Evaluating the Acceptability and Feasibility of Providing Egg or Cereal Breakfast during a Family-Based Treatment for Children with Overweight/Obesity: The Families and Breakfast Pilot Trial

Abstract

Background: Family-based behavioral treatment (FBT) is the most successful weight-loss treatment for children with overweight and obesity, however, long-term success is only achieved by a third of children over time. The use of foods that induce satiety, such as eggs, could improve adherence to calorically restricted diets in children and improve outcomes. This study explored the consumption of eggs (FBT+egg) or cereal (FBT+cereal) for breakfast as part of an FBT program, when breakfast foods were provided to families. Methods: Fifty 8-12-year-old children with overweight and obesity and their parents were randomized to a 4-month FBT+egg or FBT+cereal treatment program. Families were provided the ingredients for their assigned breakfast at each treatment session, and instructed to consume the breakfast a minimum of 5 days per week. Families attended assessments at baseline, post-treatment, and 4months post-treatment. Results: Results showed that both treatments were well liked, FBT attendance was similar, and there was high compliance with consumption of the specified breakfast. Children experienced moderate weight loss at post-treatment [-0.11 standardized BMI (BMIz)] through 4-month follow-up (-0.09 BMIz), with no statistically significant differences (mean difference-0.05 BMIz, 95% confidence interval-0.19 to 0.09) observed between egg and cereal conditions across any anthropometric or appetitive measures. Conclusions: The use of eggs for breakfast in children enrolled in FBT was well tolerated, and future studies should include larger samples and longer follow-up periods to assess the potential differential effects of prescribed breakfasts on children's weight and eating behaviors.

The Impact of Ready-to-Eat Cereal Intake on Body Weight and Body Composition in Children and Adolescents: A Systematic Review of Observational Studies and Controlled Trials

“…There were 20 observational studies [ 2 , 4 , 5 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ] and five RCTs [ [33] , [34] , [35] , [36] , [37] ] evaluating the relationship of RTEC with body weight and body composition outcomes. Most observational studies were cross-sectional in design, with only two prospective analyses from cohorts or longitudinal intervention studies [ 17 , 22 ].…”

“…Five RCTs evaluating the impact of RTEC on body weight and body composition outcomes in children were identified [ [33] , [34] , [35] , [36] , [37] ] ( Table 3 ). Two long-term RCTs (3–4 mo) compared daily RTEC breakfasts with egg-based or high-protein breakfasts in overweight/obese children and adolescents and found no difference in body weight, BMI, and/or fat mass between the RTEC intervention and the egg-based or high-protein breakfast [ 33 , 35 ]. However, Boutelle et al.…”

“…However, Boutelle et al. [ 33 ] reported a moderate but significant decrease in BMI z-score in children within the RTEC and egg-based breakfast groups over the 4-mo study period (both treatments also received nutrition and physical activity education). One RCT in 178 overweight/obese children in Mexico reported daily RTEC consumption over 12 wk, compared with a usual breakfast, contributed to weight loss (0.9 kg) and lower percent body fat when combined with nutrition education, whereas when RTEC was provided daily, or twice daily, without nutrition education, children gained 0.9 kg over the 12 wk [ 37 ].…”

“…The comparator diet should also be carefully considered. Some RCTs compared a RTEC breakfast to an egg-based or high-protein breakfast [ 33 , 35 ], both of which may have been different than a typical breakfast for the subjects; thus, studies that use a typical breakfast as a control are also needed. Controlling for energy intake and physical activity is also critical, particularly since the one RCT demonstrating a benefit of RTEC intake on body weight and body composition did not measure energy intake or physical activity [ 37 ], so it is unclear how these variables may have contributed to the results.…”

No food for thought–How important is breakfast to the health, educational attainment and wellbeing of school‐aged children and young people?

“…A diet rich in high‐quality protein has been linked with weight loss and/or prevention of weight gain or regain (Westerterp‐Plantenga et al., 2009) via regulation of appetite and energy intake, suggesting that a protein‐rich breakfast may contribute to improved weight management. An intervention comparing higher protein breakfasts (egg, milk, fruit cup vs. cereal, milk, fruit cup) for 4 months alongside family‐based behavioural treatment focussing on nutrition and physical activity, parenting skills and behaviour modification strategies in both groups reported a modest but significant reduction in BMI z‐score of overweight/obese children (8–12 years) and at 4‐month follow‐up, with no difference between egg and cereal conditions (Boutelle et al., 2019). A recent systematic review and meta‐analysis of 10 RCTs examined the effect of a protein‐rich breakfast (protein dose ranged from 12.2 g to 58 g) compared with normal protein (NP)/traditional breakfast consumption on subsequent energy intake at lunch and subjective appetite in children and adolescents (aged 7–19 years).…”