Educate Your Patients on the Health Risks of Prolonged Sitting, Encourage Small but Significant Changes in Daily Routine to Stand Up to Obesity

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania.

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Dear Colleagues,
We have seen more research released on the dangers of too much sitting. One of these dangers is obesity, which, as we know, also puts individuals at risk for developing metabolic syndrome. Excessive sitting has been linked to increased risk of cardiovascular disease, cancer, type 2 diabetes, and recent studies have found that prolonged sedentary time is independently associated with deleterious health outcomes regardless of physical activity. While we educate our patients on the importance of consistent exercise, I think we might also share with them the dangers of a sedentary lifestyle and encourage them to incorporate more movement in their daily routine by making small but significant changes.

One contributor to excessive sitting is the changes in our workforce over the past 20 years, which has seen a decrease in more active manufacturing jobs and an increase in service-oriented jobs. This has caused our daily energy expenditure to go down. For example, the auto industry used to rely on the manual labor of workers standing and carrying fenders back and forth. Now, much of these processes are automated. Speaking of automobiles, another contributor is transportation—just think of how the minutes spent sitting in the car or on a train, bus, or airplane add up during the weeks, months, and years!

According to a 2013 survey,[1] more than 86 percent of office workers reported sitting at work all day, every day. Many news reports liken excessive sitting or “Sitting Disease” to smoking, saying, “sitting is the new smoking.” Like smoking, the hazards of prolonged sitting has received the attention of health organizations. In June 2013—the same month the American Medical Association (AMA) declared obesity a disease—the AMA declared that sitting down for too long is hazardous to your health. They referred to several studies demonstrating the link between too much sitting and health problems and encouraged businesses to offer employees alternatives to sitting all day.

In previous editorials I have echoed the message “small but significant changes can help your patients improve obesity and related comorbidities.” I believe that being mindful and working to decrease sitting is an important and realistic goal in which our patients should work toward. In terms of recommendations from us, it’s an example of low-hanging fruit that we can work into our conversations with patients.

In talking to a patient about the dangers of sitting, you could work in the data from a recent study published in the Annals of Internal Medicine.[2]

Excessive sitting is associated with the following:
•    18 percent increased risk of dying of cardiovascular disease
•    17 percent increased risk of dying from cancer
•    91 percent increased risk of getting type 2 diabetes,
•    13 and 14 percent increase in the risk of being diagnosed with cancer or heart problems

A simple remedy to excessive sitting during the day is making more effort to be vertical: encourage patients to stand a minimum of 60 to 90 minutes. One resource for facts on too much sitting and tips for incorporating more standing time throughout the day is JustStand.org. In their “Sit-Stand Basics,” they state, “Standing is like walking: It increases energy, burns extra calories, tones muscles, improves posture, increases blood flow and ramps up metabolism.” Additionally, they offer eight easy ways to work more standing into your day. Some recommendations include parking farther away from work, setting a timer for standing/stretching, standing on the bus/train, and standing/stretching during TV commercial breaks. I would add that the use of sit/stand products, such as standing desks and balance ball chairs may be helpful.

Reducing sedentary time has also been shown to improve mental health.3 Additionally, reduction of excessive sitting in the workplace has been linked to more productivity,[4] which may be of particular interest to employers.
With all of the thorough research coming out about the hazards of sedentary behavior and recognition from the AMA, I am encouraged that we are moving in the right direction. Just as the contributors and effects of obesity are multi-faceted, so too are the approaches we take in fighting them. Educating patients on the health risks of prolonged sitting and encouraging less sedentary time is another tool in our toolbox.

Sincerely,

Christopher Still, DO, FACN, FACP

References
1.    Ergotron JustStand® Survey & Index Report. 2013
2.    Biswas A, Oh PI, Faulkner GE, et al. Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 Jan 20;162(2):123-32.
3.    Teychenne M, Costigan SA, Parker K. The association between sedentary behaviour and risk of anxiety: a systematic review. BMC Public Health. 2015 Jun 19;15:513.
4.    Chau JY, Sukala W, Fedel K, et al. More standing and just as productive: Effects of a sit-stand desk intervention on call center workers’ sitting, standing, and productivity at work in the Opt to Stand pilot study. Prev Med Rep. 2015 Dec 12;3:68-74.

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