The Calorie Balance Point

The simplest and least reliable way of estimating the present calorie balance point requires only information about the patient's age, sex, present body weight, and occupation. It is assumed that the basal metabolism is not far from normal and that the activity of the patient is similar to that of other obese persons in the same occupation and cultural environment.

Table 5 (for men) and Table 6 (for women) provide crude estimates based on these assumptions for obese people 20 to 60 years old in relatively sedentary occupations. For patients who spend most of the time in bed and have no more than a minimum of very light activity, 20 per cent should be deducted from the tabular figures. For people whose activity is more than relatively sedentary, more calories should be added of course. A 10 per cent addition to the tabular figures would be appropriate for the people whose jobs require them to stand and walk about slowly all day or for persons who do some gardening or other light activity outside of their regular occupation. Add 20 per cent for carpenters and builders generally, or for very industrious housewives.

The proof of the accuracy of the estimate made with the help of Tables 5 and 6 is what happens to the body weight on a measured reducing diet. If the weight change does not correspond with the prediction from the calorie deficit, the estimate of the balance point was wrong and should be changed accordingly. The calorie difference between the present balance point and the reducing diet is the crude calorie deficit. The true or effective calorie deficits corresponding to various present calorie balance TABLE 5CALORIE BALANCE (Constant Weight), OBESE MEN Crude preliminary estimate of daily calorie expenditure of obese men maintaining constant weight in a relatively sedentary occupation (e.g., businessman, teacher, watchman).

	Age	Age	Age	Age	Age
Weight	20	30	40	50	60
10 st. (140 lb.)	2,480	2,360	2,240	2,140	2,040
11 st. 6 lb. (160 lb.)	2,660	2,530	2,410	2,310	2,200
12 st. 12 lb. (180 lb.)	2,830	2,700	2,570	2,450	2,350
14 st. 4 lb. (200 lb.)	2,990	2,850	2,730	2,600	2,480
15 st. 10 lb. (220 lb.)	3,140	2,990	2,850	2,720	2,600
17 st. 2 lb. (240 lb.)	3,280	3,130	2,970	2,830	2,710
18 st. 8 lb. (260 lb.)	3,410	3,250	3,090	2,940	2,810
20 st. (280 lb.)	3,530	3,370	3,210	3,040	2,910
21 st. 6 lb. (300 lb.)	3,640	3,470	3,310	3,150	3,010
22 st. 12 lb. (320 lb.)	3,750	3,570	3,410	3,250	3,110

TABLE 6CALORIE BALANCE (Constant Weight), OBESE WOMEN Crude preliminary estimate of daily calorie expenditure of obese women maintaining constant weight in a relatively sedentary occupation (e.g., office worker, teacher, housewife with only minor housework).

	Age	Age	Age	Age	Age
Weight	20	30	40	50	60
7 st. 2 lb. (100 lb.)	1,700	1,630	1,570	1,510	1,450
8 st. 8 lb. (120 lb.)	1,850	1,770	1,700	1,630	1,570
10 st. (140 lb.)	2,000	1,910	1,840	1,760	1,690
11 st. 6 lb. (160 lb.)	2,140	2,050	1,970	1,880	1,810
12 st. 12 lb. (180 lb.)	2,280	2,180	2,090	2,010	1,930
14 st. 4 lb. (200 lb.)	2,410	2,300	2,210	2,130	2,050
15 st. 10 lb. (220 lb.)	2,540	2,420	2,320	2,240	2,160
17 st. 2 lb. (240 lb.)	2,660	2,540	2,430	2,350	2,270
18 st. 8 lb. (260 lb.)	2,750	2,630	2,540	2,450	2,370
20 st. (280 lb.)	2,860	2,740	2,640	2,550	2,470

points and reducing diets are given in Table 7. The weight losses predicted from these calorie deficits are given in Table 8.

It is much better to make a direct estimate of the present calorie balance point by measuring the foods that hold the weight constant. For this you need a bathroom scales, a dietetic scales for weighing the food, and a diary or notebook to record the body weight and the diet. All of these are also needed for any reducing programme.

A good estimate of your present (pre-diet) calorie balance point will be obtained by eating all your meals for several weeks in a metabolic kitchen where you will also learn practical details about counting calories. But this is expensive and inconvenient.

TABLE 7No Change in Activity The diet on which your weight is now constant is your "Present Diet". The table gives the true daily calorie deficit, initially, when you change to the reducing diets indicated at the tops of the columns.

Calorie Deficit on Diets of: 1,000 cal. 1,400 cal. 1,800 cal. 2,300 cal.

1,600	540	180	-	-
1,800	720	360	-	-
2,000	900	540	180	-
2,200	1,080	720	360	-
2,400	1,260	900	540	90
2,600	1,440	1,080	720	270
2,800	1,620	1,260	900	450
3,000	1,800	1,440	1,080	630
3,200	1,980	1,620	1,260	810
3,400	*	1,800	1,440	990
3,600	*	1,980	1,620	1,170
3,800	*	*	1,800	1,350
4,000	*	*	1,980	1,530
* Deficits over

Moreover, going to the diet kitchen may alter your mode of life so that the calorie report, while accurate, does not actually match the way you live ordinarily. The same job can be done at home, particularly with some professional advice.

