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Energy balance measurement: when something is not better than nothing

Abstract

Energy intake (EI) and physical activity energy expenditure (PAEE) are key modifiable determinants of energy balance, traditionally assessed by self-report despite its repeated demonstration of considerable inaccuracies. We argue here that it is time to move from the common view that self-reports of EI and PAEE are imperfect, but nevertheless deserving of use, to a view commensurate with the evidence that self-reports of EI and PAEE are so poor that they are wholly unacceptable for scientific research on EI and PAEE. While new strategies for objectively determining energy balance are in their infancy, it is unacceptable to use decidedly inaccurate instruments, which may misguide health-care policies, future research and clinical judgment. The scientific and medical communities should discontinue reliance on self-reported EI and PAEE. Researchers and sponsors should develop objective measures of energy balance.

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Acknowledgements

Dr Allison, Dr Brown and Ms Jeansonne are supported in part by grant P30DK056336 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases. The opinions expressed are those of the authors and not necessarily those of the NIH or any other organization.

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Correspondence to D B Allison.

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Competing interests

Dr Schoeller reports a patent, Methods of determining energy balance using breath carbon isotope ratios, pending. The remaining authors declare no conflict of interest.

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Author contributions

Nikhil Dhurandhar and David Allison conceived this manuscript and drafted the majority of its content. All other authors read and edited the manuscript for important content. The corresponding author, David Allison, had the final responsibility for the decision to submit for publication.

The ‘Energy Balance Measurement Working Group’ members listed alphabetically

David B Allison, PhD, Distinguished Professor, Quetelet Endowed Professor of Public Health, Associate Dean for Science, Director of the Office of Energetics, Director of the Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA. E-mail: Dallison@UAB.edu

Arne V Astrup, MD, DMSc, Head, Professor, and Faculty of Science, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark. E-mail: ast@life.ku.dk

Richard L Atkinson, MD, Clinical Professor of Pathology, Virginia Commonwealth University; Director, Obetech Obesity Research Center; Richmond, VA, USA. E-mail: ratkinson2@vcu.edu

Martin Binks, PhD, FTOS, Associate Professor, Nutritional Sciences, Texas Tech University, Lubbock, TX, USA. E-mail: mbinks@binkshealth.com

George L Blackburn, MD, PhD, S. Daniel Abraham Chair in Nutrition Medicine Harvard Medical School and Director, Center for the Study of Nutrition Medicine Beth Israel Deaconess Medical Center, Boston, MA, USA. E-mail: gblackbu@bidmc.harvard.edu

John E Blundell, Professor and Chair, PsychoBiology, Institute of Psychological Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK. E-mail: j.e.blundell@leeds.ac.uk

Michelle M Bohan Brown, PhD, Assistant Professor, Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC, USA. E-mail: mbohanb@clemson.edu

Andrew W Brown, PhD, Scientist, Nutrition Obesity Research Center and Office of Energetics, University of Alabama at Birmingham, Birmingham, AL, USA. E-mail: awbrown@uab.edu

Nuala M Byrne, BHMS, MAppSc, PhD, Program Head of Exercise and Sports Science, Director of CRN for Advancing Exercise and Sports Science, Faculty of Health Sciences & Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD, Australia. E-mail: n.byrne@qut.edu.au

Lawrence J Cheskin, MD, FACP, Associate Professor, Health, Behavior & Society; Medicine (GI); Human Nutrition; Public Health Studies; Director, Johns Hopkins Weight Management Center; Director, Rapid Response Project Core; Co-Associate Director, Johns Hopkins Global Center on Childhood Obesity, Johns Hopkins School of Public Health, Baltimore, MD, USA. E-mail: lcheskin@jhsph.edu

Richard Cooper, MD, Professor and Chair, Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA. E-mail: rcooper@lumc.edu

Barbara E Corkey, PhD, Zoltan Kohn Professor of Medicine and Vice Chair for Research, Obesity Research Center, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. E-mail: bcorkey@bu.edu

Nikhil V Dhurandhar, PhD, John Henry Hernandez Endowed Professor in Health Promotion, Infection and Obesity Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA. E-mail: Nikhil.Dhurandhar@pbrc.edu

John P Foreyt, PhD, Professor and Director of the Behavioral Medicine Research Center, Baylor College of Medicine, Houston, Texas, USA. E-mail: jforeyt@bcm.tmc.edu

Paul Selberg-Franks, PhD, Adjunct Professor of Nutrition, Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. E-mail: paul.franks@med.lu.se

Yoni Freedhoff, MD, CCFP, Medical Director, Bariatric Medical Institute, Ottawa, ON, Canada. E-mail: drfreedhoff@bmimedical.ca

Michael I Goran, PhD, Dr Robert C and Veronica Atkins Endowed Chair in Childhood Obesity and Diabetes, Co-Director, USC Diabetes and Obesity Research Institute and Professor of Preventive Medicine, Director, Childhood Obesity Research Center (CORC), USC Keck School of Medicine, Los Angeles, California, USA. E-mail: goran@usc.edu

Barbara C Hansen, PhD, Professor of Internal Medicine and Director of Center for Preclinical Research, Department of Internal Medicine & Pediatrics, University of South Florida, Tampa, FL, USA. E-mail: bhansen@health.usf.edu

Johannes Hebebrand, MD, Professor, Department of Psychiatry, Psychosomatics and Psychotherapy for Children and Adolescents, Institute of the University of Duisburg-Essen, NW, Germany. E-mail: johannes.hebebrand@lvr.de

