Open Access Open Badges Research article

Quantification of the energy gap in young overweight children. The PIAMA birth cohort study

Saskia W van den Berg1*, Jolanda MA Boer1, Salome Scholtens12, Johan C de Jongste3, Bert Brunekreef24, Henriette A Smit14 and Alet H Wijga1

Author Affiliations

1 National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

2 Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology, University Utrecht, Utrecht, The Netherlands

3 Department of Pediatrics/Respiratory Medicine, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands

4 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

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BMC Public Health 2011, 11:326  doi:10.1186/1471-2458-11-326

Published: 17 May 2011



Overweight develops gradually as a result of a long term surplus on the balance between energy intake and energy expenditure. Aim of this study was to quantify the positive energy balance responsible for excess body weight gain (energy gap) in young overweight children.


Reported data on weight and height were used of 2190 Dutch children participating in the PIAMA birth cohort study. Accumulated body energy was estimated from the weight gain observed between age 2 and age 5-7. Energy gap was calculated as the difference in positive energy balance between children with and without overweight assuming an energy efficiency of 50%.


Ten percent of the children were overweight at the age of 5-7 years. For these children, median weight gain during 4-years follow-up was 13.3 kg, as compared to 8.5 kg in the group of children who had a normal weight at the end of the study. A daily energy gap of 289-320 kJ (69-77 kcal) was responsible for the excess weight gain or weight maintenance in the majority of the children who were overweight at the age of 5-7 years. The increase in daily energy requirement to maintain the 4.8 kilograms excess weight gain among overweight children at the end of the study was approximately 1371 kJ.


An energy gap of about 289-320 kJ per day over a number of years can make the difference between normal weight and overweight in young children. Closing the energy gap in overweight children can be achieved by relatively small behavior changes. However, much more effort is required to lose the excess weight gained.