The patient, at home, tries not to change the accustomed diet and activity but measures every item of food and drink. Every item that provides calories, including alcoholic beverages, must WEIGHT LOSS PREDICTED FROMCALORIE DEFICIT This table gives the pounds of weight loss in 30, 60, and 90 days predicted from the calorie deficit at the start of the diet with no change in activity.

Daily calorie		Weight Loss in:
Deficit	30 days	60 days	90 days
90	0.8	1.5	2.2
180	1.7	3.3	4.7
270	2.5	4.8	6.9
360	3.4	6.5	9.3
450	4.2	8.0	11.5
540	5.1	9.7	13.9
630	5.9	11.2 '1	16.1
720	6.8	12.9	18.5
810	7.6	14.5	20.8
900	8.5	16.1	23.7
990	9.3	17.7	25.3
1,080	10.1	19.3	27.6
1,170	11.0	20.9	29.9
1,260	11.8	22.5	32.2
1,350	12.7	24.2	34.6
1,440	13.5	25.7	36.8
1,530	14.3	27.3	39.1
1,620	15.2	29.0	41.5
1,800	16.9	32.2	464
1,980	18.6	35.4	50.7

be recorded. The tables at the end of this book will enable you to translate the amounts of food into calories. The body weight is recorded from time to time to make sure it is constant, at least to within a pound or two. At the end of 14 days all calories eaten are added up and the sum is divided by 14. The result is as good an estimate of your present calorie balance point as you are likely to get by any practical method. If the diet followed during this test period is really a faithful continuation of the usual diet preceding the test, you can estimate the calorie balance point within about 10 per cent. It is a good idea to have the computations checked by a dietician or a doctor experienced with diet questions.

Alternatively, and better in some respects, start your programme by changing to one of the low fat diets for which menus are given in this book. The balance point is estimated on this diet, with such adjustment of food as is needed to maintain weight constant, and the reducing diet is developed from that point. This two-stage diet correction may be easier and has the advantage that right from the outset your diet is improved in quality.

In other words, either the 1,800- or the 2,300-calorie series of menus is your basic diet, and you add calories in easy-to-count form as needed to find the point where the body weight seems to be stable. If you gain weight on 1,800 calories daily, subtract food items from the 1,800-calorie menus. A good estimate of your present calorie balance point can usually be made in a month in this way, and professional supervision is hardly needed.

It is essential, of course, that the weight stay constant, preferably for two weeks or more. The only bad feature of this method of estimating the balance point is that it is very easy to start losing weight as soon as you go on the fat-controlled diet. If you are going to go on a serious reducing diet later you should prevent weight change at this stage.

The start, then, is simply to hazard a very rough guess at your present (constant weight maintenance) calorie use using Table 5 or 6. Suppose this preliminary estimate is balanced at 2,500 calories daily. Now live exclusively on the 2,300-calorie menus in this book, but add 200 calories daily of whatever kind of food you like (except pure fat or fat meat). Watch the body weight and appetite and adjust the calories in the diet accordingly. What you actually eat is recorded for each day, of course. If you really eat the full 2,300-calorie menu plus two slices of bread and a table-spoonful of marmalade and nothing else, the day's entry is simply:

Menu	2,300 calories
2 slices bread at 65	130 calories
1 tablespoon marmalade	55 calories
TOTAL	2,485 calories

After your weight has proved to be steady (several weeks), add up all the calories eaten, divide by the number of days, and the result is the calorie balance point.

Reducing Plan for a Target Weight As soon as the calorie balance has been obtained by any method, it is possible to estimate how low the reducing diet should be to reach the target weight in a given period of time. A weight loss target of six to ten pounds a month is suitable except in extreme obesity. A good deal of weight may be lost in a "crash" programme, but more often than not the weight is regained in the next six months because you never learned to live on something like a normal diet.

A relatively slow reduction programme is not only safer from the standpoint of the physical strength and the disposition of the patient; it allows establishment of a new eating pattern and attitude towards food. A series of 90-day reducing periods are needed in cases of extreme obesity. A 90-day programme does nicely.

In this book detailed menus are given for 1,000-, 1,800-, and 2,300 calorie diets, and these, plus the tables of calorie values of foods, make it easy to provide any level of the diet above 1,000 calories daily. It is very rarely desirable to go below 1,000 calories. If the calorie balance point is indicated to be of the order of 1,200 calories or below, choose the 1,000-calorie diet and increase the daily exercise. Table 7 gives the daily calorie deficits produced at the start of the programme by diets of 1,000, 1,400, 1,800, and 2,300 calories when these replace the pre-reduction diet ("Present Diet") given in the left-hand column of the table. Deficits over 2,000 calories daily are seldom desirable and should never be undertaken except under careful medical supervision.

If the physical activity of the reducer is not changed, these calorie deficits are estimated to produce, on the average, the 30-day, 60-day, and 90-day weight losses given in Table 8. As weight is lost, the actual calorie deficits will decrease, but allowance has been made for this change in calculating the predicted weight losses.