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# Pediatric Weight Management

## PWM: Determining Energy Needs in Overweight Children and Adolescents (2007)

Determining Energy Needs in Overweight Children and Adolescents

According to the 2005 US Institutes of Medicine "Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients)," total energy expenditure in overweight youth (ages 3-18) in a weight maintenance situation should be calculated using the following equations:

Overweight Boys Ages 3 Through 18 Years

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)

Overweight Girls Ages 3 Through 18 Years

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)

Detail Summary

In 2005, the US Institutes of Medicine released Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients).

As part of this effort, the entitles responsible for creating the Dietary Reference Intakes (Panel on Macronutrients, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes) developed equations for estimating total energy expenditure (TEE) for different populations based on research and data from the doubly labeled water (DLW) method of measuring total energy expenditure.

The report identifies different measurements of energy needs:

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).

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

Resting metabolic rate (RMR) is the energy expenditure under resting conditions, tends to be somewhat higher (10 to 20 percent) than under basal conditions due to increases in energy expenditure caused by recent food intake (i.e., by the “thermic effect of food”) or by the delayed effect of recently completed physical activity

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.

Equations to Estimate Energy Expenditure in Overweight and Obese Children and Adolescents (3-18 years)

Based on analysis of the data from several research efforts, the authors of the IOM report provide two sets of predictive equations for estimating TEE in overweight and obese youth (ages 3-18) (overweight defined in the IOM report as BMI>=85% for age and sex):

• A set of equations (for boys and girls) who are not in a situation for weight loss or weight maintenance (equations estimate BEE—the basic energy cost of living for a 24 hour period)
• A set of equations (for boys and girls) who are in a weight maintenance situation (equations estimate TEE—BEE plus other energy consuming processes and activities not counting growth)

One key difference between these two sets of equations is that the equations for weight maintenance do not include a growth component. According to the report,

“The energy cost of growth as a percentage of total energy requirements decreases from around 35 percent at 1 month to 3 percent at 12 months of age, and remains low until the pubertal growth spurt, at which time it increases to about 4 percent (the body uses energy.”

The IOM report also includes predictive equations for normal weight children and adolescents. The reader who is interested in these questions is referred to the IOM report.

Total Energy Expenditure in Overweight Youth (ages 3-18) in a Weight Maintenance Situation

The equations used to estimate TEE include a physical activity component.

TEE in Overweight Boys Ages 3 Through 18 Years

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

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)

Basal Energy Expenditure in Overweight Youth (ages 3-18)

Because the BEE estimates the basic energy cost of living, it does not include a physical activity component.

BEE for overweight and obese boys:

BEE (kcal/d) = 420 – (33.5 × age (y)) + 418.9 × height (m) + 16.7 × weight (kg)

BEE for overweight and obese girls:

BEE (kcal/d) = 516 – (26.8 × age [y]) + 347 height (m) + 12.4 × weight (kg)

The reader who is interested in the details of the IOM Report’s methods for creating the equations may find them at http://www.nap.edu/catalog/10490.html (especially chapter 5 and Appendix I).