10/20/2013 08:54 EDT | Updated 12/20/2013 05:12 EST

How Trying to Control Your Weight Is like Running Down the Up Escalator

One of the games I used to play as a kid was to run down the up escalator.

To get to the bottom, I had to run down faster than the escalator was moving upwards. If I ran any slower, the escalator would gradually but steadily take me back to the top.

In fact, even to just stay half-way down, I'd have to keep running at about the speed the escalator was moving up. If I stopped running even for a second, I'd be moving up again.

I use this analogy with my patients to help them understand the incredible challenge of losing weight and keeping it off.

To me, the escalator represents all the complex neuroendocrine responses to weight loss that will always want to take you back to the top -- the only way to reach the bottom or to even maintain your place half-way down is to keep running.

Alas, in real life, the weight-loss escalator is even trickier. For one, there is no real bottom -- i.e. no matter how fast you run, you will never reach the bottom and be able to simply get off. No matter how far down the escalator you manage to get, you are still running on an escalator that will keep moving you back up to the top the minute you stop running.

But things get even more depressing, because, the further down the escalator you get, the faster it runs. This means that the further down the escalator you manage to get, the harder you have to keep running to just stay where you are.

Or, in other words, when you start from the top, the escalator is running relatively slowly and you may easily manage to get down the first five steps. But as you go down, the escalator picks up speed and so, if you just keep up running at the speed you started at, you may not even manage to hold your place five steps down.

And, to get to ten steps down, you'll definitely have to speed up -- unfortunately, with every additional step you manage to make your way down, the escalator moves up even faster.

By the time you manage to get down 20 steps, the escalator is moving upward so fast that it is all you can do to just try and not be carried back up.


If we could only find a way to slow down the escalator. Or even better, if you could only get to the bottom and get off!

Alas -- that is not how our bodies work.

Yes, for some people the escalator moves slower that for others -- this is why some find it easier to run down and it takes them less effort to maintain their position half-way down. Others have to fight harder to get there and for others, the escalator simply gets too fast, eventually carrying them all the way back up -- no matter how hard they try.

What can you do to slow down your escalator?

Addressing the issues that is causing it to move up in the first place is a good start. Then, changing you diet and activity levels, getting more sleep, working on life-stress balance will help. And of course, bariatric surgery and obesity medication can help slow down the escalator -- or rather, prevent it from speeding up quite as fast as you try to run down. This is why many people (surely not everyone) can maintain a lower spot on the escalator with the same effort as before -- but go off your diet, your exercise plan, your meds or reverse your surgery and the escalator speeds up again only to carry you back all the way to the top.

The world is full of people who have lost weight (sometimes incredible amounts) but they are all running down their own personal escalator -- some at speeds that are simply awe-inspiring. (Check out the weight loss stories linked to these pages to see just how much effort and hard work it takes).

These folks are certainly not "cured"; their weight is "controlled," "managed," "treated" -- whatever you chose to call it. Unfortunately, even the shortest "lapse" in their efforts (like an injury) and they will be back to their former weight before they know it.

This is why, the longer you wait, the fewer people you find who have done it: Losing 50 lbs is hard work; keeping them off for a year is even harder; keeping them off for 5 years is exceptional; keeping them off for 10 years is almost a miracle; keep them off for 20 years -- it's time to write a book and become a TV celebrity (unfortunately, most celebrity "experts" don't even wait that long).

How fast is your escalator moving up? How fast can you run down (and keep running)?

Adapted from a previous post on Dr. Sharma's Obesity Notes


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