Resting Energy Expenditure
Predicting Velocity of Weight Loss
KONSTANTIN N. PAVLOU, SC.D. MARTHA A. HOEFER, B.A.
The predicted resting metabolic rate (pRMR), as is estimated
by the Harris-Benedict equation (HBE), was compared with the
actual resting metabolic rate (mRMR), as assessed by indirect
calorimetry, in 31 moderately obese (X above ideal body weight
= 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/
day), but significantly higher (p < 0.001) than pRMR
(1,636 ± 133 kcal/day), if ideal body weight was used in the
HBE formula. Individual variation of the mRMR and pRMR
ranged from 65-105% and 95-155% of the expected normal
population values, respectively. The findings suggest that if the
reduced daily caloric needs observed are added to the metabolic
suppression occurring during dietary restriction, it might explain
why many obese individuals experience difficulties in maintaining
predicted rates of weight loss. An equation was derived to predict
RMR in moderately obese male patients.
O BESITY is considered one of the most common
medical disorders.' Current estimates from the
National Center for Health Statistics cite the in-
cidence of obesity (defined as > 130% of ideal body weight)
at 14% for males and 27% for females.2 Its treatment is
credited with a concomitant reduction in the incidence
of such life-threatening conditions as coronary heart dis-
ease, hypertension, and diabetes.3'4
The various treatment techniques available5 attempt
to create an energy imbalance in which daily caloric ex-
penditure exceeds the prescribed kilojoule intake. To
achieve this, standard predictor equations are used to es-
timate resting energy needs6 with an additional 20% for
daily physical activity.
During the initial weeks of dietary treatment, almost
every patient demonstrates a psychologically gratifying
Reprint requests: Dr. Pavlou, Cancer Research Institute, 194 Pilgrim
Road, Boston, MA 02215.
Submitted for publication: September 16, 1985.
136
in Moderate Obesity
GEORGE L. BLACKBURN, M.D., PH.D.
From the Nutrition/Metabolism Laboratory, Cancer Research
Institute, New England Deaconess Hospital, Harvard Medical
School, and Nutritional Management, Inc.,
Boston, Massachusetts
rate of weight loss. Some of this weight loss is fat due to
kilojoule deficit; the remainder is due to losses in protein
and water.7 The inability of many obese patients to sustain
a predetermined rate of weight loss, especially as they near
their ideal body weight goal, is well known to clinicians.
A recently published study attempted to explain this
discrepancy.8 These researchers report that morbidly obese
subjects preparing for gastric bypass surgery demonstrate
a lower resting metabolic rate (RMR) than is estimated
using the Harris-Benedict Equation (HBE). However, they
were unable to explain a significant amount of the variance
in RMR attributable to the independent variables and
therefore could not propose a clinically useful equation
to predict more accurately the daily kilojoule needs for
the obese.
In an effort to develop a new standard predictive equa-
tion of the RMR of the obese patients, we compared the
predicted resting metabolic rate (pRMR), as is estimated
by the HBE, with measured resting metabolic rate
(mRMR), as assessed by indirect calorimetry in moder-
ately obese male subjects.
Methods
Thirty-one moderately obese male subjects participated
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
these men prior to dietary intervention is presented here.
They ranged from 30 to 60 years ofage (X age = 48 ± 8.5
years), and 21 to 70 (X = 44 ± 15.6)% above ideal body
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-
ing found them free of any physical, psychological, or
metabolic impairment. These men had previously at-
tempted to lose weight. Many had failed to lose significant
amounts of weight, citing a discouraging inability to
maintain the rate of weight loss demonstrated in the early
phase of their weight loss regimen; others had been unable
to maintain the weight loss they had achieved.
To prevent any confounding of the measurement of
RMR, patients were required to report to the pulmonary
laboratory in the postabsorptive state (8-12 hours after
the last meal). In addition, caffeine-containing beverages
were prohibited during the premeasurement period, and
subjects did not engage in any physical activity or smoke
any cigarettes during that period.
