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Predicting basal metabolic rate in the obese is difficult

Article  in  European Journal of Clinical Nutrition · March 2003

DOI: 10.1038/sj.ejcn.1601542 · Source: PubMed

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 European Journal of Clinical Nutrition (2003) 57, 335–340
ß 2003 Nature Publishing Group All rights reserved 0954–3007/03 $25.00
www.nature.com/ejcn

ORIGINAL COMMUNICATION
Predicting basal metabolic rate in the obese is difficult
GW Horgan1* and J Stubbs2

1
Biomathematics and Statistics Scotland, Aberdeen, UK; and 2Rowett Research Institute, Aberdeen, UK

Objective: To reassess the validity of the Schofield equations for predicting basal metabolic rate (BMR) in the obese.
Data: The data collection compiled from many studies by Schofield in 1985.
Methods: Nonparametric curve fitting and comparison of groups.
Results: BMR increases more slowly at heavier weights in men (above about 75 kg) and women (above about 65 kg), and to
ignore this is to predict overestimates of BMR. Data obtained from studies of different populations show substantial differences,
which are influential when data are combined.
Conclusions: The Schofield equations are unsuitable for obese populations. Given that current Western populations exhibit
prevalences of obesity many times greater than those in the Schofield database, this indicates the need for further study of
suitable predictors for these individuals.
Sponsorship: Ministry of Agriculture, Fisheries and Food, UK.
European Journal of Clinical Nutrition (2003) 57, 335 – 340. doi:10.1038=sj.ejcn.1601542

