Breakfast Skipping Among Medical Students

Yasser Al-hasan1*, Emmanuel Batan Jr.2*, Paul Justin Belvis3*, Earl Anthony Bisda4*, Modesto

David Bolislis5*, Keven Joy Calugan6*, Richard Damoco7*, Marco Neoman Dela Cruz8*,

Margarette Aiza Martin9*, Jefferson Rodriguez10*

*Third year Medical Student, Saint Louis University School of Medicine, A. Bonifacio Street,

Baguio City, Philippines 2600

Corresponding Author:

1 E-mail: yaz8graz@yahoo.com 6 E-mail: kevenky@yahoo.com

Tel: +639273192245 Tel: +639068520538

2 E-mail: bieh_jhay@yahoo.com 7 E-mail: matilda692@yahoo.com

Tel: +639351160982 Tel: +639175006533

3 E-mail: jhei_beie@yahoo.com 8 E-mail: marco10ph@yahoo.com

Tel: +639175203334 Tel: +639177263773

4 E-mail: earlbisda@yahoo.com 9 E-mail: margamartin@yahoo.com

Tel: +639175402241 Tel: +639266878043

5 E-mail: onin.skies@gmail.com 10 E-mail: rodriguezjeff@yahoo.com

Tel: +639277731313 Tel: +639175202090

The total number of words of the manuscript: 1976

The number of words of the abstract: 259

The number of tables: 4

ABSTRACT

Study Design: Cross-sectional study

Background: Skipping breakfast is a common practice among young adults who undergo

a transition from high school into university life, in which they are exposed to more stress and less

free time. The purpose of this research was to determine breakfast habits among medical students

as measured by a twelve-item questionnaire. The objectives of this study were to determine the

prevalence of breakfast skipping; to determine the reasons for skipping breakfast; and to determine

if there is an association between breakfast skipping and age, gender, year level, and living with

parents.

Methods: Data were gathered with the use of a survey questionnaire. 404 medical students

from Saint Louis University were asked to respond to the twelve-item survey. The questionnaire

included data on demographic characteristics, breakfast skipping frequency, content of breakfast,

and the reason for skipping breakfast.

Results: The survey results indicated that 26.24% almost never skip breakfast; 33.42%

skip breakfast sometimes; 21.29% skip breakfast often; and 19.06% almost always skip breakfast.

For those students who skip breakfast, 20.79% chose lack of time as the main reason for skipping

breakfast; 14.85% said they get up late; and 13.37% said they don’t want to eat in the morning.

There was an association between breakfast skipping and living with parents (p<0.001).

Conclusion: The provision of energy and nutrients throughout the day is extremely

important and breakfast has been considered an important dietary factor for energy regulation.

Despite continuing studies on global burden of nutrition, various concerns arise from specific

population, specifically the medical students and their eating habits.

INTRODUCTION

Background

It is becoming increasingly difficult to ignore the importance of not skipping breakfast.

The provision of energy and nutrients throughout the day is important and breakfast has been

considered an important dietary factor for energy regulation 1. Evidence suggests that breakfast

plays an important role in the maintenance of our well-being in a number of areas.

Skipping breakfast is a common practice among young adults who undergo a transition

from high school into university life, in which they are exposed to more stress and less free time.

One concern arising from this is the development of poor eating habits overtime 2.

In recent years, there has been an increasing interest in the effects of skipping breakfast3-6.

They have shown adverse effects on cognitive function that has been associated with skipping

breakfast in children and young people3. According to Pelican et al, teachers report that hungry

children are more likely to be apathetic, inattentive, and disruptive4 (p2). Reduced breakfast energy

intake was also associated with higher total daily energy intake and when breakfast is skipped it

can be difficult to properly compensate for it later in the day 5. Better physical health was reported

in those who ate breakfast almost every day than those who skip breakfast 6. In 2011, Gan et al.

highlighted the presence of unhealthy eating behaviours and inadequate nutrient intake among

university students. The study concluded that there was a need to promote healthy eating habits

among young adults to achieve a healthy nutritional status 7(p2).

However, in relation to medical students, it has been assumed that they would practice

healthy dietary habits compared to non-medical students 6. This concept has recently been

challenged by a study in China demonstrating medical students exhibiting early risk factors for

chronic diseases due to poor eating habits. It was found that although medical students had
sufficient knowledge regarding good dietary habits, they failed to apply this knowledge into

practice 8.Because of stress of university life and medical study load, these become factors that

negatively influence their diet 9.

