Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
19 Mar

Dear Mark: Excess Skin After Major Weight Loss?

Today’s Dear Mark topic is a sensitive one: excess, or loose skin after major weight loss. This is a problem for a lot of people, and it can really take the sails out of someone who’s had otherwise seamless success losing weight. I may ruffle a few feathers here, but I assure my intent is merely to give folks who have loose skin the best shot at reaching their desired body composition. So, as you read my response to the reader question, keep that in mind.

With that said, let’s get to it:

Hi Mark,

Excess skin after weight loss is a big topic in most weight loss communities, yet I rarely hear about it in the Primal community. Does the Primal lifestyle prevent excess skin? Are there any tips from either yourself or from the members of the community about avoiding or preventing excess skin after weight loss? I am currently approx 100 lbs overweight so this is something that really concerns me.


Before getting into potential methods of treating and/or preventing excess skin after weight loss, let’s explore the phenomenon itself. What exactly is loose, or excess skin?

Most cases of loose skin are actually just cases of excess subcutaneous body fat covered by skin. And because subcutaneous fat is “soft” fat, it is looser and easier to confuse with skin. It droops and jiggles and the skin that surrounds it conforms to its shape. That’s not to suggest that legitimately loose skin isn’t a real problem, because it is. But I would wager that many if not most cases of loose skin can be explained by overly stubborn deposits of subcutaneous fat.

Stubborn fat is actually a real thing. As Martin Berkhan explains, adipose tissue is full of alpha-2 and beta-2 receptors. A-2 and b-2 receptors are the major lipolytic receptors in adipose tissue, meaning they interact with the catecholamines (adrenaline and noradrenaline) to cause stored body fat to release. B-2 receptors are associated with “easy fat,” or fat that burns off easily. A-2 receptors are associated with “stubborn fat,” or fat that’s harder to burn. All adipose tissue has both a-2 and b-2 receptors, and the higher the b-2:a-2 ratio, the easier it is to burn the fat. The lower the ratio, the more stubborn the fat. Belly fat has a notoriously low b-2:a-2 ratio, which is why it’s usually the last to go (especially for men). If your belly fat is stubborn, it may resemble loose skin even as the rest of your body has mostly leaned out.

If your loose skin is thicker than a few millimeters, there is residual body fat. And because adipose tissue – which, remember, is actually a major endocrine organ, rather than an inert piece of tissue – remains, the skin has no reason to return to its former size and elasticity. As long as the subcutaneous fat attached to it remains, the skin will appear loose and drape-y. Skin that fills your hand when you squeeze it isn’t just skin.

This isn’t really bad news, believe it or not. It actually means that you’re almost there. It means that your “loose skin” isn’t necessarily out of your control. If indeed it is simply stubborn subcutaneous fat, once you manage to lose the excess fat, the “loose skin” might just disappear along with it. In fact, I’d imagine that most such cases of “loose skin” can and will be remedied in this manner. Men, get down to around 10-12% body fat before you start considering surgery or anything drastic. Women, get down to 15-17% body fat before taking any surgical steps.

Hey, if that sounded harsh to you, at least I’m not as bad as Ron Brown, PhD, who claims loose skin is nothing but a myth. Go ahead and check out his argument, but try to avoid meeting his steely gaze. Lock eyes with Dr. Ron at your own peril; you will be consumed. Despite the intense shirtless photo, he has a point that skin is not a passive slab of flesh. Instead, it is an active organ that should be able to adapt to the body’s “internal and external environment.”

That said, if your loose skin is paper thin, closer to the thickness of your eyelid or the back of your hand (about 1 mm thick), and resembles rolled up papyrus or parchment, you likely suffer from excess skin. What can be done to prevent or deal with actual excess skin?

First and foremost, any weight loss regimen must be accompanied by resistance training. Yeah, I’ve said it before, and I’ll say it again: you have to be lifting heavy things in order for the best things to happen to your body composition. There are a few genetic outliers who can put on muscle as easily as breathing, but those folks probably won’t have the problem of loose skin anyway. For the rest of us, however, we need to lift weights in order to maintain and/or build lean mass during weight loss. If your loose skin is caused by a rapid diminishing of body mass, packing on a bit more mass in the form of muscle can mitigate the problem.

