When we first caught up with Levine to discuss NEAT, we found him in transit, walking to his office in downtown Phoenix, Arizona. Levine walks a lot. He routinely conducts meetings, interviews, and many other tasks on the go.

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“Contrary to popular belief, I do sit from time to time,” says Levine, but he makes a habit of doing most things standing if he can. Asked just how bad sitting is for you, Levine rattles off a list of 16 associated health risks including obesity, diabetes, hypertension, high cholesterol, cardiovascular disease, depression, swollen ankles, joint problems, back pain, depression, and cancer. Even one’s creativity, he suggests, may be dulled from sitting too much.

That’s why Levine has called for a “moratorium on the chair.” He believes it is time to fundamentally redesign our environments so that higher NEAT is the norm. Toward that end, he is working with the mayor of Phoenix on initiatives to encourage more walking among commuters, and he also works with businesses and school systems to make workplaces and classrooms more active—or, as Levine puts it, “NEATER.”

“What’s really cool about NEAT is that everyone can do it,” says Levine. “You can have somebody who’s 150 pounds going for a ‘walk and talk’ meeting with someone who’s 350 pounds. You can promote NEAT in all people without having to change their clothes.”

Though it’s easy to get discouraged about our modern obesity epidemic—as discouraged, perhaps, as a person who tries desperately, and fails, to lose weight—Levine stresses that obesity has crept up on us slowly. “The obesity epidemic has occurred over about four generations,” he notes. If little steps got us into this mess, he notes, then little steps may get us out—provided they are done consistently.

The degree of positive energy balance that has produced our obesity epidemic has been termed our “energy gap.” Addressing the energy gap means identifying the change in energy expenditure relative to energy intake necessary to restore energy balance. It turns out that the amount is less than you might think.

By some estimates, a lifestyle change that reduced energy intake or increased energy expenditure by 100 kcal per day would completely abolish the energy gap, and hence weight gain, for most of the population. Walking just one extra mile each day would increase one’s energy expenditure by about 50 to 100 kcal per day, depending on body weight. You can estimate the energy you expend in walking by using this relationship: For every mile you walk (between 2 and 4 miles per hour) the energy you expend (in kilocalories) is essentially equal to your body weight in kilograms. For example, if you weigh 150 pounds (68 kg), you will expend approximately 68 kcal for every mile you walk. Similarly, taking two or three fewer bites of food at each meal would reduce energy intake by 100 kcal per day. The problem, of course, is that our current environment strongly discourages both of these things. (INFOGRAPHIC 15.15)

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James Levine once referred to NEAT as the “crouching tiger, hidden dragon” of societal weight gain. What he meant was that the behaviors that lead to obesity may be both sneakier and more deadly than we ever imagined. “Whoever thinks about the amount of time they spend sitting?” Levine asks. “No one does.”

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