And so could I, but the title isn’t meant to be a reflection on my current state of obesity or yours.

An interesting article appeared in the New York Times online that caught my eye centered on the idea that we gain weight because we sit too much and that we can reverse that to some degree at least if we stand more.

Reading the article brought to mind another piece I had read recently, about how former Defense Secretary Donald Rumsfeld had gotten excoriated in the press for a note he jotted on a GITMO report about the detainees there being asked to stand for up to four hours a day. His hand-written comment in the margin of the report was “Only 4 hours?”

The note was seen by many in the press and elsewhere as proof of his approval of the use of cruel and unusual punishments for GITMO detainees. Whatever Mr. Rumsfeld’s feelings might have been on the subject of treatment of detainees (about which I am making absolutely no value judgement here pro or con) the ‘standing’ comment probably wasn’t proof of callousness or cruelty, because apparently it is Mr. Rumsfeld’s habit to stand all day long as he works. According to the article I read, he long ago had a special standing-height desk fashioned for himself and he works, standing at it, all day long. Thus, for a man who chooses to stand for 8 hours a day, the seemingly heartless ‘Only 4 hours?’ comment maybe wasn’t intended to be. Whatever else one may say about Rummy, for a man who will turn 78 this year, he’s in pretty darned good shape. He stands ramrod straight and is reasonably trim of frame and flat of ab, so maybe there’s something to this standing business.

For quite some time now, this very idea–standing more–has been something that Mike and I have discussed at length in our ongoing search for what changed in our lives (and the lives of our peers) during the quiet slide from 40 to 60. What happened that could account for the difficulty so many of us clearly experience in holding the line against weight gain (let alone losing weight) as we age, even in the face of a eating about the same amount of food and doing about the same amount of exercise as we did in our younger years.

One of the things that has changed, for us at least, is what we do for a living and the lifestyle differences that shift engendered.

Thirty years ago we first went into clinical practice and for the next nearly twenty years after that, our days were spent working 10 to 12 hours a day, 5 to 7 days a week, seeing patients in the clinic. A day in our lives as clinic doctors looked something like this: walk to exam room door, pick up chart, go into exam room, sit on a backless stool for about 5 or 10 minutes coning down on the patient’s chief reason for being there, stand to wash hands and examine the patient, sit again (or often continue to stand) beside the patient to discuss findings and recommend testing to be done, walk out of room, track down nurse to carry out the orders, walk to the x-ray suite to check developed films or to the lab to check results, all done standing, walk to the next exam room, repeat the process 50 or more times a day. We were in and out of rooms, up and down and up and down all day long, with a whole lot of it spent ‘up’ and not much spent sitting. Most of those years, we spent almost zero time ‘working out’ or doing any formal kind of ‘exercise’.

Contrast that with our lives of the last ten or so years, spent mainly as writers and researchers of the medical literature.

When we’re home, in our normal routine, our lives as full-time writers and researchers look something like this: sit down at the computer and work for three or four hours in the morning. Take a break every hour or so to walk to the kitchen to make a cup of coffee, then right back to the computer.

I go to the kitchen about 1 o’clock or so to fix lunch or we might hop in the car to go grab a burger someplace, where we sit to eat it. Mike usually works at the computer until time to eat.

Then it’s back to the computer to sit for two or three more hours, with maybe a break to get another cup of coffee, and right back at it, sitting.

Our level of formal ‘working out’ on average hasn’t really changed much over the years. If anything it’s increased. Some days we’ll do a Slow Burn weight work out, which takes just a few minutes. In summer or when we are in SB, Mike will take a break in the late afternoon to go walk a few holes on the golf course and he plays 18 a couple of times a week. I occasionally will take a walk on the beach or on trails, but not regularly. Sometimes I will do pilates. Or maybe I will just go to the kitchen to fix dinner, which is at least standing.

Most days, we’ll both go back to the computer after dinner to sit, working, for another hour or two. Sometimes we’ll work late into the night, depending on whether there’s a big writing project going or not.

Then we get up the next day and do that again.