There’s no hard data on this, but I’d imagine that crash diets, ones that consume lean mass and fat mass indiscriminately in the pursuit of rapid weight loss, will be more likely to leave you with excess skin. If you’re losing weight and feeling weaker, disoriented, lazy, rundown, and generally crappy, you’re probably doing it wrong. Weight loss should imbue you with vigor and strength, easy, smooth energy. You should be burning clean body fat for energy, not breaking down your lean tissue. Remember what I wrote last week about fasting preferentially targeting body fat versus lean mass? Yeah, fasting might be just the ticket for ridding yourself of stubborn body fat while avoiding the accumulation of excess skin due to concurrent lean mass breakdown.

Another major cause of loose skin is compromised skin elasticity. If your skin loses elasticity, it will lose its ability to spring back to its former glory. Lost elasticity is usually thought of as a characteristic of growing old, but it can also strike younger people. Besides finding the fountain of youth, what can you do to improve skin elasticity?

One study found that dietary gelatin improved skin elasticity (PDF). Eating real bone broth, fatty gelatin-rich meats like oxtail, poultry feet, or short ribs, or even using gelatin powder as a supplement might be able to restore or preserve skin elasticity. You’re already getting dietary gelatin anyway, right?

Another study found that a proprietary blend of nutrients, including selenium (salmonbrazil nuts, seafood), zinc (oystersred meat), vitamin C (vegetables, fruit, raw liver), and various carotenoids (fruits and vegetables, red palm oil), was effective at increasing skin elasticity.

Vitamin C is important for collagen formation, which is vital for skin elasticity. Make sure to get enough vitamin C.

If weight loss occurs and you’re at a low-enough body fat percentage to determine that you truly have excess skin, give it several months before you turn to the scalpel. My guess is that for Primal eaters who are eating a nutrient-dense diet (including plenty of the aforementioned nutrients), truly excess skin won’t be as big a problem as it might be for the general dieter.

Now I’d like your help. Did you have excess skin after weight loss? Was it truly just skin, or was there also fat left over? Please, leave a comment and let everyone know what worked – and didn’t work – for you. Thanks for reading!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. 20 months after having my youngest child (the oldest is 5.5) I have extremely thin folds (not thick with fat) of loose skin at the bottom of my belly. I’m 5’1″ so I won’t be surprised if that is a permanent result of having kids. That said, I do still have some soft fat on my belly, so it is possible the skin will tighten up if I lose that fat.

    Carrie S. wrote on March 23rd, 2012
  2. I’ve dropped 20 lbs in 7 weeks after going grain-free.

    I am an avid weightlifter (I lift quite heavy, the deadlift being the core of all my exercises).

    While I was pleasantly happy with losing 20 lbs, when I looked in the mirror, I still had a belly. But I then touched around my belly and noticed that it was much softer and looser than before, so the appearance of my belly is just loose skin LOL.

    I’m fairly certain that my skin will correct itself eventually.

    hitfan wrote on March 23rd, 2012
  3. Hi Mark: I had to trot on over to Mark Browns site halfway though this post. I just about fell on the floor laughing at his “steely gaze”. Thank you so much for that!!!

    Tonja Pizzo wrote on March 23rd, 2012
  4. I think the fat on my butt has an extremely low b-2:a-2

    MamaB wrote on April 14th, 2012
  5. Coco butter ladies.. I use to have stretch marks and I use coco butter as lotion after every shower.. stretch marks gone. I am now doing the primal eating way of life and losing weight.. but putting more coco butter on and after about a month by skin is getting firmer. :) And I still have about 30 lbs to lose. Hope this trick keeps working.

    Joy Curry wrote on April 26th, 2012
  6. Hi. I have fluctuated in the past with my weight. To date (started losing weight in 2005) I have lost 160lbs and still have about 30lbs to lose. When I first lost the 160lbs I had excess skin(or fat) and then gained back about 80lbs. I am now back down to my lowest weight and still have the excess skin- it is so awful I do not show my legs where it is the most obvious.. I fast now(eat stop eat) and lift weights twice a week. Should I keep lifting and hope this problem will go away when I get to goal?