Despite continuing studies on the global burden of nutrition, various concerns arise from

specific population, specifically the medical students and their eating habits. So far, however, there

has been little discussion in the Philippines about investigating the factors in the faulty eating

habits of medical students and the reasons for such behavior. The aim of this study is to

determine/examine skipping breakfast among medical students in a Philippine university.

Objectives

The objectives of this study were to determine the prevalence of breakfast skipping; to

determine the reasons for skipping breakfast; and to determine if there is an association between

breakfast skipping and age, gender, year level, and living with parents.

METHODS

Study design: It was decided that the best method to adopt for this investigation was to use a

cross-sectional design. The subset population of the Saint Louis University School of Medicine is

selected, and from these individuals, data are collected to help answer research questions of

interest. The data gathered represents what is going on at only one point in time. Data were

gathered with the use of a survey questionnaire.

Setting: The data gathering took place in the Rizal Building of Saint Louis University, Baguio

City. Data were gathered from multiple sources at various time points during December 9 – 14,

2013.

Participants: The participants include the first, second and third year medical students of Saint

Louis University School of Medicine. The study does not include fourth year medical students.
The survey-questionnaires were given to the participants and asked to answer it during their vacant

time. The questions include how often they skip breakfast, why they skip breakfast and how

skipping breakfast affects their school performance. Survey questionnaires were given back 2 -3

days after.

Variables: The confounding variables included age, gender, year level and parental supervision;

if the participant is living with his/her parents or not. The design of the questionnaires was based

on the study of Khan, A., comprising twelve questions used to explore the breakfast habits of

medical students. Under the study included data on demographic characteristics, breakfast

skipping frequency, content of breakfast, when and what is their first meal of the day, if they

skipped breakfast and the reason for skipping breakfast. Demographic questions in the

questionnaire were related to age, gender and year level.

Bias: To control for bias, measurements were carried out by another person. In an attempt to make

each interviewee feel as comfortable as possible, the interviewer told that the questionnaires need

not to be returned immediately. They can return it in 2-3 days and asked to answer it only during

their free time.

Study size: All first, second and third year medical students are included in the study.

Quantitative variables: Four quantitative variables were used for the study in determining the

breakfast skipping habits among medical students in Saint Louis University: age, gender, current

year level, and type of residence. Age is classified into 2 groups: a. 20-24 years old and b. 25 years

old and above. Gender was divided into two groups: a. male and b female. The students were

divided into three groups according to the year level, we clustered it into 3 groups, which are: a.

1st year, b. 2nd year, c. 3rd year. Lastly, type of residence was clustered into 2 groups: a. living
with parents and b. not living with parents (i.e living separately from parents or living with non-

relative).

Statistical methods: Data management and analysis was performed using Epi Info™ 7. The

software was used to determine demographic profile, frequency of skipping breakfast, and reasons

for skipping breakfast. Chi square test was done to determine association between breakfast

skipping and age, gender, year level and living with parents.

RESULTS

There were 404 participants; 246 females (60.89%) and 158 males (39.11%). Among the

participants, 348 (86.14%) have an age between 20 and 24 while 56 (13.85%) are 25 years old and

above. Regarding year level, 132 (32.67%) were first year students, 156 (38.61%) were second

year students, and 116 (28.71%) were third year students. 158 (39.11%) students live with their

parents, and 246 (60.89%) live without parental supervision.

Table 1. Demographic Profile

FREQUENCY PERCENTAGE
AGE
20 - 24 348 86.14%
25 - 29 53 13.12%
30 and above 3 0.74%
Total 404 100.00%
GENDER
male 158 39.11%
female 246 60.89%
Total 404 100.00%
YEAR LEVEL
1st year 132 32.67%
2nd year 156 38.61%
3rd year 116 28.71%
Total 404 100.00%
 Table 2. Frequency of Breakfast Skipping

Response FREQUENCY PERCENTAGE

Almost Never 106 26.24%
Sometimes 135 33.42%
Often 86 21.29%
Almost Always 77 19.06%
Total 404 100.00%

Majority of the participants (33.42%) skip breakfast sometimes, 26.24% almost

never skip breakfast, 21.29% often skip breakfast, and 19. 06% almost always skip their

breakfast. Having no time to eat was the highest reason (20.79%) for skipping breakfast.

One out of the four factors was significantly associated with skipping breakfast. Living

with parents is associated with breakfast skipping with a p-value of <0.001.