Keywords: obesity; basal metabolic rate; Schofield equations

Introduction
Many studies have examined the associations between basal
metabolic rate (BMR) and body weight, height, age and a
variety of variables derived from these primary measures
(such as body mass index ¼ weight=height2). The most com-
prehensive examination of the matter to date was carried out
by Schofield (1985a), who assimilated a wide-ranging collec-
tion of data from other published sources, and derived
prediction equations from the combined database. These
equations have been much used as a simple and widely
applicable way of predicting BMR from weight, and possibly
height, when it is impractical to measure it directly. They
have been adopted by the World Health Organisation
(WHO) for general use in predicting BMR (FAO=WHO=
UNU, 1985). Their study was based on an analysis of data,
original and summary, collected in 114 previous studies.
Their results therefore have an authority greater than that
*Correspondence: GW Horgan, Biomathematics and Statistics Scotland,
Rowett Research Institute, Aberdeen AB21 9SB, UK.
E-mail: g.horgan@bioss.ac.uk
Guarantor: GW Horgan.
Contributors: GWH chose the methods, analysed the data and wrote
the paper. JS conceived the project and advised on the biological
significance of the results.
Received 23 August 2001; revised 15 May 2002;
accepted 28 May 2002
of the many local limited studies that have taken place
before and since. However, being compiled from an unstruc-
tured set of data collection obtained for a diverse set of
purposes over a long time range leads to potential problems,
and Schofield (1985a) readily acknowledges the abuse of
sampling assumptions.
However, there has been some doubt about the applica-
bility of these studies to obese individuals. This matter has
been raised by, for example, Pullicino et al (1996), who found
that the Schofield equations systematically underestimated
BMR in a sample of Maltese women. The obese are an
increasing proportion of the population. Among the subjects
used to derive the Schofield equations, 14.6% of those over
16 had a body mass index (BMI) in excess of 25 and 4.5%
were in excess of 30. For a recent UK sample (DOH, 1999) the
corresponding proportions were 40.8 and 9.7%. Because of
the adverse effects of obesity on health, the obese are
increasingly the focus of scientific studies. A central part of
such studies is the comparison of individual energy intake
and expenditure. Estimates of BMR are a central feature of
many such studies, because BMR is used for a variety of
purposes, for example to compare body energy requirements
under a variety of conditions (eg pregnancy, lactation,
undernutrition). They are also used to derive daily energy
requirements as a multiple of BMR, and used for a variety of
clinical and epidemiological purposes. Estimates of BMR
obtained this way can be used to detect misreporting.
 Predicting BMR in the obese
GW Horgan and J Stubbs
336
The Schofield equations are linear in weight, a choice that
was made for ease of computation, and which seems a
reasonable model over much of the weight range of the
individuals studied. The assumption of linearity has been
retained by others who have reassessed the data, such as
Hayter and Henry (1994). Their work also draws attention to
another problem with the data. There are significant differ-
ences in the BMR=weight association between the different
populations comprising the Schofield data. Significant
differences were found between most pairs of groups defined
geographically (north European and American, Indian,
Chinese, Italian), with the Italian group showing the greatest
difference. This is of particular concern, since they comprise
45% of the data.
Our intention here is to question this use of linearity, and
to investigate more carefully the BMR=weight association in
heavier individuals. Any results will be subject to the same
weaknesses as the original Schofield study. To the extent that
the obese are a small subset of the original data, these
weaknesses will be greater: the results will be strongly influ-
enced by just a few of the component studies. We will also
examine differences between groups in this association.
Methods
We have re-examined the data collection compiled for the
Schofield (1985a) study, and described by Schofield (1985b).
Our interest is in adults, and so we have considered only
men and women in the age range 18 – 60. The data comprise
3514 observations on men and 1376 on women, when some
high altitude studies have been excluded. Some of these
observations are not of individuals, but are means of many
individuals. These observations were given appropriately
greater statistical weight in our analysis. Their contribution
to the results was the same as if all individuals were placed at
the mean.
Schofield (1985a) presents, for each sex, separate linear
regressions for ages 18 – 30 and 30 – 60, and a table, intended
to be applicable to all ages under 60. For the 18 – 60 age
group, we have fitted, separately for men and women, a
fourth-order cubic smoothing spline (Hastie & Tibshirani,
1990) to the weight=BMR association. This is a type of
generalized additive model, and can be seen as an alternative
to fitting polynomial terms to a non-linear association
whose true parametric form is unknown. A series of cubic
polynomial curves is constructed, constrained to be contin-
uous in value and slope where they join. The order of the
spline determines how smooth it is. We chose a fourth-order
spline as the data were numerous enough to fit this order,
and a greater order would allow too many fluctuations which
might reflect only artefacts of the different study compo-
nents. Any observations with a standardized residual greater
than 3.5 were rejected as outliers. The effect of the influential
study 20 was examined by recomputing the spline fit when it
had been excluded. This study was of 116 male Chin and
Kachin hill dwellers in Burma (Chitre et al, 1959).
European Journal of Clinical Nutrition
The residuals from the fitted spline were then used to
investigate whether, at fixed weight, BMR changes with
age. This was done by fitting a smoothing spline (again
fourth-order) for age to the BMR=weight residuals. This was
done separately for men and women. We considered this to
be more natural than the separate fitting of prediction
equations for different age groups, as done by Schofield
(1985a). This produced unnatural jumps in predicted BMR,
for example at age 30.
Finally, the residuals from this regression were used, in the
same way, to determine whether there was a marginal
association between BMR and height, at fixed age and
weight. This differs from the multiple regression fitted to
height and weight by Schofield (1985a). Because of the small
effect of height at a given weight, we considered the pre-
sentation of this effect as an adjustment to the main predic-
tion to be more useful.
Results
BMR and weight
Figure 1 shows the fitted spline (r ¼ 0.57) for BMR and
weight for men. Also shown for comparison, are the
Schofield 18 – 30 and 30 – 60 equations, and a table for
under-60s presented in the original paper. The most striking
feature of this plot is that there is good agreement up to
about 75 kg, but that above this weight, mean BMR does not
increase any further, but remains at 7.4 MJ=24 h. Some 13.8%
of the Schofield males over 16 weighed more than 75 kg.
However, 75 kg is now about the weight of the average
western man. The behaviour of BMR in men over 75 kg is
clearly of much greater importance now than when the
Schofield equations were originally derived (as those over
75 kg were such a small proportion of the original data, we
have not achieved substantial improvement in overall
goodness of fit).
Figure 2 shows the corresponding plot for women
(r ¼ 0.70). Here the agreement with the Schofield results is
much closer. There is no levelling off of BMR with increasing
weight, up to 85 kg, although the rate of increase seems to
decrease after about 60 – 65 kg. We present our revised
prediction for BMR based on weight in Table 1.
Figure 3 shows a plot of individual BMR and weight
values for the six largest groups of males over 70 kg. These
are summarised in Table 3. Taken overall, there is no
indication of an increase in BMR with weight: the correla-
tion coefficient is 7 0.08 (P < 0.05). However, within each
group, the correlations are positive. For groups 20, 29, 55,
67, 80 and 84, the correlations are 0.25, 0.20, 0.30, 0.48,
0.30 and 0.14, all but the last being significant at 5%. Thus
there is good evidence that, within populations, BMR does
continue to increase at heavier weights in men. The flat
line in the plot reflects between group differences. If the
group 20, which had the heaviest weights, is omitted, a
different prediction is obtained, and this is also indicated
on Figure 1. A corresponding table is presented in Table 2.
 Predicting BMR in the obese
GW Horgan and J Stubbs
337

Figure 1 Basal metabolic rate vs weight for men. The lines Sch:18 – 30 and Sch:30 – 60 denote predictions based on the Schofield equations for these
age ranges. The line for Sch:18 – 30 is lower below 50 kg and higher above 50 kg. The Table 4 line refers to that table in Schofield (1985a).The Spl-x20
curve is derived with group 20 excluded.