    Lara wrote on May 11th, 2012
  7. This article is amazing, I lost 25kg due to pancreatitis and went back to what I weighed and how My body looked when I was 19 but the flesh is soft and not firm, it’s definitely not skin but as you said subcutaneous fat, my problem is that I cannot afford to lose any more so how do I deal with that remaining fat? I can’t firm it up as it isn’t muscle just under-skin fat.

    DNACowboy wrote on May 21st, 2012
  8. I have excess skin around my abdomen (4 kids) – I strength train – lift very heavy, core is very strong. I can even see my ab muscles now. However, the more weight (fat) I lose the more the excess skin shows. I am asian and have heard that asians have the least elasticity in their skin and are prone to stretch marks / excess skin after pregnancy. I’m thinking once I reach my goal size I’ll have to get it surgically removed.

    Salina wrote on May 27th, 2012
  9. Hello and Help:)
    I have a body fat % of 13.5% and have a tendency for water retention.
    I want to lose weight even if my BMI is at a normal level, as I have a little belly that disappears when I eat little but still bloats- even if I eat healthy food.

    Helene wrote on May 28th, 2012
  10. Helene if you want to lose weight at 13.5% body fat either that numbers is way higher then you think or your should think about speaking to a healthcare professional about body dysmorphic disorder. You are just about at essential BF levels for women.

    Kia wrote on May 28th, 2012
    • agreed – in fitness competitions, most females step on stage at about 15% bf. Are you measuring under your arm or by your hip? Those areas could be particularly thin while other areas may not, which would completely throw off your results. Best testing methods usually cost big bucks, water displacement is probably the most accurate. At 13.5% you could likely only pinch skin, and rather than a pouch of belly, you would have drapes of skin – literally looks like vertical drapes, especially when you bend over – additionally, females tend to lose that fat before say the but under your rear and inner thighs…And lastly, once elite trainers reach such low body fat levels, thier BMI is no longer healthy, is low, and should not be used as a measuring guide for athletes

      lisa wrote on June 5th, 2012
  11. I have lost about 50/60 lbs in the past couple years. This has equated to 13 inches off my waist and 7 inches off my chest since Jan 2011.

    I recently became very distraught because what I thought was loose skin on the top of my sides. Mortified. Truly. I had always been warned that it would happened with severe weight loss, but thought I was “young enough” my skin would bounce back (I’m about to be 25).

    This article was VERY informative, and I now know it’s subcutaneous fat.

    I also just last month learned that I have a Gluten and Dairy sensitivity. Adjusting my eating accordingly has been hellish. I have been working closely with a nutritionist for 5 years, and we made a new plan. My body has not yet adjusted.

    I’m hoping the weight will melt off once I adjust. But then I’ll have the subcutaneous fat issue big time.

    I’m an avid gym person as it is now. Weights, cardio, flexibility. Everything. I’m even a belly dancer. (pretty good for weighing over 300 lbs).

    But live and learn, right?

    This article was VERY helpful

    Christie S. wrote on June 22nd, 2012
  12. i lost 100 lbs. about 14 years ago, to be honest, i think it is loose skin and subcutaneous fat, i have gotten as low as 190 ( I am 6’3″) and still had the same amount of skin and subc fat as i do at 220 (with more muscle). At this point i have dieted, i am in excellent condition and @ 36 still staying in shape, i have learned to live with the skin but I truly hate it. I try to use it as a reminder of how big I was when I was over 300 lbs. as a teenager. Still doesnt make me feel better in a bathing suit, i lost over 10 inches off my waist so i am just going to live with it.

    josh wrote on June 29th, 2012
  13. I just managed to get to under 10% body fat this June after a lot of hard work all year. It’s my first time this low and indeed.. there’s some loose skin below the belly button I really never even knew I had. It’s the focus of my next 3 months.. burning that away. Indeed, it’s the toughest to get rid of.. or seemingly so because it’s the last to go. My goal is 6% body fat so I’m quite curious if it will be completely gone once I reach that. I feel confident that it will but I’ll know soon enough!
    Great article.

