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Running Down the Up-Escalator (Part 3)



EscalatorIn the last couple of posts, I used the analogy of running down the up-escalator to describe the challenge of weight management.

I also noted that trying to run down that escalator without first addressing the reasons you ended at the top in the first place, may make the descent even harder.

But why use the escalator analogy at all? Why is the escalator moving up? Why does it get faster as you get further down? And why is there no bottom, where you can simply get off?

Let’s start with the upward moving escalator – most of us are on it to start with as most of us tend to gain weight with age – unfortunately, some people faster than others. Very few of us manage to keep our teenage weights into late adulthood. There are many reasons for this – for one, our metabolism “slows down” as we get older, so do our levels of physical activity. Then there are other drivers of weight gain that tend to accumulate as we get older – stress, lack of sleep, arthritis, medications, to name a few. This means that for most of us, to not be carried higher on that escalator, we already have to take the occasional step down – the faster our personal escalator is moving up, the more effort we will have to put into simply “marking time”.

But that’s the easy part (preventing weight gain is always easier than treating obesity). To lose weight, you have to actually start moving down the escalator faster than it is moving up. Depending on how fast your personal escalator is moving up, the more effort this will take. The tricky part comes when the escalator starts speeding up as you make your way down – this is what is often referred to as the “starvation response” – a complex series of metabolic and behavioural responses aimed at preventing further weight loss and promoting weight regain.

In previous posts I have discussed some of these factors – leptin, ghrelin, sympathetic nerve activity, body temperature – the net result is that as you get lower down on the escalator, the fewer calories you need and the greater your hunger and appetite gets. This is why, keeping weight off gets harder and harder rather than easier and easier the more weight you lose. (Many people think that if I can only lose the first 20 lbs, losing the next 20 will be easier – that is almost never true).

Finally, why is there no bottom where I can simply get off? This is because based on the “setpoint theory” (which is actually far more than just a “theory”), your body always wants to get back to its highest weight (or back to the top of the escalator). Unfortunately, from everything we know about weight management, there is no “cure” for obesity – meaning you will always have to continue doing whatever it is you did to lose the weight to keep it off.

As I noted in my previous post, anti-obesity medications or surgery may make keeping weight off somewhat easier, but they do not “cure” obesity – stop your medications or reverse your surgery and your weight comes right back. This appears to be a rule in weight management – when you stop the treatment, the weight comes back (the same goes for “diet and exercise” as a treatment).

Although depressing, I do hope the escalator analogy is helpful in understanding how weight management works, why keeping weight off is so difficult, why very few people can ever hope to reach and maintain their “dream weight”.

Anyone, who promises you anything else is simply not being honest.

No doubt we need more effective treatments for obesity and perhaps one day we may even find a “cure” – till then, we’ve got to work with what we have.

@DrSharma
Edmonton, AB

5 Comments

  1. Dr. Sharma, you wrote, “the net result is that as you get lower down on the escalator, the fewer calories you need and the greater your hunger and appetite gets.”

    That just seems so wrong. I mean, yes, I need fewer calories, of course, I weigh less, but why is it that someone who has been obese need fewer calories to maintain any given weight than someone who hasn’t ever been obese?

    I am very curious about why this is…if the hypothesis is true–that our bodies are supposed to regulate our hunger cues (and likely our activity cues, though I suspect we have become culturally deaf to them) so that our bodies are not too fat nor too thin, then why doesn’t weight loss “fix” this apparently broken mechanism? This “starvation” response is just more brokenness according to the homeostasis model. Is the model wrong? Or is the period of “fixing” not over until the body has achieved a weight that is “not too fat and not too thin” for a long period of time–like three or four years? Or–if we can’t ever get off the escalator–are you saying that a formerly obese person will never, ever be able to eat “normally” (say 1500 cal/day) and maintain a “normal” weight range (according to bmi, say)?

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  2. “Is 1500 calories a day a normal intake? Wow. That’s low.”
    It depends on the person.

    Certainly 1500kCal per day would be too low for most people. I had a BMI of 17.5 on that figure and was still loosing weight but I’m a 174cm male but it could be a healthy intake for a small female.

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  3. Coming at it from another angle – I’ve lost 115# (partly the “old-fashioned way”, partly gastric surgery) and am currently 188#. For ME, 1500 a day is too much – although I’d love to be able to enjoy that much food. I maintain 188# on about 1200 calories a day. It kinda sucks, but life is SO much better at 188# than 304#.
    I’m very fortunate in having a supportive family doctor who is encouraging me to have skin removal surgery (I have a lot of hanging skin but will only have the apron removed) and learn to enjoy life at this weight instead of fighting to weigh less. Reality is that the less I weigh the less I can eat on a daily basis, and even 1200 calories is pretty limiting.

    Kelly-Anne

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