While we haven’t really changed the amount of time we spend doing ‘actual exercise’ what’s really changed when you compare the last ten years to the twenty before them is the standing. As a clinical doctor, you do a lot of standing. Or at least we did. And it takes a lot more muscle work to stand than to sit.

If you’ve followed our writing in books and blogs, you’re probably saying, Hey wait a minute! You’ve said many times before that exercise is not a good way to lose weight. And that is absolutely true.

In our most recent book, The 6-Week Cure for the Middle Aged Middle, we wrote an entire chapter debunking the whole idea of ‘eat less and exercise more’ as an effective strategy for weight loss. And we stand behind that chapter.

What we also discuss in The Cure is the difference in EAT (exercise activity thermogenesis) and NEAT (non-exercise activity thermogenesis.) EAT is the energy cost in calories of exercise taken for exercise’s sake–i.e., running, rowing, the hour spent doing aerobics or pilates or yoga. NEAT is the energy spent doing every other sort of activity in the remainder of the 24 hour day–i.e., the fidgeting, wiggling, walking, standing, stooping, and squatting we do in the activities of daily living and the moving we do in our sleep. It’s easy to see that 30 minutes or an hour spent ‘doing exercise’ even if it’s pretty rigorous, is far outweighed by the amount of time in a day we don’t spend doing it. So as far as energy expenditure in the course of a day or a month or a lifetime, NEAT is the main source of guzzling calories, not EAT.

Let me illustrate. The average 150 pound person expends 720 calories in an eight hour day just lying quietly in bed. If sitting at a desk to work, he or she expends 912 or an additional 192 calories during that same 8 hour period. Standing to work, the caloric expenditure rises to 1176 or an additional 264 calories. So all other things being equal (and I realize that’s a pretty big assumption) just spending most of one’s work day standing instead of sitting costs the body an additional 1874 calories per week or the rough equivalent of a one-half pound of potential weight gain a week.

But the body isn’t merely a ‘black box’ into which calories go and out of which calories flow. A change in one area (expenditure) causes changes in other areas (intake) that can easily correct course and keep the body in balance. It’s not just eat more exercise less. Clearly it isn’t that simple, because if it were, taking a brisk 3 mph walk every day (which would burn 300 calories) would offset the difference occasioned by sitting all day to work. But it doesn’t, at least not completely.

As I wrote about in The Cure, when my weight began an inexorable creep upward as I passed 50, in spite of my knowing what to do and for the most part doing it, I undertook a program of daily walking of about 3.5 miles per day, six days a week for a solid 10 months, and didn’t lose a pound or an inch. There’s more than simply calories in and calories out as we normally think of those things in what drives us to store fat. If it were that elementary, we’d all be thin!

The kind of calories coming in matter. Hormonal balance matters. Stress matters. And maybe, just maybe, standing more matters.

At any rate, I intend to do the Rummy and give it a try. I’ll let you know how it works out.

*Rumsfeld photo – Wikipedia


  1. I’m hoping that “you could sit on a Pilates ball to lose a few pounds” is also true. As with most people, I am paid to be productive (at my desk), and making it a standing desk just isn’t possible, since I work for someone else (who provides my desk). From some of the articles I’ve read, using a large exercise ball to balance on while working at my desk may serve much the same NEAT purpose.

    I am curious of your thoughts about this – do you agree, or do you think it’s just wishful thinking?

    COMMENT from MD EADES: Common sense would dictate that it would be more challenging from a muscle standpoint than sitting comfortably in a chair to work, though maybe not as much work as standing. That’s just a WAG on my part, though, since I haven’t seen any sort of actual study done on pilates balls.

  2. What do you mean by “do the Rummy”?

    COMMENT from MD EADES: Slang for ‘take a page from Rumsfeld’s book’ and stand while I work at my computer.

  3. Funny, I just posted to OEvolve about working while standing yesteday… I suspect you’ve hit on the next paleo “let’s try this” meme.

