The Myth of Loose Skin

http://www.bodyfatguide.com/LooseSkin.htm

by Ron Brown, author of The Body Fat Guide

A WOMAN recently asked my advice concerning her "loose skin," which
remained with her despite losing a great deal of excess body weight
following her pregnancy. I advised her to continue losing body fat
until her skin tightened up. Here is part of her angry response to my
advice:
"I am disgusted with the way you responded to my question...Not only
did it not make any sense, but what you were saying was ridiculous,
absurd, and physically impossible."

"...after giving birth to a baby eight months ago, and with having to
let my body try and recover from gaining 87 lbs during the
pregnancy...you would think that my body would have had some changes
made to it. After a tiny 108 pound body stretches to almost double
its size, you better bet that you're going to have some major
stretched skin."
"And being the 'expert' that you claim to be, you should know this
already...... If someone gains a large amount of weight in a short
time, or loses the large amount of weight in a even shorter time,
there will be extra skin there because it does not have the fat
underneath it anymore to make the skin expand to where it was before."
"The skin cannot go back in with just dieting alone because it
doesn't have any more "fat" underneath it to get rid of, and it
doesn't have the extra layers of fat on the body to cover anymore, so
it just hangs there, left as a reminder of how fat you once were, and
how much your body was forced to stretch out to accommodate the large
amount of weight that was gained. By exercising, the skin does pull
in some-with the muscle, but there will still be excess skin left on
the body that can't be 'starved off.'"

Skin Thickness
Many people would agree that this woman's argument makes sense. In
such cases, plastic surgery is usually offered as the best solution
to eliminate hanging remnants of excess skin. But, a closer look
reveals this logic to be faulty. Is loose skin really unavoidable and
inevitable after substantial weight loss? I believe the answer is no!
The human integumentary system (skin) is not a passive layer of
tissue that remains stretched out like an empty plastic bag after
losing large amounts of bodyweight. Rather, it is a living organ,
actively adapting to the body's internal and external environments.
The skin is usually thickest on the soles of the feet, and thinnest
on the eyelids. As a typical example of your skin's thickness, pinch
the skin on the back of your hand. If it were true, as this woman
claims, that the folds of skin hanging off her body had absolutely no
fat left underneath to diet away, every inch of this skin would hang
in sheets as thin as folds of paper. However, common observation of
the folds of skin in such examples reveals this is not always the case.
Measuring the thickness of these hanging folds of skin provides
evidence that there is still a substantial amount of body fat
underneath the skin. The skin is not so much "loose" as it is flabby.
Even if some areas have completely thinned out, there will still
likely be excess body fat stored in adjacent areas that contribute to
the overall condition.
Why does the skin sometimes take on this hanging appearance
(abdominal pannus) during the course of losing large amounts of
weight? The answer may be that as body fat is broken apart and lost,
the remaining fat is not packed in as solidly and does not support
itself as it did at the beginning of one's weight-loss program. The
droopy appearance of folds of skin is also exacerbated by crash diets
that sacrifice large amounts of supporting lean body mass.
Whatever the reason for the appearance of hanging folds of skin, as
one continues to draw upon and break apart excess fat reserves, one's
body, including one's skin, gradually returns to its normal size and
shape. It is just a matter of the dieter seeing the removal of excess
body fat through to the end.

Nevertheless, people, like the woman above, feel that after losing so
much weight, a few more pounds of lost body fat could not make that
much of a difference in tightening up "loose skin". But, that's where
they are wrong! Here's why: Imagine an igloo is made out of a solid
block of ice. Now imagine the ice within the igloo gradually melting
away. From the outside, you still see the shell of the igloo intact.
The shell itself will not start shrinking until there is no more ice
left within to melt. Think of your body in the same way as that
igloo. It's those last few pounds of lost body fat that will start
shrinking your flabby skin the most, just like the shell of the igloo
shrinks the most after the ice is gone from within.
Age is claimed to be a factor that reduces skin elasticity and thus
reduces the ability of the skin to readjust it's size after weight
loss. However, it is rare to see a person over 60 undergo large
changes in bodyweight. Many cases of "loose skin" are found in
relatively young people who have lost weight, so the effect of age on
skin elasticity is not really a factor.
The television program Extreme Makeover recently featured a segment
about a man who lost 210 pounds in less than a year, reducing from
405 pounds and a 50+ inch waist to a 34-inch waist. At times he lost
up to 30-40 pounds a month. Video clips showed him lifting weights
while on his weight-loss diet, a sure way to lose lean body mass
(see: Are You Getting Workout Results?) His rapid rate of loss
obviously included a large amount of lost lean body mass, which
tended to increase the drooping of his abdominal pannus and the
hanging skin under his arms and on his thighs as well as giving his
face a drawn look.
Yet, at 195 pounds, this man still had at least another 20-30 pounds
of excess body fat to lose in order to reach his desired goal of
looking good at the beach with his shirt off. Regaining 20 pounds of
muscular weight by changing to a diet adequate in the muscle-building
nutrients that his reducing-diet lacked would also improve his
appearance, and allow him to continue dieting past his weight-loss
plateau. However, after recovering from anemia which he developed
following his inadequate unbalanced diet, he opted for an extreme
surgical procedure instead—a triple body tuck performed by three
surgeons.

