Todayâs 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 whoâs 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, letâs get to it:
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.
Before getting into potential methods of treating and/or preventing excess skin after weight loss, letâs 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 âsoftâ fat, it is looser and easier to confuse with skin. It droops and jiggles and the skin that surrounds it conforms to its shape. Thatâs not to suggest that legitimately loose skin isnât 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 BerkhanÂ 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 âeasy fat,â or fat that burns off easily. A-2 receptors are associated with âstubborn fat,â or fat thatâs 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 itâs 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 residualÂ body fat. And because adipose tissue â which, remember, is actually a major endocrine organ, rather than an inert piece of tissue â 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.Â SkinÂ that fills your hand when you squeeze it isnât just skin.
This isnât really bad news, believe it or not. It actually means that youâre almost there. It means that your âloose skinâ isnât necessarily out of your control. If indeed it is simply stubborn subcutaneous fat, once you manage to lose the excess fat, the âloose skinâ might just disappear along with it. In fact, Iâd imagine that most such cases of âloose skinâ 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 Iâm not as bad as Ron Brown, PhD, whoÂ 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; youÂ willÂ 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 bodyâs âinternal and external environment.â
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