# 8.2 – Balancing Energy Input with Energy Output

## Learning Objectives

• Estimate your daily energy requirement.
• Define basal metabolism and explain the factors that affect the basal metabolic rate.
• Describe hunger, satiation, appetite, and satiety.
• Summarize why the amount of food we eat (appetite) is not completely under our conscious control.

Table 8.2.1: Physical Activity(P.A.) Categories and Values
A table showing different physical activity categories and some values that associate with them.
Activity Level MEN P.A. Value Women P.A. Value Description
Sedentary 1.00 1.00 P.A.L.*: 1.0-1.39

No physical activity beyond typical daily living activities

Low Active 1.11 1.12 P.A.L.*: 1.4-1.59

Typical daily living activities PLUS 30-60 minutes of moderate activity

Active 1.25 1.27 P.A.L.*: 1.6-1.89

Typical daily living activities PLUS at least 60 minutes of daily moderate activity

Very Active 1.48 1.45 P.A.L.*: 1.9-2.5

Typical daily living activities PLUS at least 60 minutes of moderate activity PLUS an additional 60 minutes of vigorous activity or 120 minutes of moderate activity

*Physical Activity Level to be used for identifying PA value to use in E.E.R formula. These values only apply to normal-weight adults and not to children or pregnant or lactating women. Source: Health Canada. “Dietary Reference Intake Tables.” Last modified October 21, 2020.

The numbers within the equations for the E.E.R. were derived from measurements taken from a group of people of the same sex and age with similar body size and physical activity level. These standardized formulas are then applied to individuals whose measurements have not been taken, but who have similar characteristics in order to estimate their energy requirements. Thus, a person’s E.E.R. is, as the name suggests, an estimate for an average person of similar characteristics. E.E.R. values are different for children, pregnant or lactating women, and for overweight and obese people. Also, remember the E.E.R. is calculated based on weight maintenance, not for weight loss or weight gain.

Table 8.2.2: Estimated Daily Calorie Needs
A table showing daily calorie need estimates for a child
Sex Age(years) Sedentary Moderately Active Active
Child(Female and Male) 2-3 1,000 1,000 – 1,400 1,000 – 1,400

Table 8.2.2:Estimated Daily Calorie Needs (Male)
A table showing daily calorie need estimates for females
Age(years) Sedentary Moderately Active Active
4 to 8 1,200 to 1,400 1,400 to 1,600 1,600 to 2,000
9 to 13 1,600 to 2,000 1,800 to 2,200 2,000 to 2,600
14 to 18 2,000-2,400 2,400-2,800 2,800-3,200
21 to 30 2,400 2,600-2,800 3,000
31-40 2,400 2,600 2,800-3,000
51+ 2,000-2,200 2,200-2,400 2,400-2,800

Table 8.2.2:Estimated Daily Calorie Needs (Female)
A table showing daily calorie need estimates for males
Age(years) Sedentary Moderately Active Active
4 to 8 1,200 to 1,400 1,400 to 1,600 1,400 to 1,800
9 to 13 1,400 to 1,600 1,600 to 2,000 1,800 to 2,000
14 to 18 1,800 2,000 2,400
19 to 20 2,000 2,200 2,400
21 to 50 1,800-2,000 2,000 to 2,200 2,200 to 2,400
51+ 1,600 1,800 2,000
Source: US Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 2015.

The 2015-2020 Dietary Guidelines provides a table (Table 8.2.2 ) that gives the estimated daily calorie needs for different age groups of males and females with various activity levels. The 2015-2020 Dietary Guidelines also states that while knowing the number of calories you need each day is useful, it is also pertinent to obtain your calories from nutrient-dense foods and consume the various macronutrients in their Acceptable Macronutrient Distribution Ranges (A.M.D.R.s) (Table 8.2.3 ).

Table 8.2.3: Acceptable Macronutrient Distribution Ranges
A table showing acceptable macronutrient distribution ranges for 3 age groups
Age Carbohydrates (% of Calories) Protein (% of Calories) Fat (% of Calories)
Young Children (1 to 3) 45 to 65 5 to 20 30 to 40
Older children/adolescents (4 to 18) 45 to 65 10 to 30 25 to 35
Adults (19 and older) 45 to 65 10 to 35 20 to 35
Source: Institute of Medicine. “Dietary Reference Intakes: Macronutrients.” Dietary Reference Intakes for Energy, Carbohydrate. Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. September 5, 2002.

