Understanding and Calculating Caloric Need
Harris Benedict Equation
Once we have established the BMR, we can now calculate the individual's daily caloric needs based on energy expenditure using the Harris Benedict Formula.
The Harris Benedict Equation uses the Basal Metabolic Rate (BMR) and then applies an activity factor to determine the total daily energy expenditure in calories. The only factor omitted by the Harris Benedict Equation is lean body mass. Leaner bodies need more calories than less leaner ones. Therefore, this equation will be accurate in all but the very muscular - it will underestimate calorie needs, and the very fat - it will overestimate calorie needs.
First, determine BMR using the BMR calculator or the BMR formula from the previous page.
Then, multiply the BMR by the appropriate activity factor (underlined), as follows:
| Sedentary Adults (little to no exercise whatsoever) | Daily Calories Needed = | BMR x 1.2 |
| Lightly Active Adults (light exercise/sport participation 1-3 days per week) | Daily Calories Needed = | BMR x 1.375 |
| Moderately active Adults (moderate exercise/sports participation 3-5 days per week) | Daily Calories Needed = | BMR x 1.55 |
| Very Active Adults (hard exercise/sport participation 6-7 days per week) | Daily Calories Needed = | BMR x 1.725 |
| Extra Active (very hard exercise/sport participation and a physical job, or training 2 times per day) | Daily Calories Needed = | BMR x 1.9 |
Example: Take our patient from the previous page, the 35 year old female weighing 140 pounds who is 5 feet 5 inches tall. We determined her BMR to be 1405 calories. This patient is lightly active. She takes her dog for a short walk every day and does a gente yoga class twice a week. Therefore, we will multiply her BMR of 1405 by 1.375 which is 1931 calories. This is the total number of calories needed in order to maintain her current weight.
Once you know the number of calories needed to maintain a patient's current weight, you can easily calculate the number of calories a patient needs in order to gain or lose weight.
If a patient wants to gain weight, they will need to consume more calories than they burn. One pound of body weight is roughly equivalent of 3500 calories, so eating an extra 500 calories per day will cause patients to gain one pound per week.
Let's say our female 35 year old patient wants to lose ten pounds. She would need to eat 1931(the total number of calories needed to keep her current weight) subtracted by 500 which is 1431. This 500 calorie deficit will cause her to lose one pound per week if her activity level remains the same. It will take her about 10 weeks to lose ten pounds.
Now, lets' say our 35 year old female patient was to gain five pounds. She would need to increase her daily caloric intake by 500, so 1931 + 500 = 2431. A 500 calorie increase will cause this patient to gain one pound a week if her activity level remains lightly active. It will take her about five weeks to gain five pounds.
If a patient wants to lose weight, a guideline that has been established by the American College of Sports Medicine (ACSM) for lowering calorie intake is to reduce calories by at least 500, but not more than 1000 calories below maintenance level. For people with only a small amount of weight to lose, 1000 calories will be way too little. As a guide to minimum calorie intake, the ACSM recommends that calorie levels never drop below 1200 calories per day for women or 1800 for men. Even these calorie levels are quite low and in many cases can cause fatigue and slow healing in patients.
Please take a moment to calculate your own BMR and then using the Harris Benedict Equation, please calculate your daily caloric needs.
The Body Mass Index Chart can serve as a guideline to help acupuncturists determine their patients weight status. Please note that this chart does not take into consideration body composition such as muscle mass and fat mass. A very muscular patient may be indicated as "overweight" according to the BMI or a very lean athletic person may be considered "underweight" by the BMI. If this is a concern, recommend that your patient get more advanced testing such as hydrostatic weighting, dexa scans, caliber fat tests, or pod bod to determine their body composition.
A number of Body Mass Index Charts can be found online on google images I recommend you choose one for you that is easy to read, and print it out so you can have it available as a quick reference for your patients.