Calculating Caloric Requirements in Obese Adolescents

Introduction to Caloric Calculation

The American Academy of Pediatrics recommends using the Schofield equation based on actual body weight and height to calculate resting energy expenditure (REE), then multiplying by an appropriate physical activity factor to determine total daily caloric needs in obese adolescents 1

For ages 10-18 years, the REE can be calculated as: Boys: REE (kcal/day) = 17.7 × weight (kg) + 658, Girls: REE (kcal/day) = 13.4 × weight (kg) + 692 1
For ages 3-10 years, the REE can be calculated as: Boys: REE (kcal/day) = 22.7 × weight (kg) + 504, Girls: REE (kcal/day) = 20.3 × weight (kg) + 486 1
Multiply the calculated REE by the appropriate activity level: Sedentary/hospitalized: PAL = 1.2-1.3, Light activity: PAL = 1.5, Moderate activity: PAL = 1.7, Vigorous activity: PAL = 2.0 1

Always use the adolescent's actual body weight in the Schofield equation, not ideal or adjusted weight, as the equations were developed using actual weight, and body weight is the main predictor of energy expenditure 1
Measure REE using indirect calorimetry in obese adolescents with suspected metabolic alterations, severe complications, or when initial weight management approaches have been unsuccessful 1

For weight maintenance, use the calculated Total Energy Expenditure (TEE) as the daily caloric target 1
For weight loss, subtract 500-750 kcal/day from the calculated TEE to achieve approximately 0.5 kg (1 pound) weight loss per week, ensuring intake never falls below 900 kcal/day minimum under medical supervision 1, 2

With proper caloric restriction and comprehensive lifestyle intervention, expect BMI reduction of approximately 1.18 kg/m² over 6-12 months and weight loss of 3-4 kg over the intervention period 1