Author: Amanda Oakes-Cornellissen



Physical inactivity (PI) and a sedentary lifestyle are contributing factors to the obesity epidemic.  Health professionals have traditionally counselled clients on the importance of including moderate- to vigorous-physical activity (PA) in their daily routines, as part of a weight loss or weight maintenance regime.  Clients with obesity often find it difficult to adhere to such PA regimes, leading to poor health outcomes.

Dr. James Levine who works for the Mayo Clinic in America, published his first article on the NEAT concept in 2003.  NEAT is an acronym that stands for: Non-Exercise Activity Thermogenesis, which excludes sleeping, eating or sports-like exercise.  NEAT includes any energy-burning activity performed with activities of daily living like walking, climbing stairs, standing, and fidgeting.  Dr Levine and his team have studied how obesity is affected by NEAT and numerous human functions such as the basal metabolic rate (BMR), total energy expenditure (TEE), and the thermic effect of food (TEF).  They believe that NEAT can have a positive effect on the obesity crisis, by adding an extra 2000 kcal of daily expenditure, depending on an individual’s body weight and level of activity.  His numerous publications on the topic encourage all health workers to include NEAT in addition to the usual exercise prescription, as part of their PA client recommendations.


In the past 50 years, there has been a sharp incline in PI due to the high rate of seated jobs, and daily motorized conveniences like motor vehicles, dishwashers, washing machines, vacuum cleaners, and escalators.  With these conveniences and poor nutritional habits, there has been a worldwide rise in body weight and adiposity which have been implicated in the obesity epidemic.

NEAT should be engineered into clients’ daily lives in the form of walking, doing housework, gardening, taking stairs instead of using the lift, choosing the furthest parking spot from the entrance, fidgeting, singing, laughing, and standing instead of sitting.  These activities will lead to energy expenditure and have the potential to increase thermogenesis and energy consumption.

Total Energy Expenditure (TEE) – the energy costs of the processes essential for life (BMR) + the energy expended during PA.

Basal Metabolic Rate (BMR) – the number of calories the body burns as it performs basic (basal) life-sustaining functions like breathing, beating of the heart, cell production, body temperature maintenance, circulation, and food digestion.

Thermic Effect of Food (TEF) – the amount of energy it takes for the body to digest, absorb, and metabolize food.

BMR is estimated to make up 60% of the TEE, PA 15 to 30%, and TEF only accounts for 10% of the TEE.  The TEF varies for each person;  compared with lean individuals, the TEF is lower in obese people, especially in high-carbohydrate meals.  In Levine’s first studies he showed how two individuals of similar body size can expend different caloric amounts, based on their activity levels.  Considering that BMR and TEF are relatively constant, PA (organized exercise + NEAT) has the greatest potential for change burning calories.

As Healthcare Providers, we have the potential to help our clients who are struggling with their weight, by promoting not only organized exercise programmes but also including NEAT for long-term benefits in weight reduction and management.


“Life is like riding a bicycle. To keep your balance, you must keep moving.”

Albert Einstein (1879-1955)



Levine JA. Non-exercise activity thermogenesis. Proc Nutr Soc. 2003 Aug;62(3):667-79. doi: 10.1079/PNS2003281. PMID: 14692603.

Levine, J. A., Vander Weg, M. W., Hill, J. O., & Klesges, R. C. (2006). Non-exercise activity thermogenesis: the crouching tiger hidden dragon of societal weight gain. Arteriosclerosis, thrombosis, and vascular biology26(4), 729-736.

Levine, J. A. (2014, August). The chairman’s curse: lethal sitting. In Mayo Clinic Proceedings (Vol. 89, No. 8, pp. 1030-1032). Elsevier.