by Ron Brown, Ph.D., B.Sc. Dietetics, author of The Body Fat Guide 

"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

"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."

"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.'"

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!

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.

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. 

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.

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. 

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. 

The Cause of "Loose 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?

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.

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. 

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. 

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.  

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.

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, 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.

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

toward a normal maintenance intake amount. This replenishment helps provide the firmness and fullness to muscle that is lacking in flabby skin. However, you must take extreme care to avoid over-replenishment above maintenance calorie levels, which will start increasing your body fat level again! In effect, your dieting isn't really complete until you have fully replenished all your muscle losses without regaining body fat. 

Lean body mass replenishment can occur in small daily amounts each dieting day. For example, on a moderate restricted diet of approximately 1200-1800 calories only a portion of each dieting day is actually spent in a state of gluconeogenesis when your calorie intake briefly dips below your calorie expenditures, as occurs when you are engaged in physical activity. Muscle losses are replenished during those portions of the day when your calorie intake briefly rises above your calorie expenditures, for example, following a meal. 

By the way, it makes absolutely no difference when you eat your meals or engage in activity while on a diet, because the total net difference between your calorie intake and expenditures, known as your energy balance, will still come out the same over the course of 24 hours. To monitor and modify your energy balance, see The Body Fat Guide.

On the other hand, lean body mass replenishment can also occur over several days following a period of very strict dieting, fasting, or alternate-day fasting. For example, a person who fasts for several days is in a continuous state of gluconeogenesis, and often follows the fast with a controlled re-feeding period to restore healthy lean weight. Interestingly, I believe part of the reason why more females than males develop anorexia is because females, in general, tend to omit this recovery of muscle from dieting, which they consider unimportant in their drive for thinness. Generally, males are less likely to disregard replenishment of their muscle mass. See Never Thin Enough. I also believe that most females, including anorexia patients, are interested in having "toned muscle." What they may not understand is that muscle tone is maintained through adequate caloric intake, regardless how much one exercises.

Monitoring body composition levels of lean body mass will guide you in determining the correct balance between your calorie intake and calorie expenditures, which will allow you to replenish and maintain levels of lean body mass that are burned while dieting. See The Body Fat Guide to monitor changes in your lean body mass and body fat levels. Experienced dieters often take a weekly "break day" from dieting, knowing that it recharges them. Regardless if replenishment occurs daily, every several days, or weekly or more, failure to restore depleted lean body mass is the number one cause of "loose skin." 

It is possible to be at the ideal bodyweight according to Body Mass Index charts (BMI), but still have too much body fat and not enough lean body mass. For example, a young woman in her twenties with "loose skin" recently appeared on a popular radio talk show.  She had lost over two-hundred pounds in one year, and her bodyweight at 5' 8" was now in the 120's. Yet, her abdomen was covered with flabby skin that hung off of her. I would guess there is at least another 20 pounds of excess body fat stored in those folds of skin. However, if she lost another 20 pounds of bodyweight, she would obviously look like an emaciated stick! But, that's not because she is too low in body fat...it's because she lacks sufficient lean body mass! My suggestion to this young woman would be to replenish her lost lean body mass with a healthy balanced diet, and to tone her muscle with weight training (See Muscle Mass Myths). After increasing her bodyweight with 20 pounds of replenished lean body mass, she can then lose the rest of her excess body fat, without sacrificing any more lean body mass. Then she would have both a normal bodyweight AND a normal body composition.

What is required to avoid muscle loss during a diet, and gain back lost muscle, is an easy method to measure changes in one's body composition (muscle and body fat levels), and a method to monitor and modify one's energy balance, which is the balance between the calories one eats and burns each day. Such a method is available in The Body Fat Guide.

Keeping track of changes in your body composition using The Body Fat Guide allows you to see how much muscle you are losing on a diet, and more importantly, it allows you to make calorie intake changes to prevent or replenish that loss. Using the scale alone, most dieters are unaware of their body composition changes. For example, if you start your diet at 220 pounds with 34% body fat and end at 135 pounds with 18% body fat, you might expect to look toned and trim after having lost 85 pounds of bodyweight and reducing your body fat percentage almost in half, but The Body Fat Guide will show you that you will have also lost 35 pounds of muscle in the process, and you will probably have plenty of flabby skin as a result! If you don't want this to happen to you, use The Body Fat Guide regularly to measure changes in your body fat and muscle levels and adjust your diet until you get perfect results! 

