AWM: Assess Energy Needs 2014
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.
AWM: Measure Resting Metabolic Rate (RMR)
If indirect calorimetry is available, the registered dietitian nutritionist (RDN) should use a measured resting metabolic rate to determine energy needs in overweight or obese adults. Measurement of resting metabolic rate using indirect calorimetry is more accurate than estimating resting metabolic rate using predictive equations.
AWM: Use Mifflin-St. Jeor Equation to Estimate RMR
If indirect calorimetry is not available, the registered dietitian nutritionist (RDN) should use the Mifflin-St. Jeor equation using actual weight to estimate resting metabolic rate (RMR) in overweight or obese adults. The majority of research reviewed supports the use of the Mifflin-St. Jeor equation (using actual body weight) to predict RMR in overweight or obese adults because it demonstrated good accuracy and correlation with indirect calorimetry.
AWM: Estimate Total Energy Needs
The registered dietitian nutritionist (RDN) should multiply the resting metabolic rate (RMR, measured or estimated) by one of the following physical activity factors to estimate total energy needs:
- Sedentary: 1.0 or more to less than 1.4
- Low active: 1.4 or more to less than 1.6
- Active: 1.6 or more to less than 1.9
- Very active: 1.9 or more to less than 2.5.
Risks/Harms of Implementing This Recommendation
Conditions of Application
The application of these recommendations depends on the availability of indirect calorimetry.
Mifflin-St. Jeor Equations
- Males: RMR (kcal per day) = 10 X Weight (kg) + 6.25 X Height (cm) - 5 X age (years) + 5
- Females: RMR (kcal per day) = 10 X Weight (kg) + 6.25 X Height (cm) - 5 X age (years) – 161.
- Sedentary: Typical daily living activities (e.g., household tasks, walking to the bus)
- Low active: Typical daily living activities plus 30 to 60 minutes of daily moderate activity (e.g., walking at 5km to 7km per hour or 3mph to 4mph)
- Active: Typical daily living activities plus at least 60 minutes of daily moderate activity
- Very active: Typical daily living activities plus at least 60 minutes of daily moderate activity plus an additional 60 minutes of vigorous activity or 120 minutes of moderate activity.
Potential Costs Associated with Application
- Costs of medical nutrition therapy (MNT) sessions vary; however, MNT sessions are essential for improved outcomes.
- If applicable, costs of equipment and staff time with the use of indirect calorimetry may be additional.
- The majority of research reviewed supports the use of the Mifflin-St. Jeor equation (using actual body weight) to predict resting metabolic rate (RMR) in overweight or obese adults because it demonstrated good accuracy and correlation with indirect calorimetry (Scalfi et al, 1993; Frankenfield et al, 2003; St. Jeor et al, 2004; Weijs, 2008; Skouroliakou et al, 2009; Weijs and Vansant, 2010; Ruiz et al, 2011; de Oliveira et al, 2012; Faria et al, 2012)
- Other equations evaluated did not predict resting metabolic rate as accurately as the Mifflin-St. Jeor equation (Heshka et al, 1993; Scalfi et al, 1993; Siervo et al, 2003; Livingston and Kohlstadt, 2005; Lazzer, Agosti, Resnik et al, 2007; Lazzer, Agosti, Silvestri et al, 2007; Skouroliakou et al, 2009; Spears et al, 2009; Weijs and Vansant, 2010; Horie et al, 2011; Ruiz et al, 2011; de Oliveira et al, 2012).
Recommendation Strength Rationale
The Conclusion Statement in support of these recommendations received Grade I.
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
de Oliveira FC, Alves RD, Zuconi CP, Ribeiro AQ, Bressan J. Agreement between different methods and predictive equations for resting energy expenditure in overweight and obese Brazilian men. J Acad Nutr Diet. 2012; 112(9): 1,415-1,420.
Faria SL, Faria OP, Menezes CS, de Gouvea HR, de Almeida Cardeal M. Metabolic profile of clinically severe obese patients. Obes Surg. 2012; 22(8): 1,257-1,262.
Frankenfield DC, Rowe WA, Smith JS, Cooney RN. Validation of several established equations for resting metabolic rate in obese and non-obese people. J Am Diet Assoc. 2003; 103: 1,152-1,159.
Heshka S, Feld K, Yang MU, Allison DB, Heymsfield SB. Resting energy expenditure in the obese: A cross-validation in the obese: A cross-validation and comparison of prediction equations. J Am Diet Assoc. 1993; 93 (9): 1,031-1,036.
Horie LM, Gonzalez MC, Torrinhas RS, Cecconello I, Waitzberg DL. New specific equation to estimate resting energy expenditure in severely obese patients. Obesity (Silver Spring). 2011; 19(5): 1,090-1,094.
Lazzer S, Agosti F, Silvestri P, Derumeaux-Burel H, Sartorio A. Prediction of resting energy expenditure in severely obese Italian women. J Endocrinol Invest. 2007; 30 (1): 20-27.
Lazzer S, Agosti F, Resnik M, Marazzi N, Mornati D, Sartorio A. Prediction of resting energy expenditure in severely obese Italian males. J Endocrinol Invest. 2007; 30 (9): 754-761.
Livingston EH, Kohlstadt I. Simplified resting metabolic rate - predicting formulas for normal-sized and obese individuals. Obes Res. 2005; 13 (7): 1,255-1,262.
Ruiz JR, Ortega FB, Rodriguez G, Alkorta P, Labayen I. Validity of resting energy expenditure predictive equations before and after an energy-restricted diet intervention in obese women. PLoS One. 2011; 6(9): e23759.
Scalfi L, Coltorti A, Sapio C, DiBiase G, Borrelli R, Contaldo F. Predicted and measured resting energy expenditure in healthy young women. Clin Nutr. 1993; 12: 1-7.
Siervo M, Boschi V, Falconi C. Which REE prediction equation should we use in normal-weight, overweight and obese women? Clin Nutr. 2003; 22(2): 193-204.
Skouroliakou M, Giannopoulou I, Kostara C, Vasilopoulou M. Comparison of predictive equations for resting metabolic rate in obese psychiatric patients taking olanzapine. Nutrition. 2009; 25(2): 188-193.
Spears KE, Kim H, Behall KM, Conway JM. Hand-held indirect calorimeter offers advantages compared with prediction equations, in a group of overweight women, to determine resting energy expenditures and estimated total energy expenditures during research screening. J Am Diet Assoc 2009; 109 (5): 836-845.
St. Jeor ST, Cutter GR, Perumean-Chaney SE, Hall SJ, Herzog H, Bovee V. The practical use of charts to estimate resting energy expenditure in adults. Topics in Clinical Nutrition 2003;19:51-56.
Weijs PJ. Validity of predictive equations for resting energy expenditure in US and Dutch overweight and obese class I and II adults aged 18-65 years. Am J Clin Nutr. 2008; 88(4): 959-970.
Weijs PJ, Vansant GA. Validity of predictive equations for resting energy expenditure in Belgian normal weight to morbid obese women. Clin Nutr. 2010; 29(3): 347-351.
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS. 2011 Compendium of Physical Activities: A second update of codes and MET values. Med Sci Sports Exerc. 2011; 43(8): 1, 575-1, 581.
Otten JJ, Hellwig JP, Meyers LD, editors. Institute of Medicine/National Academy of Sciences. Dietary DRI Reference Intakes: The Essential Guide to Nutrient Requirements, 2006. Accessed at http://www.nal.usda.gov/fnic/DRI/Essential_Guide/DRIEssentialGuideNutReq.pdf.
Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services, 2008.