## Total Energy Expenditure (Output)

The amount of energy you expend every day includes not only the calories you burn during physical activity, but also the calories you burn while at rest (basal metabolism), and the calories you burn when you digest food. The sum of caloric expenditure is referred to as total energy expenditure (T.E.E.). Basal metabolism refers to those metabolic pathways necessary to support and maintain the body’s basic functions (e.g. breathing, heartbeat, liver, and kidney function) while at rest. The basal metabolic rate (B.M.R.) is the amount of energy required by the body to conduct its basic functions over a certain time period. The great majority of energy expended (between 50 and 70 percent) daily is from conducting life’s basic processes. Of all the organs, the liver requires the most energy (Table 8.2.4 ). Unfortunately, you cannot tell your liver to ramp up its activity level to expend more energy so you can lose weight. B.M.R. is dependent on body size, body composition, sex, age, nutritional status, and genetics. People with a larger frame size have a higher B.M.R. simply because they have more mass. Muscle tissue burns more calories than fat tissue even while at rest and thus the more muscle mass a person has, the higher their B.M.R.. Since females typically have less muscle mass and a smaller frame size than men, their B.M.R.s are generally lower than men’s. As we get older muscle mass declines and thus so does B.M.R.. Nutritional status also affects basal metabolism. Caloric restriction, as occurs while dieting, for example, causes a decline in B.M.R.. This is because the body attempts to maintain homeostasis and will adapt by slowing down its basic functions to offset the decrease in energy intake. Body temperature and thyroid hormone levels are additional determinants of B.M.R..

The energy required for all the enzymatic reactions that take place during food digestion and absorption of nutrients is called the “thermic effect of food” and accounts for about 10 percent of the total energy expended per day. The other energy required during the day is for physical activity. Depending on lifestyle, the energy required for this ranges between 15 and 30 percent of the total energy expended. The main control a person has over T.E.E. is to increase physical activity.

## How to Calculate Total Energy Expenditure

Calculating T.E.E. can be tedious, but has been made easier as there are now calculators available on the Web. T.E.E. is dependent on age, sex, height, weight, and physical activity level. The equations are based on standardized formulas produced from actual measurements on groups of people with similar characteristics. To get accurate results from web-based T.E.E. calculators, it is necessary to record your daily activities and the time spent performing them. A spreadsheet for doing so is available here.

##### Interactive 8.4: Interactive T.E.E. Calculator

Interactive Calculator

## Factors Affecting Energy Intake

### Physiology

In the last few decades, scientific studies have revealed that how much we eat and what we eat is controlled not only by our own desires but also is regulated physiologically and influenced by genetics. The hypothalamus in the brain is the main control point of appetite. It receives hormonal and neural signals, which determine if you feel hungry or full. Hunger is an unpleasant sensation of feeling empty that is communicated to the brain by both mechanical and chemical signals from the periphery. The process within our body that results in our desire to stop eating a meal is called satiation. Satiation is influenced by variety, energy density,amount, and the nutrients within the foods available.  Satiety is the process that determines how long we stay satisfied after a meal before we begin to experience hunger signals again.   All of these processes are determined by mechanical and chemical signals relayed from the periphery. The hypothalamus contains distinct centers of neural circuits that regulate hunger, satiation, and satiety (Figure 8.2.2).

Hunger pangs are real and so is a “growling” stomach. When the stomach is empty it contracts, producing the characteristic pang and “growl.” The stomach’s mechanical movements relay neural signals to the hypothalamus, which relays other neural signals to parts of the brain. This results in the conscious feeling of the need to eat. Alternatively, after you eat a meal the stomach stretches and sends a neural signal to the brain stimulating the sensation of satiation and relaying the message to stop eating. The stomach also sends out certain hormones when it is full and others when it is empty. These hormones communicate to the hypothalamus and other areas of the brain either to stop eating or to find some food.

Fat tissue also plays a role in regulating food intake. Fat tissue produces the hormone leptin, which communicates to the satiety center in the hypothalamus that the body is in positive energy balance. The discovery of leptin’s functions sparked a craze in the research world and in the diet pill industry as it was hypothesized that if you give leptin to a person who is overweight, they will decrease their food intake. Alas, this is not the case. In several clinical trials, it was found that people who are overweight or obese are actually resistant to the hormone, meaning their brain does not respond as well to it.1 Therefore, when you administer leptin to an overweight or obese person there is no sustained effect on food intake.

Congenital leptin deficiency is a rare disorder where individuals do not make leptin. They do not feel satisfied and will gain excessive amounts of weight as their hypothalamus does not receive the signal from leptin to tell the body it is full (satiated). These individuals will lose weight once they are given injections of leptin. The injections would need to continue for life, much as an individual with Type 1 diabetes would need insulin.  By studying these individuals, scientists have learned how leptin works within the body. 2

Nutrients themselves also play a role in influencing food intake. The hypothalamus senses nutrient levels in the blood. When they are low the hunger center is stimulated, and when they are high the satiety center is stimulated. Furthermore, cravings for salty and sweet foods have an underlying physiological basis. Both undernutrition and overnutrition affect hormone levels and the neural circuitry controlling appetite, which makes losing or gaining weight a substantial physiological hurdle.

