"Ron Brown is a certified fitness trainer who doesn't have an inch of flab on his body. He'll tell you what you can do to become fit and trim too." TALK TO AMERICA, Washington DC

"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.'"

"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."

A change in a woman's body shape before and after normal pregnancy is another example of the skin's flexibility to snap back to normal size. By normal pregnancy, however, I mean without large accumulations of excess body fat, unlike the case of the woman above.

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, 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 in all cases, if at all.

However, common observation of the folds of skin in such examples reveals this is not usually 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 due to excess body fat. Even if some areas have completely thinned out, excess body fat is likely to be stored in adjacent areas that contribute to the overall flabby condition.

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.

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. The argument of the woman above about the cause of loose skin is a myth. Rather, skin is a living organ, actively adapting to the body's internal and external environments. People on extended fasts consuming nothing more than water have demonstrated that the skin can lose 20% or more of its size.

Many people would agree that this woman's argument appears to make sense. In such cases, plastic surgery is usually offered as the best solution to eliminate hanging remnants of excess, lax, or redundant skin, especially if the condition is associated with skin disorders. 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!

Now, imagine the effect if you lose several hundred pounds of bodyweight, and your muscle loss is twice as much, 40-50% or more of lost bodyweight. Those voluminous folds of flab can become an enormous problem.

Would you expect your body to look as shapely and firm under these circumstances, with a higher percentage of body fat? NO! At 115 pounds, body parts that used to be filled with toned muscle are now filled with a greater volume of flabby fat instead. Pound for pound, fat takes up more volume than muscle, pushing farther out until it begins to hang in folds of skin. Continuing on with your diet only exacerbates the problem as your muscle level drops even more. Even worse, if your bodyweight dips below your healthy starting point, you are now too thin and covered with flabby skin!

Now, after your severe diet, you have returned to your starting bodyweight of 115 pounds, but your internal body composition is altered. You have 20 fewer pounds of muscle on your body, and 20 more pounds of body fat, even though you weigh as much as you did before you put on the extra weight! The percentage of your bodyweight that is fat is now higher than before you gained weight.

And, because muscle can rapidly dehydrate and sacrifice protein to provide an additional supply of energy to your body, muscle loss increases the more active you are on a severe diet. But let's stick to a modest number of 20% muscle loss in this example.

However, let's say not all of the weight you lose is body fat. Perhaps 20% of your lost weight is muscle. This is not unusual on a severe crash diet, and many people lose much more muscle than that on these diets. In fact, if you were to fast on just water, 60% of your weight loss would be muscle.

In the meanwhile, here's an example to illustrate how muscle loss on a diet can cause droopy folds of flabby, loose skin. Let's say you start at a bodyweight of 115 pounds, in good toned shape with firm skin, but you gradually gain 100 pounds of body fat. You then go on some sort of crash weight-loss program or have bariatric surgery to quickly lose those 100 pounds.

In my opinion, the droopy appearance of folds of skin is most probably caused by crash diets that sacrifice large amounts of supporting muscle, or lean body mass. Even less severe diets and weight loss from bariatric surgery can result in a substantial amount of muscle loss over time. Perhaps future scientific research will show a correlation between loss of lean body mass on a diet with the development of redundant skin.

Why does the skin sometimes take on this hanging appearance (e.g., abdominal pannus) during the course of losing large amounts of weight? Why is it that not everyone who loses weight has this problem? Why do we see flabby skin develop even in people who have lost much less weight? What is the difference between those people who suffer from flabby or loose skin, and those who achieve weight loss while completely or partially avoiding this problem?

