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. 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 (salmon, brazil nuts, seafood), zinc (oysters, red 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!



About the Author Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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