1 Dardeno, T. A. et al. “Leptin in Human Physiology and Therapeutics.” Front Neuroendocrinol. 2010;31(3): 377–93. Accessed July 5, 2019.

2 Paz-Filho G, Mastronardi C, Delibasi T, Wong ML, Licinio J. Congenital leptin deficiency: diagnosis and effects of leptin replacement therapy. Arq Bras Endocrinol Metabol. 2010;54(8):690–697. Accessed June 30, 2019.

## Genetic Influences

Genetics certainly play a role in body fatness and weight and also affects food intake. Children who have been adopted typically are similar in weight and body fatness to their biological parents. Moreover, identical twins are twice as likely to be of similar weights as compared to fraternal twins. The scientific search for obesity genes is ongoing and a few have been identified, such as the gene that encodes for leptin. However, overweight and obesity that manifests in millions of people is not likely to be attributed to one or even a few genes, but rather to the interactions of hundreds of genes with the environment. In fact, when an individual has a mutated version of the gene coding for leptin, they are obese, but only a few dozen people around the world have been identified as having a completely defective leptin gene.

## Psychological/Behavioral Influences

It is without a doubt that American society affects what and how much we eat. Portion sizes have increased dramatically in the past few decades. For example, a bagel is now more than twice the size it was in the 1960s. Today, American teenagers have access to a massive amount of calorie-dense foods and beverages, which is a large contributor to the recent rapid increase in overweight and obesity in adolescents in this country. Even different cultures within the United States have different eating habits. For instance, southern Americans, in general, consume more foods high in fat, which is a contributing factor to their higher incidences of overweight and obesity than Americans who live in the northern states. (Alaska is an exception because it also has a high incidence of overweight and obesity, which is also partly attributed to diet.)

The fast-food industry in America not only supplies Americans with a large proportion of their diet but because of its massive presence in society dominates the workings of the entire food system. To generalize, most fast food items have little nutritional merit as they are highly processed and rich in saturated fat, salt, and added sugars. Despite fast foods being a poor source of nourishment, Americans spend over one hundred billion dollars per year on fast food, up from six billion dollars in the early 1970s. The fast-food business is likely to continue to grow in North America (and the rest of the world) and greatly affect the diets of whole populations. Because it is unrealistic to say that Americans should abruptly quit eating fast food to save their health (because they will not) society needs to come up with ideas that push nutrient-dense whole foods into the fast-food industry. You may have observed that this largely consumer-driven push is having some effect on the foods the fast food industry serves (just watch a recent Subway commercial, or check the options now available in a McDonald’s Happy Meal). Pushing the fast food industry to serve healthier foods is a realistic and positive way to improve the American diet.

##### Video: 8.2.1 – History, Structure, and Ethics of the Fast Food Industry

Author: Maisalish1
Published on Mar 19, 2012

##### Tools For Change

Support the consumer movement of pushing the fast food industry and your favorite local restaurants into serving more nutrient-dense foods. You can begin this task by starting simple, such as requesting extra tomatoes and lettuce on your burger and more nutrient-dense choices in the salad bar. Also, choose their healthier menu options and help support the emerging market of healthier choices in the fast-food industry. In today’s fast-paced society, it is difficult for most people to avoid fast food all the time. When you do need a quick bite on the run, choose the fast-food restaurants that serve healthier foods. Also, start asking for caloric contents of foods so that the restaurant becomes more aware that their patrons are being calorie-conscious.

## Factors Affecting Energy Expenditure

### Physiological and Genetic Influences

Why is it so difficult for some people to lose weight and for others to gain weight? One theory is that every person has a “set point” of energy balance. This setpoint can also be called a fat-stat or lipostat, meaning the brain senses body fatness and triggers changes in energy intake or expenditure to maintain body fatness within a target range. Some believe that this theory provides an explanation as to why after dieting, most people return to their original weight not long after stopping the diet. Another theory is referred to as the “settling” point system, which takes into account (more so than the “set-point” theory) the contribution of the obesogenic environment to weight gain. In this model, the reservoir of body fatness responds to energy intake or energy expenditure, such that if a person is exposed to a greater amount of food, body fatness increases, or if a person watches more television body fatness increases. A major problem with these theories is that they overgeneralize and do not take into account that not all individuals respond in the same way to changes in food intake or energy expenditure. This brings up the importance of the interactions of genes and the environment.

