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High protein breakfast may help prevent overeating and obesity

Healthcare Nov 18, 2022 at 15:07

High protein breakfast may help prevent overeating and obesity

Researchers investigated the link between protein consumption and caloric intake.
They found a link between lower protein consumption and higher caloric intake from fats and carbohydrates, which may increase obesity risk.
They concluded that consumers, industry, and the government should prioritize reducing the intake of highly processed foods and increasing whole food intake.

Obesity is linked to some of the leading causes of preventable, premature deathTrusted Source, including heart disease, stroke, type 2 diabetes, and cancer. Between 1999 and 2020, population obesity ratesTrusted Source in the United States increased from 30.5% to 41.9%.

First proposed in 2005, the protein leverage hypothesis (PLH)Trusted Source is a theory for the cause of obesity. It states that if the body’s needs for protein consumption are unmet, fat and carbohydrate consumption increases, dampening satiety signals and increasing food intake.

StudiesTrusted Source have shown that as the percentage of energy from protein has decreased in American diets, obesity rates have risen.

Another study found that inpatient adults exposed to ultra-processed diets ingested more carbohydrates, fat, and total energy than those on unprocessed diets and consequently gained weight.

Understanding the health effects of highly processed foods and low protein intake could improve obesity prevention strategies.

Recently, researchers analyzed population health data to understand the relationship between protein intake and obesity.

They found a link between lower protein intake during the day’s first meal and higher overall food intake throughout the day.

The study’s findings appear in ObesityTrusted Source.

Protein intake’s impact on overall diet

The researchers analyzed data from the 2011-2012 National Nutrition and Physical Activity Survey from the Australian Bureau of Statistics. They included data from 9,341 people with an average age of 46.3.

Data included:

caloric intake from protein, carbohydrates, fat, fiber, and alcohol
time of food consumption
body mass index (BMI)
The average energy intake was 2072 calories, including:

18.4% from protein
43.5% from carbohydrates
30.9% from fat
2.2% from fiber
4.3% from alcohol

By comparing energy intake and time of consumption, the researchers found that those who consumed lower amounts of protein in their first meal of the day had higher calorie intake in later meals.

The researchers noted that as protein intake decreased, energy from fat, carbohydrates, sugars, and alcohol increased in what is known as “protein dilution.”

They further noted that those who consumed less protein in their first meal consumed more highly-processed foods throughout the day.

“Our study suggests that in free-living humans, eating low protein meals early in the day results, via protein leverage, in energy (fat and carb) over-consumption,” said Prof. David Raubenheimer, a study author and Chair of Nutritional Ecology at the University of Sydney, Australia.

“Even though people who have low-protein breakfasts tend to select higher protein meals thereafter (at lunch and dinner), they don’t quite compensate for the low protein start so that at the end of the day the overall daily diet is lower in protein and higher in fats and/or carbs than people who begin the day with higher protein meals,” Prof.

Protein deficiency and overeating

The researchers noted that many factors might explain why humans are predisposed to consume highly processed foods. These include:

taste
cheap price
convenience
aggressive marketing
general availability
corporate political activity interferingTrusted Source with public health policy
They also noted that umami-flavored, savory snack foods might hijack the body’s protein-seeking responses in what is known as the “protein decoy effectTrusted Source.” They wrote that these products might exacerbate, rather than satisfy, a protein deficiency.

Adding protein to breakfast

MNT spoke with Dr. Dana Ellis Hunnes Ph.D., MPH, R.D., Assistant Professor at UCLA Fielding School of Public Health, who was not involved in the study. Dr. Hunnes is also the author of “Recipe for Survival: What You Can Do to Live a Healthier and More Environmentally Friendly Life.”

“Protein slows down the rate at which we digest and absorb sugars and carbohydrates from our foods, as does fat. If we eat a breakfast that is full of highly processed or sugary foods, we digest and absorb those foods rapidly.”

– Dr. Hunnes

“This causes our insulin levels to spike very rapidly, causing our cells to take the sugar (glucose) out of our blood very rapidly- assuming we don’t have diabetes,” she noted. “This then leads to a rapid decrease in blood sugar levels that can make us feel hungry again, and stoke that appetite, even if we are not “truly hungry.”

