Discrepancy between self-reported and actual caloric intake and exercise in obese subjects.

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N Engl J Med 1992 Dec 31;327(27):1893-1898

Discrepancy between self-reported and actual caloric intake and exercise in
obese subjects.

Lichtman SW, Pisarska K, Berman ER, Pestone M, Dowling H, Offenbacher E,
Weisel H, Heshka S, Matthews DE, Heymsfield SB.

Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia
University College of Physicians and Surgeons, New York, NY.

BACKGROUND AND METHODS. Some obese subjects repeatedly fail to lose weight
even though they report restricting their caloric intake to less than 1200
kcal per day. We studied two explanations for this apparent resistance to
diet--low total energy expenditure and underreporting of caloric intake--in
224 consecutive obese subjects presenting for treatment. Group 1 consisted
of nine women and one man with a history of diet resistance in whom we
evaluated total energy expenditure and its main thermogenic components and
actual energy intake for 14 days by indirect calorimetry and analysis of
body composition. Group 2, subgroups of which served as controls in the
various evaluations, consisted of 67 women and 13 men with no history of
diet resistance. RESULTS. Total energy expenditure and resting metabolic
rate in the subjects with diet resistance (group 1) were within 5 percent
of the predicted values for body composition, and there was no significant
difference between groups 1 and 2 in the thermic effects of food and
exercise. Low energy expenditure was thus excluded as a mechanism of
self-reported diet resistance. In contrast, the subjects in group
1underreported their actual food intake by an average (+/- SD) of 47 +/- 16
percent and overreported their physical activity by 51 +/- 75 percent.
Although the subjects in group 1 had no distinct psychopathologic
characteristics, they perceived a genetic cause for their obesity, used
thyroid medication at a high frequency, and described their eating behavior
as relatively normal (all P 0.05 as compared with group 2). CONCLUSIONS.
The failure of some obese subjects to lose weight while eating a diet they
report as low in calories is due to an energy intake substantially higher
than reported and an overestimation of physical activity, not to an
abnormality in thermogenesis.


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