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?

questionToday’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.

Gabrielle

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. Can I just say that I am super disappointed to see Mark advocating a 15-17% BF for women. As a woman who has been down that low in the past and struggled with disordered eating, I am now battling the consequences with amenorrhea and potential fertility issues even though my BF has now “normalized”. The majority of women would not be healthy at that low BF percentage. This is well documented especially with female triad syndrome, and women in the Paleo community talk about this all the time!

    Michelle Stiff wrote on July 21st, 2013
  2. To help with excess skin you might want to look into dry skin brushing. You use a dry natural fiber brush to brush the skin towards the heart.

    Monica wrote on July 21st, 2013
  3. I’ve lost 143 lbs to date, and have about 20 to lose to get to my goal. I do notice my lower abdomen is taking the longest to shape up…and I do know I still have subcutaneous fat there…but when I went for annual physical, the doctor gave basically the same advice given here…finish getting to goal and see…the skin could go with the fat and you may not notice the small amt. of excess skin you have left….keeping my fingers crossed..but in the meantime doing lots of HIIT, running, p90x, and ab work to speed the process:)

    april wrote on August 17th, 2013
  4. Hello, I have lost 175 pounds and have kept it off since 2005. I recently lost 7 more as I decided I wanted to get down to a size 8. I am a 51 year old female autoworker(28years) and my job is physically demanding. There is alot of weight lifting required on my job. For the life of me I cannot get rid of the excess sagging skin under my arms, thighs and belly. PLEASE HELP ME! I read so many different things and I dont want surgery. Please send me a private message on Facebook @ Lou Moos

    Lou Moos wrote on September 15th, 2013
  5. In Aug, 2010, my doctor’s record said I was 254 lbs. I tried calorie counting and lost about 20 lbs, but my HA1c starting coming back horrible. The doctor put me on a non-insulin injection daily which made me so sick, I couldn’t move without heaving, so that was out. I refused to take it anymore, and I promised that if she let me test my blood sugar 4 X per day, I would get things under control.

    I am female, age 56. I knew nothing about paleo/primal, but the testing showed me what foods spiked my sugars, and surprise! Surprise! Carbs did it! I adjusted to proteins and fats. I have now lost 94 lbs.

    My abdomen, butt and thighs look awful. My thighs look like balloons filled with Jello. But I’m not trying to get into a swimsuit or look like a super model. Just a normal person.

    I have a severe swayback which makes my upper abdomen tight and look like I’m pregnant. (People often ask me when my baby is due!) I have the “apron” on the lower ab, but by the description above it’s probably adipose fat. Any ab work causes spasms in the upper abs….I’ve tried! Surgery is completely out of the question.

    How much gelatin? How much vitamin C? I get ideas, but no real direction.

    Clover wrote on October 2nd, 2013
  6. Thank you for this article. Wanted to lose about 20lbs after my daughter turned 3 (and I had no reasons anymore not to lose the weight gained). Have lost about 13lbs in about 17 weeks and was feeling that the skin around my arms and tummy has loosened and is jingling. But according to the criteria you give, it looks like it is not the skin, but the residual fat. Hoping to lose the rest 7lbs and hope that this fat goes away by the end of this year. Thanks again.

    dtrivia wrote on October 7th, 2013
  7. hi, thanks for your good news. i really thought there was no way for me to lose this shape my body has got after i lost weight during these 8 months. i’m 189 centimeters tall and i weighed 125 kilograms. i started dieting, lifting and aerobics 8 months ago and the results were dramatic! now i weigh 91 kilograms and also have got some muscle(though it’s not enough at all, but it’s better than nothing). i still do lifts and aerobics but i can’t get on with my diet any more because i start to feel really weak if i do it. the problem i’ve got with my body is the loose shape of my belly and my breasts which embarrasses me a bit since it some how resembles a teen girl’s breasts. if you could help me about that i would be so grateful. by the way, thanks for your good news that i’m not left with no hope. i will get on with my exercise plans to see what happens. and I’m waiting for your further help. again, thanks a lot!

    Arash wrote on October 11th, 2013
  8. What people including the author of this article are failing to understand is that with massive weight loss we are no longer just talking about losing a bit of extra fat and skin retracting to where it should be.
    If you get fat enough or stay fat for long enough or lose and gain fat enough times not only do your existing fat cells overfill but you grow new ones. SO when you eventually lose the weight/fat you end up with a larger number of less full fat cells – they don’t just die off or disappear. Unfortunately those extra fat cells come with connective tissue, capillaries, blood supply and all the other bits and pieces that make up human ‘flesh’. Its not JUST skin and fat. As has been mentioned fat is an organ all its own with all the tissue mass & machinery that comes with that. Consequently once a certain point of fatness is reached it becomes IMPOSSIBLE to get rid of this ‘excess’ flesh or tissue (including fat and possibly skin) without surgery. If a never-been-fat or mildly fat person gets to 25% body fat from some higher figure to get rid of sagginess or loose skin then a long-time or extreme-weight fat person would need to get to far less than this say 15% for that to occur. Not only do you have to lose your ‘extra weight’ but also the extra fat cells and tissue that came with it as you got bigger and bigger. So unless you’re prepared to go to ridiculously low bodyfat %s to try and overcompensate there is no solution except for surgery to remove that fat tissue and lax skin. I know this isn’t what people want to hear but better to face facts than persist with pointless ‘diet and exercise’ regimes that are ineffectual because we are dealing with a whole other beast.

