Estimating the effects of energy imbalance on changes in body weight in children

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Abstract
Background: Estimating changes in weight from changes in energy balance is important for predicting the effect of obesity prevention interventions. Objective: The objective was to develop and validate an equation for predicting the mean weight of a population of children in response to a change in total energy intake (TEI) or total energy expenditure (TEE). Design: In 963 children with a mean (±SD) age of 8.1 ± 2.8 y (range: 4–18 y) and weight of 31.5 ± 17.6 kg, TEE was measured by using doubly labeled water. Log weight (dependent variable) and log TEE (independent variable) were analyzed in a linear regression model with height, age, and sex as covariates. It was assumed that points of dynamic balance, called “settling points,” occur for populations wherein energy is in balance (TEE = TEI), weight is stable (ignoring growth), and energy flux (EnFlux) equals TEE. Results: TEE (or EnFlux) explained 74% of the variance in weight. The unstandardized regression coefficient was 0.45 (95% CI: 0.38, 0.51; R2 = 0.86) after including covariates. Conversion into proportional changes (time1 to time2) gave the equation (weight2/weight1) = (EnFlux2/EnFlux1)0.45. In 3 longitudinal studies (n = 212; mean follow-up of 3.4 y), the equation predicted the mean follow-up measured weight to within 0.5%. Conclusions: The relation of EnFlux with weight was positive, which implied that a high TEI (rather than low physical activity and low TEE) was the main determinant of high body weight. Two populations of children with a 10% difference in mean EnFlux would have a 4.5% difference in mean weight.