Over the development of my changing thoughts on achieving greater health I’ve altered how I present the “calories out” portion of the equation, when sitting face to face with a patient in the exam room..
A few years ago I was telling people to “exercise more”. I now tell them to “move more”. That’s not entirely true, I also tell them to exercise, because I recommend to everyone some type of weight lifting. I also recommend walking, especially as a family unit because the benefits to marriage and family relationships is obvious. The power of modeling regular exercise to the younger family members can not be discounted. So I do recommend exercise.
Then I spend a lot of time talking about finding a way to move more. NEAT= non exercise activity thermogenesis. NEAT may be the under appreciated missing factor to improved health. I think for a long time NEAT has been thought of as “fidgeting”, which probably is not really true. I’ll link another blog later that discusses this very well.
Do the experiment for yourself on the health calculator here:
For my stats, age 36, weight 170, if I put my sleep in (7 hours last night) my BMR is 1778 and my TDEE is 2346. With no activity and sitting my whole day.
The idea that someone can sit almost all day may seem absurd, but there’s a lot of information to suggest that it’s not that far off for many Americans. So let’s say I’m a very sedentary guy and I start going to the gym for a 20 minute run on the treadmill every day (moderate exercise wheel). That moves my TDEE to 2520. That’s a change of 174 calories and if I make no change to my intake I’ll probably start losing about a pound every 20 days. Not bad. Trouble is that the average American male takes in 3000 kcal per day.
Now I move the moderate wheel back to 0 and dial the standing/walking wheel up to equal that 2520- takes roughly 2:10 for that same calorie output. Meaning that finding a way to just standing more in the day for 2 hours is as effective as that trip to the gym. If you consider travel time to and from the gym, it’s not hard to imagine that “moving more” might be as effective as bothering to “exercise”. If you use the “light exercise”- say I start gardening 40 minutes per day, that’s as effective as that 20 minute run. Now we’re really getting somewhere when thinking about that travel time to the gym.
I think anecdotally people see this in their lives- people naturally tend to be more active during the summer and weight comes down a little and less active during the winter when weight comes up. People will blame it on the holidays all the snacks, cookies, Thanksgiving, etc, but seems to me that July 4th picnics, summer BBQ’s, ice cream cones, and snow cones may add up to an equal amount of “irregular eating episodes”.Maybe it’s really the shifts in NEAT?
So here’s where I’ll link to another blog, this is the post that lead me to reading the Carbsane blog. In this post she discusses differences in NEAT between self reported “couch pototoes” half of whom were overweight and half of whom were thin. She summarizes the findings in this paragraph.
“While the obese have higher RMR’s, because they do have more lean mass in addition to more fat mass, the expanded NEAT chart shows that the obese have considerably lower NEAT. This seems counter-intuitive. After all, moving 250 lbs will require more energy than moving 150 lbs, right? Well, this study demonstrates that the obese don’t move their weight nearly as much as their lean counterparts. In “A” upper left, the sit vs. ambulate bars are almost flipped. And it bears mentioning that all participants considered themselves couch potatoes. The obese are much more so in this study. It’s interesting to me that the lean appear to burn more than twice the calories per kg body weight vs. the obese just standing. This tells me that they stand more actively — shifting weight, moving upper body, etc. It was mentioned in the figure caption that there was no difference in the amount of time the two groups slept.”
The question that remains un-answered (at least as far as I can tell) is if NEAT is hardwired or learned. Are you born more likely to stand/walk and be thinner or is that people are raised being more active (less TV time, more playing, etc). Not sure it matters, because I remain convinced that people can change it. Carbsane has a post later that may suggest that it’s more hardwired, though I was not convinced.
I myself have made an effort to increase my NEAT. I have started taking an extra walk to the cafeteria to get another cup of ice tea (that I often don’t drink) to add that extra 400 foot walk to my day. I have also started standing (when appropriate) in the patient room. My standard is to sit and be at eye level with patients to minimize any power differentials and try to assure open dialogue, but some patients I know well and know that my standing in the room will not create any issues. I’m also pretty short so if someone is on the exam table, me standing in the room is eye to eye.
I’ve also frankly found that now that I’m eating enough I find myself having more energy on weekends for working in the garden or outside at the house despite working out harder in the gym then I was a year ago. Energy intake matters also for being able to move outside of the gym! This is my final point for this post. Restrictive diets decrease TDEE disproportionately to the mass lost! This study shows that people who reduced calories by 25% (roughly 700 kcal per day) and didn’t increase exercise then naturally decreased their TDEE, which was almost certainly through reduced NEAT. My body was saying to me “Want to starve me, ok fatty then you’ll sit more all day and decrease your calories burned”. This effect was attenuated by a smaller deficit (~12.5%) and an increase in exercise. But what I see in a lot of people is that they were already “exercising” (going to the gym regularly or walking) and when they go to “lose weight” they usually decrease calories by a lot, probably closely mimicking the group that ultimately lowered their TDEE. The rest of this study is kind of a stinker. The groups are not well randomized and some of their statistical analysis seemed forced (trying to lump different groups to find an effect). They (in their intro) also almost seem to be looking for data to support ways to decrease metabolism for life span extension purposes (which some recent studies suggest against calorie restriction having a benefit). But the effects within the groups are still valid and interesting.
Again, I’m pretty sure I felt this same effect myself when I started decreasing my calories about 2 years ago, I just found I didn’t have much energy beyond my gym workouts. I attributed it to having toddlers at home and getting called into work at nights. But the same is now true (two toddlers and getting called in more if anything) but now that I’m eating enough I have the energy to move and garden, etc despite working out even harder at the gym.
So move more! Exercise, but move more. Live life. You’ll never look back on your life and wish you had watched more TV. You’ll never look back and think “I wish I had spent more time on the couch.” The only way to move more is to eat enough. If you really need to lose weight (see my last post) and are already eating enough (or too much) then decrease calories slightly and move more. Lift all the things. Pursue health for the sake of health, not a number on the scale or a pants size.
Edit: I remembered this article that covers the same ground in a People health blog, though I’d link: