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Resting Metabolic Rate in Moderate Obesity
Resting Metabolic Rate in Moderate Obesity
Resting Metabolic Rate in Moderate Obesity
KONSTANTIN N. PAVLOU, SC.D. MARTHA A. HOEFER, B.A. GEORGE L. BLACKBURN, M.D., PH.D.
The predicted resting metabolic rate (pRMR), as is estimated From the Nutrition/Metabolism Laboratory, Cancer Research
by the Harris-Benedict equation (HBE), was compared with the Institute, New England Deaconess Hospital, Harvard Medical
actual resting metabolic rate (mRMR), as assessed by indirect School, and Nutritional Management, Inc.,
calorimetry, in 31 moderately obese (X above ideal body weight Boston, Massachusetts
= 44 ± 2.8%) male subjects (X age = 48 ± 4.5 years; X weight
= 107.3 ± 17.1 kg; X% fat = 34 ± 3.9). Measured resting met-
abolic rate (mRMR) (1,942 ± 293 kcal/day) was found to be
significantly (p < 0.001) lower than pRMR (2,108 ± 270 kcal/ rate of weight loss. Some of this weight loss is fat due to
day), but significantly higher (p < 0.001) than pRMR kilojoule deficit; the remainder is due to losses in protein
(1,636 ± 133 kcal/day), if ideal body weight was used in the
HBE formula. Individual variation of the mRMR and pRMR and water.7 The inability of many obese patients to sustain
ranged from 65-105% and 95-155% of the expected normal a predetermined rate of weight loss, especially as they near
population values, respectively. The findings suggest that if the their ideal body weight goal, is well known to clinicians.
reduced daily caloric needs observed are added to the metabolic A recently published study attempted to explain this
suppression occurring during dietary restriction, it might explain discrepancy.8 These researchers report that morbidly obese
why many obese individuals experience difficulties in maintaining
predicted rates of weight loss. An equation was derived to predict subjects preparing for gastric bypass surgery demonstrate
RMR in moderately obese male patients. a lower resting metabolic rate (RMR) than is estimated
using the Harris-Benedict Equation (HBE). However, they
O BESITY is considered one of the most common were unable to explain a significant amount of the variance
medical disorders.' Current estimates from the in RMR attributable to the independent variables and
National Center for Health Statistics cite the in- therefore could not propose a clinically useful equation
cidence of obesity (defined as > 130% of ideal body weight) to predict more accurately the daily kilojoule needs for
at 14% for males and 27% for females.2 Its treatment is the obese.
credited with a concomitant reduction in the incidence In an effort to develop a new standard predictive equa-
of such life-threatening conditions as coronary heart dis- tion of the RMR of the obese patients, we compared the
ease, hypertension, and diabetes.3'4 predicted resting metabolic rate (pRMR), as is estimated
The various treatment techniques available5 attempt by the HBE, with measured resting metabolic rate
to create an energy imbalance in which daily caloric ex- (mRMR), as assessed by indirect calorimetry in moder-
penditure exceeds the prescribed kilojoule intake. To ately obese male subjects.
achieve this, standard predictor equations are used to es-
timate resting energy needs6 with an additional 20% for Methods
daily physical activity.
During the initial weeks of dietary treatment, almost Thirty-one moderately obese male subjects participated
every patient demonstrates a psychologically gratifying in a study of weight loss resulting from a 4180 kj (1000
kcal) balanced deficit diet and an aerobic exercise pro-
gram. Analysis of the baseline RMR measurements of
Reprint requests: Dr. Pavlou, Cancer Research Institute, 194 Pilgrim these men prior to dietary intervention is presented here.
Road, Boston, MA 02215. They ranged from 30 to 60 years ofage (X age = 48 ± 8.5
Submitted for publication: September 16, 1985. years), and 21 to 70 (X = 44 ± 15.6)% above ideal body
136
Vol. 203 * No. 2 RESTING ENERGY EXPENDITURE IN MODERATE OBESITY 137
TABLE 1. Anthropometric Characteristics*
Age Height Weight LBM
N (years) (cm) (kg) AIBW % (kg) FM %
31 48.5 ± 4.5 178.1 ± 5.1 107.3 ± 17.1 44.5 ± 15.8 68.4 ± 10.7 36.4 ± 11.2
* Mean ± S.D. LBM = lean body mass. AIBW = above ideal body weight. FM = fat mass. Patients ranged from 21 to 70% above ideal
body weight.
