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Many customers are worried about the prospect of excessive loose skin following substantial weight loss and frequently ask their Consultants what they can do to help to minimise this problem. I have recently had several enquiries from Consultants, asking what exercises they should be recommending to their customers to help deal with ‘saggy’ skin. 

While exercise is not a cure, it can certainly help to improve the appearance of the skin and can help to tone the body. This article will explain why we get loose skin and, most importantly, what we can do to help combat the problem by looking at the role that exercise can play.

Why do we have loose skin following weight loss?

Skin is the largest organ in the body and it is made up of several different components, including water, protein, lipids, and different minerals and chemicals. The main functions of skin are protection, regulation (body temperature) and sensation (pain, touch, etc.).

Skin is an incredibly elastic tissue, meaning that as we put on weight, it stretches to fit our bodies. Similarly, as we lose weight our skin also ‘shrinks’, so that it continues to fit. However, sometimes — especially when people have lost a significant amount of weight — the skin unfortunately loses some of its elasticity. It does not contract fully to fit our new body shape, which leaves us with the problem of excess skin. The most common places affected are usually abdominal skin that reaches past the belly area, and triceps.

Why do some customers suffer more than others?

The elasticity of the skin is affected by many factors, such as weight loss, age, excessive sun exposure, and nutritional deficiency. Therefore, some customers will suffer more than others.

The two biggest factors are the amount of weight lost and age. Those with the biggest weight losses are at the greatest risk and, unfortunately, the elasticity of the skin decreases as we get older.

How long a customer has been overweight also has a lot to do with how much the skin will resume a tight appearance. For example, if a customer has only been overweight for nine months, their skin is more likely to become taut than if they have been overweight for nine years.

Smoking also reduces the elasticity of the skin, so those that smoke are at greater risk, and excessive sun exposure also has a negative effect. Having said this, there are exceptions to all of the above. There are stories of people in their 50's and 60's who have gained and lost huge amounts of weight over a short period of time, and their skin has returned to its normal shape.

Genetics also play a big part, so make sure that you choose your parents very carefully!

Can exercise help or is surgery the only answer?

While exercise is not a cure, it can certainly help, and should be encouraged throughout the weight-loss process. The health benefits associated with regular physical activity are well documented and include a reduced risk of cardiovascular diseases, cancer, type 2 diabetes, and many other metabolic diseases.

In order to achieve these benefits, the government currently recommends that we aim to do 30 minutes of moderate intensity exercise at least fi ve days a week. However, for many customers — especially if they are morbidly obese or unfit — these guidelines are unachievable.

If this is the case, encourage your customers to start slowly. It may be that they do something as simple as walking down their front path every day or become more active around the home. As they get fitter and lose weight, exercising will get easier. You should encourage them to increase the distance that they are walking or the speed that they walk at. Remember, anything is better than nothing!

Which exercises will help to prevent ‘saggy’ skin?

When large amounts of weight are lost, it is likely that your customers will lose some muscle (fat-free mass), as well as fat. Carrying out resistance exercises, in addition to aerobic exercises, will help to preserve and even increase fat-free mass, which in turn will help to tone the body and help tighten skin.

They can do a resistance programme at home (using small dumbbells, body weight or household items, such as tins of food, etc.) or in their local gym. They should aim to exercise all the major muscle groups. As a guide, they should select a weight that they can lift at least ten times (if they can’t lift it eight times, it’s too heavy; if they can easily do 15 repetitions, it is too light). Initially, they should try to complete 12-15 repetitions of each exercise. As they get stronger, they should gradually increase the weight and/or try to complete two sets of each exercise.

Excellent examples of exercises that can be done include squats, lunges, tricep dips, shoulder press and bicep curls. (Please see Inspiration, Autumn 2010 for a home exercise programme).

Your customers should aim to complete at least two muscle strengthening sessions per week, but not on consecutive days. Examples of muscle-strengthening activities include:

  • Climbing stairs
  • Walking uphill
  • Carrying/lifting shopping
  • Digging the garden
  • Weight training

What about cosmetic surgery? For some customers, surgery may be the only option, but this should only be considered in extreme cases and as a last resort. Skin will continue to tighten up over time and it is difficult to tell in the early stages just how much excess skin will be left. It is important that they allow time for their body to adjust to its new shape. According to NICE (National Institute for Clinical and Health Excellence) guidelines, cosmetic surgery undertaken exclusively to improve appearance is generally excluded from the NHS and will only be considered in previously obese patients who have achieved a stable BMI between 18-27 and who have maintained this weight loss for at least two years. Furthermore, surgery will usually only be offered:

  • Where there is a high likelihood that severe psychiosocial dysfunction will be alleviated 
  • Where there are severe functional problems, including recurrent intertrigo (inflammation or rash, sometimes caused by infection) beneath the skin fold
  • When there are significant ambulatory restrictions caused by the excessive skin

Relatively few people will qualify for NHS surgery

In summary, losing large amounts of weight is a fantastic achievement, but can occasionally be associated with the problem of excess skin. Carrying out regular physical activity, while not a cure, will help to lessen the problem, as well as providing many other positive health benefits.

Written by Penny Porter

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