June 28 — 29, 2007 Advisory Committee Meeting
Minutes

Energy Balance

Dr. Howley was introduced to discuss energy balance.

In contrast to the other clinical conditions that have been discussed, the achievement of energy balance is equally dependent upon energy intake as well as energy expenditure.

Two questions should be re-examined: How much physical activity is needed to prevent migration from normal BMI to overweight BMI or from overweight BMI to the obese BMI category; and second, how much physical activity is needed to prevent weight regain after a large weight loss in formally obese individuals? There appears to be more agreement in the literature regarding the latter question than the former. Additionally, we should also address physical activity recommendations within the context of weight-loss programs because of the health-related impact of physical activity and the participants in those programs that are independent of weight loss. There is considerable evidence indicating numerous health outcomes from such interventions, and they should be included as a part of this session.

Quantity versus quality also needs to be addressed. For example, it will be helpful to know if there's a difference between moderate intensity physical activity and vigorous intensity physical activity when the volume of exercise is held constant as far as energy balance issues are concerned. In addition and within this context, we should examine the role of gender and age as variables that might impact the role of physical activity on energy balance, with special attention to pre- and post-menopausal women and those experiencing sarcopenia. And lastly, we should make sure that we review resistance training independent of endurance training in this context.

Children, separated out between boys and girls, should be singled out in a special category. Given that children are naturally in a state of positive energy balance, a weight maintenance physical activity recommendation doesn't make a great deal of sense. Additionally, the role of physical activity in weight-loss programs for obese children should be examined.

The following special populations should be addressed relative to physical activity and energy balance: Type 2 diabetes; pregnant women relative to healthy weight gain; and populations with disabilities.

Finally, a couple of measurement issues should be discussed at some point. Given that heavier individuals have a larger gross caloric expenditure for any combination of exercise intensity and duration.

Energy balance should also address the relationship of physical inactivity to energy balance in whatever populations for which those data are available.

Further discussion on energy balance included placing primary emphasis on the issue of the relationship between physical activity and prevention of excessive weight gain in those who are not already overweight.

Other population sub-groups that should be addressed include underweight people and underserved and minority populations.

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