Move a Little, Lose a Lot: A Review

I rely on regular attendance at aerobics classes to help keep my weight under control.  But although a recent week of babysitting my grandchildren (the reason, BTW, for no blog post last week) kept me too busy to visit the gym, the needle on the scale held steady.  James A. Levine, MD, PhD would undoubtedly call that a textbook example of NEAT (nonexercise activity thermogenesis) in action  Hoisting a 4-year-old girl to see over a fence, running to keep up with an 8-year-old boy, and bending over to pick up about a million Legos apparently provided all the exercise I needed – enough to offset not only my absence from the gym but also the extra ice cream I had to eat to keep the children company. :)

Dr. Levine is a professor of medicine at the Mayo Clinic in Rochester, MN, where he specializes in nutrition and metabolism. He has achieved international prominence as an expert on obesity and has published widely in both scientific journals and the popular press.

He is also the inventor of the Walkstation, a combination treadmill and desk, complete with keyboard and monitor. This contraption, which at first blush may sound just about as practical as a cross between an electric razor and a blender, epitomizes his conviction that our bodies are designed for standing, not sitting, for moving, not staying still. His enthusiasm is so infectious that he has managed to persuade Steelcase to manufacture the things and a number of visionary employers to buy them, to the tune of several thousand dollars apiece.

Now Dr. Levine has written a book describing the detrimental effects of sitting, explaining how we got ourselves into this pickle, and telling us how to reclaim our bodies’ birthright. Over two million years ago, our ancestors got up on their hind legs and evolved the anatomical modifications needed to stay there. We are walking animals.  But in the past fifty years, and especially in the past ten to twenty years, a mere eyeblink in terms of human history, we’ve become amazingly adept at developing devices that enable us to carry out our daily lives in a sitting position instead of on our feet as nature intended. Gone are the outhouse, the butter churn, the wind-up alarm clock that our grandparents used. Here instead are the computer, the internet, the cell phone, and a host of machines to do everything from shoveling the snow to feeding the cat to brushing your teeth automatically – and many of these gadgets have remote controls so we don’t even have to get up to operate them. The result is what he terms sitting disease, characterized by obesity, hypertension, diabetes, cancer, depression, and myriad other health problems.

To get back on track, Levine advocates actively reincorporating motion into your daily life. Park as far as you can from your office, get up and talk with your coworkers instead of e-mailing, walk on a treadmill while watching TV, go to a museum instead of watching TV, schedule walking meetings, etc., etc. (He even urges his readers to walk while reading this book – raising the question of whether an audiobook might have been a safer and more appropriate format!)  He also addresses the issue of energy intake, urging the reader to think of food as “potential energy” and to link what you eat to your NEAT. In practice, this adds up to around 1400 calories/day plus “free” fruits and vegetables, distributed across 7 “fuel cells” (2/meal and one snack) of around 200 calories each. He tries to be minimally prescriptive but emphasizes strategies such as eating breakfast, avoiding “fast food,” and not eating in the car. All good.

Levine’s combination of erudition and evangelical fervor is seductive. By the time I’d finished his paean to the NEAT life, “filled with vibrant little movements infused into your day,” I was starting to feel optimistic that I could lose weight by pirouetting around the kitchen while whisking up a frittata and eager to proceed to the second half of the book, The Plan. What a surprise, then, to discover that the very first day, the first step in a program unfolding over eight weeks and designed to establish a pattern that can be maintained for a lifetime, mandates three 20-minute walks. That would amount to walking 3 miles, at the average human walking speed of 3 miles per hour. By Day 7 of the last week, your daily total includes three 45-minute walks (2 hours and 15 minutes – nearly 7 miles) plus 44 Core Chargers and 16 Sunrise Stretches. (These exercises are described in detail on p. 151; briefly, a Core Charger is a standing elbow-to-opposite-knee calisthenic exercise and a Sunrise Stretch is a toe-touching exercise.) To be fair, the “walks” can include activities you’d be doing anyhow – vacuuming, gardening, and yes, even formal exercise.  (And here, the line between NEAT and intentional exercise becomes blurred almost to the vanishing point.) Still, despite Levine’s efforts to downplay the investment of time and energy required to meet the demands of the program, to many this will sound like a daunting amount of nonexercise.

For this reason, I’m doubtful that large numbers of Levine’s readers will embrace his plan sufficiently to achieve and maintain substantial weight loss. More likely it will resemble any other diet or fitness program – adopted by many with initial enthusiasm, providing lasting benefit to a few but followed for the rest by partial or complete relapse.  That said, I think this is a valuable book nonetheless, one that can raise consciousness about the hazards of excessive sitting, the benefits of activity, the concept of food as fuel for that activity, and the ease of making at least modest lifestyle changes. Even those who fall short of full compliance are likely to derive some good from this book.

One reservation, hinted at above: In his eagerness to persuade the reader that NEAT is something new and different, Levine unnecessarily disparages intentional exercise and overstates its difference from NEAT. If you want proof, he argues, that exercise is a dirty word (though one he uses repeatedly himself), just consider the term “workout.” Get it? Work. Well, I’ve been enrolling in fitness classes for nearly 20 years and my experience is as follows: The parking lot at the gym is always crowded; lines form for a turn on the elliptical; the aerobics room is filled (and I do mean filled) with familiar faces who have gone through a long series of peak life events – graduations, marriages, babies, illnesses, loss of loved ones – with each other and with the instructor. So even after the many who don’t stick with it are gone, there are plenty left who come back day after day and year after year. Before becoming an aerobics devotee, I was an avid runner for nearly twenty years, and I had plenty of company on the trail, too. I mention this not to contradict Levine’s point about the need for more physical activity in our daily lives but simply to observe that it would be a shame if anyone who enjoys and benefits from regular exercise quit “exercising” because of this book. Levine’s prescriptions should be an add-on, not a replacement, for what you’re already doing. (And by the way, whatever happened to the idea that you need a certain amount of aerobic activity, causing a sustained elevation of heart rate, for cardiac health? Given that understanding the benefits of physical activity is both his life’s work and his passion, Levine must have an answer to this question, but if it’s in this book, it got by me.)

Although this program wasn’t developed with smokers in mind, it is potentially useful for anyone trying to quit:

  1. It offers dozens of constructive suggestions and inspiring examples of ways to weave additional physical activity into the fabric of your daily life, promoting lifestyle adjustments that can help to counteract the weight gain typically associated with quitting.
  2. As noted in Life After Cigarettes, the amount of exercise needed to combat acute craving or episodes of depressed mood is less than needed for weight management. Core Chargers and Sunrise Stretches are good examples of the kind of exercise that can be used on an acute basis to alleviate the symptoms of nicotine withdrawal.

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