'Sitting Is The New Smoking'? Well, No, But Got Your Attention

I'd been nagging — I mean, gently reminding — my husband to arrange some sort of standing work desk for himself for months, so when he came across this big sign in the MIT gym recently, he texted me a photo as reassurance that mine was not a voice in the wilderness. My message had been reinforced in a palace of fitness.

Any sort of "You're right, honey" is surely pleasant, but I found myself also struggling with some ambivalence that I can sum up in one word:

Really???

That is, do the health data really show that sitting is tantamount to smoking, the ultimate unhealthy behavior?

I didn't rule it out. In recent months, study after study has suggested that sitting too much can shave years off your life — even if you work out. We've written about some of them, and included Dr. Eddie Phillips' nicely turned phrase, "Sitting is a 'disease state.'

I certainly don’t want to feel that every time I cuddle up next to my wife on the couch it’s the equivalent of lighting a cigarette.

But the 'new smoking' headlines have been proliferating to the point that the phrase seems to be turning into one of those little viral units of culture called memes. Runner's World warns: Sitting is the new smoking even for runners. Wired reports from the center of its universe: In Silicon Valley, Sitting Is The New Smoking. Baltimore TV weighs in: Sitting Is The New Smoking, with the sub-headline, "Are chairs causing more deaths than cigarettes?" And even the august Harvard Business Review: Sitting is the Smoking of our Generation.

I suspect that one particular researcher may have particularly helped fuel the sitting-smoking meme. From the Los Angeles Times piece headlined, "Don't Just Sit There."

"Sitting is the new smoking," says Anup Kanodia, a physician and researcher at the Center for Personalized Health Care at Ohio State University's Wexner Medical Center. As evidence, he cites an Australian study published in October 2012 in the British Journal of Sports Medicine that compared the two pastimes. Every hour of TV that people watch, presumably while sitting, cuts about 22 minutes from their life span, the study's authors calculated. By contrast, it's estimated that smokers shorten their lives by about 11 minutes per cigarette.

For a reality check, I turned to Dr. David Katz, director of the Yale University Prevention Research Center, fellow of the American College of Preventive Medicine and author of Disease Proof, a new book he describes as sharing "the truth about what it takes to get to health" and offering the skill set needed to get there. I asked him to take my question — "Really? Sitting is the new smoking?" — and riff on it as he saw fit. His response, lightly edited:

It seems to be the case that for any message to break through in our popular culture, it's got to be hyperbolic. As we’re talking, one of the hot news items is that Oreos are more addictive than cocaine, all of this based on a study of about three rats. It’s completely overblown. That's what we do.

So the specifics of smoking and sitting would be best addressed by looking at populations that do both and asking what 'gets' them. If you’ve got populations that sit comparably, and one group smokes and one doesn't — and we've had that natural experiment, we’re a very sedentary society, we all do a lot of sitting — but there are smokers and non-smokers, and smokers tend to die younger and horribly. So clearly smoking is worse than sitting.

But there's what the message says, which isn’t quite true — smoking is clearly worse, and if you are a person doing both, I’d say focus on giving up the cigarettes and then we’ll get you out of your chair — but I think what he message is meant to imply rather than what it states explicitly is that this is a threat to health, being too sedentary, spending too much time on our backsides.

It’s actually something of an unnatural position — in nature, there's very little sitting. Animals are either up and moving around or sort of sprawled out. It is a position that sort of crinks us and wrinkles us and folds us in ways that, in addition to just not moving, are probably detrimental. We’re compressing a part of our body; we're stifling blood flow; your knees are bent, so for people who are prone to blood clots in the lower extremities, sitting for long periods can do that. We know that from long plane travel, that's a risk factor for deep venous thrombosis. So there are a number of ways in which sitting per se is harmful. And it’s obviously a marker for lack of movement in general.

