Estimating the Energy Gap Among US Children: A Counterfactual Approach

Abstract

Quantifying the energy imbalance responsible for recent changes in weight distribution among children can provide salient targets for population intervention. Consistent behavioral changes averaging 110 to 165 kcal/day may be sufficient to counterbalance the energy gap. Changes in excess dietary intake (eg, eliminating one sugar-sweetened beverage at 150 kcal per can) may be easier to attain than increases in physical activity levels (eg, a 30-kg boy replacing sitting for 1.9 hours with 1.9 hours walking for an extra 150 kcal). Youth at higher levels of weight gain will likely need changes in multiple behaviors and environments to close the energy gap.

Estimates of the energy deficit required to reverse the trend in childhood obesity in Australian schoolchildren

“…While it is not possible to compare these studies directly, the estimates are consistent with population weight gain being driven by a relatively small excess in consumption over the requirement for basal metabolism and habitual energy expenditure. Wang et al 25 and van den Berg et al 26 have reported comparable studies in children. The former, using data from the US National Health and Nutrition Examination Surveys from 1988–1994 and 1999–2002, estimated that an energy gap of between 0.46 and 0.69 MJ/day could have prevented the weight gain seen over this 10‐year period.…”

Obesidade na criança e no adolescente: quantas calorias a mais são responsáveis pelo excedente de peso?

“…It is necessary to consider that the energy imbalance is already expected due to the extra energy costs required for the intense anabolic process of growth, which implies in persistent positive energy balance. It should, therefore, separate the characteristic energy accumulation for growth and the excessive energy intake (18,21,22) . During the stage of growth and development, differences in the body composition and in the degree of energy accumulation by age, height, gender, ethnicity and pubertal stage are usually expected (21,23) .…”

“…Wang et al (18) considered the extra energy necessary for normal growth, but this study was limited by its cross sectional design. The long-term prospective studies performed by Plachta-Danielzik et al (19) and van den Berg et al (20) took into consideration the limitations of the prior studies, and were able to provide more accurate estimates of the energy gap.…”

“…Assuming a uniform weight gain over the time, and the energy efficacy from 50 to 75%, a lesser energy intake from 110 to 165kcal/day could have prevented the weight gain in most of the pediatric population. Among overweight adolescents (12 to 17 years old in NHANES 1999-2002), the change proved to be far higher, from 678-1017kcal/day, which resulted in the accumulation of a mean 26.5kg above the normal for growth (18) . (19) examined the distribution of adequate and excessive energy intake in 2057 initially eutrophic children, considering the impact of age and gender on the body composition of the individuals.…”

“…Although the values correspond to half of the estimates when a 50% metabolic efficacy is considered, they still represent twice the values stipulated by Hill et al (9) for adults. Wang et al (18) analyzed the data of the National Health and Nutrition Examination Survey (NHANES) cross-sectional study in the periods 1988-94 and 1999-2002 to compare the distribution of the BMI percentiles of two cohorts of North American children and adolescents, who were initially 2-4 and 5-7 year-old. In a fictional scenario, based on the 1988-94 data, the authors built a curve of height and weight gain, considering on optimal growth pattern (in which the energy balance represented the gain weight proportional to the height), and projected this same curve by ten years ahead, assuming that the percentages would remain the same.…”