Non-Surgical Removal of "Loose Skin" To eliminate and prevent the droopy appearance of the remnants of excess body fat during and following weight loss, without resorting to surgical procedures, you must change your body composition, not just lose bodyweight. That means paying particular attention to the ratio of your body fat to muscle, or lean body mass. Preventing loss of lean body mass while dieting to lose body fat will dramatically improve your appearance. "I lost ten pounds in one week!" How often has the public seen such advertisements for rapid weight loss? Everybody wants fast results. But even if you manage to lose ten pounds in a week, the real question is what kind of pounds did you lose? Muscle? Fat? Imagine discovering that you lost 9.5 pounds of muscle and only half a pound of fat in one week! That's the dirty little secret of rapid weight loss claims. Now imagine the psychological shock if you discover that after all your hard work to take off 100 pounds this past year, you need to gain back 75 of those pounds as muscle. The quick-fix weight loss method is not worth the effort. Almost every dieter has experienced rapid weight regain after dieting. Aside from regained body fat resulting from a return to overeating habits, many people don't realize that regained bodyweight can often include a significant amount of replenished lean body mass that was lost during dieting. Dieters actually look and feel betterless haggard and with less droopy skinafter regaining this kind of lean weight. So, how is muscle lost on a diet, anyway? During a diet a process called gluconeogenesis (which means a new source of glucose) utilizes muscle and body fat to supply energy not provided by food. For each pound burned during gluconeogenesis, 60% is burned from muscle and 40% from fat. Twenty-five percent of bodyweight lost on very-low calorie diets (400-800 calories) is from muscle and supporting connective tissue (Saris, "Very-low-calorie diets and sustained weight loss," Obesity Research, 2001). In my opinion, the best approach to avoid muscle loss while dieting is to supply a daily calorie intake equal to no less than your resting metabolic rate, the calories burned by your muscle mass at rest, which is about 1,200 to 1,800 calories or higher for most people. Professional bodybuilders have resting metabolic rates over 3,000 calories! Do not estimate your resting metabolic rate according to your bodyweight. Scientists have developed formulas to calculate resting metabolic rate according to fat-free or lean body mass levels. See The Body Fat Guide to calculate your exact resting metabolic rate according to your lean body mass. This calorie intake, and perhaps a few hundred additional calories depending on your activity level, is the minimum amount needed to maintain and replenish your muscle as body fat is burned off through physical activity, much as an athlete burns off body fat in training. You never see serious athletes like Olympic champion Michael Phelps training while eating only 400-800 calories! Athletes get lean by relying on exercise to burn fat while eating enough to maintain muscle. Don't expect optimal results from sitting around and "starving" yourself. Dietitians suggest people increase their activity by 500 calories a day and cut their normal calorie intake by 500 calories. Stated more precisely, burn off body fat by eliminating only the portion of your diet that would otherwise fuel your usual daily activity (assuming it equals 500 calories), and burn off an additional 500 calories of body fat with additional activity, equivalent to 1-2 hours of normal walking for most people, depending on your bodyweight. This leaves you enough food to maintain muscle while losing two pounds of body fat a week. That's a good deal that no quick-fix diet can match! The Body Fat Guide will show you exactly how to do it. Two pounds of body fat lost a week is only a suggestion, not dogma. People have different activity levels and resting metabolic rates. Once you understand and master dieting without muscle loss you can customize and accelerate your training for even greater results, provided you are willing to put in the work. People often become motivated to work harder to achieve greater results, but they are held back by lacking the knowledge to do it properly. For example, many people misunderstand the advice to exercise and cut their calorie intake by 500 calories. Five-hundred calories isn't very much, and people may figure they can get better results by cutting 1,000 or more calories from their diet. Sure enough, they begin to see their weight drop rapidly when they cutback by more than 500 calories, which reinforces their dieting behavior. But they don't understand that the suggestion to cut their diet by 500 calories only applies to calories burned from normal activity; it doesn't apply to the calories needed to maintain their resting metabolic rate and muscle mass. Their rapid weight loss is mainly muscle. When dietitians warn that severe dieting slows down your metabolism and reduces fat loss, what they really mean is that muscle loss on a severe diet reduces your resting metabolic rate. In the meantime, fat loss continues as your body becomes flabbier with loose skin. Loose skin from dieting is not a matter of how fast or slow you lose bodyweightit's a matter of whether you provide sufficient calories to avoid or replenish depleted muscle. Periodically replenishing depleted lean body mass with controlled, small increases in your calorie intake is how you avoid an overall net loss of muscle during or after dieting. Because a muscle's volume consists of 70% fluid, muscle usually begins to replenish very rapidly as soon as you begin to increase your calorie intake back