OBESITY : A NEAT SOLUTION

Imagine …
Imagine two people working in the same office, sitting behind a computer. Both are young, middle aged men of the same height. Both start working at 8.30 am and go home at 5.30 pm. Both have thin parents. Let us further imagine that both do not do rigorous exercise or indulge in competitive sports. For a moment, may I ask you to further consider that both eat food in similar quantities. However, what if their weights were to be different? What if one of them, Mr. A, were have a weight of 66 kg, and the other gentleman (Mr. B) were to be 90kgs in weight? This is important, because obesity and diabetes (and heart disease and hypertension) go hand-in-hand.

You will agree that this situation is not uncommon. Haven’t we seen people eating and eating but remaining thin? Haven’t we seen fat people doing morning walks, making us wonder why they are still fat? It is quite easy for people to say that this is “hereditary”, but it is quite common to see siblings with different body weights. As a doctor, I often see brothers and sisters with very different body fat measures.

What is the reason for this? Well, emerging research seems to offer a NEAT solution to this problem. The concept of NEAT or Non-Exercise Activity Thermogenesis is fast catching on worldwide, leading to sweeping policy changes by corporate decision makers and human resource development staff worldwide.

NEAT is Non-Exercise Activity Thermogenesis

What is NEAT? To begin with, everyone understands that if we take in too much energy, but do not spend it with activity, we will become fat. Well, all of us have one major source of energy: food or calorie consumption. And this energy is expended in 3 ways: firstly by the energy needed to digest food (diet induced thermogenesis), which is a miniscule aspect. Secondly is the exercise that we carry out, which can help us to lose energy. Finally, comes NEAT, which is the amount of energy that we expend on our day-to-day activities.
Recent research has shown that the energy that we spend on day-to-day activities is the most important indicator of our body weight. Therefore, imagine once again, in the case of the two men that I alluded to earlier. What if the thin Mr. A, is also hyperactive, jittery, restless, always moving about, and running around for small errands (even without being asked to) all the time? What if the fat Mr. B spends his day slouched in his chair, ordering people around, and is a man who uses his limbs only to punch the keyboard of the computer, and runs only when he has to catch the closing doors of an elevator/ lift?

What’s the NEAT-savvy person like?

In other words, NEAT is determined by the activity that you do as part of your daily life, and not as active exercise. Several studies have shown that increasing NEAT throughout the day is superior to hours and hours of intensive activity in the gymnasium. In other words, the work that you do, the profession that you choose becomes a marker for your weight, and subsequent risk of diabetes and heart disease.

A manual laborer or a policeman, would, just by the activity involved in his profession, be in a better position to prevent diabetes, as compared to a person who sits in a white-collar-office job! A housewife who has to shop for groceries, clean the house as well as cook the food is likely to be more healthy than the memsaab who orders the menu, watches TV serials and freaks out on kitty parties. In other words, dear reader, primitivity is the name of the game!! By discovering high tech gadgets, we are gifting ourselves with obesity. Imagine the remote control, the TV, the hands-free blue tooth devices, the wi-fi gizmos and the luxury sedans: aren’t they all reducing our NEAT ? And to increase our NEAT, we only have to go back to a primitive hunter-gatherer society, where intense physical activity is the rule of the game!!

All this does not mean that diet and planned exercise are not important. Of course they are. But the point is, activity that is incorporated into our daily work is better, because it is much easier to sustain in the long term. Exercise and diet requires that bit of voluntary effort- some call it will power- which is not very easy to practice.

So, how can we all incorporate NEAT in our lives ? Well imagine a large room where a hundred people are relaxing on lounge chairs, and all are watching a world cup cricket match on a giant digital screen. Can we make them spend more energy at that time? Yes, we can, if we are able to make them stand and watch the match. And we can make them stand by two ways: firstly, by removing the lounge chair, which leaves them with no option but to stand (a social strategy). The second method would be to change their mind, i.e. to make them want to stand (a individual behavioral strategy).


The Social Strategy to increase NEAT

Several corporations in the United State are practicing this. There are now offices with no chairs at all!! The employee stands behind a computer. Sometimes, he stands on a treadmill floor, which means that he is forced to move his legs and walk while he works at his job!! This would make the employees more active and less likely to fall sick with diabetes and heart disease, and eventually this would translate into profits for the company. Add to the fact that health-related corporate expenditures are brought down, and you have a very useful strategy indeed.

Several corporations in the United States are insisting on walking meetings. This means that people are actively walking during the meeting, instead of sitting in chairs and drinking tea and biscuits. Walking meetings are more swift, short, crisp and business-like. In addition, several business firms have started rewarding employees and teams that have begun to become more activity-savvy.


Behavioral Techniques to increase NEAT.

It is well known that what we see in the media dominates our attitudes and tastes. Eating pizzas, potato chips, using gizmos and drinking fizzy drinks are all desires created within us by the media. What if the media tells us to exercise? What if movie stars, sportspersons and corporate honchos were to tell us about their physical activities? Wouldn’t that make it more fashionable to become a physically active and fit person? While this has been actively employed to change behavior in the west, many of the so-called role models for Indian youth continue to champion the cause of soft drinks and potato chips.

At the biological level, there are a lot of studies looking at molecules that can activate the brain and make people more physically active. These molecules act on the brain and inculcate the desire to do work, and to be a more active person. In other words, they increase NEAT. However, many of these drugs are still in the research phase at present.

In addition, several scientists, notably from Dr Levine’s laboratory at the Mayo Clinic in the United States, are trying to quantitate NEAT and give it a measurable value. This means that like blood pressure, cholesterol and blood sugar, physical activity will soon have a measure and can be expressed in numbers. Who knows, the next millennium may well herald the use of several strategies (including medicines) that can increase our physical activity levels! And what is more, we may be able to accurately measure our energy expenditure, and doctors may be able to titrate this too!

Implications for India

Indians have more abdominal fat. This abdominal obesity makes them more prone to develop type 2 diabetes, which is the most common type of diabetes worldwide. Abdominal fat excess makes the body resistant to insulin, which is a hormone that can lower blood glucose. Insulin resistance causes high blood glucose levels i.e. diabetes mellitus. Untreated, diabetes leads to heart attacks, kidney failure, foot amputations and blindness. The impact of this catastrophic illness on a growing economy like ours is likely to be devastating.

India is currently among the fastest growing economies in the world, and our GDP is increasing by 8-9% per year. However, this comes with the price that we have to pay in the form of lifestyle diseases like diabetes and heart disease. It is logical to postulate that the exponential increase in diabetes, obesity and heart disease might ultimately slow down India’s economic growth. Only drastic, societal changes in diet and physical activity can tackle this epidemic. Hence, it is important that both doctors and the public at large join hands with governmental and non-governmental agencies to influence the genesis of a vibrant, healthy and physically active India.