    Normally, I’m not active like you were as a doctor, but my pattern is to move around a fair bit during the day, both inside and outside. However, when I was seriously hypothyroid this fall, I was sedentary in the way that Gary Taubes describes in obese people in GCBC: I simply didn’t move unless really necessary. (Even walking across the room was a chore; walking for five minutes with the dog made me want to lay down to rest.) That lack of ordinary movement destroyed my conditioning in just a few weeks; the effect was far greater than just not working out regularly. So perhaps wiggling around in an ordinary way has a greater impact on our fitness than most people suppose.

    COMMENT from MD EADES: Rummy wasn’t built in a day 🙂 I’d work into it. Stand for a period of time and increase that in small increments and the next thing you know, you’ll be there.

    In any case, I do want to try converting my workspace to standing, and I’ve temporarily rigged it up to do that. However, my feet don’t seem to be up to the task yet. They’re tired! I think I need to ease into it.

  4. Hi
    Think you are onto something.
    Bey and Hamilton (mainly Hamilton) have published stuff (cant remember refs) which the gist of is that the fat burning biochemical machinery changes down to low gear in muscle when not used for a period of time eg when sitting. Further, there are certainly oppuotunities for permanent postural adaptations to occur for long term sitters- especially those that do not do exercise ie to regain ROM. This is most clearly seen in the aged who do little standing and can only adopt a somewhat flexed posture.

    But these type of changes are now present, to a less extent, in many middle aged and younger persons with sedentary bent.

    The postural changes also correlate with repeated injury that results in the transition from running, gym running machine, to bike to swimming ie less extended position and then less weight bearing.

    Huntergatherers do a lot of gait based activity so a big deviation from that would be expected to have adverse consequences.

    This is an area that most of the primalpaleo sources have not really directly addressed. I have my own ideas but I’m eager to see what yourselves and others make of it.

    PS standing while working at PC is a good idea assuming the “ergonomics” of the workstation are set up ie screen height, keyboard height.

    PPS Voice recognition techniology also enables the use of portable recorders that will transcribe later. They can be fitted with headphone mikes or lapel mikes. You can walk around while you dictate (ie where the background noise is not too high)

    COMMENT from MD EADES: Re: the postural and other changes you mention, I couldn’t agree more. In engineering, there is a concept about ‘specific adaptation to an imposed demand’ which is exactly what you are talking about with the postural changes. The other thing that I think happens, perhaps more in women than in men, there are ‘posterior’ changes that occur as well–an unfortunate broadening of the beam to make a better and more comfortable ‘platform’ for sitting. Over time there are actual shape changes that occur from the hours spent in a seated position. I could stand to lose that, too!

  5. I do “The Rummy” every day from 3pm to 6pm making the best classic (de-carbed) American/Italian/French foods ever invented. It’s the best, especially when the hubby does the dishes and the kids set the table 😉

    The strange thing is that when we have to have an “easy meal”, like burgers or dogs (because of a concert, etc), I feel deprived of my standing prep time. I don’t know what to do with myself and I get fidgety, restless, and don’t sleep well.

    Chopping shallots and reducing stock is good for your health.

  6. I’d love to stand more, but a pinched nerve from a few years ago cuts my standing time down.

    Also, you guys go get burgers? Is that fast food?

    COMMENT from MD EADES: We do go get burgers, but not from the big fast food chains. When we are in Santa Barbara, there are two really great burger spots that use local or regionally raised meat of good quality. Our favorite is The Habit, where we get the Double Bacon Char Burger, lettuce wrapped, with pickled peppers on the side and a large unsweetened ice tea. When we’re in Tahoe, it’s usually a trip to T’s Mesquite BBQ for barbecued tri-tip, with similar fixins and maybe some slaw.

  7. Regarding Pilates ballsexercise balls they will increase muscular activation due to instability. In Australia our OHS authorities recommend not using them as you can slip off (not sure if NIOSH have taken a “stance” regarding this issue).
    Probably the middle ground is the way to go ie if you decide use them use for periods interspersed with ordinary seat. Also have a look around the general area and make sure that if you did slip you are not going to hit a pointy or hard surface. Posturally, sitting is sitting so the exercise ball would not help with the psotural flexion side of things.

  8. Oh, and on the walking? When I hit 40 and was 30 pounds overweight I began walking 3.5 miles (1 hour) every morning, M-F with the dog. For the first six years logging over 6,000 miles I gained ANOTHER 30 pounds.

