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Energy balance measurement: when something is not better than nothing


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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  1. Bell J, Bauer J, Capra S, Pulle CR . Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine? Can J Physiol Pharmacol 2013; 91: 489–495.

    Article  CAS  Google Scholar 

  2. Gilbert JA, Miller D, Olson S, St-Pierre S . After-school snack intake among Canadian children and adolescents. Can J Public Health 2012; 103: e448–e452.

    PubMed  Google Scholar 

  3. Ford ES, Dietz WH . Trends in energy intake among adults in the United States: findings from NHANES. Am J Clin Nutr 2013; 97: 848–853.

    Article  CAS  Google Scholar 

  4. Ervin RB, Ogden CL . Trends in intake of energy and macronutrients in children and adolescents from 1999–2000 through 2009–2010. National Center for Health Statistics: Hyattsville, MD, USA, 2013. NCHS 411 data brief no. 113..

  5. Hall KD, Heymsfield SB, Kemnitz JW, Klein S, Schoeller DA, Speakman JR . Energy balance and its components: implications for body weight regulation. Am J Clin Nutr 2012; 95: 989–994.

    Article  Google Scholar 

  6. Thomas DM, Bouchard C, Church T, Slentz C, Kraus WE, Redman LM et al. Why do individuals not lose more weight from an exercise intervention at a defined dose? An energy balance analysis. Obes Rev 2012; 13: 835–847.

    Article  CAS  Google Scholar 

  7. Austin GL, Ogden LG, Hill JO . Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971-2006. Am J Clin Nutr 2011; 93: 836–843.

    Article  CAS  Google Scholar 

  8. Freedman LS CJ, Commins JM, Moler JE, Arab L, Baer D, Kipnis V et al. Pooled results from 5 validation studies of dietary self-report instruments using recovery biomarkers for energy and protein intake. Am J Epidemiol 2014; 180: 172–188.

    Article  Google Scholar 

  9. LS F. Recommendations, Dissents and Comments for [Freedman LS et al., Am J Epidemiol 2014, 180(2):172-88]. F1000Prime; 2014 (cited 2014 05 Oct); available from:

  10. Schoeller DA, Bandini LG, Dietz WH . Inaccuracies in self-reported intake identified by comparison with the doubly labelled water method. Can J Physiol Pharmacol 1990; 68: 941–949.

    Article  CAS  Google Scholar 

  11. Archer E, Hand GA, Blair SN . Validity of U.S. Nutritional surveillance: national health and nutrition examination survey caloric energy intake data, 1971-2010. PLoS One 2013; 8: e76632.

    Article  CAS  Google Scholar 

  12. Hu FB, Rimm E, Smith-Warner SA, Feskanich D, Stampfer MJ, Ascherio A et al. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr 1999; 69: 243–249.

    Article  CAS  Google Scholar 

  13. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA et al. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 1991; 45: 569–581.

    CAS  Google Scholar 

  14. Johnstone AM, Murison SD, Duncan JS, Rance KA, Speakman JR . Factors influencing variation in basal metabolic rate include fat-free mass, fat mass, age, and circulating thyroxine but not sex, circulating leptin, or triiodothyronine. Am J Clin Nutr 2005; 82: 941–948.

    Article  CAS  Google Scholar 

  15. Heitmann BL, Lissner L . Dietary underreporting by obese individuals—is it specific or non-specific? BMJ 1995; 311: 986–989.

    Article  CAS  Google Scholar 

  16. Plasqui G, Westerterp KR . Physical activity assessment with accelerometers: an evaluation against doubly labeled water. Obesity (Silver Spring) 2007; 15: 2371–2379.

    Article  Google Scholar 

  17. Walsh MC, Hunter GR, Sirikul B, Gower BA . Comparison of self-reported with objectively assessed energy expenditure in black and white women before and after weight loss. Am J Clin Nutr 2004; 79: 1013–1019.

    Article  CAS  Google Scholar 

  18. Villars C, Bergouignan A, Dugas J, Antoun E, Schoeller DA, Roth H et al. Validity of combining heart rate and uniaxial acceleration to measure free-living physical activity energy expenditure in young men. J Appl Physiol 2012; 113: 1763–1771.

    Article  CAS  Google Scholar 

  19. Tudor-Locke C, Martin CK, Brashear MM, Rood JC, Katzmarzyk PT, Johnson WD . Predicting doubly labeled water energy expenditure from ambulatory activity. Appl Physiol Nutr Metab 2012; 37: 1091–1100.