In conversation with MNT, Kristin Kirkpatrick, a registered dietitian nutritionist at the Cleveland Clinic, not involved in the study, added: “If you are hungry, then you are more likely to eat, and if you are experiencing cravings, lack of sleep, near food, smell food- there are so many complex variables here on what one will choose, even your gut microbiota plays a role in the type of food you choose- then you may be more likely to eat.”

How much protein should you eat?

A study earlier in the year suggested that diets with less animal protein and higher levels of complex carbohydrates are most beneficial for long-term health and lifespan.

When asked how the findings in the current study suggesting higher levels of protein correspond to these earlier findings, Dr. Hunnes noted that the studies do not contradict each other but “demonstrate the nuance of nutrition and how studies can be misinterpreted.”

Dr. Raubenheimer further explained that the earlier study noted that fiber could be a healthy substitute for high protein levels.

“The [theory that] low protein ‘leverages’ high intakes of fats and carbohydrates applies to diets that have a large proportion of processed foods that are low in both fiber and protein. In those conditions, we over-eat energy to reach our protein target.

However, for people eating diets with high proportions of whole plant foods, which are rich in fiber, the fiber partly replaces protein in providing the feeling of fullness which stops eating.”

– Dr. Raubenheimer

He explained that the advantages of higher fiber intake include reduced protein intake, which has been linked to extended healthspans, and increased levels of micronutrients and other beneficial compounds like antioxidants lost in industrial food processing.

“All these mechanisms likely explain why the diets associated with the longest healthy lifespans (e.g. traditional Okinawa diet, Mediterranean Blue zone, etc.) are low in protein (not much above 10% of energy, vs around 15%-18% for typical USA/Australian diets) and rich in plant foods,” Dr. Raubenheimer noted.

Limitations

When asked about the study’s limitations, Dr. Hunnes noted that it didn’t differentiate between types of protein and that the findings may glorify protein as a “miracle nutrient when it is not.” She explained that overall diet quality is a better measure and predictor of health, longevity, and disease risk, and it should be taking into account what other nutrients are being incorporated into one’s diet, such as fiber and whole foods.

Kristen Kirkpatrick added: “I often caution my patients that food intake, weight status, and health do not just boil down to one thing. We as humans are complex, and our choices are as well. Environment, social support, genetics, activity, level, even geographic location may all play a role in how we decide and implement a specific dietary pattern.”

Implications on food choices

Dr. Raubenheimer hopes that his findings will decrease processed food consumption and increase whole, especially plant-based, food consumption. He noted that his message to consumers is to “target foods that come from fields, not factories”.

Noting that this can be difficult as whole foods can often be expensive, he added that governments and industry must also play a role. For governments, he said:

“Develop policy and other interventions that help transform our food environments in directions that enable and encourage healthy food choices. Failing to do so is not only socially irresponsible but also fiscally irresponsible because unhealthy diets are associated with massive costs to productivity and national health systems.”

And to the food industry, he noted: “The science now unequivocally links highly processed industrial foods to obesity and disease. There is no better time to seriously implement transition strategies aligned with public health. Except perhaps yesterday.”

Treating obesity with culinary medicine: Could it be a solution?

Obesity is a risk factor for many health conditions. Current treatments include calorie restriction, bariatric surgery, and medications. But the number of people with obesity continues to increase. Many factors lead to weight gain, including the increased availability of calorie-dense foods. Medical News Today looked at whether culinary medicine might be an effective treatment for obesity, and investigated what approaches might work on a population level.

According to the World Health OrganizationTrusted Source (WHO), in 2016 more than 1.9 billion adults worldwide were overweight and, of these, 650 million had obesity. The worldwide prevalence of obesity tripled between 1975 and 2016.

In the United States, more than 40%Trusted Source of adults have obesity, and in the United Kingdom, more than a quarter live with the condition.

Obesity is known to be detrimental to health. The Centers for Disease Control and Prevention (CDC) list many risks of obesityTrusted Source, including:

increased mortality (death risk) from all causes
high blood pressure (hypertension)
high LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (dyslipidemia)
type 2 diabetes
coronary heart disease
stroke
osteoarthritis — a breakdown of cartilage and bone within a joint
sleep apnea and breathing problems
many types of cancerTrusted Source.