Table 3. Reasons for skipping breakfast

Reason FREQUENCY PERCENTAGE

Usually not hungry 14 3.47%
Want to lose weight 4 0.99%
Have no time to eat 84 20.79%
Dieting 2 0.50%
Get up late 60 14.85%
Spend too much time
on other things 12 2.97%
Doesn't like the food 10 2.48%
Doesn't want to eat
in the morning 54 13.37%
Food not available 11 2.72%
Total 251 62.00%
 Table 4. Association between breakfast skipping and age, gender, year level

and living with parents

Live with parents FREQUENCY PERCENTAGE

Yes 158 39.11%
No 246 60.89%
Total 404 100%

DISCUSSION

The sample group for this study was 404 respondents; 39.11% male and 60.89% female,

86.14% 20-24 years old and 13.86% 25 years old and above, 32.67% first year, 38.61% second

year and 28.71% third year. A total of 60.89% indicated that they are not living with parents and

39.11% are living with parents.

Our study shows majority of the medical students (33.42%) at least sometimes skip their

breakfast with 21.29% of medical students often skip their breakfast, 19.06% indicating that they

almost always skip breakfast and 26.24% indicating that they almost never skip breakfast. Previous

research has found a wide range of responses in regards to frequency of skipping breakfast. The

findings of the current study are supported by a study of Barsur (1998) which found that 42%

children do not regularly consume breakfast.

Our study shows that 20.79% of medical students skip their breakfast because of time

factor. “Not enough time” is often a response given by an adolescent as to why they do not eat

breakfast. Barbara Kines of the Parent Connection states, “if you allow 15 minutes for breakfast,

you can cover three food groups with offerings such as whole grain toast with peanut butter and a

glass of milk; cereal with milk and fruit” (1997). 14.85% of medical students indicated that they

get up late, 13.37% do not want to eat in the morning, 3.47% usually not hungry, 2.97% spend too

much time on other things, 2.72% food not available and 2.48% do not like the food. A small
percentage of students indicate that they want to lose weight (0.99%) and diet (0.50%). Reasons

offered for skipping breakfast mainly had to do with personal choice and convenience, rather than

dieting and concern about body shape. Singleton and Rhoads (2002) found that the most common

reasons given for skipping breakfast were no time (43%) and not being hungry (42%); less

common reasons included being on a diet to lose weight, not feeling good, no one to prepare food,

not liking the food served and food not being available.

Our study shows that there is no association between age, gender and year level of medical

students and breakfast skipping. This is in contrary to the finding of Shaw (1998) that females skip

breakfast more than three times as often as males but Shaw’s research focused on adolescents

where body image issues and dieting are more prevalent. Gender was not reported in many studies.

One possible reason for not reporting gender in most of the studies could be that gender was not

significant, hence, not reported. The overall prevalence of skipping breakfast of medical students

is high. Apparently, this is a very serious public health problem. Neumark-Sztainer, et al, 1997,

their study showed that breakfast skipping is less common among the older than adolescents.

However, our study shows living with parents has a significant factor breakfast skipping.

The literature shows that breakfast eating habits tend to be learned. The American Dietetic

Association points out that parent need to be role models for children, especially when it comes to

eating breakfast. Parental habits of eating breakfast and establishing good eating habits at an early

age set the tone for lifetime healthy habits. In the article “Trends in Breakfast Consumption”, Riz

points out that omission of breakfast may be due to lack of companionship to share the meal, lack

of desire to prepare breakfast themselves and limited availability of ready to eat foods.

This study has several advantages, first of all, this correlate the significance between socio-

demographic data, living with or without parents and breakfast skipping. This study may warn
medical students the bad effects of breakfast skipping. According to research, skipping breakfast

can actually make weight control more difficult. However, this study also has some limitations.

This study did not determine the habits of medical students like alcohol consumption, smoking

and regular physical exercise, time of breakfast, and presence of kitchen. It is possible that some

medical students eat their breakfast at ten or eleven o’clock in the morning and some medical

students are living in a boarding house without kitchen. Living with a maid is not included as an

option in the last question of the questionnaire. The study should be conducted in a randomized

method and financial status should be included in the socio-demographic data.

This study implies that majority of medical skip breakfast because of no time and living

without parents to prepare their meal for them. The prevalence of skipping breakfast can lessened

by cafeterias in the campus should provide affordable foods for students. This may be also a way

of providing healthy diet for medical students. Changing the school timetable can be also helpful

since majority of the students do not have time to eat their breakfast.

Conclusion

In conclusion, a major percentage of medical students often or almost always skip

breakfast. The main reason for this is insufficient time. Age, gender, and year level of the medical

students were not significant factors in breakfast skipping. However, living with parents was found

to have a significant association. Our study findings could help health care professionals develop

targeted interventions designed to increase breakfast consumption.

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