Accuracy of resting energy expenditure calculations in unselected overweight and obese patients.

AIMS: Measurements of resting energy expenditure (REE) were compared with the data of 14 equations to determine their accuracy. METHODS: REE measurements by indirect calorimetry in 1,032 unselected overweight and obese men (n = 306) and women (n = 726) were compared with calculations by 14 different formulas. RESULTS: The mean (± SD) values calculated with the Owen, Robertson and Reid and WHO-I equations were not significantly different from our measurement of 1,682 ± 441.9 kcal/24 h. The values obtained with the Livingston, Mifflin, Müller and Bernstein equations were significantly different but still within a range of ±100 kcal/24 h. For females, the best comparison was observed with the Müller equation which, however, differed substantially in males. For men, the Cunningham equation was best, but it gave the worst comparison in women. A good individual match was only obtained with the equation of Robertson and Reid in 34% of the men and with the Owen equation in 38% of the women. All other formulas were less accurate. Drug treatment for 55% of the subjects had no effect on the mismatch between calculated and measured data. CONCLUSION: Calculations of REE with most equations seem to be valid in a group analysis but they are not helpful for the estimation of an obese patient's individual energy expenditure.

Impact of breakfast on daily energy intake--an analysis of absolute versus relative breakfast calories.

OBJECTIVE: The role of breakfast energy in total daily energy intake is a matter of debate. Acute feeding experiments demonstrated that high breakfast energy leads to greater overall intake supported by cross-sectional data of a free-living population. On the other hand, a large intraindividual analysis has indicated that a high proportion of breakfast to overall intake is associated with lower daily energy intake. To evaluate these apparently contradictory results in greater detail both ways of analysis were applied to the same data set of dietary records. METHODS: On an intraindividual basis total daily energy intake was related to the absolute values of breakfast energy intake or to the ratio of breakfast to overall intake, respectively. Food intake of 280 obese and 100 normal weight subjects was analyzed who recorded over 10 (obese) or 14 (normal weight) consecutive days, respectively. RESULTS: Increasing breakfast energy was associated with greater overall intake in normal weight and obese subjects. The increasing ratio of breakfast to total daily energy intake was associated with a significant reduction of overall intake on days where post-breakfast energy was significantly reduced. Correlational and multiple regression analysis support the concept that absolute breakfast calories have the strongest influence on daily energy intake. CONCLUSION: Reduced breakfast energy intake is associated with lower total daily intake. The influence of the ratio of breakfast to overall energy intake largely depends on the post-breakfast rather than breakfast intake pattern. Therefore, overweight and obese subjects should consider the reduction of breakfast calories as a simple option to improve their daily energy balance.

Successful weight loss and maintenance in everyday clinical practice with an individually tailored change of eating habits on the basis of food energy density.

BACKGROUND: Weight change was analyzed in a cohort of obese patients whose eating habits were changed individually mainly on the basis of food energy density (ED) to evaluate the feasibility of this concept for a larger controlled trial. METHOD: Five hundred and thirteen outpatients were treated between January 2003 and December 2006. Dietary counseling was based on a pretreatment food diary. In January 2008, a follow-up (FU) was made. For pre- and post-change eating habits, 5184 dietary protocols of 189 patients were analyzed. RESULTS: During 10.5 months of treatment, patients lost weight from an initial BMI of 38.8 ± 8.5 by -0.195 kg/m(2) per month; 36% had weight loss >5%, 44% lost 0-4.9% and 20% had weight gain. At follow-up, 413 patients (80.5%) were reached of whom 80 were still in treatment while 333 were considered as self-treatment (ST) group. The ST group had further weight loss by -0.053 kg/m(2) per month over 16.8 months (40% weight loss, 46% maintenance and 14% weight gain), and 164 patients with type-2-diabetes had greater weight loss compared to those without diabetes during ST (Δ-BMI-0.166 vs. -0.028 points/month; p < 0.0001). Energy intake (EI) was reduced by lower ED, beverages and number of meals. Average carbohydrate, fat and protein intake was reduced by 28, 42, and 7%, respectively. CONCLUSION: In a unselected cohort of substantially obese patients, the individual change of eating habits based primarily on food ED in conjunction with beverage intake and meal frequency weight loss continued beyond the supported treatment phase indicating a good patient adherence. We consider these data as an encouraging pilot study that certainly requires confirmation under controlled conditions.

Contribution of energy density and food quantity to short-term fluctuations of energy intake in normal weight and obese subjects.

BACKGROUND: In normal weight subjects it is known that day-to-day energy intake (EI) can vary substantially while this question has not been examined in obese subjects. From acute feeding experiments one would assume that these perturbations are mainly due to differences in food energy density (ED). However, food quantity (FQ) during single meals, number of meals, cognitive and sensory mechanisms may also contribute to the modification of EI. OBJECTIVE AND DESIGN: To obtain more detailed information about day-to-day variations of food intake food diaries recorded during 10 consecutive days of 280 obese and 100 normal weight subjects were examined. RESULTS: The chronological analysis shows a fairly constant pattern for EI, FQ and ED in both groups. The group analysis, however, masks individual fluctuations since the coefficients of variation were between 20 and 24% for the three parameters, respectively. This corresponds to a range of 1,200 kcal. Sixty-five percent can be accounted for changes in FQ and 35% as the result of variations in ED. Snacks between main meals account for 20% of daily EI but only 10% of FQ. Furthermore, snack EI is not compensated during main meals. CONCLUSION: Small day-to-day changes of EI are due to increased meal quantities while greater fluctuations are also due to higher food ED. The present data suggest that modification of FQ by cognitive and sensory factors plays an important role in the variation of daily EI under real life conditions with no major difference between normal weight and obese subjects.