# 10.4: Balancing Calories and Eating Healthfully

## Calorie Balance: Food and Beverage Intake

Controlling calorie intake from foods and beverages is fundamental to achieving and attaining calorie balance. Understanding calorie needs, knowing food sources of calories, and recognizing associations between foods and beverages and higher or lower body weight are all important concepts when building an eating pattern that promotes calorie balance and weight management. Many Americans are unaware of how many calories they need each day or the calorie content of foods and beverages.

## Understanding Calories Needs

The total number of calories a person needs each day varies depending on a number of factors, including the person’s age, gender, height, weight, and level of physical activity. In addition, a desire to lose, maintain, or gain weight affects how many calories should be consumed. Estimates range from 1,600 to 2,400 calories per day for adult women and 2,000 to 3,000 calories per day for adult men, depending on age and physical activity level.

Within each age and gender category, the low end of the range is for sedentary individuals; the high end of the range is for active individuals. Due to reductions in basal metabolic rate that occurs with aging, calorie needs generally decrease for adults as they age. Estimated needs for young children range from 1,000 to 2,000 calories per day, and the range for older children and adolescents varies substantially from 1,400 to 3,200 calories per day, with boys generally having higher calorie needs than girls. These are only estimates, and more accurate calorie needs may be determined using the Harris Benedict Equation shown below:

Step 1 – Calculating the Harris–Benedict BMR

The original Harris–Benedict equations published in 1918 and 1919.

 BMR calculation for men BMR = 66 + (6.2 x weight in pounds) + (12.7 x height in inches) – (6.76 x age in years) BMR calculations for women BMR = 655 + (4.35 x weight in pounds) + (4.7 x height in inches) - (4.7 x age in years)

Step 2 – Determine Recommended Intake

The following table enables calculation of an individual's recommended daily kilocalorie intake to maintain current weight.

 Little to no exercise Daily kilocalories needed =BMR x 1.2 Light exercise (1–3 days per week) Daily kilocalories needed = BMR x 1.375 Moderate exercise (3–5 days per week) Daily kilocalories needed = BMR x 1.55 Heavy exercise (6–7 days per week) Daily kilocalories needed = BMR x 1.725 Very heavy exercise (twice per day, extra heavy workouts) Daily kilocalories needed = BMR x 1.9

Knowing one’s daily calorie needs may be a useful reference point for determining whether the calories that a person eats and drinks are appropriate in relation to the number of calories needed each day. The best way for people to assess whether they are eating the appropriate number of calories is to monitor body weight and adjust calorie intake and participation in physical activity based on changes in weight over time. A calorie deficit of 500 calories or more per day is a common initial goal for weight loss for adults. However, maintaining a smaller deficit can have a meaningful influence on body weight over time. The effect of a calorie deficit on weight does not depend on how the deficit is produced—by reducing calorie intake, increasing expenditure, or both. Yet, in research studies, a greater proportion of the calorie deficit is often due to decreasing calorie intake with a relatively smaller fraction due to increased physical activity.

Table $$\PageIndex{1}$$. Estimated Calorie Needs Per Day By Age, Gender, and Physical Activity Level*

Estimated amounts of calories needed to maintain calorie balance for various gender and age groups at three different levels of physical activity. The estimates are rounded to the nearest 200 calories. An individual’s calorie needs may be higher or lower than these average estimates.

 gender age (years) Physical activity level: sedentary Physical activity level: moderately active Physical activity level: active child (female and male) 2-3 1000-1200 1000-1400 1000-1400 female 4-8 1200-1400 1400-1600 1400-1800 9-13 1400-1600 1600-2000 1800-2200 14-18 1800 2000 2400 19-30 1800-2000 2000-2200 2400 31-50 1800 2000 2200 51+ 1600 1800 2000-2200 male 4-8 1200-1400 1400-1600 1600-2000 9-13 1600-2000 1800-2200 2000-2600 14-18 2000-2400 2400-2800 2800-3200 19-30 2400-2600 2600-2800 3000 31-50 2200-2400 2400-2600 2800-3000 51+ 2000-2200 2200-2400 2400-2800
• Based on Estimated Energy Requirements (EER) equations, using reference heights (average) and reference weights (healthy) for each age/gender group. For children and adolescents, reference height and weight vary. For adults, the reference man is 5 feet 10 inches tall and weighs 154 pounds. The reference woman is 5 feet 4 inches tall and weighs 126 pounds. EER equations are from the Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington (DC): The National Academies Press; 2002.
• Sedentary means a lifestyle that includes only the light physical activity associated with typical day-to-day life. Moderately active means a lifestyle that includes physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life. Active means a lifestyle that includes physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life.
• The calorie ranges shown are to accommodate needs of different ages within the group. For children and adolescents, more calories are needed at older ages. For adults, fewer calories are needed at older ages. d. Estimates for females do not include women who are pregnant or breastfeeding.

