Sitting’s the New Smoking

“Sitting is the new smoking” is a popular health phrase that emerged in the 2010s, warning about the dangers of prolonged sedentary behavior. While it’s a catchy slogan, the comparison is somewhat overstated. Smoking is definitively more dangerous, but the underlying concerns about excessive sitting are legitimate. When we were younger, much less when our parents were younger, seeing a movie with a guy like Humphrey Bogart sucking on a cigarette, was normal and not so evocative of something bad. Now, when we see a film clip with heavy smoking (I watch a lot of WWII movies…which the theatrical world seems to want to perpetuate for all its worth) and you see someone taking a drag and breathing the smoke deep into his or her lungs, I think we are all appalled and almost unable to think of anything other than the shock that they could not know how much bad they were doing to themselves.

Tomorrow I will take my eighth weekly shot of Zepbound. Based on the latest data, here’s what we know… approximately 4% of Americans were taking GLP-1 drugs in 2024 for weight loss, obesity, or Type 2 diabetes. More recent surveys from 2025 show that about 12-13% of U.S. adults report having ever taken a GLP-1 agonist, though not all are currently using them. In 2024, an estimated 6.9 million adults with diagnosed diabetes were using GLP-1 injectables, representing 26.5% of all adults with diagnosed diabetes. This represents dramatic growth… usage soared 155% between 2018 and 2022. Estimates forecast 40 million people globally on GLP-1s by 2029, with 44% in the U.S., translating to $126 billion in sales. There is a very real reason why Eli Lilly is the first pharmaceutical company to reach a $1 trillion valuation. I predict that will only grow bigger and faster as more of us get into this highly effective weight loss prescriptive. Kim and I both have lived a combined 140 years and ALL of those years, despite repeated sincere efforts and anxiety, we have been unable to grab hold of the problem in a way that our respective GLP-1’s have allowed us to do. We are very realistic about the difficulty of wrestling this monster to the mat. We have both had bariatric surgery (me a Lapband for 19 years and Kim a Lapband and then Bypass surgery six years ago) and we would both agree that physical adjustment was critical to our respective weight loss success, but we have both gone on to using a GLP-1 (Kim has three years of Ozempic and now a month of Maunjaro and I have had two months of Zepbound). We are not exactly test pilots in either arena, but we are both apparently successful early and serious adopters of both. And here’s the bottom line, while the war goes on, we are both down to minor skirmishes as the major battles have been won and we are mostly fine-tuning at this stage.

As we are on a vacation at the moment, we are taking the usual array of nice selfies of ourselves here and there. As I looked at them this morning, I was taken aback about how much better and healthier we both look than we looked in the wedding photos taken when we married 18 years ago. Kim is 70 pounds lighter (29% down). I am currently 167 pounds lighter (35% down). Note that we are both 33-36% older than we were, so its particularly interesting that in photos we look so much better (I don’t think that’s an objective overstatement). Kim has been a regular workout person over the last five years and I have been a lot more active…less working out and more busy in the garden. I am far more sedentary than Kim, but that too is changing. Yesterday, when we arrived in Edinburgh we had to walk up about eight flights of stairs, carrying our not light hand baggage. In days gone by, I would certainly have had a problem with that, and while not happy with it, I was able to handle it just fine. I have noticed recently that around the house as well, I am much more up and about rather than getting more sedentary.

About 19% of adults ages 50-64 report having ever taken GLP-1 drugs, higher than other age groups . Among adults 65 and older, only 1% report taking them solely for weight loss, likely due to Medicare’s prohibition on covering these drugs for weight loss. What a shame…but perhaps things like the LillyDirect reduced direct cost programs will change that. So many people would benefit from a healthier happier retirement if they could afford these weight loss prophylactics.

The health risks of prolonged sitting include increased risk of cardiovascular disease, type 2 diabetes, certain cancers (particularly colon and endometrial), and earlier mortality. Sitting for long periods slows metabolism, affects how the body regulates blood sugar and blood pressure, and reduces the breakdown of fats. Some studies suggest sitting more than 8-10 hours daily significantly increases health risks, even for people who exercise regularly, though exercise does help mitigate some of the damage. As I sit here today with “Zepbound Brain”, and while I do not want to become a stereotypical “fat-shamer”, I find it harder and harder to not watch people eating potato chips and being sedentary as the same as watching Bogey smoking. When we got in last night, Kim went out to walk around the Christmas Markets with Gary & Oswaldo while I had some dinner with Barbara & Frank. I had red lentil soup, two bites of a panini and a few green beans. That is a healthier blend of smarter eating and non-sedentary activity than the two of us would have taken 18 years ago…and we both feel good about it.

The key difference between smoking and sitting is that smoking causes direct, dose-dependent harm with no safe level of exposure. Sitting is a natural human position that becomes problematic mainly in excess and when uninterrupted…sort of like eating. The risks are also more easily reversible, simply standing up and moving breaks the harmful cycle, whereas smoking damage is often permanent. But add a GLP-1 to the equation with intended and attendant weight loss and you have a practical solution to a healthier lifestyle that simply seems to finally work.

Taking short movement breaks every 30-60 minutes (like my Apple Watch always reminds me) makes a real difference. Standing desks (or alternating sit-stand desks), walking meetings, using stairs, parking farther away, and incorporating movement into daily routines all help. Even light activity like standing or slow walking provides benefits. You don’t need intense exercise to counter sitting’s effects, though regular exercise certainly helps overall health. I have commissioned my physical therapist, a gal who helped solve a joint issue for me last year and is currently helping Kim with a shoulder problem, to design a core exercise program for me to start when I return home. My plan is to go into my home gym every morning to start my day and help me get stronger and to get moving and more and more active. I don’t want future home videos of me to make people be appalled and almost unable to think of anything other than the shock that I could not realize how much bad I was doing to myself.