So if we get past smoking, if we become a society that banishes smoking, what we then have to deal with is what is the residual burden of chronic disease and what's accounting for it? And then we move on to the other big factors and clearly sitting isn’t alone. Lack of physical activity is hugely important but so is poor diet. And then there are several other things that need to be factored in, like lack of adequate sleep. Sleep doesn’t get the respect it deserves; that’s clearly a risk factor for lots of bad stuff. Not managing stress effectively. I have colleagues in mental health who would say that’s the most important thing.

So I think this [slogan] is an attempt to say: this is the thing I focus on, I want to get people up and moving, and in order to get your attention, I'm going to compare it to something everybody knows is really big and really bad, and that would be smoking.

So we do clearly have evidence that the more hours you sit each day, the greater your risk of premature death. Additional minutes of sitting every day can add up to mean a reduction in your lifespan. The evidence of that is pretty clear. The good news, of course, is it works in reverse: The fewer hours you spend sitting every day, the greater your vitality in general, but also the greater your overall life expectancy.

And we really have pretty remarkable evidence about a huge return on a very small investment in physical activity. There was a study in the past year in the Journal of the American Medical Association looking at children at high risk for diabetes — pre-diabetic, insulin-resistant, relatively young children. And 20 minutes of physical activity five times a week was enough to prevent the development of Type 2 Diabetes in a very significant percentage of them. You know, 20 minutes out of a day is 1.39% of the minutes in a day, and 20 minutes five times a week is 0.99 percent of a kid’s weekly minutes, so a tiny investment brings a huge return.

So I like the spirit of the message: We need to get up, we need to move, but I think there's an attempt here to hype it a bit, to involve a fear factor, and I think it does exaggerate a bit to say sitting is smoking. I certainly don’t want to feel that every time I cuddle up next to my wife on the couch it’s the equivalent of lighting a cigarette. That sort of takes on moral overtones. You almost feel guilty. Your tush touches the couch or the cushion and it sort of burns. I’m bad, I'm evil, I’m transgressing. No, I think that’s wrong. But we do sit too damned much.

I think this is a very important point: We tend to attach to health messages this sort of moral overlay — you should — and you can kind of picture the finger wagging at you. And lost in that is maybe a much more critical and inviting message, that's what health is for. The reason you should listen to these messages about what's good for you and bad for you, the reason you should care about what the medical experts have to say is that healthy people simply have more fun.

Thinking about what you should or shouldn’t do, it isn’t about being a good person, it’s about having a better life. And when we remember that, it puts you in the driver's seat. Because you can say, my life is better if I sit from time to time and that’s what health is for, so I’m going to strike a balance between being healthy and sitting.

And I think that also pertains to how we eat; my recommendation to people is that you want to love food that loves you back. There's pleasure that comes from good food, I don't think we want to give that up; there's pleasure from good health; I don't think we should give that up to pay for the pleasure of dinnertime. We want both.

I think we health professionals sometimes lose sight of the fact that health is for something. It’s for living the life you want to have. Better health means a better life. And we could do a better job of conveying that. Because it means, look, you’ve got choices to make and there are things you can do that will make you healthier and vital, and you're going to want to make a certain number of them because your life will be better. Every now and then there will be something you could do that would make you even healthier, but you’ll say yeah, that one’s not worth it to me. Never sitting again isn’t worth it to me.

[One lingering question: Companies that make expensive standing desks are propagating the anti-sitting data. Do you see that influence? Or is the sitting data really there?]

Yes to both. The business of business is business. I commend people who come up with creative solutions to keep us moving. And let's keep in mind, we're naturally active, itinerant and high-endurance species. We're more like wolves than any other animal. We're good at going long distances — our ancestors presumably did that most of the time.

So even if you get to the gym an hour a day it’s just stunningly less physical activity than the human body is adapted to. And the idea you would be in motion most of the time throughout the day —  it kind of used to be that way. Survival used to require that. So in some ways this is just a new-age replication of an ancestral condition and it's to be commended. But then once you've got a product and it solves a problem, you want to tell people about the product...But don't think they're cooking the books. By and large, the studies indicate that more sitting means less years in life and less life in years — those are studies done independently of this industry and it's the industry reacting to them. So it’s fairly virtuous.