## Macronutrient Proportions

The Institute of Medicine has established ranges for the percentage of calories in the diet that should come from carbohydrate, protein, and fat. These Acceptable Macronutrient Distribution Ranges (AMDR) take into account both chronic disease risk reduction and intake of essential nutrients.

To manage body weight, Americans should consume a diet that has an appropriate total number of calories and that is within the AMDR. Strong evidence shows that there is no optimal proportion of macronutrients that can facilitate weight loss or assist with maintaining weight loss. Although diets with a wide range of macronutrient proportions have been documented to promote weight loss and prevent weight regain after loss, evidence shows that the critical issue is not the relative proportion of macronutrients in the diet, but whether or not the eating pattern is reduced in calories and the individual is able to maintain a reduced-calorie intake over time. The total number of calories consumed is the essential dietary factor relevant to body weight. In adults, moderate evidence suggests that diets that are less than 45 percent of total calories as carbohydrate or more than 35 percent of total calories as protein are generally no more effective than other calorie-controlled diets for long-term weight loss and weight maintenance. Therefore, individuals who wish to lose weight or maintain weight loss can select eating patterns that maintain appropriate calorie intake and have macronutrient proportions that are within the AMDR ranges recommended in the Dietary Reference Intakes.

## Individual Foods and Beverages and Body Weight

For calorie balance, the focus should be on total calorie intake, but intake of some foods and beverages that are widely over- or under consumed has been associated with effects on body weight. In studies that have held total calorie intake constant, there is little evidence that any individual food groups or beverages have a unique impact on body weight.

Although total calorie intake is ultimately what affects calorie balance, some foods and beverages can be easily over- consumed, which results in a higher total calorie intake. As individuals vary a great deal in their dietary intake, the best advice is to monitor dietary intake and replace foods higher in calories with nutrient-dense foods and beverages relatively low in calories. The following guidance may help individuals control their total calorie intake and manage body weight:

• increase intake of whole grains, vegetables, and fruits: Moderate evidence shows that adults who eat more whole grains, particularly those higher in dietary fiber, have a lower body weight compared to adults who eat fewer whole grains. Moderate evidence in adults and limited evidence in children and adolescents suggests that increased intake of vegetables and/or fruits may protect against weight gain.
• reduce intake of sugar-sweetened beverages: This can be accomplished by drinking fewer sugar-sweetened beverages and/or consuming smaller portions. Strong evidence shows that children and adolescents who consume more sugar-sweetened beverages have higher body weight compared to those who drink less, and moderate evidence also supports this relationship in adults. Sugar-sweetened beverages provide excess calories and few essential nutrients to the diet and should only be consumed when nutrient needs have been met and without exceeding daily calorie limits.
• Monitor intake of 100% fruit juice for children and adolescents, especially those who are over- weight or obese: For most children and adolescents, intake of 100% fruit juice is not associated with body weight. However, limited evidence suggests that increased intake of 100% juice has been associated with higher body weight in children and adolescents who are overweight or obese.
• Monitor calorie intake from alcoholic beverages for adults: Moderate evidence suggests that moderate drinking of alcoholic beverages is not associated with weight gain. However, heavier than moderate consumption of alcohol over time is associated with weight gain. Because alcohol is often consumed in mixtures with other beverages, the calorie content of accompanying mixers should be considered when calculating the calorie content of alcoholic beverages. Reducing alcohol intake is a strategy that can be used by adults to consume fewer calories.

Strong evidence in adults and moderate evidence in children and adolescents demonstrates that consumption of milk and milk products does not play a special role in weight management. Evidence also suggests that there is no independent relationship between the intake of meat and poultry or beans and peas, including soy, with body weight. Although not independently related to body weight, these foods are important sources of nutrients in healthy eating patterns.

Table $$\PageIndex{2}$$. Recommended Macronutrient Proportions by Age

 Carbohydrate Protein fat Young children (1-3 years) 45-65% 5-20% 30-40% Other children and adolescents (4-18 years) 45-65% 10-30% 25-35% Adults (19 years and older) 45-65% 10-30% 20-35%

Source: Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington (DC): The National Academies Press; 2002.

## Developing Healthy Eating Patterns

Because people consume a variety of foods and beverages throughout the day as meals and snacks, a growing body of research has begun to describe overall eating patterns that help promote calorie balance and weight management. One aspect of these patterns that has been researched is the concept of calorie density, or the amount of calories provided per unit of food weight. Foods high in water and/or dietary fiber typically have fewer calories per gram and are lower in calorie density, while foods higher in fat are generally higher in calorie density. A dietary pattern low in calorie density is characterized by a relatively high intake of vegetables, fruit, and dietary fiber and a relatively low intake of total fat, saturated fat, and added sugars. Strong evidence shows that eating patterns that are low in calorie density improve weight loss and weight maintenance, and also may be associated with a lower risk of type 2 diabetes in adults.

Although total calories consumed is important for calorie balance and weight management, it is important to consider the nutrients and other healthful properties of food and beverages, as well as their calories, when selecting an eating pattern for optimal health. When choosing carbohydrates, Americans should emphasize naturally occurring carbohydrates, such as those found in whole grains, beans and peas, vegetables, and fruits, especially those high in dietary fiber, while limiting refined grains and intake of foods with added sugars. Glycemic index and glycemic load have been developed as measures of the effects of carbohydrate-containing foods and beverages on blood sugar levels. Strong evidence shows that glycemic index and/or glycemic load are not associated with body weight; thus, it is not necessary to consider these measures when selecting carbohydrate foods and beverages for weight management. For protein, plant-based sources and/or animal-based sources can be incorporated into a healthy eating pattern. However, some protein products, particularly some animal-based sources, are high in saturated fat, so nonfat, low-fat, or lean choices should be selected. Fat intake should emphasize monounsaturated and polyunsaturated fats, such as those found in seafood, nuts, seeds, and oils.

Americans should move toward more healthful eating patterns. Overall, as long as foods and beverages consumed meet nutrient needs and calorie intake is appropriate, individuals can select an eating pattern that they enjoy and can maintain over time. Individuals should consider the calories from all foods and beverages they consume, regardless of when and where they eat or drink.

## Calorie Balance: Physical Activity

Physical activity is the other side of the calorie balance equation and should be considered when addressing weight management. In 2008, the U.S. Department of Health and Human Services released a comprehensive set of physical activity recommendations for Americans ages 6 years and older. Weight management along with health outcomes, including premature (early) death, diseases (such as coronary heart disease, type 2 diabetes, and osteoporosis), and risk factors for disease (such as high blood pressure and high blood cholesterol) were among the outcomes considered in developing the Physical Activity Guidelines for Americans. Getting adequate amounts of physical activity conveys many health benefits independent of body weight.

Strong evidence supports that regular participation in physical activity also helps people maintain a healthy weight and prevent excess weight gain. Further, physical activity, particularly when combined with reduced calorie intake, may aid weight loss and maintenance of weight loss. Decreasing time spent in sedentary behaviors also is important as well. Strong evidence shows that more screen time, particularly television viewing, is associated with overweight and obesity in children, adolescents, and adults. Substituting active pursuits for sedentary time can help people manage their weight and provides other health benefits.

The Physical Activity Guidelines for Americans provides guidance to help Americans improve their health, including weight management, through appropriate physical activity. The amount of physical activity necessary to successfully maintain a healthy body weight depends on calorie intake and varies considerably among adults, including older adults. To achieve and maintain a healthy body weight, adults should do the equivalent of 150 minutes of moderate-intensity aerobic activity each week. If necessary, adults should increase their weekly minutes of aerobic physical activity gradually over time and decrease calorie intake to a point where they can achieve calorie balance and a healthy weight. Some adults will need a higher level of physical activity than others to achieve and maintain a healthy body weight. Some may need more than the equivalent of 300 minutes per week of moderate-intensity activity.