    Jeff wrote on July 1st, 2012
  14. Reading this article makes me really happy. Although this does mean I still have fat to burn after my weight loss, it also means that there is a way to get rid of my unsightly looking belly, without considering surgery.

    Ricky wrote on July 4th, 2012
  15. Hi
    For a month now i have been taking monavie RVL as a meal supplement but i have also been yousing kettlbells for 20 minutes per day twice per day. 3 Months ago i weigh 280 pounds and started to exersis a bit and the last time i weighed in i was 260 pounds . I have not weighed my self now for 6 weeks and i will not do it again until my birthday on September 15Th . I know that by using kettle bells daily i am loosing inches and avoiding the left over skin. I beleave the weight scale is more of a deterrent and as long as you can get rid of inches do not get on the scale as it can destroy you. For proper weight loss all you need is a comonsence diet with exersis ,but not only while you are loosing weight but you must exersise now every day for the rest of your life.

    Wayne Clark wrote on July 15th, 2012
  16. Hi Mark
    Reading your article gives real hope to those of us who have lots to loose. I am a 56 year old male and recently i picked up some kettle bells and wow i dont see a problem with excess skin as the resistance training makes all the difference in the world. 3 months ago i weighed in at 280 pounds and with my large medium frame i should be 180 at the most. When i weighed my self 4 weeks ago i was down to 255 pounds and at that time i got rid of the weigh skale and have just focused on how i feel and the loss’s in inches. I find that getting on the scale only discourages one from going forward as muscle is heavier then fat and therefore please stay away from the scale for 2 months at a time as long as you are loosing inches. I find that drinking my Monavie RVL meal replacements once per day also helps as it gives me the fruits that i need and also a lots of energy. I close by saying to all of us who need to loose never give up,as youwillucceed. Find your self a mentor and together keep up the good fight against the battle of the bulge.

    Wayne Clark wrote on July 15th, 2012
  17. i feel i have loose skin i have lost 163 lb and body fat at 11% and i am not a meat eater i will try gelatin and see i do workout

    gene wrote on August 1st, 2012
  18. Hello everyone. My name is Austin, I’m 16 years old and I weigh 248 lbs. This is my story and it follow with some questions that have been on my mind. I was a skinny child up until age 5. I’ve looked at pictures when I was 3 and I was a very thin and active child. Starting at around age 5 I started eating a lot of junky food and I ate a lot of it, mainly because my mom was poor and we were living on food stamps and could only afford fatty snacks and dinners. As a result of consuming these foods, I started gaining weight fairly rapidly. When I was around 9 I lost some weight but gained it back again. And then when I was 12 me and my dad started walking at the high school and I started eating healthier and eventually started working out. I ended up losing 90 lbs within 7 months. I went from 220 to 130 lbs. I was so happy! I didn’t notice any loose skin maybe a few stretch marks but nothing horrible, mainly just the “stubborn fat” the article talked about. Then I started falling back into old eating habits and I stopped exercising and fastfoward 3 years and I’ve almost 120 lbs back. I feel AWEFUL about myself. I want to eat right again I want to exercise but I just CANNOT find the motivation! I feel lazy constantly and I sleep for hours at a time and binge on junk food. And then I try to limit my calories and that works for maybe 3 or 4 days and The cravings and impulses get the best of me and I just give in /: I’m really serious about losing the weight again, now here come the questions. Since I gained back so much weight, will the elastcity of my skin be completely damaged and ruined? I’ve noticed big stretch marks which sucks. And I know genes play a role in this and my dad is 42 or 43 years old and he is in AMAZING shape. He’s been in almost the shame shape he’s been in since high school. Really buff and muscular and I hope that helps mea bit. My mom was a thin child too but her dad died at 14 and after that she gained a lot of weight from stress and im 2007 she had gastric bypass and lost weight but now she suffers from loose skim which has made her so self conscious about herself and it makes me SO SAD for her :( but anyway, I’m 16 5ft 5 1/2 inches tall and weigh 248 lbs and my goal is to lose at least 100 lbs. I’m worried I’ll have loose skin but taking into consideration my moms genes (before she got severly depressed) and my dads genes, and my age, will this make it more likely i won’t get loose skin? Also I thought I should mention even though I’m very obese, I don’t realy LOOK that huge. I think it might be my frame so I hope you guys have some answers for me cause I’m so worried /:

    Austin wrote on August 6th, 2012
    • You’re very young and you have that to your advantage. Stretch marks do fade over time as well. You also have the advantage that your Mum & Dad have good genes. If you lose the weight over time, your skin will bounce back much better than if you start when you’re 40 !!

