 1975
• Still lots of room for improvement in Ohio

Food Research and Action Center, 2004 School
Breakfast Scorecard, www.frac.org
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Food Research and Action Center, 2004 School
Breakfast Scorecard, www.frac.org
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Missing Out

• In a number of states, millions of eligible
  children are still missing out on free breakfast
• The states themselves are forgoing hundreds of
  millions of dollars in available funding for
  child nutrition
• Both children and states suffer from lack of
  participation
• An increase in student participation to just 55
  would bring an additional 16 million into the
  local economy

Food Research and Action Center, 2004 School
Breakfast Scorecard, www.frac.org
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Getting Students to Eat Breakfast

• Nationally, only 43 of those who qualify for
  free and reduced price lunch at school also eat
  breakfast at school.
• Hungry children are not eating the free breakfast
  provided. Why?
• Many do not wish to identify themselves as
  low-income by eating school breakfast
• Universal school breakfast programs
• Offers breakfast at no charge to all students
  regardless of income level

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Arguments for Universal School Breakfast

• Many children do not eat a nutritious breakfast
  every morning
• Money, time
• Increased student participation in the program
• Stigma removed, free food, convenience
• Improved achievement, behavior and diet
• Foods offered at school may simply not be
  available at home

Food Research and Action Center, 2004 School
Breakfast Scorecard, www.frac.org
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Offering Universal Breakfast

• Schools no longer have an excuse to not
  participate in the universal breakfast program
• Child Nutrition and WIC Reauthorization Act of
  2004 signed June 30, 2004
• Reduced paperwork and made getting sufficient
  reimbursement easier
• Removal of a waiting period

www.frac.org/html/federal_food_programs/cnreauthor
//severeneed.htm
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Implementing Programs

• There are a number of strategies used by schools
  to serve breakfast
• Breakfast at no charge (universal breakfast)
• Breakfast in the classroom
• Breakfast foods available in the classroom to all
  students that they can eat during attendance and
  announcements
• GrabnGo breakfast
• Works especially well in middle and high schools.
  Students grab breakfast on the way to class and
  take it to the classroom with them

www.ohtf.org/TMC/breakfast.html
www.ohtf.org/TMC/breakfast.html
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Outlook for Ohio

• Beginning this year, all Columbus city schools
  are offering universal breakfast
• Cleveland city schools offer universal breakfast
  as well as a kiosk-based GrabnGo breakfast
  program
• Lima city and Noble local schools offer a
  Breakfast in the Classroom program
• Participation in these areas has already
  increased dramatically
• Hopefully, it will continue to rise

http//www.childrenshungeralliance.org/NEWS/0412/0
412-casestudies.html
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Continued Progress

• Childrens Hunger Alliance created The Meal
  Connection in 2003
• Campaigning to make a difference
• Community engagement
• Getting communities, as well as schools, involved
• Public policy
• Advocating the support of legislation to promote
  school breakfast and other food programs
• Research and analysis
• Collect and analyze data on numbers, attendance,
  eligibility participation

http//www.ohtf.org/TMC/index.html
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What you can do
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Getting Adults to Eat Breakfast

• Educate them
• Stress importance of modeling to other family
  members
• Stress the benefits
• Offer ways to fit breakfast into the schedule
• Get up earlier
• GrabnGo products
• Offer solutions to their excuses

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Shooting Down Excuses

• Im not hungry in the morning
• It doesnt matter, your body still needs
  breakfast
• Just because you are not hungry does not mean
  that your body is not in need of that energy
• I last longer if I dont eat breakfast
• Eat higher fiber, higher protein foods that will
  last longer, and less refined sugars which are
  processed too quickly.
• Make breakfast 1/3 of your total calories for the
  day.
• Spread breakfast out to include a snack at 1000am

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To Sum Up

• Breakfast is the most important meal of the day!
  And
• Ultimately, there is no excuse for skipping

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Resources

• ERIB handout
• Breakfast handout in registration packet
• Breakfast poster

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Breakfast handout side 1
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Breakfast Handout side 2
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Start The Day Right! Fuel Up First!

• No Breakfast?
• Whats Your Excuse?
• Arent hungry? Dont fill up late at night!
• No time in the morning? Plan your meal the night
  before so it is quick can be on the go!
• Conserving calories? Space your calories and
  allow some in the morning so you dont over eat
  later

The Fact Is Breakfast provides health
benefits. Eat breakfast to reduce your risk
for Heart disease Type 2 Diabetes
High Cholesterol Breakfast eaters
consume fewer calories in the day than those who
do not start out with a meal!
Unbeatable Benefits of Breakfast

• Gives you more energy
• You will feel more relaxed
• You will experience less stress
• Helps in weight loss and weight maintenance
• You will make healthier choices throughout the
  day
• More likely to meet your daily nutrient
  requirements
• Helps your memory
• Gives you strength and endurance

Quick and Easy Breakfast Ideas

• Carry a container of whole grain cereal and top
  with non-fat milk
• Combine low-fat yogurt with your cereal or fruit
• Spread peanut butter on a whole wheat bagel

An Affordable Breakfast

• Oats or cereal .50
• Piece of fruit .25
• Yogurt .63

Prepared by Christine Wisler, Dietetic Intern,
OSU Department of Human Nutrition