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After a massive weight loss, what's the best way to get rid of unflattering saggy skin?
By MSNBC contributor
updated 12/23/2008 8:18:40 AM ET 2008-12-23T13:18:40

Can you lose a lot of weight without becoming a ‘saggy, baggy elephant’? How well can exercise fight the flab? And is it possible to lose fat only in desired areas but not in others? Smart Fitness answers your queries.

Have an exercise question? To e-mail us, click here . We’ll post select answers in future columns.

Q: I am a 36-year-old woman who is obese and gradually losing weight. My starting weight was 350, and I'm down to 310. I am worried about stretched skin. How likely is it if I continue to eat healthy and exercise that my skin will shrink with me? I don't expect it to be perfect, but I've heard horror stories. This is something that's worried me for a long time.

A: We’ve been getting quite a few comments like yours in recent months, including an e-mail from a reader who worried about losing weight but gaining a “loose suit.” Another lamented that after losing 40 pounds, she was starting to resemble a “saggy, baggy elephant.” One even said she thinks it looks better to be fat than thinner but with sagging skin.

First off, let’s be clear about one thing: It is better to be at a healthy weight but saggy than it is to be morbidly obese, at least as far as health is concerned. So anyone who is obese and planning a New Year’s resolution to shape up and slim down is taking a positive step toward better health.

“The bigger ‘horror stories’ are someone who’s massively overweight and dying of a heart attack or stroke,” says Dr. Alan Gold, president of the American Society for Aesthetic Plastic Surgery.

Of course, Gold is a plastic surgeon who spends his days helping patients look better, so he feels our readers’ pain. Surgery can help with saggy skin, although it can be very expensive. A surgeon’s fees alone for a tummy tuck average more than $5,000, according to ASAPS. Gold notes that some insurance companies do cover tummy tucks, thigh lifts and other body-contouring surgeries for patients who’ve lost a lot of weight and then develop significant problems like chafing and skin irritation from the excess skin.

But not everyone who loses a lot of weight needs — or wants — to take such drastic measures.

Some people are more likely than others to have a lot of excess skin after they’ve lost weight, especially when they’ve lost a significant amount, says Gold. “If you’re talking about losing 20 to 30 pounds it’s different than 200 pounds.”

John Jakicic, director of the Physical Activity and Weight Management Research Center at the University of Pittsburgh, says people who are overweight, with a body mass index between 25 and 30, may experience “a little jiggle” after weight loss. Obese people with a BMI of 30 or more, especially those with BMIs upwards of 35 and 40, will have more excess skin after losing significant weight.

Gastric bypass patients, for instance, who might lose 50 percent or more of their body weight, should expect some sagging skin, Gold says. “Unquestionably, your skin is not going to have the elasticity to recoil and tighten to what it used to be.”

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Other factors that can play a role in skin resiliency include sun damage, smoking, a person’s age and genetics, how much yo-yo dieting they’ve done and whether they have stretch marks (an indication of poor elasticity), according to Gold.

So while the reader in the question above has age working in her favor, her excessive weight likely means that her skin won’t perfectly shrink the way she hopes as she drops more pounds. But Jakicic points out that most of his patients feel so much better after they lose weight that they don’t view saggy skin as a big problem, not one big enough to undergo major plastic surgery anyway.

While exercise that includes a strength-training program to firm up deconditioned muscles under the skin certainly can help a person’s body look better and more toned, Jakicic notes, it can’t completely remedy extreme sagginess after massive weight loss.

Muscles only get so big (most people aren’t going for the Mr. Universe look anyway), and the exercise doesn’t actually make the stretched skin shrink.

Q: I am losing weight, and the first visible weight loss I have is always my butt and thighs. I don't mind my thighs shrinking so much but I hate losing my butt. What can I do to lose weight evenly and especially in my stomach?

A: Sorry, but there’s no way to control where you lose weight, says Jakicic. “It kind of comes off where it goes on.”

In other words, if you gained a lot in your buttocks and thighs, more so than in other places, those fatty areas are where you’ll lose first. “There’s no way to prevent that from happening,” he says.

During weight loss, the body taps the biggest fat stores first. So during the initial stages of weight loss, Jakicic explains, you’ll look “the same shape but smaller.” People with a pear body shape will go from looking like a big pear to a smaller pear — not an apple, for instance.

Those who gained the most in their buttocks or breasts, say, will likely see those areas shrink first. As weight loss continues, the body will then draw more from the smaller fat stores.

So eventually — with a lot of commitment to a healthful diet and regular exercise — you can lose weight all over, including your stomach.

© 2013 msnbc.com

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