      Why don’t you start walking to High School again ? That would be a good start, and find a sport you really love. I LOVE dancing, even thought I’m not very good at it :) I take bellydancing lessons and bop around in my living room.

      If you join the forums here you’ll get good support, and a Paleo diet will give you all the nutrients you need for your skin to repair itself. The sooner you start, the better you’ll feel !

      All the best !

      Molly wrote on August 6th, 2012
      • Thanks Molly! What exactly is the Paleo diet?

        Austin wrote on August 6th, 2012
        • Austin, you can learn about the paleo/primal diet on this website. Go to the “freebies” section at the top of the page, download the books (they’re all short/straight to the point/entertaining) and learn all about it.

          Melissa wrote on August 7th, 2012
    • Hey Austin…I’m going to bet that because of your age (young adults are stretchy…meaning you have a lot of great collagen still) you’ll spring right back. I’m going from info about younger women getting pregnant and afterwards they spring right back into shape most of the time, MUCH better than women in mid twenties and on getting pregnant. I’m sure as long as you eat good fats your body will spring right back as well. In fact I’m betting that if older people ate great fats their collagen would be in a much greater supply and wouldn’t have many loose skin problems…or at least I’m hoping because I’m 30 and have about 60 lbs to lose and would love to not have loose skin. :-) Good luck and GOOD FOR YOU DUDE!!!!!!!! GREAT job finding such a healthy way to lose weight at such an early age!!!! I have been fat my whole life (proportionately so…but still…ALWAYS wanted to be thin/healthy ) and JUST NOW found this this year and it’s amazing how easy it is and how great I feel. I wish I’d known about this in highschool instead of trying to starve myself on iceburg lettuce and soymilk!

      Melissa wrote on August 7th, 2012
  19. Thank you for your honest answer… it gives me hope! I gave birth to full term twins and my normally flat tummy with no fat was stretched to the point where I thought it would split. After the birth and the months that followed I also lost the 60lbs in weight I had put on during pregnancy and am now left with saggy, stretch marked skin. I thought the only solution would be a tummy tuck but this gives me something to focus on to try to remedy it naturally. Although i know the stretch marks will be there forever it will be nice to at least try to get rid of the baggy skin. Spanx are not a long term solution for me!!!

    Rose wrote on August 17th, 2012
  20. Can you go further into a definition of “lift heavy things”? Does it have to be traditional weights? I train with kettlebells at least 5 days a week, and I’ve got much, much stronger. Would this be enough, or do I HAVE TO do bench presses and such?

    Kirk wrote on August 20th, 2012
  21. Thank you for this honest and informative answer. I have lost about 105 lbs pretty quickly, and have a trainer and such as well as the medical weight loss program I was using for a time, and have been very frustrated and disappointed that the one area that shows most consistently, my upper arms, seem to be going nowhere. I have some very legit muscles built, but the sagging lower arm has been a point of contention with myself and truly makes me feel like I have not accomplished as much as I truly have. Knowing now this truth and such gives me hope that I WILL still get to where I want to be in the arms, and a couple other areas, and gave me the push to keep moving forward.

    Thanks you.

    Sue Antos wrote on August 24th, 2012
  22. I have the worse case of loose skin! & i know it isnt fat because my stomach is very tight but its very wrinkled right around the belly button & below. Something that has made a HUGE improvement was body wraps & dead sea salt scrubs/baths. i guess that plays into the hydrating & exfoliating. But its getting much better. I shall see within the next year!

    Ash wrote on August 27th, 2012
  23. can you please translate this to english. thanks.

