Calculating Caloric Requirements in Pediatric Obesity

Introduction to Caloric Calculation

The American Academy of Pediatrics recommends calculating resting energy expenditure (REE) using the Schofield equation based on weight and height, then creating a 500-750 kcal/day deficit from maintenance needs, ensuring intake never falls below 900 kcal/day minimum under medical supervision 1

For pediatric populations, the Schofield equations are the preferred method for calculating REE, with equations varying by age and sex 2, 3
For ages 3-10 years, boys: REE (kcal/day) = 22.7 × (weight in kg) + 504, and girls: REE (kcal/day) = 20.3 × (weight in kg) + 486 4
For ages 10-18 years, boys: REE (kcal/day) = 17.7 × (weight in kg) + 658, and girls: REE (kcal/day) = 13.4 × (weight in kg) + 692 4
The Schofield equation using both weight and height is least likely to underestimate REE compared to measured values and is therefore the preferred calculation method 3, 5

Multiply the calculated REE by an appropriate physical activity factor, with sedentary/hospitalized: PAL = 1.2-1.3, light activity: PAL = 1.5, moderate activity: PAL = 1.7, and vigorous activity: PAL = 2.0 2, 3
Include additional calories for normal growth, which varies by age, such as 20 kcal/day for ages 6-12 months, 20 kcal/day for prepubertal children, and 30 kcal/day for peak pubertal growth velocity 2, 3

Subtract 500-750 kcal/day from the calculated total energy expenditure (TEE = REE × PAL + growth) to achieve weight loss of approximately 0.5 kg (1 pound) per week 1

Use actual body weight in the Schofield equation, as the equations were developed using actual weight, and body weight is the main predictor of energy expenditure 2, 3, 4
Measure REE using indirect calorimetry in children with suspected metabolic alterations, severe malnutrition, or when initial weight management approaches have been unsuccessful 2, 3

Ensure a nutritionally balanced diet with moderate fat intake, adequate protein, carbohydrates from whole grains and fiber-rich sources, nutrient-dense, low-energy-density foods, elimination of liquid calories, and limitation of added sugars, sodium, and highly processed foods 1

Expect BMI reduction of approximately 1.18 kg/m² over 6-12 months and weight loss of 3-4 kg over the intervention period with appropriate caloric restriction and comprehensive lifestyle intervention 1
After initial weight loss, transition to a weight maintenance program focusing on normocaloric-eucaloric diet, continued physical activity, and ongoing behavioral support with family involvement 1

Adjust the nutrition regimen based on outcomes such as hyperglycemia, growth velocity changes, and other metabolic disturbances, and review individual nutritional requirements regularly as patients' needs can frequently change 6