Finishing the Job
It is obvious that released prisoners of war usually come out of
prison camps weighing much less than when they entered the camp.
Despite drastic changes in bodyweight, there is hardly any evidence
of the type of hanging skin on these survivors as referred to above.
People on extended fasts consuming nothing more than water have
demonstrated that the skin can lose 20% or more of its size.
You don't have to go to such extremes to eliminate flabby folds of
skin. But many people, especially people facing a loss of large
amounts of weight, find it difficult to continue their weight-loss
programs through to their final goal. When you have already lost
hundreds of pounds, it is easy to quit before your final goal is
reached, and settle for your current progress.
Misinformation, like the beliefs stated in the woman's letter above,
discourages people from pursing their goals to the end. Getting those
last few pounds off, especially after losing a large amount of
weight, involves more than sheer will-power and motivation. As
important as those character traits are, will-power alone is rarely
enough to achieve optimum results.
To eliminate the droopy appearance of the remnants of excess body
fat, you must change your body composition, not just lose weight.
That means paying particular attention to the ratio of your body fat
to lean body mass. Gaining muscle to replace some of those lost
pounds of body fat and preventing loss of lean body mass while
dieting will dramatically improve your appearance.
People focus on having the right "bodyweight" when the problem of
flabby skin really concerns having the right "body composition,"
specifically, having the right amount of lean body mass (skeletal
muscle) and body fat. It is possible to be at the ideal bodyweight
according to Body Mass Index charts (BMI), but still have too much
body fat and not enough lean body mass.

For example, a young woman in her twenties with "loose skin" recently
appeared on a popular radio talk show. She had lost over two-hundred
pounds in one year, and her bodyweight at 5' 8" was now in the 120's.
Yet, her abdomen was covered with flabby skin that hung off of her. I
would guess there is at least another 20 pounds of excess body fat
stored in those folds of skin. However, if she lost another 20
pounds, she would obviously look like an emaciated stick! But, that's
not because she lacks body fat...it's because she lacks lean body mass!
After dieting so severely for so long (with the so-called "help" of a
gastric bypass), this young woman obviously sacrificed a significant
amount of lean body mass. It's true that losing 20 pounds of lean
body mass over a year may not seem like much considering she lost so
much body fat, but that amount of lost lean body mass is enough to
distort her body composition, even though her bodyweight is "normal."
My suggestion to this young woman would be to replenish her lost lean
body mass with a healthy balanced diet and weight training (See
Muscle Mass Myths). Ironically, the gastric bypass that made it
easier for this young woman to diet so severely may work against her
as she attempts to eat a normal amount of food. Nevertheless, lost
lean body mass usually replenishes fairly rapidly on a balanced
calorie-sufficient diet. After increasing her bodyweight with 20
pounds of replenished lean body mass, she can then lose the rest of
her excess body fat, without sacrificing any more lean body mass.
Then she would have both a normal bodyweight AND a normal body
composition.
What is required to assist one in doing all this is an easy method to
measure changes in one's body composition (muscle and body fat
levels), and a method to monitor and modify one's energy balance,
which is the balance between the calories one eats and burns each
day. Such a method is available in The Body Fat Guide.

WOW! Great post. Informative and logical!

There is some truth to this post. I went from 350 to 270 and at first my skin was "loose" but in 6 months it tightened right back up. I was 37 at the time.

Some truth, yes. I noticed a lot of the "lose skin" surgeries, there's still a lot of subcutaneous fat. But in a lot of the surgery shows the doctors comment how the muscle under the skin, especially in mothers, had stretched and could't go back into place. I guess the muscles are damaged and torn.

Also, I do know they sometimes put skin stretchers in people, balloons they fill with air to stretch out the skin to create more skin in order to cover surgery areas, especially on people with severe facial deformities. This creates a big pocket of skin, with no subcutaneous fat at all. I don't know what would happen if they took out the balloon thing and left it there, would it go back or not?

thanks for this article Loose skin has been a major concern of mine since I have a lot to get rid of.

Reviewers at Amazon.com didn't like the book. I don't have it, so can't exactly comment from any experience, but one of the reviewers said it has no references. That sounds a warning bell in my head. I don't know if Ron Brown is right about the skin thing or not, though. I want him to be right...

I've never had my bodyfat measured, but I've been an exerciser before, during, and after achieving a healthy weight. I assume that even though I weigh at the higher end of "ideal" for my height, I have significantly more lean body mass than the average 60-yr-old woman.