It may seem counterintuitive at first to think that you need to eat more calories to maintain the muscle and energy you need to exercise more and burn off body fat. Why not just eat fewer calories to reduce your weight without all that work? The answer is that you need to eat sufficient calories to maintain your lean body mass, otherwise changes in your body composition will not be optimal.

Here is a letter I received from another woman since first publishing this article:

"Hi!
I've read literally hundreds of online sites regarding loose skin which seems to inevitably accompany weight loss. Your site is the only one to list positive news regarding this dilemma! Every other site states loose skin is unavoidable, with post weight-loss surgery as the only solution, which of course is extremely discouraging.

How successful is your advice; does it always work if followed properly? I've read hundreds of personal stories at various forums and everyone seems plagued with loose skin after weight loss. I've read your article on loose skin and I need some further encouragement and convincing!"

It has been many years since this article on loose skin first appeared on the web. I have received numerous positive responses from people who have read the article and have since applied my advice. However, before presenting a testimonial at the end of this article from a reader, here is my response to the woman above.

Anyone who actually measures their level of body fat (very few people know how to do that...that's where my book can help) can easily see that, even after losing substantial amounts of bodyweight, they may still have plenty of body fat remaining under their skin. 

Perhaps you are a male who reduced from 40% body fat all the way down to 12-18% body fat. That's an impressive amount of progress! However, if you expect to pose for the cover of a fitness magazine, consider that bodybuilders and male fitness models regard themselves as fat at 12-18% body fat, and usually begin dieting down to 5% body fat or less. In a 1994 research article titled "The lower limit of body fat in healthy active men," Friedl et al. suggested that approximately 5.5 lbs of body fat is the minimum healthy level in males. 

There's nothing special about losing excess body fat in "loose skin," provided you know how to properly measure and modify your diet and activity level. But, restricting yourself to certain foods and following unbalanced diets won't teach you how to manage that. When a person relies exclusively on an unbalanced diet to lose weight they eventually reach a plateau due to nutritional imbalances, boredom and cravings. 

The advantage to learning how to lose weight by correctly balancing the number of calories you eat and burn each day is that you can adjust so many factors to keep on making progress. You can eat whatever you want as part of a well-balanced diet to avoid cravings and imbalances. You can 

change the speed of your loss, slower or faster as you like, and you can exercise at a pace that suits you. If you go over your calorie intake allowance on your diet, simply consider the extra calories as part of your next day's allowance and get back on track without losing any time. You have complete control and flexibility over the balance between your calorie intake and calorie expenditures. This enables you to continue on to reach and maintain your weight-loss goal in a way that an unbalanced diet alone never can! 

More importantly, by monitoring changes in your muscle and body fat levels, something the scale alone can't do, and by modifying your calorie intake to avoid cutting calories too drastically, you will maintain your lean body mass and prevent loose skin. 

I have received letters from readers asking for photos to prove my argument. People have become so brainwashed by before-and-after photos that they neglect simple logic. I challenge anyone to show me a photo of a woman with 10% body fat who has loose skin. No one will be able to do so because a woman with 10% body fat has very little excess body fat, and therefore she has no "loose skin," regardless how overweight she may have once been. (Click for examples of female Hollywood Celebrities with 10% body fat.) 

So, the answer to your question is, yes, anyone can non-surgically reduce skin folds of excess body fat, provided they follow the body composition and energy balance numbers until the job is done right...and if anyone else doubts you and tells you it can't be done because they didn't do it, ask to see their body composition and energy balance numbers. After they scratch their head, you can explain it all to them!

Of course, you can always elect to have surgery to fix your "loose skin" problem, but consider this: First, the more you improve your condition before surgery by natural means, the better your chance of having a safe outcome after surgery. But, second, and more importantly, ask yourself what is going to prevent you from regaining the weight all over again, even after surgery? Sooner or later, you will have to deal with the root cause of your problem, which is your inability to control your weight because you don't know how to properly modify the balance between the calories you eat and burn each day. There is a way to learn that...The Body Fat Guide. 

To read a positive, unsolicited and unedited testimonial about loose skin received from a reader in December 2004, click here.