One of the things I am having to deal with already in my weight loss effort is loose skin on my inner thighs, lower abdomen, and pelvic regions. I have looked around on Google and gotten a LOT of conflicting information that focused mainly around BMI and lean tissue vs body fat content.  I am not sure what to trust short of going to a dermatologist or Cosmetic Surgeon for a consultation and asking, “What do I do?”

– Anonymous Reader

Well, anonymous, let me state right off the bat here that if you want a definitive answer to this question you SHOULD go see a medical professional for a consultation.  I’m not a doctor, nor is anyone here at ShrinkGeek, and all of what I’m about to offer is simply a healthy mix of some internet research peppered with my personal opinion.  I don’t have the fancy letters after my name to prove that anything you’re about to read is true, nor do I have the malpractice insurance behind me if it turns out I’m completely wrong.

Now that I’ve gotten all those messy disclaimer things out of the way to cover my posterior let me state that I have, indeed, done a bit of research into this subject.  I, too, have wrestled with the loose skin question and have often said that I may end up needing to have surgery to remove it as well.  I have even gone so far as to have consulted a plastic surgeon about my predicament, and as such I’m happy to pass on what I have learned to you.

In order to fully appreciate the complexity of this situation it is important that you understand two different numbers that our reader mentioned in their original question above:  Body Mass Index and Body Fat Percentage.

Body Mass Index (BMI) is a number calculated from your height and weight, and it is a very good baseline number to look at when you’re evaluating your weight to determine if you are at risk for obesity related illness.  What it is not, however, is an accurate reflection of the actual weight of the fat (both good and bad) that is currently being stored in your body.  Body Fat Percentage is actually a very difficult number to accurately measure.  While several methods are available do so (including the pinch based caliper test that is often an early source of public humiliation to overweight kids in high school), the most common method of measuring body fat these days is called Bioelectric Impedence Analysis.  In this test a small electrical charge is sent through your body.  The longer it takes to pass through you the more body fat you have, as muscle is a better conductor of electricity than fat.  It is entirely possible for you to have a healthy percentage of body fat and still have a high BMI.  In fact, many professional body buiders would be considered obese if you measured their BMI, but they generally have a body fat percentage that is less than 10%.

The reason it is important that you understand these numbers is because there are two different schools of thought when it comes to loose skin as a result of weight loss.  The first holds that your skin can only be stretched out so far before it begins to lose elasticity and thus the ability to “snap back” into place after lowering your BMI.  The other school states that while you may have achieved a healthy BMI your actual body fat percentage is still high and that is cause of your loose skin.  The answer you get on how to deal with the loose skin question varies greatly depending on which school of thought the responder belongs to, and in almost every case they are trying to sell you a product based on their belief.

My personal belief is that both schools of thought are correct in a fashion and that the ultimate decision you make on how to deal with the cosmetic end of your weight loss is going to be based largely on your lifestyle.  Before you get to the point where you have to make a decision about whether or not to go under the knife, though, you have to hit your goal weight.  There are several things you can do while on that journey that can help to minimize the amount of excess skin on your body.

Lose Weight Slowly

A healthy rate of weight loss is 1 to 2 pounds a week.  It is entirely possible to lose weight faster than that, and many people do, but it’s not necessarily good for you.  Our bodies store fat as a means to prevent starvation, and if you lose weight too quickly your body will think you are starving and will resort to burning your lean muscle mass instead of fat.  If you are dropping weight faster than the recommended rate after the first few weeks you are likely losing muscle as well as fat and should consider looking into ways to slow things down.  Not only will you lose less muscle mass, but you’ll be more likely to keep the weight off if you lose it gradually over a long period of time.

Include Strength Training In Your Weekly Exercise Routine

You don’t necessarily have to go to commit to the kind of insanity that Rafe does, but lean muscle mass does burn more calories in a body at rest than fat does (not at a rate that increasing muscle mass alone will result in significant weight loss, but every bit counts).  In addition to that, if your muscles increase in size as your weight decreases your skin will still have something to cling to as the fat is burned away.  In essence you can work to replace your fat with muscle.

Feed Your Skin

Make sure that whatever diet you are on includes a high percentage of foods that are good for the health of your skin.  This would include things like low-fat dairy for Vitamin A, fruits and vegetables for antioxidants, foods rich in essential fatty acids like nuts and salmon, healthy oils, and whole grains.  All of these foods are essential for the overall health of your skin and can aid greatly in the prevention of skin sag. In addition to all of that it is essential you remain hydrated and should aim to drink at least a half a gallon of plain water daily in order to keep your skin healthy and maximize its ability to transport toxins out of your body.

So let’s say you’ve done all of the above and you’re still dealing with loose skin after you hit your goal weight.  If you want to avoid surgery I would suggest increasing the intensity of your strength training and begin to focus more on body fat percentage and less on BMI.  Honestly I’d suggest this for anyone who was at their goal weight regardless of whether or not they wanted to git rid of excess skin.  The important thing to remember when doing this kind of work on your body, though, is that it is much more important to focus on measurements and less on weight.  Get a body fat tester or scale and a measuring tape and keep track of those numbers as well as the numbers on the scale.  If you’re losing body fat but gaining weight that’s not a bad thing.

Omron Full Body Composition Monitor with Scale

If you opt to go the surgical route you can probably expect to spend anywhere between six and ten thousand dollars out of your own pocket, depending on the type of surgery you choose to receive.  The most common form of surgery requested after weight loss is called an Abdominoplasty or “Tummy Tuck.” Most insurance companies will not cover this type of procedure as it is considered cosmetic surgery (although some people have successfully made the case for having the skin removed to prevent rashes and infections).  According to the physician I went to part of the procedure does include using liposuction to remove fat before tightening the skin, which goes to support the theory that loose skin is the result of excess body fat in my opinion.  Recovery from this type of operation can take several weeks and will almost always result in some fairly severe scars.

The best way to deal with loose skin is a very personal decision that I can’t make for you.   I know that my research has convinced me to do everything I can with diet and exercise before opting to go the surgical route but that going under the knife is not out of the question.  I still have a long way to go before I hit my goal weight, and I have no idea how I’m going to look when I get there.  If you’re like me and still trying to get to and maintain a healthy weight worrying about the excess skin now is putting the cart before the horse.  Concentrate on getting healthy first.  Deal with how you look naked when you get there.