Total daily energy expenditure and activity level in anorexia nervosa

Regina C. Casper*, Dale A. Schoeller, Robert Kushner, Jeanne Hnilicka, Sarah Trainer Gold

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

131 Scopus citations


Clinical reports consistently comment on high physical activity for anorexia nervosa patients but provide few quantitative measurements. To assess activity, total daily energy expenditure (TDEE) by doubly labeled water, basal metabolic rate (BMR), and thermic effect of meals (TEM) were measured in six female outpatients with anorexia nervosa (67% of ideal body weight) and age-, sex-, and height-matched to six control subjects. Anorexia nervosa patients expended more energy as physical activity than did control subjects [0.084 ± 0.012 vs 0.044 ± 0.008 MJ/kg body wt, respectively (20.1 ± 3.0 vs 10.5 ± 1.9 kcal/kg body wt, respectively), P < 0.04], although they had a lower BMR [4.17 ± 0.37 vs 5.52 ± 0.15 MJ/d, respectively (997 ± 89 vs 1319 ± 37 kcal/d, respectively), P < 0.01]. TDEE and TEM were similar in both groups. There was a reduction in serum triiodothyronine (T3; 1.20 ± 0.15 vs 2.04 ± 0.13 nmol/ L, respectively; P < 0.003) and a slight reduction in serum thyroxine (T4); reverse T3, thyrotropin, free T4, serum cortisol, and adrenocorticotropin values were normal. BMR correlated with total body weight and fat-free mass. These results provide quantitative evidence for increased physical activity in anorexia nervosa despite profound underweight and hypometabolism.

Original languageEnglish (US)
Pages (from-to)1143-1150
Number of pages8
JournalAmerican Journal of Clinical Nutrition
Issue number5
StatePublished - May 1991


  • Body composition
  • Doubly labeled water
  • Mass spectrometry
  • Thyroid hormones

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Medicine (miscellaneous)


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