    I still walk for the enjoyment and the “head clearing” it does for me to start the day, but it took a proper LC paleo diet, brief intense resistance training and intermittent fasting to lose the 60 pounds I’ve lost. …And maybe standing at my desk helped a bit too.

  9. Hi MaryDan –

    Well, I’m not convinced it will do much save for making your tootsies a tad sore. But if while your standing you add in some Slow Burn body weight squats, I think you’ll see a difference! 🙂

    Sorry the NMS meeting was cancelled – Linda and I were so looking forward to seeing you!


  10. Interesting. Since I went back on low carb and began regular strength training, I’ve experience a pleasant surprise. I wake, with no alarm, at about 5:30. Then I have some coffee, actually a lot of coffee, and pace while working at the counter, for 2 to 4 hours. Then breakfast, one of your protein shakes. I didn’t realize I was burning so many calories. I don’t pace for any particular reason, I just seem to think better.

  11. I’d love to see more research on this. I work in an office with several hundred employees and am considering proposing (once I figure out to whom I should) that we make the default configuration for workstation desks to be at standing height (a note from a physician is required for those who wish to deviate from the default). I think this could potentially save us a lot on medical costs, at least due fewer back problems, even if it doesn’t help much with fat loss. I also think that employees who have the option to stand at work tend to have an easier time staying alert, but that’s just a guess.

  12. Mrs Allo..Hope you and Clan E are well.

    Do you please or any of yr readers know of anything that implicates saturated fat in abating menstrual cramps please ?

    Or any pointers or links ?

    Thanks v. muchm

    Simon (Fellows)

    1. @ Simon Fellows – Hey, Simon. I don’t know of any specifics regarding sat fat and menstrual cramping. Magnesium’s a benefit and caffeine. I will discuss with he who knows all and post if so.

  13. Ah thats strange couldnee see it but then when pressed submit there it is awaiting consideration..sorry to send 2 extra

  14. Maybe Rummy would lead a chorus of the Bob Marley anthem:

    “Get up, stand up, stand up for your LIVES (rights)” !?

  15. Speaking of burgers…just want to give a shout-out to In-and-Out Burgers’ “Protein-style” cheeseburger which I recently tried…no bun, wrapped in lettuce, get it with the grilled onions! Mouth-watering! Ask for it when you order, it’s on their “secret” menu.

    COMMENT from MDE: And it’s YUMMY! Also the Habit, a Santa Barbara institution that I’ve blogged about before, that lettuce wraps all their sandwiches if asked.

  16. A man I work with had bad sciatic nerve problems and his physical therapist wouldn’t allow him to sit any longer. (We are all sitting at computers 8+ hours a day – so unhealthy!) I helped him set up his computer and keyboard so he can operate while standing. At first he said he was very tired at night but now he looks like he’s used to it and I rarely see him sit. He says he lies down when watching TV at night. Since I’m quitting in a few weeks, I am SO excited to be able to stand and move about more each day AND to cook at home and eat healthy!

  17. I stock at a grocery store so stand while working for several hours. Works very well. I have also been diagnosed with IBS and am taking Amitiza for it for the last 2 days. (I hate it). I would be interested in finding out how a diet such a power protein helps IBS suffererers like me. Mary L. Mantel

  18. I like this since stocking in a store every day for 3 to 4 hours does provide some relief to back pain. I also have been diagnosed with IBS and am interested in finding out whether a diet such as protein power can help with that. (I am also taking Amitiza for the last 2 days, which I hate). Mary L. Mantel

    1. A lower carb diet of minimal grains and zero gluten (wheat, barley, rye) replete with fresh low-starch and low-sugar fruits and vegetables and plenty of good quality protein and fat seems to benefit many of the irritable and inflammatory bowel disorders, but is something you should discuss with your physician, who knows you and your case.