Still, one of these days, I'm going to locate an underwater weighing lab around town, and find out for sure. Just because.

I don't have a loose skin problem, and I'm sure my high-protein LC diet gives me plenty of building material for healthy body tissue.

I dont think that was from his book, I think its an article he wrote online which can be found here http://www.bodyfatguide.com/LooseSkin.htm

I know from my own personal experience that after 100+ pounds lost I had some loose skin, but a lot of it was firming up and it wasnt as bad as I expected it to be. I also had a bit more to lose but in my case it was pretty accurate.

I've seen that link posted 3 times, and every time it's posted it makes me so angry.

Obesity damages fat and skin in ways that are permanent. It creates a lot more fat and skin. When I say "creates more fat" I mean more fat tissue (cells), these don't go away when you depelete the cell by under eating. You look deflated. Quality of skin is also damaged, and there is too much. It's more than "loose", it's like there is extra skin (and the skin is scarred and stretched too thin).

You cannot simply lose more weight to make it go away. First of all, even at 104 my skin was horrible (I am 5'5). Second, there is nothing you can do about the areas that concentrated most of your severe obesity. My thighs have all these excess fat and skin tissue that can only be reasonably addressed with surgery (liposuction + removing the skin). I could become emaciated (where all my bones were visable) and it wouldn't help. You can't diet away all that created fat and skin tissue.

So after 2 kids there is some hope for me??? Hehe. Although I guess the same cannot be said for stretch marks. Oh well!

Thanks!

Talking about prisoners of war underscores the problem with his logic overall. People who grow so obese that loose skin becomes a problem don't end up in the military. So he's comparing people who were normal weight and lost maybe 20% of their body weight to people who lose 100%, even 200% and more, of their bodyweight. Nobody denies that the skin is a resilient organ, but is it resilient enough to shrink by half, even more?

Congestive heart failure usually happens when heart tissue has been "stretched," as it were, by something like high blood pressure. The heart doesn't return to its old shape when the blood pressure or whatever else caused the problem is treated: once it's stretched, it's stretched for life. I suspect the skin is like that, too, to a certain extent. It will shrink back some, but there are limits.

Along these lines, I was reading about Richard Simmons and an appearance he made on the Howard Stern show about a decade ago. Stern started making jokes about Simmons' stomach, saying it was all shrivelled up or something like that, and from what I read, Simmons ran out of the studio crying. Now, Simmons at that point had been thin for what, a decade? Longer? And nobody can claim Simmons doesn't exercise.

I think this guy has a pleasing-sounding theory that sort of makes sense, but I don't think it holds up when you look at it closely. As someone who is beginning to see some loose skin, I hope I'm wrong, but this article doesn't convince me.

The issue definitely is fat cells under the skin, or at least one issue. But I've read recently that fat cells do die off, contrary to what was once believed, that they never do.

I agree with his point about building/preserving your LBM through diet and resistance training. But he's not taking into account severely stretchmarked skin, I have a hard time believing that will firm up. I figure if the skin won't retract, at least I can fill it up with muscle, it's my only strategy to combat loose skin, since I can't afford surgery. Just eat a good amount of protein, and lift those weights!

How does a fat cell die off?
I read this article http://www.healthcentral.com/drdean/408/60848.html but that was done by destroying blood vessels.

Perhaps there is something genetic to it? My mother, after her fifth pregnancy went back to being a tight 105 pounds.

When I lost my weight I had some loose skin but it didn't look like what my friend who had a gastric bypass looked like. She had what she called her "apron" because it just flapped and hung down. Mine looked more like wrinkles and were only really noticeable when I would lay down. When I would stand my skin would get tight. I also have a good amount of stretch marks but only on my arms, breasts and stomach but they faded and you can only really tell they are there if you look carefully. Nothing at all on my thighs, no loose skin or stretch marks.

The article does have an interesting point.

As a history buff, I've seen a number of photos comparing concentration camp victims before and after. Many of them were quite plump before hand, and they don't have any hanging skin.

However, all this proves is that in cases of extreme long term starvation the body will scavenge extra skin, along with muscle, bone mass and internal organ volume to stave off death.

The question is, how serious will the body be about scavenging in cases where death isn't the issue, and nutrition is ample, even if calorically limited.

I suspect that eventually the excess skin would be reabsorbed. How tightly, and what its condition would be, is almost certainly a function of age and genetics. When I was in my early 20s and lost nearly 200 lbs, my skin, except for breast tissue, did tighten up pretty well. Now that I'm in my late 30s, the skin on my hands a face is starting to loosen as a function of age. It wouldn't be reasonable to assume that the rest of my body would get any tighter than that.

There's also the question of how long will the body take on it's own? It may take several years, and most people after successful weight loss want to be tighter NOW, not 2 years from now.