    HomeBetty wrote on October 25th, 2013
  9. I think Betty is right. I have had this problem for about two years now after losing 35 pounds and nothing, I repeat, nothing I do seems to change it. I eat strict (very strict) paleo, I workout with heavy weights, and I’ve got a stomach that I don’t want to be seen by the public at all, even though there’s a six pack under the folds. I am down to a low BF everywhere else but I can’t lose any more weight – I have tried, and that scale won’t budge, which is disheartening.

    Tyrannocaster wrote on November 6th, 2013
  10. i have a lot of fat around my stomach and tighs…what to do for burning it…heavely..

    aaya wrote on December 7th, 2013
  11. The never-ending story and issue on weight loss. Now there’s excess skin after losing weight. What’s next?

  12. hi mark , I cannot take any thing to do with beef . so how do I get gelatine that will work as well. also is the a veg alternative. .. that will work . i.e. agar agar.

    thanks pasis

    pasis wrote on February 19th, 2014
  13. how do I get gelatine , I cannot take beef . thanks

    pasis wrote on February 19th, 2014
  14. Just wondering if these remedies you suggest would also benefit someone who has excess skin on their face? I lost weight a little faster than I should have about a year ago (I now realize my mistake) and that included losing fat in my face. While I love having more definition in my jawline, I don’t love that i now have several lines under my eyes and around my mouth when I smile. I’m only 28 years old and I doubt I would have suddenly aged that much in a year! I’m not sure how to get rid of these other than applying anti-aging creams and a few natural remedies (e.g. coconut oil, which I’ve yet to try). Any suggestions on targeting loose skin in this area? Thanks in advance!

    Pooja wrote on February 24th, 2014
  15. I have lost A LOT of weight over the past year by seriously improving my eating habits, working out three times a week, and oh yeah…pushing a 9 pound baby out my body! I lost 60 pounds which was great but my stretch marks actually got worse!

    I have tried a few different products and found the Somatique Stretch Mark Cream to be one of the most effective for the price. Its from Lady Somas website. I also found that by massaging their stretch mark cream into my tummy it makes my skin feel so much softer and smooth. I would totaly recommend this too along with the somatique moisturizer. Just these two things has simply been the best thing I’ve done for lessening the appearance of any stretch marks. I noticed results within the first month, skin is much more smooth and firm.

    Grace a wrote on February 27th, 2014
  16. Yup. I’ve got the apron on the lower belly also. I’ve had it since I had a child in 2003. I was on bedrest for 6 of 9 months of pregnancy and went from 114 to 183 by the end of it. When I popped out my 9 lb guy i dropped a lot of weight quickly because there was so much water retention. After that I slowly dieted. Took about a year to get back to ten lbs of my pre-pregnancy weight, but had the gross flap of skin. Weight has yo-yoed over the years, but over the last year Ive made a HUGE change in my lifestyle. I eat cleaner, tho not perfect, and workout frequently. At my smallest I was 106%. Just one lb over the lowest possible healthy number for my weight and my skin flap looked ten times worse. I put weight back on on purpose because I felt like I looked too small and the skin looked worse anyway. I do muscle strength training. I definitely have nice ripples in my arms and good definition in my upper abs. But no matter what I do or try I cannot get any definition in my lower abs or make the skin shrink at all. Its heartbreaking for me as Im super excited to have the body I have now. I look so much better, and feel better, but still feel like I have to hide my body. Its humiliating to me. I feel like there’s nothing else I can do to make it go away outside of surgery, which there is no potential for. Am I wrong? Any ideas?

    Beckie wrote on March 6th, 2014
  17. 106 lbs. not %

    Also. My boyfriend is on a weight loss journey now too. He has about 100 lbs to loose. Maybe more. Before he is at a healthy weight. He has a definite overhang on the tummy. Hes afraid that hes going to have the lose skin. Doesn’t bother me as far as looks. We can just compare. Lolol. But I understand the feeling. He thinks that weight training while dietong will help with that. But I think he needs to lose weight before muscle training. It’s not about who is right or wrong. Just would like to know what is optimal because if he can avoid having to go through the crappy feelings with tge loose skin, I’d like to help him.
    Thanks!

    Beckie wrote on March 6th, 2014
  18. Good lord. Wish I could edit my posts and correct spelling errors. Lose, loose. Dieting. The.
    That’s what I get for being a third shifter posting on not enough sleep. :-)

    Beckie wrote on March 6th, 2014
  19. Thanks Mark. Very helpful and reassuring.

    John D wrote on March 21st, 2014

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