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Recommendations Summary

Pediatric Weight Management (PWM) Determination of Total Energy Expenditure

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    PWM: Option for Determining Energy Expenditure

    If possible, RMR should be measured (e.g., indirect calorimetry). If RMR cannot be measured, then the equations for estimating total energy expenditure in overweight youth provided in the 2005 US Institutes of Medicine "Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients), " may be used. Estimated energy needs should be based on Total Energy Expenditure (TEE--see below for TEE calculation).

    Rating: Consensus
    Conditional

    PWM: Types of Energy Expenditure Indices

    Total Energy Expenditure (TEE) is the sum of BEE (which includes a small component associated with arousal, as compared to sleeping), thermic effect of food, physical activity, thermoregulation, and the energy expended in depositing new tissues and in producing milk.

    Basal energy expenditure (BEE) is determined by extrapolating BMR to 24 hours, expressed as kcal/24 h.

    Basal metabolic rate (BMR) corresponds to the situation in which food and physical activity have minimal influence on metabolism. The BMR reflects the energy needed to sustain the metabolic activities of cells and tissues, plus the energy needed to maintain blood circulation, respiration, and gastrointestinal and renal processing (i.e., the basal cost of living).

    PWM: Calculations for Total Energy Expenditure

    TEE in Overweight Boys Ages 3 Through 18 Years in a Weight Maintenance Program

    TEE = 114 – (50.9 × age [y]) + PA × (19.5 × weight [kg] + 1161.4 × height [m])

    Where PA is the physical activity coefficient:

    • PA = 1.00 if PAL is estimated to be = 1.0 < 1.4 (sedentary)
    • PA = 1.12 if PAL is estimated to be = 1.4 < 1.6 (low active)
    • PA = 1.24 if PAL is estimated to be = 1.6 < 1.9 (active)
    • PA = 1.45 if PAL is estimated to be = 1.9 < 2.5 (very active)

    TEE in Overweight Girls Ages 3 Through 18 Years in a Weight Maintenance Program

    TEE = 389 – (41.2 × age [y]) + PA × (15.0 × weight [kg] + 701.6 × height [m])

    Where PA is the physical activity coefficient:

    • PA = 1.00 if PAL is estimated to be = 1.0 < 1.4 (sedentary)
    • PA = 1.18 if PAL is estimated to be = 1.4 < 1.6 (low active)
    • PA = 1.35 if PAL is estimated to be = 1.6 < 1.9 (active)
    • PA = 1.60 if PAL is estimated to be = 1.9 < 2.5 (very active)

    Evidence analysis not completed on pediatric population; not a recommendation.

    • Risks/Harms of Implementing This Recommendation

      None

    • Conditions of Application

      Use of the 2005 US Institutes of Medicine "Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) is suggested. However, the practitioner's clinical judgement should be used to determine the appropriate method of energy expenditure estimation.

    • Potential Costs Associated with Application

      Measuring energy expenditure requires specialized equipment which may be cost prohibitive for some programs.

      If costs of the measurement of energy expenditure is passed along to families in the program, costs could be prohibitive to lower income families.

    • Recommendation Narrative

      No evidence analysis was completed for this question at this stage.

    • Recommendation Strength Rationale

      Consensus rating is based on the lack of evidence analysis carried out for pediatric weight management.

    • Minority Opinions

      None