A reportTrusted Source published in August 2022 gave the following warning: “Given dire implications in terms of comorbidities and mortality, these updated epidemiological findings call for coordinated actions from local and regional governments, the scientific community and individual patients alike, as well as the food industry for the obesity pandemic to be controlled and alleviated.”

The authors called for coordinated international efforts to combat the obesity pandemic similar to those used against COVID-19.

Why is obesity on the rise?

A recent editorial in the journal ObesityTrusted Source suggested the following explanations for the rise in this condition:

“Increase in per capita food supply, increased availability and marketing of high-calorie and high-glycemic-index foods and drinks, larger food portions, leisure time physical activities being replaced with sedentary activities such as watching television and use of electronic devices, inadequate sleep, and the use of medications that increase weight.”

Dr. Mir Ali, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, concurred, telling Medical News Today that “the causes of obesity are multifactorial; certainly genetics plays a role; evolution is a very slow process but can also play a role.”

“Primarily, obesity is driven by the change in our diets to more energy-dense foods, a more sedentary lifestyle, and environmental factors, such as urbanization can also play a role,” he explained.

Risks in cases of childhood obesity

Obesity is not increasing only in adults — the number of children with obesity has risen alarmingly. Worldwide, the number of children and adolescents with obesity has increased tenfold since 1975. If this trend continues, soon there may be more children with obesityTrusted Source than there are underweight children.

This is particularly worrying, as obesity when young predisposes a person to many health issues.

Dr. Daniel Ganjian, a pediatrician at Providence Saint John’s Health Center in Santa Monica, CA, told MNT: “The younger a child is when developing obesity, the higher the chances of developing health problems as an adult. Furthermore, the earlier the child suffers from obesity, the earlier the health problems begin.”

These health problemsTrusted Source may include fatty liver disease, sleep apnea, type 2 diabetes, asthma, cardiovascular disease, high cholesterol, menstrual abnormalities, impaired balance, and orthopedic problems.

And children with obesity are likely to continue with obesity into adolescence and even adulthood. According to one analysis of existing studiesTrusted Source, 55% of children with obesity will go on to have obesity in adolescence, and 80% of those adolescents will still have obesity when adults.

“Unfortunately, there is no clear cut, long term solution. Education on healthy eating at an early age would be an excellent starting point, as well as establishing and encouraging proper exercise; and reducing or limiting the ease of accessibility to energy dense foods may also help have a significant impact.”

– Dr. Mir Ali

However, the same analysis notes that of adults with obesity, 70% did not have childhood obesity, so targeting childhood obesity is unlikely to solve the problem.

Obesity as a global concern

For individuals with obesity, there are treatment options, which Dr. Ali outlined: “Surgery for those with an appropriate body mass index. […] There are newer medications available that have shown promising results in the appropriate patients. Dietary and exercise education/counseling can also be effective for certain individuals, though this is the least effective approach.”

However, according to the WHOTrusted Source, obesity and overweight are no longer just a problem for individuals, but a global epidemic — which it refers to as “globesity” — that is taking over in many parts of the world. And it is not only an issue in industrialized countries; obesity is a growing concern in developing countries.

Speaking to MNT, Dr. Eamon Laird, senior research fellow at Trinity College Dublin in Ireland, noted that the issue does not revolve around a preoccupation with outdated beauty stereotypes that view thinness as desirable.

He openly denounced obesity discrimination in healthcare. “No one should be doing any sort of ‘fat shaming,’ which is completely wrong,” he emphasized. “As health professionals, we should be supporting and giving advice on healthy lifestyle goals.”

Instead, he argued that the concern with obesity is due to the numerous health risks linked to this condition. “[W]e also cannot bury our heads in the sand and say obesity is normal and does not matter — it has been scientifically proven that it puts health at a serious increased risk of disease and it needs to be managed,” said Dr. Laird.

So what can be done to address obesity at a sustainable level globally?

One 2011 studyTrusted Source looked at the efficacy of public-health campaigns in combating obesity and concluded that “there is little evidence that community-based interventions and social marketing campaigns specifically targeting obesity provide substantial or lasting benefit.”

The authors suggested that “[a] more appropriate strategy would be to enact high-level policy and legislative changes to alter the obesogenic environmentsTrusted Source in which we live by providing incentives for healthy eating and increased levels of physical activity.”

But combating the global problem of obesity will take more than just telling people to eat less and exercise more. We need to understand how people interact with their environments, and how that environment influences food intake.

