The Beneficial Effects of a Protein-rich Breakfast on Appetite Control & Cognition in Overweight and Obese Adolescents

Breakfast skipping, which is a common, yet unhealthy dietary habit among young women, has
been strongly associated with over-eating (especially in the evening), weight gain, and
obesity. Breakfast skipping has also been shown to reduce cognitive function in this
population. However, it is unclear as to whether the addition of breakfast, with specific
emphasis on increased dietary protein, leads to improvements in these outcomes. This study
will provide mechanistic evidence supporting the addition of a protein-rich breakfast to
improve and/or re-establish appetite control, energy intake regulation, and cognitive
function in overweight/obese 'breakfast skipping' young women. 25 overweight and obese
'breakfast skipping' adolescent girls will participate in the following randomized
within-subject crossover-design breakfast study. The participants will randomly complete the
follow breakfast patterns at home for 6 days: 1) Breakfast Skipping; 2) Consumption of Normal
Protein breakfast meals(i.e., 350 kcal; 15% of the meal as protein, 65% CHO, & 20% fat); and
3) Consumption of Protein-Rich breakfast meals (i.e., 350 kcal; 40% of the meal as protein,
40% CHO, & 20% fat). On the 7th day of each pattern, the participants will report to the
MU-Brain Imaging Center in the morning to complete the respective 10-h testing day. The
participants will begin the testing day by either skipping breakfast or consuming their
respective breakfast meal. Blood samples and assessments of perceived appetite,
pleasure/reward, and cognitive function will be collected/completed at specific times
throughout the day. A standardized lunch will also be provided. Prior to dinner, a brain scan
will be completed using functional magnetic resonance imaging (fMRI) to identify brain
activation patterns in response to food pictures. Following the fMRI, the participants will
be provided with an ad libitum dinner buffet to consume of the facility. They will also be
given evening snacks to consume ad libitum, at home throughout the remainder of the day.
There is a 7-day washout period between each breakfast pattern. Primary outcomes include
morning, mid-day, afternoon, and evening appetite, satiety, pleasure/reward, hormonal
responses (plasma glucose, insulin, ghrelin, and PYY concentrations), brain activation
patterns, evening energy intake, and daily energy intake.

Inclusion Criteria:

The participants must meet the following inclusion criteria:

- Female

- Age range 15-20 y

- Overweight to obese (85th -99th percentile for BMI for age; BMI: 25-39.9 kg/m2

- No metabolic, psychological, or neurological diseases/conditions

- Not currently/previously on a weight loss/other special diet

- Frequently eats lunch ( ≥ 5 eating occasions/wk)

- Consistently skips breakfast every week day (i.e., 5 week days/week)

- Right-handed (necessary for the fMRI analyses)

Exclusion Criteria:

The participants will be excluded from participation in the study if they meet the
following exclusion criteria:

- Male

- Age >20 y and <15 y

- Under Weight (<5th percentile for BMI for age; BMI: <18 kg/m2)

- Normal Weight (6th-84th percentile for BMI for age; BMI: 18-24.0 kg/m2)

- Morbidly Obese (BMI: >40 kg/m2)

- Clinically diagnosed with diabetes (Type I or Type II), having an eating disorder, or
having any other metabolic, psychological, or neurological diseases/conditions that
would influence the study outcomes.

- Not currently/previously on a weight loss or other special diet (in the past 6 months)

- Skip lunch ( ≥ 2 eating occasions/wk)

- Consume breakfast (≥ 2 eating occasions/wk)

- Left-handed

- Claustrophobic (≥ 2 past bouts of claustrophobia when exposure to small spaces)

- Do not meet the fMRI criteria established by the MU-BIC (regarding metal implants,
etc.)

- Pregnant