    Article  Google Scholar 

  20. Hollis JF, Gullion CM, Stevens VJ, Brantley PJ, Appel LJ, Ard JD et al. Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prev Med 2008; 35: 118–126.

    Article  Google Scholar 

  21. McGowan CA, McAuliffe FM . Maternal nutrient intakes and levels of energy underreporting during early pregnancy. Eur J Clin Nutr 2012; 66: 906–913.

    Article  CAS  Google Scholar 

  22. Heitmann BL, Frederiksen P . Imprecise methods may both obscure and aggravate a relation between fat and breast cancer. Eur J Clin Nutr 2007; 61: 925–927.

    Article  CAS  Google Scholar 

  23. Heitmann BL, Lissner L . Can adverse effects of dietary fat intake be overestimated as a consequence of dietary fat underreporting? Public Health Nutr 2005; 8: 1322–1327.

    Article  Google Scholar 

  24. Bross R, Noori N, Kovesdy CP, Murali SB, Benner D, Block G et al. Dietary assessment of individuals with chronic kidney disease. Semin Dial 2010; 23: 359–364.

    Article  Google Scholar 

  25. Schatzkin A, Kipnis V, Carroll RJ, Midthune D, Subar AF, Bingham S et al. A comparison of a food frequency questionnaire with a 24-hour recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study. Int J Epidemiol 2003; 32: 1054–1062.

    Article  Google Scholar 

  26. Aune D, Chan DS, Vieira AR, Navarro Rosenblatt DA, Vieira R, Greenwood DC et al. Dietary compared with blood concentrations of carotenoids and breast cancer risk: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 2012; 96: 356–373.

    Article  CAS  Google Scholar 

  27. Samuel-Hodge CD, Fernandez LM, Henriquez-Roldan CF, Johnston LF, Keyserling TC . A comparison of self-reported energy intake with total energy expenditure estimated by accelerometer and basal metabolic rate in African-American women with type 2 diabetes. Diabetes Care 2004; 27: 663–669.

    Article  Google Scholar 

  28. Gu Y, Nieves JW, Stern Y, Luchsinger JA, Scarmeas N . Food combination and Alzheimer disease risk: a protective diet. Arch Neurol 2010; 67: 699–706.

    Article  Google Scholar 

  29. Warren JM, Ekelund U, Besson H, Mezzani A, Geladas N, Vanhees L . Assessment of physical activity - a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2010; 17: 127–139.

    Article  Google Scholar 

  30. Martin CK, Correa JB, Han H, Allen HR, Rood J, Champagne CM et al. Validity of the Remote Food Photography Method (RFPM) for estimating energy and nutrient intake in near real-time. Obesity (Silver Spring) 2012; 20: 891–899.

    Article  CAS  Google Scholar 

  31. Martin CK, Han H, Coulon SM, Allen HR, Champagne CM, Anton SD . A novel method to remotely measure food intake of free-living individuals in real time: the remote food photography method. Br J Nutr 2009; 101: 446–456.

    Article  CAS  Google Scholar 

  32. Dong Y, Hoover A, Scisco J, Muth E . A new method for measuring meal intake in humans via automated wrist motion tracking. Appl Psychophysiol Biofeedback 2012; 37: 205–215.

    Article  Google Scholar 

  33. Sazonov ES, Makeyev O, Schuckers S, Lopez-Meyer P, Melanson EL, Neuman MR . Automatic detection of swallowing events by acoustical means for applications of monitoring of ingestive behavior. IEEE Trans Biomed Eng 2010; 57: 626–633.

    Article  Google Scholar 

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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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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:

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

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

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

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:

John E Blundell, Professor and Chair, PsychoBiology, Institute of Psychological Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK. E-mail:

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

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

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:

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:

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

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:

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:

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

Paul Selberg-Franks, PhD, Adjunct Professor of Nutrition, Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. E-mail:

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

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:

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:

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:

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

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:

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:

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:

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

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

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

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

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:

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

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:

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:

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:

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:

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

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

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:

Dale A Schoeller, PhD, Professor of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA. E-mail:

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

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

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:

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:

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

Luc Van Gaal, MD, PhD, Associate Professor, Diabetes and Metabolic Disorders, Universiteit Antwerpen, Antwerp, Belgium. E-mail:

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

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:

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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).

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