Obesity and Resting Metabolic Rate Assessed by Indirect Calorimetry in Pediatric Patients from Northeastern Romania

Pediatric obesity is a growing public health concern, significantly increasing the risk of metabolic and cardiovascular comorbidities. Background/Objectives: This study aims to explore the burden of obesity, its associated comorbidities, and resting metabolic rate (RMR) assessed by indirect calorimetry among children and adolescents in a cohort of 223 participants from Nord-East of Romania. Methods: A cross-sectional study was conducted among 223 children and adolescents (aged 4–18 years) who were diagnosed with obesity at Saint Mary Emergency Children’s Hospital Iași. Anthropometric measurements, clinical assessment, and biochemical parameters were recorded. RMR was measured by indirect calorimetry, using the Fitmate Pro Metabolic Technology (Cosmed, Rome, Italy), under a stable environment for 15 min, following a fasting period of minimum 6–8 h. Data were analyzed using SPSS 22.0, applying descriptive statistics and Pearson correlations. Results: A total of 223 participants were included in the analysis, with a mean age of 12.03 ± 3.32 years (range 4–17 years) and a mean body mass index (BMI) of 31.21 ± 5.84 kg/m². The average RMR was 1687.5 ± 425.5 kcal/day, with higher values in males compared with females. RMR showed significant positive correlations with age (r = 0.60), BMI (r = 0.51), waist circumference (r = 0.67), and fat mass measured with a three-site formula technique (r = 0.51) and systolic (r = 0.45) and diastolic blood pressure (r = 0.19), all with p < 0.001. A weak inverse correlation was observed between RMR and the fitness index (r = −0.24, p < 0.001), indicating an association between lower fitness scores and higher RMR values. RMR showed no significant correlation with fasting glucose or lipid levels, indicating that metabolic rate was more influenced by body composition than by biochemical markers. Conclusions: Pediatric obesity is strongly linked to multiple comorbidities, emphasizing the need for early detection and targeted interventions. Higher BMI and central adiposity were associated with increased RMR. Indirect calorimetry provides valuable insights into the metabolic profile of children with obesity and can inform individualized management strategies.