Patients rested for 30 to 45 minutes, reclined in a dark-
ened, quiet, and comfortable room. Thereafter, while
subjects rested supine in bed, one author (KP, with the
help of an assistant, a trained, hospital-based pulmonary
technician) measured resting metabolic rate (mRMR) ev-
ery 30 seconds by indirect calorimetry, using the Beckman
Horizon metabolic measurement cart (Beckman Instru-
ments, Inc., Schiller Park, IL). The system measures ox-
ygen consumption (V02 ml/min) and carbon dioxide
production (CO2 ml/min). Resting metabolic rate was au-
tomatically calculated by the abbreviated Weir formula'0
and expressed in kcal/min and kcal/day by the equation:
RMR in kcal/day
= 3.94 X V02(L/min) + 1.1 X VCO2(L/min).
Kcalories were converted to kj by multiplying them with
the factor 4.18. To assure the validity of our RMR mea-
surements, mean values achieved during the last 10 min-
utes of steady state (Fig. 1) were used in the calculations.
Predicted resting metabolic rate (pRMR) was calculated
from the Harris-Benedict Equation6 for males:
RMR in kj/day
= [5(H) + 13.7(W) + 66 - 6.8(A)] X 4.18,
where H = height in cm, W = weight in kg (current and
ideal), A = age in years. Comparisons between measured
RMR (mRMR) and predicted RMR using current weight
[pRMR (current)] or ideal weight [pRMR (ideal)] in the
HBE calculations were performed using a Student's two
tailed t-test for paired data, with a level of significance set
at alpha = 0.05. All analyses were done using the Statistical
Analysis System (SAS, SAS Institute Inc., Cary, NC).
Linear regression analysis was performed to assess the
relationship between mRMR and pRMR, using both ideal
weight and current weight in the HBE. Multiple regression
analysis was used to describe the relationship between
mRMR and the predictive variables height, age, weight,
and per cent above ideal body weight (% AIBW) and to
develop a clinically useful predictor equation for appli-
cation in obese male populations.
Results
Statistical analysis showed that the predicted values of
RMR were indeed significantly different from the mea-
sured values in our obese, male population. Measured
resting metabolic rate (mRMR = 8118 ± 1246 kj/day)
was found to be significantly lower (p < 0.001) than pre-
dicted resting metabolic rate using current weight in HBE
(pRMR (current) = 8811 ± 1129 kj/day). Measured RMR
(mRMR) was significantly higher (p < 0.001) than pRMR
(X = 6838 ± 556 kj/day) if ideal body weight was used
in the calculation (Table 2).
Measured RMR (mRMR) was 92 ± 10% of the pRMR
(current weight) and 119 ± 12% of the pRMR (ideal) (Ta-
ble 2). Individual variation of the mRMR ranged from
65 to 109% of the expected normal values, with only 64%
of them having RMR within ± 10% of the expected (Fig.
2). When mRMR was expressed as per cent of expected,
with ideal body weight in the HBE, only 26% of the pa-
w
I-
Averoge value for
6.0 '(calculating
0 _ mRMR
4
E
5.8
5.6
_ 5.4
5.2
z
CO 1 2 3 4 5 6 7 8 9 40
w
MINUTES
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-
mal, with individual variation ranging from 76 to 150%
of expected values (Fig. 3).
Linear regression analysis showed a statistically signif-
icant (p < 0.001) correlation (r = +0.79) between mRMR
and pRMR predicted by the HBE (Table 3). Multiple
regression analysis with height, weight, age, and per cent
of above ideal body weight as independent variables
showed a statistically significant (p < 0.001) correlation
(r = +0.81) between these indices and mRMR (Table 3).
The regression equation resulting from our analysis:
mRMR (kj/day) = [2089.7 - 8. 1(Ht) + 16.8 l(Wt)
- 8.9(Age) - 1.03(% AIBW)] X 4.18
accounts for 66% of the variance in measured RMR.