Berit Lilienthal Heitmann, PhD, Professor and Director for Research, Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark. E-mail: Berit.Lilienthal.Heitmann@regionh.dk

Steven B Heymsfield, MD, George A. Bray, Jr. Endowed Super Chair in Nutrition and Executive Director of the Pennington Biomedical Research Center, Baton Rouge, LA, USA. E-mail: Steven.Heymsfield@pbrc.edu

James O Hill, PhD, Executive Director, Anschutz Health and Wellness Center, Anschutz Professor of Health and Wellness, Professor of Pediatrics, Medicine, and Physiology & Biophysics, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. E-mail: james.hill@ucdenver.edu

Andrew P Hills, PhD, FSAMF, Professor of Allied Health Research—Maternity & Neonatology, Mater Mothers’ Hospital Director—Centre for Nutrition and Exercise, Mater Research—University of Queensland Conjoint Professorial appointment: Centre for Musculoskeletal Research, Griffith Health Institute, South Brisbane, QLD, Australia. E-mail: ahills@mmri.mater.org.au

Gary Hunter, PhD, Professor of Kinesiology, Department of Human Studies, School of Education, and the Nutrition Obesity Research Center, Birmingham, AL, USA. E-mail: ghunter@uab.edu

Ted Kyle, RPh, MBA, ConscienHealth, Pittsburgh, PA, USA. E-mail: Ted.Kyle@ConscienHealth.org

David A Levitsky, PhD, Weiss Presidential Fellow and Professor of Nutrition and Psychology, Cornell University, Ithaca, NY, USA. E-mail: dal4@cornell.edu

Amy Luke, PhD, Professor, Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA. E-mail: aluke@lumc.edu

Ian Macdonald, PhD, Head of School of Life Sciences, Professor of Metabolic Physiology, Faculty of Medicine & Health Sciences, University of Nottingham Medical School, Nottingham, UK. E-mail: ian.macdonald@nottingham.ac.uk

Robert AJ Matthews, MA, CPhys, FRAS, Visiting Reader in Science, Aston University, Birmingham, UK. E-mail: rajm@physics.org

Corby K Martin, PhD, Associate Professor, Director of Behavioral Science and Epidemiology, Director of Ingestive Behavior Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA. E-mail: Corby.Martin@pbrc.edu

Ann Yelmokas McDermott, PhD, MS, LDN, Associate Scientist, Department of International Health and Assistant Director, Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. E-mail: amcderm4@jhu.edu

Timothy H Moran, PhD, Paul R McHugh Professor, Vice Chair, Director of Research, Director of the Behavioral Neuroscience Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA. E-mail: tmoran@jhmi.edu

Sir Stephen O’Rahilly, MD, FRS, FMSci, Professor of Clinical Biochemistry and Medicine, University of Cambridge and Director, MRC Metabolic Diseases Unit, Cambridge, UK. E-mail: so104@medschl.cam.ac.uk

Angelo Pietrobelli, MD, Associate Professor, Pediatric Section of the Department of Life and Reproduction Sciences, Verona University Medical School, Verona, Italy. E-mail: angpie@tin.it

Stephan Rössner, MD, Professor emeritus, Karolinska Institutet, Apple Bay Obesity Research Centre, Bromma, Sweden. E-mail: stephan@rossner.se

Wim HM Saris MD, PhD, Professor of Human Nutrition, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands. E-mail: w.saris@maastrichtuniversity.nl

Dale A Schoeller, PhD, Professor of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA. E-mail: dschoell@nutrisci.wisc.edu

Arya M Sharma, MD, PhD, Professor of Medicine, Chair in Obesity Research & Management, University of Alberta, Edmonton, AB, Canada. E-mail: amsharm@ualberta.ca

Diana Thomas, PhD, Professor of Mathematical Sciences, Montclair State University, Montclair, NJ, USA. E-mail: thomasdia@mail.montclair.edu

Thorkild IA Sørensen, PhD, Professor, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark and Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals – Part of Copenhagen University Hospital, The Capital Region, Denmark. E-mail: TSOE0005@regionh.dk

John R Speakman, DSc, Institute of Biological and Environmental Sciences, University of Aberdeen, Scotland, UK and 1000 talents Professor, State key laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China. E-mail: j.speakman@abdn.ac.uk

Judith S Stern, ScD, Distinguished Professor Emerita, Department of Nutrition, University of California, Davis, CA, USA. E-mail: jsstern@ucdavis.edu

Luc Van Gaal, MD, PhD, Associate Professor, Diabetes and Metabolic Disorders, Universiteit Antwerpen, Antwerp, Belgium. E-mail: luc.van.gaal@uza.be

S Stanley Young, PhD, Assistant Director of Bioinformatics, National Institute of Statistical Science, Research Triangle Park, NC, USA. E-mail: young@niss.org

Shankuan Zhu, MD, PhD, Qiushi Chair Professor, CMB Distinguished Professor, Obesity and Body Composition Research Center, Chronic Disease Research Institute Zhejiang University School of Public Health, School of Medicine, Hangzhou, China. E-mail: zsk@zju.edu.cn

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Dhurandhar, N., Schoeller, D., Brown, A. et al. Energy balance measurement: when something is not better than nothing. Int J Obes 39, 1109–1113 (2015). https://doi.org/10.1038/ijo.2014.199

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