Submitted to: Obesity
Publication Type: Peer reviewed journal
Publication Acceptance Date: 5/1/2007
Publication Date: 12/1/2007
Citation: Butte, N.F., Christiansen, E., Sorensen, T.I.A. 2007. Energy imbalance underlying the development of childhood obesity. Obesity. 15(12):3056-3066. Interpretive Summary: Childhood obesity arises from an imbalance between energy intake and energy expenditure; however, the excess amount of energy intake and/or decreased amount of energy expended in physical activity underlying weight gain in children is uncertain. The objective of this study was to develop a model to predict the total energy cost of weight gain and the increase in energy intake and/or decrease in physical activity level associated with varying rates of weight gain. The model was developed using one-year changes in weight and body composition, and basal metabolic rate in 488 Hispanic children and adolescents. We found that total energy cost of weight gain is divided into energy storage (24-36%), increase in energy expenditure (40-57%), cost of tissue synthesis (8-13%), and diet induced energy expenditure (10%). Average weight gain of 6.1 (2.4-11.4) kg/year corresponds to a total energy cost of 244 (93-448), 267 (101-485), and 290 (110-527) kcal/d at light, moderate and high levels of physical activity, respectively. Our model implies that halting the progression of childhood obesity will require a sizable decrease in energy intake and/or increase in physical activity in children.
Technical Abstract: The objective of this study was to develop a model based on empirical data and human energetics to predict the total energy cost of weight gain and obligatory increase in energy intake and/or decrease in physical activity level associated with weight gain in children and adolescents. One-year changes in weight and body composition and basal metabolic rate (BMR) were measured in 488 Hispanic children and adolescents. Fat-free mass (FFM) and fat mass (FM) were measured by DXA and BMR by calorimetry. Model specifications include the following: body mass (BM) = FFM + FM, each with a specific energy content, cff (1.07 kcal/g FFM), and cf (9.25 kcal/g FM), basal energy expenditure (EE), kff and kf, and energetic conversion efficiency, eff (0.42) for FFM and ef (0.85) for FM. Total energy cost of weight gain is equal to the sum of energy storage, EE associated with increased BM, conversion energy (CE), and diet-induced EE (DIEE). Sex- and Tanner stage-specific values are indicated for the basal EE of FFM (kff) and the fat fraction in added tissue (fr). Total energy cost of weight gain is partitioned into energy storage (24% to 36%), increase in EE (40% to 57%), CE (8% to 13%), and DIEE (10%). Observed median (10th to 90th percentile) weight gain of 6.1 kg/yr (2.4 to 11.4 kg/yr) corresponds at physical activity level (PAL) = 1.5, 1.75, and 2.0 to a total energy cost of weight gain of 244 (93 to 448 kcal/d), 267 (101 to 485 kcal/d), and 290 kcal/d (110 to 527 kcal/d), respectively, and to a total energy intake of 2695 (1890 to 3730), 3127 (2191 to 4335), and 3551 (2487 to 4930) kcal/d, respectively. If weight gain is caused by a change in PAL alone and PAL(0) = 1.5 at baseline t = 0, the model indicates a drop in PAL of 0.22 (0.08 to 0.34) units, which is equivalent to 60 (18 to 105) min/d of walking at 2.5 mph. Halting the development or progression of childhood obesity, as observed in these Hispanic children and adolescents, by counteracting its total energy costs will require a sizable decrease in energy intake and/or reciprocal increase in physical activity.