Discussion
The main reason for the observed reduction in the rate
of weight loss among obese individuals with restricted ki-
40
35-
30_ Norma
z 25-
lojoule intake has been attributed to the metabolic re-
sponse to kilojoule restriction imposed. This restriction
decreases resting metabolic rate (RMR), as reported in
previous studies.' 2 The present investigation reports that
even without kilojoule restriction, obese individuals are
characterized by a suppressed RMR when compared to
individuals of normal body weight and body composition.
Our data are in general agreement with the findings of
Feurer's recently published study8 reporting that obese
individuals preparing to undergo gastric bypass surgery
demonstrate a lower resting metabolic rate (mRMR) than
is estimated by the Harris-Benedict formula (HBE). This
should be of no surprise, since the HBE was derived from
136 male subjects with normal body weight and com-
position. No obese subjects were included in the popu-
lation studied to develop the HBE.6
Although Feurer's study clearly demonstrates that "the
resting energy expenditure of morbidly obese persons
cannot be estimated accurately by the Harris-Benedict
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-
ulation accounted for only a small amount of the variance

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
develop a new equation may be attributed to the heter-
ogeneity of the study population, which demonstrated a
degree of obesity ranging from 57-226% above ideal body
weight (% AIBW) and a mean (% AIBW) of 111 ± 35%.
In comparison, we chose to study a more homogeneous
group of obese male subjects, with a degree of obesity
ranging from 21-70% AIBW (X = 44 ± 16% AIBW).
The significant correlation coefficient of +0.81
(r2 = 0.66) found between mRMR and age, height, weight,
and % AIBW indicates that these indices adequately pre-
dict the caloric needs of the metabolically active tissues
in moderately obese male subjects (Table 3). The addition
of the index of % AIBW as an independent variable in
the multiple regression analysis increases the strength of
the relationship and indicates that the relative degree of
obesity provides a significant factor in more precisely es-
timating RMR in moderately obese male subjects. The
implications of this finding might be important, since,
during the first 2 to 3 weeks on the dietary treatment,
almost every patient demonstrates a psychologically grat-
ifying rate of weight loss. As mentioned earlier, some of
this weight loss is due to kilojoule deficit and some is due
to protein and water losses.7 But a rather large number
of patients drop out of treatment at 4 to 5 weeks, especially
those patients on balanced deficit diets. Most often, these
patients are generally classified as "noncompliant" despite
the patients' insistence of the opposite.
To demonstrate the extent of the possibility to miscal-
culate daily kilojoule needs in obesity when the HBE is

TABLE 4. Weight Loss in Two Patients

Patient A Patient B
(Subject #6) (Subject #30)
pRMR* Measured pRMR Measured
Weight (kg) 91.5 92.2
Lean Body Mass (kg) 42.5 (46.5%) 64.5 (70%)
Kcal/kg. LBM-' 27.8 28.7
Height (cm) 180.0 183.0
Age (yrs) 59.0 53.0
Resting energy expenditure (kj/day) 7603 4932 7511 7729
(1819 kcal) (1180 kcal) (1797 kcal) (1849 kcal)
20% added for daily activity (kj/day) 1521 986 1651 1534
Total kilojoule need (kj/day) 9125 5910 9012 9263
Minus 10% metabolic suppression due
to diet (kj/day) 911 594 903 928
Actual kilojoule need (kj/day) 8176 5325 8109 8335
Minus kilojoule intake (kj/day) 4180 4180 4180 4180
Daily kilojoule deficit -4034 -1145 -3929 -3946
Kilojoule deficit in 7 weeks of -197,639 -56,121 -192,531 -203,591
treatment (-47,282 kcal) (-13,426 kcal) (-46,060 kcal) (-48,706 kcal)
Weight loss (kg) (kj + 33,440) 5.9 1.7 5.7 6.1
Comments: Dropped out during week 4 of the Loss of 7.2 kg after 7 weeks of treatment.
treatment without weight loss.
* pRMR = using current weight in the HBE.