weight9 (X% fat = 36.4 ± 11.2) (Table 1). Medical screen- HBE calculations were performed using a Student's two
ing found them free of any physical, psychological, or tailed t-test for paired data, with a level of significance set
metabolic impairment. These men had previously at- at alpha = 0.05. All analyses were done using the Statistical
tempted to lose weight. Many had failed to lose significant Analysis System (SAS, SAS Institute Inc., Cary, NC).
amounts of weight, citing a discouraging inability to Linear regression analysis was performed to assess the
maintain the rate of weight loss demonstrated in the early relationship between mRMR and pRMR, using both ideal
phase of their weight loss regimen; others had been unable weight and current weight in the HBE. Multiple regression
to maintain the weight loss they had achieved. analysis was used to describe the relationship between
To prevent any confounding of the measurement of mRMR and the predictive variables height, age, weight,
RMR, patients were required to report to the pulmonary and per cent above ideal body weight (% AIBW) and to
laboratory in the postabsorptive state (8-12 hours after develop a clinically useful predictor equation for appli-
the last meal). In addition, caffeine-containing beverages cation in obese male populations.
were prohibited during the premeasurement period, and
subjects did not engage in any physical activity or smoke Results
any cigarettes during that period. Statistical analysis showed that the predicted values of
Patients rested for 30 to 45 minutes, reclined in a dark- RMR were indeed significantly different from the mea-
ened, quiet, and comfortable room. Thereafter, while sured values in our obese, male population. Measured
subjects rested supine in bed, one author (KP, with the resting metabolic rate (mRMR = 8118 ± 1246 kj/day)
help of an assistant, a trained, hospital-based pulmonary was found to be significantly lower (p < 0.001) than pre-
technician) measured resting metabolic rate (mRMR) ev- dicted resting metabolic rate using current weight in HBE
ery 30 seconds by indirect calorimetry, using the Beckman (pRMR (current) = 8811 ± 1129 kj/day). Measured RMR
Horizon metabolic measurement cart (Beckman Instru- (mRMR) was significantly higher (p < 0.001) than pRMR
ments, Inc., Schiller Park, IL). The system measures ox- (X = 6838 ± 556 kj/day) if ideal body weight was used
ygen consumption (V02 ml/min) and carbon dioxide in the calculation (Table 2).
production (CO2 ml/min). Resting metabolic rate was au- Measured RMR (mRMR) was 92 ± 10% of the pRMR
tomatically calculated by the abbreviated Weir formula'0 (current weight) and 119 ± 12% of the pRMR (ideal) (Ta-
and expressed in kcal/min and kcal/day by the equation: ble 2). Individual variation of the mRMR ranged from
RMR in kcal/day 65 to 109% of the expected normal values, with only 64%
of them having RMR within ± 10% of the expected (Fig.
= 3.94 X V02(L/min) + 1.1 X VCO2(L/min). 2). When mRMR was expressed as per cent of expected,
Kcalories were converted to kj by multiplying them with with ideal body weight in the HBE, only 26% of the pa-
the factor 4.18. To assure the validity of our RMR mea-
surements, mean values achieved during the last 10 min- w
utes of steady state (Fig. 1) were used in the calculations.
Predicted resting metabolic rate (pRMR) was calculated I-
from the Harris-Benedict Equation6 for males: Averoge value for
6.0 '(calculating
0 _ mRMR
RMR in kj/day 4
E
5.8
5.6
= [5(H) + 13.7(W) + 66 - 6.8(A)] X 4.18, _ 5.4
5.2
z
where H = height in cm, W = weight in kg (current and CO 1 2 3 4 5 6 7 8 9 40
ideal), A = age in years. Comparisons between measured w
MINUTES
RMR (mRMR) and predicted RMR using current weight
[pRMR (current)] or ideal weight [pRMR (ideal)] in the FIG. 1. Pattern of caloric needs during steady state measurement.
PAVLOU, HOE-ER, AND BLACKBURN Ann. Surg. * February 1986
138
TABLE 2. Measured and Predicted Resting Metabolic Rate (RMR)*
Predicted (kj/day) RMR (Expressed as % Expected)
Measured
Current Weight Ideal Weight (kj/day) Ideal Weight Current Weight
8811±1129t 6838 ±556t 8118±1246
(2108 ± 270 kcal) (1636 ± 133 kcal) (1942 ± 298 kcal) 119 ± 12 92 ± 10
Predicted = using Harris-Benedict equation. Measured = using Indirect Calorimetry. * = mean + S.D.; t = p < 0.001 vs. measured.