For children and adolescents ages 6 years and older, 60 minutes or more of physical activity per day is recommended. Although the Physical Activity Guidelines do not include a specific quantitative recommendation for children ages 2 to 5 years, young children should play actively several times each day. Children and adolescents are often active in short bursts of time rather than for sustained periods of time, and these short bursts can add up to meet physical activity needs. Physical activities for children and adolescents of all ages should be developmentally appropriate and enjoyable, and should offer variety.

## Principles for Promoting Calorie Balance and Weight Management

To address the current calorie imbalance in the United States, individuals are encouraged to become more conscious of what they eat and what they do. This means increasing awareness of what, when, why, and how much they eat, deliberately making better choices regarding what and how much they consume, and seeking ways to be more physically active. Several behaviors and practices have been shown to help people manage their food and beverage intake and calorie expenditure and ultimately manage body weight. The behaviors with the strongest evidence related to body weight include:

• Focus on the total number of calories consumed. Maintaining a healthy eating pattern at an appropriate calorie level within the AMDR is advisable for weight management. Consuming an eating pattern low in calorie density may help to reduce calorie intake and improve body weight outcomes and overall health.
• Monitor food intake. Monitoring intake has been shown to help individuals become more aware of what and how much they eat and drink. The Nutrition Facts label found on food packaging provides calorie information for each serving of food or beverage and can assist consumers in monitoring their intake. Also, monitoring body weight and physical activity can help prevent weight gain and improve outcomes when actively losing weight or maintaining body weight following weight loss.
• When eating out, choose smaller portions or lower-calorie options. When possible, order a small-sized option, share a meal, or take home part of the meal. Review the calorie content of foods and beverages offered and choose lower-calorie options. Calorie information may be available on menus, in a pamphlet, on food wrappers, or online. Or, instead of eating out, cook and eat more meals at home.
• Prepare, serve, and consume smaller portions of foods and beverages, especially those high in calories. Individuals eat and drink more when provided larger portions. Serving and consuming smaller portions is associated with weight loss and weight maintenance over time.
• Eat a nutrient-dense breakfast. Not eating breakfast has been associated with excess body weight, especially among children and adolescents. Consuming breakfast also has been associated with weight loss and weight loss maintenance, as well as improved nutrient intake.
• Limit screen time. In children, adolescents, and adults, screen time, especially television viewing, is directly associated with increased overweight and obesity. Children and adolescents are encouraged to spend no more than 1 to 2 hours each day watching television, playing electronic games, or using the computer (other than for homework). Also, avoid eating while watching television, which can result in overeating.

Research has investigated additional principles that may promote calorie balance and weight management. However, the evidence for these behaviors is not as strong. Some evidence indicates that beverages are less filling than solid foods, such that the calories from beverages may not be offset by reduced intake of solid foods, which can lead to higher total calorie intake. In contrast, soup, particularly broth or water-based soups, may lead to decreased calorie intake and body weight over time. Further, replacing added sugars with non-caloric sweeteners may reduce calorie intake in the short-term, yet questions remain about their effectiveness as a weight management strategy. Other behaviors have been studied, such as snacking and frequency of eating, but there is currently not enough evidence to support a specific recommendation for these behaviors to help manage body weight.

Although obesity is related to many chronic health conditions, it is not the only lifestyle-related public health problem confronting the Nation. Eating patterns that are high in calories, but low in nutrients can leave a person overweight but malnourished.

Nutritionally unbalanced diets can negatively affect a person’s health regardless of weight status. Such diets are related to many of the most common and costly health problems in the United States, particularly heart disease and its risk factors and type 2 diabetes.

Similarly, a sedentary lifestyle increases risk of these diseases. Improved eating patterns and increased physical activity have numerous health benefits beyond maintaining a healthy weight. Improved nutrition, appropriate eating behaviors, and increased physical activity have tremendous potential to decrease the prevalence of overweight and obesity, enhance the public’s health, reduce morbidity and premature mortality, and reduce health care costs.