140 PAVLOU, HOEFER,
used in the calculations, it is worth looking at two extreme
cases from this study. Subjects #6 and #30 (Table 4) are
characterized by similar age, weight, and height. If we
utilize the Harris-Benedict Equation using current weight,
we see that both patients are predicted to demonstrate
similar daily kilojoule needs and would expect to dem-
onstrate similar rates of weight loss. However, the RMR
of Subject #6 was overestimated by 54%, or 2888 kj per
day. Both subjects participated in a 7-week weight loss
program with 4180 kj daily intake. Subject #6 dropped
out of the study at week 4, unable to sustain a satisfactory
rate of weight loss beyond the first 2 weeks of the study.
As is illustrated in Figure 2, only 64% of the patients
had metabolic rates within ± 10% of the expected values
using current weight, whereas 92% of the normal body
weight, healthy volunteers studied by Boothby13 had rest-
ing metabolic rates within ± 10% of the predicted. The
mRMR of Patient B (Subject #30) of this study occurred
at 101% of the expected. As is shown in Table 4, the weight
loss predicted by using current weight in the HBE (5.7
kg) is similar in his case to predicted weight loss using
mRMR in the calculations. In addition to the 4180 kj per
day diet, the patient participated in a three-times-per-week
exercise program and achieved 7.2 kg of weight loss.
Like 36% of the subjects in this study, Patient A (Subject
#6) demonstrated a metabolic rate of <90% (66%) of ex-
pected (Fig. 1); his mRMR was only 66% of expected.
Patient A's metabolic rate was overestimated by 54%
(4932 vs. 7603 kj/day). It should be clear from this dis-
cussion that for Patient A to register a similar rate of weight
loss to Patient B, he should be placed on a very different
weight loss regimen, such as a very-low-calorie-diet (2090
kj/day) requiring strict medical monitoring.
It is of interest to note the similarities of the distribution
between Feurer's data and ours when mRMR is expressed
as per cent of expected, based either on current weight
(Fig. 2) or ideal body weight (Fig. 3). When compared to
normal weight and body composition population, the
distribution clearly illustrates that RMR of obese individ-
uals, as a group, is clearly suppressed (Fig. 2) but higher
than if the individual's ideal body weight is used in the
calculation (Fig. 3).
Although our data show that moderately obese subjects
demonstrate lower RMR than is estimated by the HBE,
they are in general agreement with previous reports in-
dicating that obese subjects have higher metabolic rates
when compared to individuals with normal weight and
body composition.'4"15 This increased metabolic rate is
probably due to greater lean body mass (LBM) present
in obese when compared to lean subjects,'6"'7 since LBM
has been found to correlate highly with RMR.' "8"9 Rest-
ing metabolic rate expressed in kj per kg of body weight
AND BLACKBURN Ann. Surg. February 1986
(X = 76.5 ± 4.6) and kj per minute (X = 5.6 ± 0.8) was
*
similar to values reported in other studies for obese in-
dividuals, and lower than those of normal weight and
body composition.'5 However, when mRMR was ex-
pressed in kj per kg of LBM, obese individuals exhibit
normal metabolic rate, as is demonstrated by this (X
= 119.7 ± 64.8 kj X kg-' of LBM) and other studies'4"18
even in extreme cases, as is seen in Subjects A and B of
this study (Table 4).
The statistically significant differences between the
mRMR and pRMR noticed in this study are due to
changes in body composition resulting from the obese
state, unaccounted for by the HBE. The increases in body
weight in obesity are mainly due to increases in fat deposits
and an accompanied moderate increase in LBM, which,
although it creates a higher metabolic need, is not high
enough to compensate for the parallel increase in body
weight (fat). Thus, an explanation is provided for the lower
metabolic needs noticed in this study.
The HBE was developed to predict daily kilojoule re-
quirements for normal weight and body composition in-
dividuals. The metabolically altered state of obesity re-
quires a new equation that will more accurately account
for these differences. The equation developed from this
study accurately predicts daily energy expenditure for
moderately obese male subjects with a degree of obesity
ranging from 21-70% above ideal body weight, and its
concluding possible applications and ways to test their
usefulness should be considered.
