Excess Skin After Rapid Weight-Loss

One of the many dangers of rapid weight loss is that you’re left with surplus skin hanging loosely around your body. It’s unsightly, it can hider your ability to move around, and it’s often painful when it gets sore from chafing. Worse still, excess skin removal surgery is expensive and risky. It’s far better to lose weight slowly, and combine it with muscle building exercise, to avoid being left with loose skin.

My Baggy Body – Channel 4 documentary

Shown earlier this week on Monday 20th January 2014, this documentary followed the fortunes of 4 people who had lost weight rapidly, only to be left with the distressing result: loose skin.

We met Sarah, in her mid twenties, who underwent a gastric bypass 3 years ago, and dropped from 21 stone to 12 stone. The NHS refused to give her free surgery to remove all the excess skin, until she got down to 10 stone. In an effort to lose another 2 stone, she joined a gym, but found that it was hard to exercise with all that loose skin flapping around.

The big mistake she made was to join a commercial diet programme based on a points system, with no distinction between healthy and unhealthy foods. “I’ve not gone over on my points, so it makes no sense,” she complained, when her weight stopped coming down.

We also met Greg, who was 27 stone 3 years ago, and managed to  lose 12 stone through diet and exercise alone. He’s now 15 stone, but tragically has loose skin despite all his efforts to lose the weight naturally. “I’d rather be morbidly obese again,” he said. It’s a shame the documentary didn’t explore in any detail his exercise regime or eating plan, but from what we were shown, it looked like mainly endurance and cardio exercise (such as the Tough Mudder challenge), no muscle-building workouts. Had he focused on building muscle, there would have been less of a loose-skin issue. What’s strange about Greg’s case is that his weight loss was not excessively rapid: he lost 168 lbs in 156 weeks, a little more than 1 lb per week.

Greg was refused skin removal surgery on the NHS, so he went private at a cost of £8,000. That sum would have covered a lot of personal training sessions with a personal trainer who specialised in muscle growth and optimum nutrition.

We then met Pauline, who was 41 stone when she had her gastric bypass, and lost a staggering 22 stone in 2 years, more than halving her weight. Her excess skin looked like it contained a lot of subcutaneous fat (fat just below the skin, something the documentary completely failed to mention), and her weight loss surgery removed 2 stone 4 lbs of excess skin and subcutaneous fat, which the surgeons referred to just as skin.

How to avoid excess skin when you lose weight

As a personal trainer in London, my advice to anyone who wants to lose a lot of weight is to avoid bariatric surgery (ie – weight loss surgery) like the plague, and lose weight through the right kind of exercise, and healthy eating. And don’t lose more than around 1 lb a week. Bariatric surgery ensures you’re unable to eat healthy amounts of food, hence the rapid weight loss which is not just fat loss but also loss of bone density, and muscle-loss.

Your skin is a living organ, the body’s largest organ. If you give it a chance, it will adapt to your reduced weight, but you have to lose weight slowly. That’s one of many reasons why all forms of crash-dieting are so bad for you.  Age and genetics do play a part in your skin’s ability to adapt, but healthy eating can go a long way to preventing loose skin.

Collagen keeps the skin strong, and elastin keeps it flexible. Both are weakened when the skin stretches when you’re overweight, and  sudden weight-loss leaves the skin too little time to adapt and renew the collagen and elastin.

Nutrition for healthy skin

Protein is vital for skin elasticity. When you crash diet, your body cannabalises your muscle, which sets up a vicious circle of lower resting metabolic rate (which prevents you burning off excess subcutaneous skin), and leaving you physically weaker.

Another consequence of bariatric surgery is that you become deficient in vitamins and minerals. Vitamin C for instance is vital for collagen formation, which is vital for skin elasticity. And vitamins A, K, and E are all important for skin health and renewal. The most important skin minerals are selenium, copper and zinc. Good sources are meat and oily fish.

In order to get plenty of vitamins and minerals you need to eat a large volume of vegetables (something you’re unable to do after bariatric surgery), and lean protein too.

You also need to eat sufficient complex carbohydrates to avoid depleting your glycogen stores in your muscles. Depleted muscles leave your body scrawny, and exacerbates the appearance of loose skin, as well as denying you the energy you need to perform muscle-building exercises.

Exercise for healthy weight loss

By far the most effective exercise for healthy weight loss is resistance exercise, either with weights or bodyweight. You can build muscle through bodyweight exercise alone, such as push-ups and squats, but the addition of dumbbells and ankle-weights will stimulate greater muscle growth.

By increasing your muscle-mass you fill out the skin, and reduce the chances of loose skin as you lose body-fat. And increased muscle-mass raises your resting metabolic rate, which helps you burn more subcutaneous fat, which many people think is just loose skin.

Dominic Londesborough is a personal trainer in London.