    Blake wrote on October 11th, 2012
  24. This is the most helpful article iv read on this subject thank you! Iv lost 145lbs and well iv learned that its not loose skin but stubborn fat good to know! So where do you buy this gelatin powder health food store? VERY good article :)

    April wrote on October 24th, 2012
  25. I have to say that this is working for me. I was satisfied at my weight loss but the loose rolls were making me so sad and I had to hide them by wearing the same kind of clothes I wore before. I read this and decided to push past the weight loss to a lower body fat- not there yet but the rolls are disappearing. Still have some paper thin wrinkly skin on my arms and inner thighs, but in the 18% level my “loose skin rolls” are slowly going away. Hoping in time they will disappear. Glad I read this article. Not easy at my age- 51. I have hope though.

    carol wrote on October 28th, 2012
  26. Before about August, I was rapidly gaining weight, I got up to about 230 before I started getting worried. I dieted over the summer and lost about 70 lbs. I am now 16 and 6 foot 2, I weigh 160 lbs, I have a size 30 waist, and I still have this left over fat that you talk about. I do P90X on and off, but I do the abb ripper X program in P90X daily because I am trying to loose what I have thought was skin over my gut. Do you think that some of this might be “baby fat”, that I have loose skin, or that I should persue for a lower weight? Thank You!!!

    Brendan wrote on November 3rd, 2012
  27. I lost a 100 pounds, and I have stretch marks from hell; they look like silver tiger stripes on my belly. I have loose thin skin on the bottom of my stomach, and I doubt it’s adipose tissue; had a dermatologist look at it, and he recomended surgery to get rid of it. It kind of sucks to be honest, every time I look at my stomach I see the indentions of my abdominals, with large stretch marks that remind me of how fat I was.
    I think this may be a larger issue in the paleo community, but people don’t want to fess up.

    Lost Weight Stretch Marks wrote on November 14th, 2012
  28. I am permanently disabled; always have been since I was born. My condition is called Arthrogryposis Amyoplasia. My condition is basically the lack of muscle in my limbs. I was 175lbs last year… I’m 112lbs now. I feel like I have loose skin on my arms and legs. But they are thicker than a couple of millimeters. More so on my arm you can see a flab that should just be cut off. I’m only 23 years old. Idk what I should do cuz most exercises I can’t do. I can’t even raise my arms high enough to feed myself. I lost weight pretty fast, I was doing crazy low calorie diets (like 500 calories or less) now I’m vegan, I eat more. Should I still be losing? I feel like I have more fat to lose but I don’t want more noticable loose skin :( my friends even notice…. Please email me back. I probably won’t go on this site again to see if you replied. I can send before and after pics too. I’d really like to know if it’ll just go away, if I need to lose more, or what??

    Katherine wrote on January 4th, 2013
  29. ^^ my email

    Katherine wrote on January 4th, 2013
  30. I used to be recommended this web site by means of my cousin. I am now not certain whether or not this put up is written by him as nobody else recognize such special approximately my difficulty. You’re incredible! Thanks!

    How to lose your thigh fat fast! wrote on January 20th, 2013
  31. You can definitely see your enthusiasm in the work you write. The arena hopes for more passionate writers like you who aren’t afraid to say how they believe. At all times go after your heart.

    how to lose armpit fat wrote on January 21st, 2013
  32. I am 5’8″ and weighed 300 pounds. Today, I weigh 175 with about 14% bodyfat. I have lots of muscle, I even have the diagram of a six pack and when I tighten, can see veins, etc, yet still have extra skin. Extra skin sucks! I’ve started wearing a sweat belt though when working out, drinking lots of water, and using weights during ab workouts a couple of times a week and have seen some improvement.

    Used to be fat wrote on February 13th, 2013
  33. I am so glad I found your article… I have been worrying about the loose skin issue since I started my weight loss journey. Everywhere you look people tell you there’s not much you can do… So to read this article and get explained the factors that can cause these post-weight loss folds makes me very happy and I feel like Ill be able to deal with them if/when they happen.

    Nicole wrote on February 20th, 2013

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