title: Energy expenditure in overweight and obese adults in affluent societies: an analysis of 319 doubly-labelled water measurements.
abstract: OBJECTIVE
  To describe the relationship between graded levels of obesity and free-living energy expenditure in men and women in affluent societies.
  
  
  METHODS
  Analysis of 319 measurements of energy expenditure in adults aged 18-64 years. The variables analysed were: total energy expenditure (TEE, assessed by the doubly-labelled water method); measured basal metabolic rate (BMR); activity energy expenditure (AEE, derived as TEE-BMR); and physical activity level (PAL, derived as TEE/BMR). Results were analysed according to four categories of body mass index (BMI): < 25.0, 25.0-29.9, 30.0-35.0 and > 35.0 kg/m2.
  
  
  RESULTS
  TEE increased steadily with increasing BMI (9.5 to 13.5 MJ/d in women, 12.9 to 17.5 MJ/d in men, ANOVA, P < 0.0001 for both sexes). BMR also increased (5.7 to 8.2 MJ/d in women, 7.2 to 11.6 MJ/d in men, P < 0.0001 for both). AEE increased steadily in women (3.8 to 5.3 MJ/d, P < 0.0003), but in men increased up to the third BMI category (5.7 to 7.5 MJ/d, n.s.) and then declined in the most obese group (5.9 MJ/d, n.s.). The increases in energy expenditure were not in direct proportion to body weight since, when expressed per kg, both TEE and AEE declined significantly with increasing BMI. PAL remained quite constant across the three lowest BMI groups, indicating similar levels of physical activity. There was a non-significant decrease in PAL in the most obese men and women.
  
  
  CONCLUSIONS
  This analysis confirms that habitual energy expenditure is substantially and progressively raised in obesity. It contradicts the claim, based on self-reported food intake, that obesity develops and is maintained in spite of very low levels of energy intake. The analysis suggests that, except in massive obesity, patterns of physical activity are quite similar at different levels of BMI. This does not exclude the possibility that an inactive lifestyle may be an important general risk factor for the development of obesity.
authors.affiliation: MRC Dunn Clinical Nutrition Centre, Cambridge, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Prentice
authors.forename: A E
authors.initials: AE
authors.lastname: Black
authors.forename: W A
authors.initials: WA
authors.lastname: Coward
authors.forename: T J
authors.initials: TJ
authors.lastname: Cole
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D015992:Body Mass Index; D003903:Deuterium; D004435:Eating / Q000502:physiology; D004734:Energy Metabolism / Q000502:physiology*; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008722:Methods; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism / Q000503:physiopathology*; D012959:Socioeconomic Factors; D014867:Water
chemical_list: D014867:Water; D003903:Deuterium