Not all individuals who take a weight-loss drug lose weight and not all people who smoke are thin. An explanation for these discrepancies is that each individual’s genes respond differently to a specific environment. Alternatively, environmental factors can influence a person’s gene profile, which is exemplified by the effects of the prenatal environment on body weight and fatness and disease incidence later in life. One of the first scientific investigations of prenatal control over energy balance was conducted in Germany. In this observational study, scientists found that offspring born to mothers who experienced famine were more likely to be obese in adulthood than offspring born to mothers who were pregnant just after World War II who lived in the same geographical location.   Matthews, C. E. “Amount of Time Spent in Sedentary Behaviors in the United States, 2003–2004.” Am J Epidemiol 167, no. 7 (2008): 875–81. DOI: 10.1093/aje/kwm390. Other studies have shown that the offspring of women who were overweight during pregnancy have a greater propensity for being overweight and for developing Type 2 diabetes. Thus, undernutrition and overnutrition during pregnancy influence body weight and disease risk for offspring later in life. They do so by adapting energy metabolism to the early nutrient and hormonal environment in the womb.

##### Audio Link 8.1: Rethinking Thin – The Myths and Realities of Dieting

Listen to this N.P.R. broadcast for scientific information about why it is so difficult for some people to lose weight.

## Psychological/Behavioral Influence

Sedentary behavior is defined as the participation in an activity in which energy expenditure is no more than one-and-one-half times the amount of energy expended while at rest and include sitting, reclining, or lying down while awake. Of course, the sedentary lifestyle of many North Americans contributes to their average energy expenditure in daily life. Simply put, the more you sit, the less energy you expend.  Fortunately, including only a small amount of low-level physical activity benefits weight control. A study published in the June 2001 issue of the International Journal of Behavioral Nutrition and Physical Activity reports that even breaking up sitting-time with frequent, but brief increased energy expenditure activities, such as walking for five minutes every hour, helps maintain weight and even aids in weight loss.2 Americans partake in an excessive amount of screen time, which is a sedentary behavior that not only reduces energy expenditure but also contributes to weight gain because of the exposure to aggressive advertising campaigns for unhealthy foods.

2 Wu, Y. “Overweight and Obesity in China.” Br Med J 333, no. 7564 (2006): 362. DOI: 10.1136/bmj.333.7564.362.

## Societal Influence

In the United States, many societal factors influence the number of calories burned in a day. Escalators, moving walkways, and elevators (not to mention cars!) are common modes of transportation that reduce average daily energy expenditure. Office work, high-stress jobs, and occupations requiring extended working hours are all societal pressures that reduce the time allotted for exercise of large populations of Americans. Even the remote controls that many have for various electronic devices in their homes contribute to the US society being less active. More “obesogenic” factors were discussed in the opening of this chapter.

Socioeconomic status has been found to be inversely proportional to weight gain. One reason for this relationship is that residents of low-income neighborhoods have reduced access to safe streets and parks for walking. Another is that fitness clubs are expensive and few are found in lower-income neighborhoods. The recent and long-lasting economic crisis in this country is predicted to have profound effects on the average body weight of Americans. The number of homeless in this country is rising with many children and adults living in hotels and cars. As you can imagine neither of these “home spaces” has a kitchen, making it impossible to cook nutritious meals and resulting in increased economically-forced access to cheap, unhealthy foods, such as that at a nearby gas station.

## Key Takeaways

• Energy balance is achieved when energy intake is equal to the energy expended. Energy balance is essential for maintaining weight. Knowing the number of calories you need each day is a useful reference point, but it is also important to obtain your calories from nutrient-dense foods and consume the macronutrients in their AMDRs.
• The amount of energy you expend every day includes not only the calories you burn during physical activity, but also the calories you burn at rest (basal metabolism), and the calories you burn when you digest food. Basal metabolic rate (B.M.R.) is dependent on body size, body composition, sex, age, nutritional status, genetics, body temperature, and thyroid hormone levels.
• The great majority of energy expended (between 50 and 70 percent) daily comes from conducting life’s basic processes.
• The main control a person has over T.E.E. is to increase physical activity.
• Energy intake is regulated by complex physiological responses and is influenced by genetics, behavior, and society.
• Energy expenditure is also regulated by complex physiological responses and is influenced by genetics, behavior, and society.

## Discussion Starters

1. Some types of transportation are becoming economically unfeasible for obese people. Discuss whether or not it is acceptable that air carriers can enforce that obese person (or what they politely call “passengers of size” or “passengers requiring extra space”) pay more for their seats.
2. Many people have a hard time understanding the difficulties of being too skinny. Discuss with your peers how to empathize with the weight problems of underweight people. Read this article to understand that being skinny does not mean a person necessarily has a lower risk of chronic disease.