A.

WEIGHT MANAGEMENT

I. For UNDERWEIGHT Patients

TER = weight present in kg. × PA + 500 kcal

or

TER = weight DBW in kg. × PA

II. For OVERWEIGHT Patients

TER = weight present in kg. × PA - 500 kcal*

or

TER = weight DBW in kg. × PA

*Note: Estimated weight reduction from fat is about 1 pound per week for daily TER less than
500 kcal1, since:

1. 1 lb. = 454.5 grams of body fat

2. 1 lb. of body weight = 3,500 kcal
3. 3,500 kcal / 7 days = 500 kcal
4. 1 gram of adipose tissue = 7.7 kcal

Additional consideration in computing for TER: use present weight and then deduct 500 kcal
from TER IF the gap between TER using present weight (less 500 kcal) and TER using DBW (without reducing 500 kcal) is
significant.

1
This is based on the model by Wishnofsky (1958). However, this is already deemed outdated.
Newer models are available. Thomas, Gonzalez, Pereira, Redman, & Heymsfield (2014) points
out the following factors which influence energy expenditure during weight loss periods:
1. Energy output decreases during negative energy balance
2. Presence of metabolic adaptations, reduced thermic effect of food and non-exercise
activity thermogenesis, possible reductions in physical activity
3. Loss of body heat producing lean tissues
Thus, when the reduction in energy output from baseline reaches the exact amount of energy
reduced, the subject’s weight loss will plateau at a new reduced weight. To reach a stable
weight plateau often takes months or even years.
Sample weight reduction plan:

Subject: Male, teacher, 5’7”, present weight 83 kg., computed DBW 63 kg.

Weight reduction = 83 kg. present weight – 63 kg. DBW

= 20 kg. × 2.2 lbs.
= 44 lbs. or 44 weeks or 11 months duration of weight reduction

TER = (83 kg. present weight × 40 kcal Light PA) – 500 kcal
= 2820 kcal or 2800 kcal/day

—————————-

Example: Female, current wt 97 kg, 5’5”, housewife with maid (light 35 kcal/kg BW)
DBW = 57 kg

a. Get the Total Energy requirement using the current weight

(TER= current weight (kg) x PA)
i. TER (current weight)= 97 kg x 35 = 3,400 kcal
b. Identify the excess weight
Excess weight = Current weight - DBW
i. Total excess weight = 97 kg current - 57 kg DBW = 40 kg
c. Identify the DBW calorie requirement
(TER= DBW (kg) x PA)
i. TER (DBW) = 57 kg x 35 = 2,000 kcal

Phase 1: TER of current weight - 500

TER = 3,400 kcal - 500 kcal = 2,900 kcal/day (Phase 1)
Duration:
a. Phase 1 Target weight = TER Phase 1 / PA Factor
= 2,900 kcal / 35 kcal = 82.85 kg
b. Total weight loss (difference) = Current weight - Phase 1 target weight
= 97 kg - 82.85 kg = 14.15 kg
c. Total no. of weeks = Weight loss difference x 2.2
= 14.15 kg x 2.2 lbs = 31.13 lbs or 31 weeks

Phase 2: TER of Phase 1 - 500

= 2,900 kcal - 500 kcal = 2,400 kcal/day (Phase 2)
Duration:
a. Phase 1 Target weight = TER Phase 2 / PA Factor
= 2,400 kcal / 35 kcal = 68.57 kg
 b. Total weight loss (difference) = Phase 1 target weight - Phase 2 target weight
= 82.85 kg - 68.57 kg = 14.28 kg
c. Total no. of weeks = Weight loss difference x 2.2
= 14.28 kg x 2.2 lbs = 31.42 lbs or 31 weeks

Phase 3: TER of Phase 2 - 400

= 2,400 kcal - 400 kcal = 2000 kcal
Duration:
a. Target weight = 2000kcal / 35 = 57 kg
b. Total weight lost = 68.57 kg (Phase 2) - 57 kg (DBW) = 11.57 kg
c. Weight loss(grams) per week = 400 kcal/7.7 kcal/gram = 51.95 g x 7 days = 363.65
g/week
d. Total no. of weeks = 11.57 kg x 1000 g/kg = 11,570 g/ 363.65 g/week
= 31.82 or 32 weeks

Phase 1
TER: 2,900 kcal/day
Target weight: 82.85 kg
Duration: 31 Weeks

Phase 2
TER: 2,400 kcal/day
Target weight: 68.57 kg
Duration: 31 Weeks

Phase 3
TER: 2,000 kcal/day
Target weight: 57 kg
Duration: 32 Weeks

Total Duration: 94 weeks / 52 weeks per year = 1.8 years