  19. Fascinating! Although I think of it from the angle that when you’re body is at a certain fat/muscle ratio, you’ll need to move around and want to move around and your body will burn up the calories easily. If you mess with that (i.e., increase the fat), you’ll become more and more sedentary and your body will go into fat storage mode. This is what I’ve found (anecdotally) with myself – if I mess with that perfect ratio by eating too many carbs and adding more fat, it will become harder to lose it, even if I eat better. The minute I reach that “perfect” ratio, I’m like an energy machine. I’m always moving around, I’m hardly hungry and when I do eat, it just “feels” like it’s processed more efficiently.

    I don’t know if I read this somewhere (the fat/muscle ratio) or just discovered it for myself. It fits with what Fred Hahn said about adding the slow weight lifting in. I also remember some crusty old weightlifting coach (can’t recall his name) saying that the average man and woman need to pack on a good amount of muscle to get enough to burn off the fat. Most women are so afraid of “getting big” by lifting weights, but I think what happens is they put on some muscle before their body loses much fat and they feel bulky and stop lifting. If they continued, their muscle would take over the process, giving them the impetus to get up and move around. After all, what else do you do with muscles? It drives me crazy to see women “lifting” tiny dumbells where you can’t see any effort being exerted by their muscles. Pick up a bigger weight and just do it! (but don’t hurt yourself – use correct form and condition your muscles into it) 🙂

    Anyway, thanks for your continued good work!

  20. Dr. Eades,
    Do you still see patients? If so, I would like to make an appointment with you.

    thanks, Laura

    COMMENT from MD EADES: Sorry, but we closed our clinical practice in September 2001 and went on clinical sabbatical. We do not see patients in a clinic at this time. There’s been discussion over the intervening years about resuming a limited clinical practice, but at preset, we have no concrete plans to do so. If we should do so, you can be assured we would announce it on the blogs.

  21. Dr. Eades, I just stumbled upon this article. I got an Ikea bar table off of Craiglist last year to use as a standing desk, and I have never looked back. I have my computer monitors and mice/keyboard mounted vertically using rack shelving next to the ikea desk. 6 months ago, I kicked it up a notch by actually creating a treadmill desk:

    I can now WALK at a very low pace while I browse, type, chat, whatever. It’s pretty easy to rack up 600-700 extra calories burned per day. Best of all, nagging back and shoulder pains from sitting all day are completely gone. Give it a shot!

  22. Every day, I see patients who tell me that they went to the gym every day for a month and didn’t lose weight. This put them off exercise forever.

    It saddens me that there is so much misinformation about exercise and weight loss. The health benefits of exercise are being clouded by hitching it onto the weight loss bandwagon.

    I also agree with your points about EAT vs NEAT. A patient of mine who was walking to work every day (an hour there and back) told me she was going to buy a stationary bike to get more exercise.
    I asked her “Do you think you’ll be using the bike in 5 years time?”
    “Probably not” was her answer.
    “What about 1 years time?”
    “Maybe not”
    “What about 3 months time?”
    “I doubt it. I hate stationery bikes”.
    “So save your money,don’t get the bike”

    This was another example of people feeling that a lack of “formal exercise” was holding them back from weight loss.

    PS This is a great blog! I just found it today and very impressed.

  23. When I worked for Digital Equipment, some eons ago, Senior VP of Manufacturing, Bill Hanson had a modified desk at which he stood as well… not sure how much sitting he did in meetings — of which, I’m sure, there were many — but I know he stood in his office… the desk went along the wall of tall mill windows in Maynard, at a slight drawing board tilt.

    Another manager I worked for insisted on having all our project meetings standing up; he believed that it helped people be more concise and on topic, leading to shorter, more productive, meetings.

  24. I agree with you Roxanne. Standing is another form of exercise to lose weight. However, there is a limit of minutes or hours in standing that benefits your body.

    Check out Denver Chiropractor for our healthy tips and wellness.

  25. I have read that Stonewall Jackson used to work standing at his desk and had a special desk built just for that purpose. He had notoriously bad health though, so hard to say if all the standing helped, or hurt!

    COMMENT from MD EADES: He also took a very cold water bath every morning, so history tells us. Who knows that the daily thermal shock and the standing were what saved him from a terrible constitution 🙂

  26. In the 6WC you talked aout your experience with bioidentical hormones but I never got the timpression that you finished what you had to say. It just ended without any results of your experiment.

