# Daily Caloric Deficit

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Weight gain, which for most is the result of consuming excess calories, is a gradual but cumulative process. Patients do not become obese in one day of excessive eating no matter how many calories are consumed. Eating 6000 calories in one day may lead to a net weight gain of about 2 lb that day, but it does not take a patient from a healthy weight to obesity. It is the consumption of an extra 100 to 300 calories per day on a regular basis that results in an extra weight gain of 10lb in one year, which turns into 20 or 30lb of weight gain over two or three decades. Likewise, a healthy weight loss does not occur in a few weeks. It, too, is a gradual but cumulative process of caloric reduction over time.

To help patients understand the amount of daily caloric reduction needed to lose 10% of their weight over the next 6 months, the patient is presented with a daily caloric deficit worksheet that has two examples. One is of a 250-lb male, which means his weight loss goal over 6 months is 25 lb. To achieve this goal, he must create a daily average deficit of 481 calories per day. Here is the process: it takes a deficit of 3500 calories that are stored as triglycerides (TGs) in adipocytes to equal 1 lb of weight loss. If the goal is a 25-lb weight loss, then 25 x 3500 = 87,500 caloric deficit must be created over 6 months. There are 182 days in 6 months, so dividing 87,500 calories by 182 days equals 481 calories per day. A woman who weighs 175 lb whose 6-month weight loss goal is 17.5 lb needs to create a daily caloric deficit of 337 calories. The patient is then shown the daily caloric deficit needed to lose 10% over 6 months (Figure 8.6). Most patients must create a daily caloric deficit between 300 and 500 calories, which is consistent with the NHLBI Obesity Guidelines, Category A evidence [8].

This mathematical exercise helps patients who like to count calories know exactly how many calories per day they must eliminate from their present consumption of food in order to lose weight. On the other hand, many patients are not interested in counting calories. Patients who are not interested in counting

EXAMPLES:

1. 250-lb male's maximal weight loss is 25 lbs over 6 months. Formula:

25 lbs x 3,500 calories per pound = 87,500 calories 6 months = 182 days, so 87,500/182 = 481 cal. deficit/day Reduce daily calories by 481/day x 6 months = 25 lbs lost

2. 175-lb female's maximal weight loss is 17.5 lbs in 6 months. Formula:

17.5 lbs x 3,500 cal. per pound = 61,250 calories 6 months = 182 days, so 61,250/182 = 337 calories per day Reduce diet by 337 calories/day x 6 months = 17.5 lbs lost

Maximal weight loss over 6 months is_lbs.

_x 3,500 calories/pound =_total calories

_calories/182 days =_calories/day

Reduce diet by_calories/day x 6 months =_lbs

Figure 8.6. Daily caloric deficit needed to lose 10% of total body weight in 6 months.

calories are reassured that they will not need to compulsively count calories. How this happens is explained during the next appointment.