However, it should be remembered that, of the remaining use of any predictions. Adding in the smaller groups did
five large groups, four are Italian military or police, and so not affect the overall pattern seen in Figure 3.
can hardly be considered a statistically representative Differences between groups in women were much less
sample of humanity in general. Caution is needed in the (Figure 4), although this is likely to reflect the smaller

Figure 2 Basal metabolic rate vs weight for women. The lines Sch:18 – 30 and Sch:30 – 60 denote predictions based on the Schofield equations for these
age ranges. The line for Sch:18 – 30 is lower below 50 kg and higher above 50 kg. The Table 4 line refers to that table in Schofield (1985a).

European Journal of Clinical Nutrition

 Predicting BMR in the obese
GW Horgan and J Stubbs
338
Table 1 Mean basal metabolic rate (MJ=24 h) as a function of weight (kg)

Weight Men Women Weight Men Women Weight Men Women

40 5.1 4.5 60 6.8 5.7 80 7.4 6.3

41 5.2 4.6 61 6.8 5.8 81 7.4 6.3
42 5.3 4.6 62 6.9 5.8 82 7.4 6.4
43 5.4 4.7 63 6.9 5.8 83 7.4 6.4
44 5.5 4.8 64 7.0 5.9 84 7.4 6.4
45 5.5 4.8 65 7.1 5.9 85 7.4 64
46 5.6 4.9 66 7.1 5.9 86 7.4 —
47 5.7 5.0 67 7.1 6.0 87 7.4 too
48 5.8 5.0 68 7.2 6.0 88 7.4 little
49 5.9 5.1 69 7.2 6.0 89 7.4 data
50 6.0 5.2 70 7.3 6.1 90 7.4 —
51 6.1 5.2 71 7.3 6.1
52 6.1 5.3 72 7.3 6.1
53 6.2 5.3 73 7.3 6.1
54 6.3 5.4 74 7.3 6.2
55 6.4 5.5 75 7.4 6.2
56 6.5 5.5 76 7.4 6.2
57 6.5 5.6 77 7.4 6.2
58 6.6 5.6 78 7.4 6.3
59 6.7 5.7 79 7.4 6.3

Table 2 Mean basal metabolic rate (MJ=24 h) for men (kg), with
Schofield study 20 excluded

Weight BMR Weight BMR Weight BMR

40 5.1 60 6.7 80 7.6

41 5.3 61 6.8 81 7.6
42 5.3 62 6.9 82 7.6
43 5.4 63 6.9 83 7.7
44 5.5 64 7.0 84 7.7
45 5.5 65 7.1 85 7.7
46 5.6 66 7.1 86 7.7
47 5.7 67 7.2 87 7.7
48 5.8 68 7.2 88 7.8
49 5.9 69 7.2 89 7.8
Figure 3 Plot of BMR against weight for men between 70 and 100 kg 50 6.0 70 7.3 90 7.8
for the six largest groups in the Schofield database. 51 6.0 71 7.3
52 6.1 72 7.4
53 6.2 73 7.4
54 6.3 74 7.4
number of studies than anything about sex differences in 55 6.4 75 7.4
inter-population variation. Five of the six largest groups of 56 6.5 76 7.5
heavier women were in the USA. As for the men, it must be 57 6.5 77 7.5
58 6.6 78 7.5
questioned whether they are statistically representative 59 6.7 79 7.6
of humanity in general.

Table 3 Characteristics of the 6 largest groups of men over 70 kg in the Schofield database
a a a
Group Description Number Age Weight BMR Reference

20 Burmese hill dwellers 99 23.5 84.3 6.5 Chitre et al. (1959)

29 Students at fascist academy 182 22.1 73.3 7.5 Felloni (1936)
55 Italian military 44 22.3 73.0 7.5 Lenti (1937)
67 Hawaiians 34 24.1 77.5 7.4 Miller and Benedict (1937)
80 Neapolitan police 160 38.0 77.0 7.6 Occhiuto and Pepe (1940)
84 Italian navy 101 20.8 73.9 7.7 Pepe (1938)
a
Mean value.

European Journal of Clinical Nutrition

 Predicting BMR in the obese
GW Horgan and J Stubbs
339
be due to greater fat free mass in taller than shorter people
at a fixed weight. The appropriate adjustment is shown in
Table 5. The pattern in men and women is similar.

