Weight Reduction in Overweight and Obese Adults

When obese individuals need to lose weight, the necessary negative energy balance can theoretically be achieved by either a reduction in energy intake or an increase in energy expenditure of physical activity (EEPA). Most usually, a combination of both is desirable (NIH, 2000) because it is hard to achieve the high levels of negative energy balance necessary for 1 to 2 lb/wk weight loss with exercise alone. In support of this contention, meta-analyses show very low levels of weight loss in structured exercise programs (Ballor and Keesey, 1991), but at the same time several studies suggest that the combination of dietary change and increased physical activity appears effective for promoting weight loss and successful weight maintenance after weight loss, perhaps by promoting

DIETARY REFERENCE INTAKES

TABLE 5-30 Basal and Total Daily Energy Expenditure in Women 30 Years of Age as Calculated from Total Energy Expenditure (TEE) Equations for Normal-weight, Overweight, and Obese Women"

Height (m [in])

Weight (kg [lb]) for a

Body Mass Index (kg/m2

) of:

PALa

18.5

22.5

24.99

25

30

35

40

1.45 (57)

Sedentary Low active Active Very active

38.9 (86)

45.2 (100)

52.5 (116)

52.6 (116)

63.1 (139)

73.6 (162)

84.1 (185)

1.50 (59)

Sedentary Low active Active Very active

41.6 (92)

48.4 (107)

56.2 (124)

56.3 (124)

67.5 (149)

78.8 (174)

90.0 (198)

1.55 (61)

Sedentary Low active Active Very active

44.4 (98)

51.7 (114)

60.0 (132)

60.1 (132)

72.1 (159)

84.1 (185)

96.1 (212)

1.60 (63)

Sedentary Low active Active Very active

47.4 (104)

55.0 (121)

64.0 (141)

64.0 (141)

76.8 (169)

89.6 (197)

102.4 (226)

1.65 (65)

Sedentary Low active Active Very active

50.4 (111)

58.5 (129)

68.0 (150)

68.1 (150)

81.7 (180)

95.3 (210)

108.9 (240)

1.70 (67)

Sedentary Low active Active Very active

53.5 (118)

62.1 (137)

72.2 (159)

72.3 (159)

86.7 (191)

101.2 (223)

115.6 (255)

1.75 (69)

Sedentary Low active Active

56.7 (125)

65.8 (145)

76.5 (169)

76.6 (169)

91.9 (202)

107.2 (236)

122.5 (270)

Very active

Very active

ENERGY 211

TEE (kcal/d) for a Body Mass Index (kg/m2)of:

18.5

22.5

24.99

25

30

35

40

1,074

1,133

1,202

1,201

1,291

1,382

1,472

1,564

1,623

1,691

1,698

1,813

1,927

2,042

1,734

1,800

1,877

1,912

2,043

2,174

2,304

1,946

2,021

2,108

2,112

2,257

2,403

2,548

2,201

2,287

2,386

2,387

2,553

2,719

2,886

1,118

1,181

1,255

1,253

1,349

1,446

1,543

1,625

1,689

1,762

1,771

1,894

2,017

2,139

1,803

1,874

1,956

1,996

2,136

2,276

2,415

2,025

2,105

2,198

2,205

2,360

2,516

2,672

2,291

2,382

2,489

2,493

2,671

2,849

3,027

1,163

1,230

1,309

1,306

1,409

1,512

1,615

1,688

1,756

1,834

1,846

1,977

2,108

2,239

1,873

1,949

2,037

2,081

2,230

2,380

2,529

2,104

2,190

2,290

2,299

2,466

2,632

2,798

2,382

2,480

2,593

2,601

2,791

2,981

3,171

1,208

1,280

1,364

1,360

1,470

1,580

1,690

1,752

1,824

1,907

1,922

2,061

2,201

2,340

1,944

2,025

2,118

2,168

2,327

2,486

2,645

2,185

2,276

2,383

2,396

2,573

2,750

2,927

2,474

2,578

2,699

2,712

2,914

3,116

3,318

1,254

1,331

1,420

1,415

1,532

1,649

1,766

1,816

1,893

1,982

1,999

2,148

2,296

2,444

2,016

2,102

2,202

2,256

2,425

2,594

2,763

2,267

2,364

2,477

2,494

2,682

2,871

3,059

2,567

2,678

2,807

2,824

3,039

3,254

3,469

1,301

1,383

1,478

1,471

1,595

1,719

1,843

1,881

1,963

2,057

2,078

2,235

2,393

2,550

2,090

2,180

2,286

2,345

2,525

2,705

2,884

2,350

2,453

2,573

2,594

2,794

2,994

3,194

2,662

2,780

2,917

2,938

3,166

3,395

3,623

1,350

1,436

1,536

1,528

1,659

1,791

1,923

1,948

2,034

2,134

2,158

2,325

2,492

2,659

2,164

2,260

2,372

2,437

2,627

2,817

3,007

2,434

2,543

2,670

2,695

2,907

3,119

3,331

2,758

2,883

3,028

3,054

3,296

3,538

212 DIETARY REFERENCE INTAKES

TABLE 5-30 Continued

Height (m [in])

Weight (kg [lb]) for a

Body Mass Index (kg/m2

) of:

PALa

18.5

22.5

24.99

25

30

35

40

1.80 (71)

Sedentary Low active Active Very active

59.9 (132)

69.7 (154)

81.0 (178)

81.0 (178)

97.2 (214)

113.4 (250)

129.6 (285)

1.85 (73)

Sedentary Low active Active Very active

63.3 (139)

73.6 (162)

85.5 (188)

85.6 (189)

102.7 (226)

119.8 (264)

136.9 (302)

1.90 (75)

Sedentary Low active Active Very active

66.8 (147)

77.6 (171)

90.2 (198)

90.3 (199)

108.3 (239)

126.4 (278)

144.4 (318)

1.95 (77)

Sedentary Low active Active Very active

70.3 (155)

81.8 (180)

95.0 (209)

95.1 (209)

114.1 (251)

133.1 (293)

152.1 (335)

a For each year below 30, add 2.5 kcal/d to BEE and 7 kcal/d to TEE. For each year above 30, subtract 2.5 kcal/d from BEE and 7 kcal/d from TEE. Equations determined from combined DLW databases (Appendix Table I-11).

favorable metabolic changes or improved dietary compliance (DePue et al., 1995; Dunn et al., 1999; Hartman et al., 1993; Holden et al., 1992; Miller et al., 1997).

Several studies indicate that energy expenditure decreases when energy intake is less than TEE, with the result that weight loss is less than anticipated based on the reduction in energy intake. As shown in Figure 5-9, a summary of studies on changes in resting energy expenditure (REE) with negative energy balance in adults have shown that the decline in REE with weight loss is greater than predicted from the loss of FFM that occurs concomitantly during negative energy balance. This suggests that there is a decrease in REE per unit of FFM during active weight loss (underfeeding).

ENERGY 213

TEE (kcal/d) for a Body Mass Index (kg/m2)of:

18.5

22.5

24.99

25

30

35

40

1,398

1,490

1,596

1,586

1,725

1,865

2,004

2,015

2,106

2,211

2,239

2,416

2,593

2,769

2,239

2,341

2,459

2,529

2,731

2,932

3,133

2,519

2,634

2,769

2,799

3,023

3,247

3,472

2,855

2,987

3,141

3,172

3,428

3,684

3,940

1,448

1,545

1,657

1,645

1,792

1,940

2,087

2,083

2,179

2,290

2,322

2,509

2,695

2,882

2,315

2,422

2,548

2,624

2,836

3,049

3,262

2,605

2,727

2,869

2,904

3,141

3,378

3,615

2,954

3,093

3,255

3,292

3,562

3,833

4,103

1,499

1,601

1,719

1,706

1,861

2,016

2,171

2,151

2,253

2,371

2,406

2,603

2,800

2,996

2,392

2,505

2,637

2,720

2,944

3,168

3,393

2,693

2,821

2,971

3,011

3,261

3,511

3,760

3,053

3,200

3,371

3,414

3,699

3,984

4,270

1,550

1,657

1,782

1,767

1,931

2,094

2,258

2,221

2,328

2,452

2,492

2,699

2,906

3,113

2,470

2,589

2,729

2,817

3,053

3,290

3,526

2,781

2,917

3,074

3,119

3,383

3,646

3,909

3,154

3,309

3,489

3,538

3,838

4,139

4,439

b PAL = Physical activity level, BEE = basal energy expenditure.

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