Journal of Clinical Densitometry, vol. 9, no. 4, 438e444, 2006 Ó Copyright 2006 by The International Society for Clinical Densitometry 1094-6950/06/9:438e444/$32.00 DOI: 10.1016/j.jocd.2006.09.001
Original Article
Caloric Expenditure in the Morbidly Obese Using Dual Energy X-ray Absorptiometry Thomas E. Vanhecke,* Barry A. Franklin, Martin A. Lillystone, Keisha R. Sandberg, Adam T. deJong, Kevin R. Krause, David L. Chengelis, and Peter A. McCullough Department of Medicine, Divisions of Cardiology, Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI
Abstract Total caloric expenditure is the sum of resting energy expenditure (REE) and caloric expenditure during physical activity. In this study, we examined total caloric expenditure in 25 morbidly obese patients (body mass index 35 kg/m2) using dual energy X-ray absorptiometry (DXA) scanning and cardiorespiratory exercise testing. Our results show average REE for all individuals was 2027 276 kcal/d and mean net caloric expenditure during 30 min of exercise was 115 16 kcals. Assuming the mean of all input values, a strict 1500 kcal/d diet combined with 150 min per wk of structured physical activity, the projected weight change was 7% (8.8 6.2 kg) for 6 mo. We conclude that morbidly obese individuals should be able to achieve only a modest weight loss by following minimal national guidelines. These data suggest that more aggressive energy expenditure and caloric restriction targets for long periods of time are needed to result in significant weight loss in this population. Key Words: Body composition; caloric expenditure; cardiorespiratory fitness; dual energy X-ray absorptiometry; exercise; weight loss.
(5). More recently, the Institute of Medicine recommended 60 min of moderate intensity of exercise per day with dietary restriction if weight management is the primary objective (6). In 2001, the American College of Sports Medicine (ACSM) updated its position on weight loss and prevention of weight gain for adults, and recommended that overweight adults progress gradually to 200e300 min of exercise per week (w 45 min/d) or O 2000 kcal/wk to obtain long-term benefits (7,8). Recent technology has increased the accuracy of estimating resting energy expenditure (REE), which has traditionally been measured by indirect calorimetry. Although the most widely used method of calculating REE is the Harris-Benedict equation or a modification of it (9,10), it was derived from a population of nonobese individuals and is inaccurate when used in overweight or obese individuals (11). Along with the obesity epidemic of the 21st century, more accurate methods of determining REE have been validated for use in obese individuals. Most of the newer equations consider adipose tissue as ‘‘energetically inert.’’ Therefore, REE is highly
Introduction Recent estimates suggest that more than half of the adults in today’s Western society will, over time, become overweight or obese (1). This is alarming when considering that deaths attributable to obesity are projected to soon overtake tobacco as the number one cause of preventable death in today’s society (2). Of those individuals attempting to lose weight, almost two-thirds of women and men reported engaging in regular physical activity; however, less than one-fifth met recommendations of eating fewer calories and participating in O 150 min/wk of physical activity (3,4). In 1998, the National Heart, Lung and Blood Institute advised 30 to 45 min of moderate activity 3 to 5 days per week along with dietary restriction for weight loss and maintenance Received 06/21/06; Revised 09/01/06; Accepted 09/01/06. *Address correspondence to: Thomas E. Vanhecke, MD, Department of Internal Medicine, William Beaumont Hospital, 3601 W. 13 Mile Rd., Royal Oak, MI 48073. E-mail: tvanhecke@gmail.com
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