Acknowledgments
The authors wish to thank the subjects who volunteered for the study
and the pulmonary technician, Patricia Carroll, for her assistance in
indirect calorimetry.
References
1. Bray GA. The Obese Patient. Philadelphia: WB Saunders Co, 1976.
2. National Center for Health Statistics. Abraham S, Obese and over-
weight adults. In U.S. Vital and Health Statistics, Series 11, No.
230, DHHS Pub. No. 83-1680 Public Health Service. Washing-
ton, DC: U.S. Government Printing Office, January 1983.
3. Rabkin SW, Mathewson FA, Hsu PH. Relation of body weight to
development ofischemic heart disease in a cohort of young North
American men after a 26-year observation period: the Manitoba
Study. Am J Cardiol 1977; 39:452-471.
4. Hubert HB, Feinleib M, McNamara PM, et al. Obesity as an in-
dependent risk factor for cardiovascular disease: a 26-year follow-
up of participants in the Framingham Heart Study. Circulation
1983; 67:968-977.
5. Stunkard A. Obesity. In Kaplan HI, Freedman AM, Sardock BG,
eds. The Comprehensive Textbook of Psychiatry, vol II, 3rd ed.
Baltimore: Williams and Wilkins, 1980.
6. Harris JA, Benedict FG. Biometric Studies of Basal Metabolism in
Man. Publication Number 297. Washington, DC: Carnegie In-
stitute of Washington, 1919.
Vol. 203 * No. 2 RESTING ENERGY EXPENDITURE
7. Yang MU, VanItallie TB. Composition of weight lost during short-
term weight reduction: metabolic responses of obese subjects to
starvation and low-calorie ketogenic and nonketogenic diets. J
Clin Invest 1976; 58:722-730.
8. Feurer ID, Crosby LO, Buzby GP, et al. Resting energy expenditure
in morbid obesity. Ann Surg 1983; 197:17-21.
9. Metropolitan Life Insurance Co. data in: Bray GA, ed. Obesity in
Perspective, vol. I. DHEW Publication (NIH) 75.708. Washing-
ton, DC: U.S. Government Printing Office, 1975; 72.
10. Der Weir JB. New methods for calculating metabolic rate with special
reference to protein metabolism. J Physiol 1949; 109:1-9.
11. Apfelbaum M, Bostsarron J, Lacatis D. Effect of caloric restriction
and excessive caloric intake on energy expenditure. Am J Clin
Nutr 1971; 24: 1405-1409.
12. Bray GA. Effect ofcaloric restriction on energy expenditure in obese
patients. Lancet 1969; 2:397-399.
13. Boothby WM. In DuBois EF, ed. Basal Metabolism in Health and
Disease, 3rd ed. Philadelphia: Lea and Febiger, 1936; 163-164.
IN MODERATE OBESITY 141
14. James WPT, Davies HL, Bailes J, Douncex MJ. Elevated metabolic
rates in obesity. Lancet 1978; 1: 1122-1125.
15. Ravussin E, Burnand B, Schutz Y, Jequiez E. Twenty-four-hour
energy expenditure and resting metabolic rate in obese, moder-
ately obese, and control subjects. Am J Clin Nutr 1982; 35:566-
573.
16. Pavlou KN, Steffe WP, Lerman RH, Burrows BA. Effects of dieting
and exercise on lean body mass, oxygen uptake, and strength.
Med Sci Sports Exerc 1985; 17:466-471.
17. Benoit FL, Martin RL, Watten RH. Changes in body composition
during weight reduction in obesity. Ann Intern Med 1965; 63:
604-612.
18. Webb P. Energy expenditure and fat-free mass in men and women.
Am J Clin Nutr 1981; 34:1816-1826.
19. Halliday D, Hesp R, Stalley SF, et al. Resting metabolic rate, weight,
surface area and body composition in obese women. Int J Obes
1979; 3:1-6.