Discussion
Our intention is not to reject the results presented by
Schofield (1985a). They are applicable to the greater part of
the weight range. Our particular interest is in the over-
weight, which regrettably form an increasing proportion of
most populations. We fitted a nonparametric non-linear
curve (the smoothing spline). This is not a model for how
Figure 4 Plot of BMR against weight for women between 60 and 100 kg
for the six largest groups in the Schofield database (15, Minnesota, USA; BMR increases with weight. Many different convex curves
27, New Orleans, USA; 41, Washington, USA; 59, Ohio, USA; 79, Italy; could have done this and it would have been difficult to
discriminate among them. The non-parametric curve is
flexible and allows predictions to be made if desired —
Table 4 BMR adjustment for age (y) these are in Tables 1 and 2. Departure from linearity can
also be tested, and for the Schofield data it was significant
Men Women (P < 0.001).
We have looked at data in the heavier part of the distribu-
Adjustment Adjustment
Age (MJ=day) Age (MJ=day)
tion of weights in the Schofield data. This has led to the first
of our two conclusions: BMR increases more slowly at heavier
18 – 20 þ 0.1 18 – 23 0.0 weights, and to ignore this is to overpredict BMR in the obese.
21 – 25 0.0 24 – 35 þ 0.1
We have also looked at the different groups that comprise
26 – 60 7 0.1 36 – 41 0.0
42 – 47 7 0.1 the Schofield data, and there are substantial differences, in
48 – 52 7 0.2 mean weight, mean BMR and the association between them,
53 – 56 7 0.3 in these groups. This implies that caution is needed in using
57 – 60 7 0.4
any of our results. Although the sampling may have been
suitably representative within the groups, it cannot be
claimed that the groups are in any sense a statistically
Table 5 BMR adjustment for height
representative sample of human populations in general.
Men Women Hayter and Henry (1994) have already pointed out that a
large proportion of the data were obtained on Italian mili-
Adjustment Adjustment tary trainees, servicemen and police, and that these differ
Height (cm) (MJ=day) Height (cm) (MJ=day) significantly from the rest of the data. We have also seen that
<156 7 0.2 <150 7 0.1 Burmese hill-dwellers, who form an important part of the
157 – 164 7 0.1 151 – 167 0.0 upper tail of the weight distribution, also show different
165 – 176 0.0 168 – 173 þ 0.1 associations between BMR and weight. Our conclusion is
177 – 183 þ 0.1 >174 þ 0.2
>184 þ 0.2
that: any general equation for predicting BMR may be biased
when used for some groups or populations.
We suggest that greater understanding of the deter-
minants of BMR is needed, in order to better guide its
BMR and age prediction from other characteristics when its measurement
Age has only a small effect on BMR, once weight has been is impractical.
accounted for. Our spline regression indicates that some
adjustment should made to the predictions in Table 1.
These are shown in Table 4. We note that the pattern differs Why do obese people have a lower BMR to weight ratio?
between men and women. In women, BMR is highest The apparent differences in the BMR of the obese relative to
between 25 and 35, whereas in men it peaks between 18 the lean can be explained in terms of body size and composi-
and 20. The decrease above 50 in women is much more rapid tion. There is little evidence that obese subjects are characteri-
than in men. zed by an inherently low metabolic rate. Indeed, it has been
repeatedly demonstrated that under standardized conditions
the obese have higher absolute energy requirements than do
BMR and height the lean, due to the greater mass of metabolically active tissue
Once weight is accounted for, height has only a small effect ( James 1992; Rucker, 1978; Jequier, 1984; Prentice et al, 1989).
on BMR. As height increases, BMR increases. This is likely to As weight is gained both fat and fat-free mass are gained.

European Journal of Clinical Nutrition

 Predicting BMR in the obese
GW Horgan and J Stubbs
340
However, this does not occur at a linear rate as body size
increases. As the body gets fatter, a greater ratio of fat to lean
tissue is deposited (Forbes, 1982, 1987). Thus adipose tissue
expands faster than lean tissue. The metabolic rate of adipose
tissue is very low compared with that of lean tissue (Miller &
Blythe, 1953). These observations mean that obese subjects
are absolutely larger than they were before they became obese.
They have an absolutely higher fat and fat-free mass. By far the
main determinant of resting metabolic rate is fat-free mass
(Miller & Blythe, 1953; Webb, 1981). Therefore, the resting
metabolic rate in absolute terms increases in a curvilinear
manner as body weight (and fatness) increase (McNeill et al,
1987). While the absolute resting metabolic rate is higher, the
BMR per kg of body weight is lower than that of the pre-obese
subject (due to the lower percentage of fat-free mass contri-
buting to body weight). By the same argument the BMR per kg
fat-free mass for most subjects is very similar.
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