Practice Consideration
Estimating Energy Requirements for Obese or Overweight Clients
Energy requirements can be difficult to estimate in those who are overweight or obese. Technology using indirect calorimetry is available to measure BMR and RMR. BMR and RMR are then used as the basis for total energy expenditure (TEE) estimates. Indirect calorimetry is not yet widely available in the clinical environment, and dietitians may need to estimate patient energy requirements using energy-predictive equations such as the Harris-Benedict, Schofield, Mifflin-St Jeor, Owens and WHO equations. They may also need to draw on physical activity energy estimation tools to determine TEE.
Energy-predictive equations vary widely in their accuracy and results are influenced by the practitioner’s choice of actual weight, ideal weight or adjusted weight. The Academy of Nutrition and Dietetics conducted a systematic review to evaluate estimated energy generated by the commonly-used equations compared to indirect calorimetry measuring RMR. The Mifflin-St Jeor equation was recommended as the most accurate formula for obese individuals. See the table below for the range of accuracy reported for the Mifflin-St Jeor and Harris-Benedict equations. Further information on the Owens and WHO formulas is reported in the Tool Kit.(1,2)
See the Tool Kit for a comparison of how well these formulas estimate RMR when compared to measured RMR.
References
1. Seagle HM, Straibn GW, Makris A, Reeves RS, American Dietetic Association. Position of the American Dietetic Association: Weight Management. JADA. 2009; 109: 330-346.
2. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014; 129: S102-138.
3. Academy of Nutrition and Dietetics. Table 3 Conclusion Statements, Accuracy of RMR Estimations. 2006; Accessed 12 September 2017. Available from: www.andeal.org/topic.cfm?menu=2693&cat=2708.
4. Frankenfield DC, Rowe WA, Smith JS, et al. Validation of several established equations for resting metabolic rate in obese and non-obese people. J Am Diet Assoc. 2003; 103: 152-159
Energy-predictive equations vary widely in their accuracy and results are influenced by the practitioner’s choice of actual weight, ideal weight or adjusted weight. The Academy of Nutrition and Dietetics conducted a systematic review to evaluate estimated energy generated by the commonly-used equations compared to indirect calorimetry measuring RMR. The Mifflin-St Jeor equation was recommended as the most accurate formula for obese individuals. See the table below for the range of accuracy reported for the Mifflin-St Jeor and Harris-Benedict equations. Further information on the Owens and WHO formulas is reported in the Tool Kit.(1,2)
See the Tool Kit for a comparison of how well these formulas estimate RMR when compared to measured RMR.
| EQUATIONS | Estimated Energy Generated by Equations Compared to Indirect Calorimetry Measuring RMR(3,4) | ||
| USING ACTUAL BODY WEIGHT | USING IDEAL BODY WEIGHT | USING ADJUSTED BODY WEIGHT | |
| Mifflin-St Jeor | Overestimated by 15% and underestimated by 20% | Not tested with IBW | Overestimated by 5% and underestimated by 94% |
| Harris-Benedict | Overestimated by 43% and underestimated by 35% | Overestimated by 5% and underestimated by 94% | Overestimated by 25% and underestimated by 42% |
References
1. Seagle HM, Straibn GW, Makris A, Reeves RS, American Dietetic Association. Position of the American Dietetic Association: Weight Management. JADA. 2009; 109: 330-346.
2. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014; 129: S102-138.
3. Academy of Nutrition and Dietetics. Table 3 Conclusion Statements, Accuracy of RMR Estimations. 2006; Accessed 12 September 2017. Available from: www.andeal.org/topic.cfm?menu=2693&cat=2708.
4. Frankenfield DC, Rowe WA, Smith JS, et al. Validation of several established equations for resting metabolic rate in obese and non-obese people. J Am Diet Assoc. 2003; 103: 152-159
Updated September 12, 2017