Sitting — Is It Really the New Smoking and Where Do We Stand?

Last week, my 6 yr old son was innocently squatting in his pyjamas on a bright red hard wooden kitchen chair (pictured above) eating his breakfast. Totally at ease in his chosen position, and remarkably skilled at placing porridge into his mouth without any spillage.

And then, as if by magic, I found myself saying ‘Sit Down’ in a rather stern tone…

Ironically, I then sat back and reflected on this instruction. Then I backtracked …‘Hang on, DON’T Sit Down’ And I went on to mention something about the evidence for reducing sedentary behaviour being a positive thing to do for health…

NOW I had his attention (he is learning the meaning of words at school you see) ; he looked up and with porridge on his chin asked: ‘Mummy, what does sedentary mean?’

Well, if you REALLY want to know about the word sedentary, I suggest we both read the great informative article about just this, by Dr John Skyes.

‘I’m afraid we are running late for school now’ I said,

‘So I promise to explain the word sedentary to you later, but right now I am just going to tell you a short story and it’s called ‘A Very Brief History of The Chair’…

Let’s begin…

You know those 4 legs with a seat and back attached that you are squatting on right now?

Well, apparently the ancient Egyptians invented the first ever one of those and called it a chair.

But when I look at the books, I can’t find any mention of chairs in the bible or Homer come to think of it. And neither can I locate a chair in Shakespeare’s Hamlet written in 1599.

And then, guess what, they suddenly appear in their hundreds (187 to be precise) in Bleak House by Charles Dickens, 1852

(Charles Dickens is the one that wrote a Christmas Carol that was later adapted into that film you love, The Muppets Christmas Carol….)

So, what changed?

Nowadays it is very difficult to avoid The Chair. Have you ever tried to ?!

Chairs are literally everywhere you look; trains, offices, cafes, cars, GP Surgeries, theatres, hospital waiting rooms, buses, schools, lecture theatres parks, soft plays, zoos, pubs, restaurants. I do have yet to see one at a garage but am very happy to be told otherwise! The wonderful writer Zoe Williams even wrote a piece about sitting upright on her horse only this weekend in The Guardian Weekend Magazine.

Now, how about chairs in YOUR HOME?: I just counted up the chairs in my house and they total a whopping 16 ! That doesn’t include the chairs in the sofa space …. Go on, have a walk about and tally them up.

The world is literally covered in chairs!

The Chair: A symbol of the arrival of our sedentary age?

Historically chairs were associated with wealth, power and high status. This association with status is present in modern society. Thinking about it, we call the person who runs the meeting ‘The Chair’, the Head of the company the Chairman or Chairwoman and how many of you have noticed that the Boss is often in possession of the ‘best chair’ in the office….

Is it time to demote the humble Chair and make a stand?

Incidentally, I was sitting and listening to a lecture at ISPAH ’18 recently delivered by Professor Jeff Vallance from Athabasca University, Canada. He presented a very thought-provoking lecture on the question ‘Evaluating the evidence on sitting, smoking and health: Is Sitting REALLY the new smoking?’.

He put up a few slides that have stayed with me since…

In 2012, the annual global cost of smoking-attributable disease was estimated at $467 billion. The cost of physical inactivity in 2013 estimated at $53.8 billion. The amount tobacco companies spent on marketing in 2016 estimated at $8.7 billion.

Currently, the economic burden of sitting is UNKNOWN. Simply put, the estimates are incomparable.

Professor Vallance presented a slide that summarised the absolute and relative risk estimates for sitting versus smoking including all-cause mortality, CVD mortality, all cancer mortality and Lung Cancer mortality as well as Type 2 Diabetes mortality.

He concluded: Risk Estimates for SMOKING far outweigh those for SITTING.

I approached Professor Vallance afterwards, we shook hands standing up. And ever since hearing him speak, I have felt motivated to write this (my first of hopefully many blogs!) NOT with the intention to confuse or downplay the risks associated with a sedentary lifestyle, but to create a platform for questioning the public health messages we read or promote when we represent a Lifestyle Medicine approach. Most importantly to Professor Vallance is that such messages are backed up by credible scientific evidence.

We need to be curious and gently challenge what we read or hear. We need to keep healthy debate alive. In this instance when comparing smoking with sitting, we are also comparing addiction with habit and we all know that behavioural change is far more complex than the simple question we started with. Public Health efforts to change sitting habits may be more amenable to change than addictive behaviours.

As health professionals, we have a responsibility to accurately represent the evidence. My concern with equating sitting with smoking is that it serves to distort and potentially trivialize the ongoing and serious risks of smoking and may even confuse people.

So, what are you waiting for? Do let me know how many chairs you have in your home ……

Further Reading