    You mention hormonal changes as we age, especially decades after menopause, but what did you find different after you started taking bioidentical hormones? Were you able to lose any weight as a result? Or did you just feel better?

    I am able to maintain my weight on low carb and did lose on the 6WC but bounced back to where I started when I went back to eating high fat meats (primarily beef). If I avoid beef completely, I can drop a pound or two but can’t take off the pesky 10 pounds I was aiming for.

    I can stand much longer now I have knee replacements but doubt I could do 8 hours.

    Anything further on those bioidentical hormones would be helpful.

  27. Hello dr. Eades
    I was reminded of this post today because of something in Sweden where a supporter of the conventional wisdom published a book of collected anecdotes from people regarding ways they’ve found to lower their cholesterol or weight.
    In a TV interwiev it was quickly mentioned about standing to loose a few but as you could expect, just a littel simple calorie expendature numbers.

    Still, now that it’s been a year since this post, have you noticed any benefits so far doing the “Rummy”?


    COMMENT from MD EADES: Can’t say it’s been a terrific weight loss tool, but as my father would have said: who knows where I might have been without it? You do get better at standing and maybe that means some fitness benefit out of it, I think. And I still do it much of the day.

  28. dear sir
    I was reminded of this post today because of something in Sweden where a supporter of the conventional wisdom published a book of collected anecdotes from people regarding ways they’ve found to lower their cholesterol or weight.

  29. I suspect hormonal issues are at play, with respect to my own weight loss difficulties. I am planning to have them tested, but even if they find hormone levels are dropping due to my age – andif I supplement – I am not aware of any studies that show that hormone supplementation aids weight loss efforts at middle age.

    Am I wrong here? I have read studies that indicate that body fat distribution can be impacted by hormone supplementation – but not overall weight loss.
    Any advice you have is greatly appreciated.

    Comment from MD Eades: I agree that the literature is relatively light on double blind placebo controlled human studies documenting specific weight loss with the correction of hormonal changes, but certainly there is anecdotal evidence (such as that is) to support it and my own clinical experience bears that out. And, for many women, restoring the (sometimes) dramatic shift in body composition and body shape that accompanies the hormonal changes of perimenopause to a more ‘normal’ one is of significant benefit even in the absence of tremendous weight loss.

  30. Thanks for such an informative article! I look forward to reading both The 6-Week Cure for the Middle Aged Middle and The Cure. And of course standing more!

  31. Thank you Dr. Eades for your follow up comment.

    I am planning to get tested shortly, but since the whole hormone therapy topic is rife with controversy (each medical professional I speak with has a different opinion it seems) – when you mention that your clinical and anecdotal experience supports that correction of hormonal changes boosts weight loss – can you be more specific? In other words, in a middle aged woman in a state of declining hormones- should raising estrogen and progesterone levels through HRT be the route to take? would we seek to raise those levels back to the levels they were in the reproductive years? thank you.

    Comment from MD Eades: I wouldn’t really be able to make a blanket statement about what all peri and post menopausal women should do, because it varies. What I would say in a general sense is that taking hormones back to actual reproductive age levels can be fraught with problems (return of menses, for instance) for some women. And for others there may be other medical reasons why they shouldn’t push replacement to that level. For my own part, I shot for the lowest level of estrogen replacement that kept my mood level and my nights sweat free. And for a progesterone level that put me at the low end of normal for a younger woman probably, but at the higher end of normal for a post-menopausal woman. Every woman’s situation is unique, however. Some for metabolic reasons are estrogen heavy, others progesterone heavy, and others deficient in everything, including enough testosterone. I wish I had a clearer answer, but it really is a tough question.

  32. Again, thank you for your comments. It is confusing to hear that hormonal issues may be at play in the battle to lose weight, but we’re not sure how or why or what or where to start or even what testing may reveal in order to try to correct or overcome….yikes.

  33. Dear Dr, did standing at work help?

    MDE responds: It made me a better stander, for sure. Not sure it did much for weight loss 🙂

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