tients were found to be within ± 10% of the expected nor- lojoule intake has been attributed to the metabolic re-
mal, with individual variation ranging from 76 to 150% sponse to kilojoule restriction imposed. This restriction
of expected values (Fig. 3). decreases resting metabolic rate (RMR), as reported in
Linear regression analysis showed a statistically signif- previous studies.' 2 The present investigation reports that
icant (p < 0.001) correlation (r = +0.79) between mRMR even without kilojoule restriction, obese individuals are
and pRMR predicted by the HBE (Table 3). Multiple characterized by a suppressed RMR when compared to
regression analysis with height, weight, age, and per cent individuals of normal body weight and body composition.
of above ideal body weight as independent variables Our data are in general agreement with the findings of
showed a statistically significant (p < 0.001) correlation Feurer's recently published study8 reporting that obese
(r = +0.81) between these indices and mRMR (Table 3). individuals preparing to undergo gastric bypass surgery
The regression equation resulting from our analysis: demonstrate a lower resting metabolic rate (mRMR) than
mRMR (kj/day) = [2089.7 - 8. 1(Ht) + 16.8 l(Wt) is estimated by the Harris-Benedict formula (HBE). This
should be of no surprise, since the HBE was derived from
- 8.9(Age) - 1.03(% AIBW)] X 4.18 136 male subjects with normal body weight and com-
accounts for 66% of the variance in measured RMR. position. No obese subjects were included in the popu-
lation studied to develop the HBE.6
Discussion Although Feurer's study clearly demonstrates that "the
resting energy expenditure of morbidly obese persons
The main reason for the observed reduction in the rate cannot be estimated accurately by the Harris-Benedict
of weight loss among obese individuals with restricted ki- formula," it failed to derive a new equation that will more
precisely estimate daily kilojoule needs. Feurer's corre-
lation coefficients of +0.46 (r2 = 0.18) for the male pop-
40 ulation accounted for only a small amount of the variance
35-
30_ Norma
z 25-
0.
*10
5-
0 60 70.. 80 10090 o 120
MesrdRMR:as % of Epce 80 90 {00 41 0 120 t30 140
(alon -CuretWeigt) Mea d RM as % of Expced
(Balon
FIG. 2. When current body weight was used in the calculations, only
64% of the obese patients, as compared to 92% of Boothby's13 normal, FIG. 3. When ideal body weight was used in the calculations, only 26%
healthy volunteers, had measured resting metabolic rates that were within of the patients had measured resting metabolic rates within ± 10% of the
+ 10% of expected values. expected values.
-
Vol. 203 No. 2 RESTING ENERGY EXPENDITURE IN MODERATE OBESITY 139
TABLE 3. Regression Equation for Resting Metabolic Rate (RMR) in Men
r r2 p
RMR kj/day = [-169.1 + 1.02 pRMR (current)] X 4.18 0.79 0.63 <0.001
RMR kj/day = [2089.7 - 8.17 H + 16.81 W - 8.9 A - 1.03 %AIBW] X 4.18 0.81 0.66 <0.001
H = height (cm); W = weight (kg); A = age (years). pRMR = predicted rent weight. %AIBW = per cent above ideal body weight.
resting metabolic rate with Harris-Benedict equation. WCW = with cur-
and thus are not of much clinical use. Their inability to the relationship and indicates that the relative degree of
develop a new equation may be attributed to the heter- obesity provides a significant factor in more precisely es-
ogeneity of the study population, which demonstrated a timating RMR in moderately obese male subjects. The
degree of obesity ranging from 57-226% above ideal body implications of this finding might be important, since,
weight (% AIBW) and a mean (% AIBW) of 111 ± 35%. during the first 2 to 3 weeks on the dietary treatment,
In comparison, we chose to study a more homogeneous almost every patient demonstrates a psychologically grat-
group of obese male subjects, with a degree of obesity ifying rate of weight loss. As mentioned earlier, some of
ranging from 21-70% AIBW (X = 44 ± 16% AIBW). this weight loss is due to kilojoule deficit and some is due
The significant correlation coefficient of +0.81 to protein and water losses.7 But a rather large number
(r2 = 0.66) found between mRMR and age, height, weight, of patients drop out of treatment at 4 to 5 weeks, especially
and % AIBW indicates that these indices adequately pre- those patients on balanced deficit diets. Most often, these
dict the caloric needs of the metabolically active tissues patients are generally classified as "noncompliant" despite
in moderately obese male subjects (Table 3). The addition the patients' insistence of the opposite.
of the index of % AIBW as an independent variable in To demonstrate the extent of the possibility to miscal-
the multiple regression analysis increases the strength of culate daily kilojoule needs in obesity when the HBE is