Is food marketing to blame?

It is a given that people want plentiful, safe, convenient, and inexpensive food — we need food to stay alive. And food manufacturing is a lucrative business, so manufacturers and retailers make huge efforts to persuade us to buy it.

Food marketing has often taken the blame for the obesity epidemic. According to a 2012 reviewTrusted Source, food marketers influence consumption in four ways:

pricing — the short or long-term price of foods influences how much people purchase and consume
marketing communications — ranging from advertising to more subtle means such as packaging design and social media activities
the product itself — the quality and quantity of the food will influence whether people buy and consume it
the eating environment — the availability and convenience of the food.
Of these, pricing is perhaps the most powerful in persuading people to overeat. The review noted that pricing was the strongest predictor of increased energy intake and obesity. When consumers pay less for a food product, they not only eat more of it, but they also tend to eat it more rapidly.

Advertising and branding also influence how much food is bought and eaten. Marketing a product as healthier, perhaps just by changing the name can be effective. A product labeled “salad special,” for example, is more likely to appeal to someone trying to be healthy than if it is labeled “pasta special,” even if the contents are identical.

But so-called healthy options can be deceptive. One study found that low-fat nutrition labels increased people’s perceptions of the appropriate serving size and decreased the guilt associated with eating the food, thereby increasing intake.

Another factor is package size. Larger packs provide better value for money for the consumer, but several older studies have shown that they increase consumption.

So, perhaps the key is persuading food manufacturers and retailers that they can still turn a profit when they are helping consumers to eat better, rather than promoting unhealthy foods.

And maybe consumers need to develop a different attitude to food, regarding it as a means of achieving and maintaining good health. This is where culinary medicine might make an impact.

What is culinary medicine?

Culinary medicine has evolved from the growing interest in the relationship of food, eating, and cooking to health. It has been described asTrusted Source “a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine.”

Culinary medicine uses a high-quality, tailored diet, to prevent and treat disease and maintain well-being. The aim is to enable individuals to use food and drink safely and effectively to achieve desired health outcomes.

Using food as medicine is not a new concept, and for some conditions, changing eating patterns can be as effective as medication.

An anti-inflammatory diet has been shownTrusted Source to provide relief from rheumatoid arthritis, and the Mediterranean diet — which emphasizes fruits, vegetables, olive oil, legumes, and whole grains, and includes less ultra-processed foods and meat than a typical Western diet — is effective in preventing cardiovascular disease and type 2 diabetesTrusted Source.

So might culinary medicine be an effective way to combat obesity?

Dr. Ali believes it could help, but is not a universal solution:

“Culinary medicine is the discipline of educating and empowering people to choose and cook healthy foods. Though, like other methods of weight loss, each individual will respond differently to this approach and thus have varying degrees of success.”

Key to its success is ensuring that healthy food gives pleasure, and is not seen as a poor substitute for the unhealthy food it replaces.

Issues with culinary medicine

One argument against culinary medicine is that these food are generally more expensive. This will not change until manufacturers and policymakers are persuaded to change pricing and taxation to make fresh foods, such as fruit and vegetables, more affordable than unhealthy foods.

But how much could be saved in healthcare costs, by individuals, and by society, if culinary medicine was effective in combating obesity? It has even been suggested that healthy foods could be prescribedTrusted Source by doctors to prevent the chronic health conditions that often result from obesity.

“[Culinary medicine] could well be the future, but at this stage, it is still very early [to tell],” Dr. Laird told MNT.

“Very few people in the world are top experts in the field of nutrition, cooking and food preparation, psychology of eating, and money economics all in one! In addition, more needs to be done in [the] education of, […] for example, medics who often get little to no official nutrition training during their courses, which would be a major starting point.”

– Dr. Eamon Laird

The outlook

Obesity is a global problem. It increases the risk of many health conditions, and it leads to long-term ill health for many. The personal and societal costs are huge.

The Lancet Commission on ObesityTrusted Source refers to obesity, malnutrition, and climate change as a “global syndemic,” and argues that obesity should not be considered in isolation but within the context of this global syndemic.

Combating obesity on a population level requires political will, not just individual action. Culinary medicine may be one approach to the problem, but until governments legislate to make healthy food affordable for all, obesity will remain a health risk.