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The downside of losing weight

Published Nov 28, 2011


London - Many people who lose dramatic amounts of weight after stomach surgery or dieting believe it will be the answer to their prayers, with a slimmer figure, greater confidence - and better health.

Certainly the recent pictures of a radiant Dawn French were a compelling advertisement for weight loss. Over the past 19 months the actress has dropped from 20st (127kg) to 16st (101kg), through eating less and exercising more.

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Yet what many won’t realise is that dramatic weight loss can have a deeply distressing side-effect.

Wendy Constable, a receptionist from Surrey, learned this the hard way after she dropped from 20st to 10 st (she’s 5ft 4in).

At her heaviest, Wendy’s body mass index (BMI) was over 47, which meant she was morbidly obese and at greater risk of heart disease, diabetes, stroke and cancer. Although the 35-year-old lost the weight gradually, she was left even more unhappy about her body because of a mass of excess skin.

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As she explains: “Physically, I feel so much better. But the excess skin was utterly depressing. I’d spend hours trying to find clothes to hide my body.”

There are also unpleasant health problems linked to excess skin, from infections to back pain.

This hidden downside of losing weight occurs as a result of damage to the deeper layers of skin, the dermis, which contains two proteins: elastin, which helps it retract, and collagen, for strength. When the skin is stretched too much through weight gain, these proteins tear and break, resulting in a loss of elasticity and strength.

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Unfortunately, while losing weight causes the fat cells to lose their fat, the skin cannot retract.

“This excess skin after weight loss is the same skin damage that occurs during pregnancy - but all over the body,” explains Guido Kohler, a plastic surgeon who works privately and at Norfolk and Norwich University Hospitals NHS Foundation Trust.

Factors that affect how much skin is left include age, how quickly the weight was lost (gastric bands are slower than bypasses, for example), and, for women, the number of children she has had.

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“After extreme weight loss, many patients develop an ‘apron’ of skin around the abdomen, and loose skin under the arms, chest and inner thighs,” explains Mr Kohler. “It can all be very uncomfortable and upsetting.”

This excess skin can cause a range of medical problems, too. One of the most common is intertrigo - a bacterial, fungal, or viral infection that occurs often due to the difficulty in keeping these folds of excess skin clean and dry.

Patients also find the folds of skin make it difficult to exercise.

Excess skin is a problem particularly for people who undergo bariatric (weight loss) surgery. Some 15,000 people in Britain underwent such surgery in 2010 alone, the majority performed privately.

“It is estimated that more than 30 percent of these go on to have some form of reconstructive surgery,” says Mark Soldin, of the British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Mr Kohler says: “Sadly, there are some patients who do not seem to have been prepared for this situation beforehand, and post-weight loss can be a very disappointing and psychologically damaging time for them. Some do question why they had the surgery in the first place.”

Lucene Hughes was left with more than a stone of excess skin after undergoing weight loss surgery.

Lucene, 42, a student and former classroom assistant from Belfast, lost 19stone in 18 months after gastric bypass surgery in 2007, going from a size 32 to a size 10. The excess skin, and the medical complications it caused, left her feeling suicidal.

“It was devastating, as I’d hated my body pretty much all my life,” explains Lucene, who has 13-year-old twins. “My dad was killed in the Falklands when I was 13, and I turned to food as a comfort. By age 15 I was a size 20.

“Over the years I tried every diet going, to no avail. It was only after I was involved in a serious car crash, aged 34, that I considered having weight loss surgery. The consultant dealing with my leg injuries suggested it.”

By this point she was 5ft 7in and 31st, with a BMI of 67.

“I hated my body and was so excited at the thought of no longer being sweaty and uncomfortable. But mostly, I wanted it done for health reasons and for my children.”

During a gastric bypass, the stomach is made smaller and part of the small intestine is bypassed to make the patient feel full more quickly. By the time Lucene left hospital six days later, she had already lost 1 stone.

But she hadn’t been warned about the large amount of excess skin she would be left with.

“By the time I got to a size 10-12, I was still having to buy 14-16 clothes just to accommodate the excess skin,” says Lucene, who now weighs 12st.

“My skin was also rubbing and becoming ulcerated and infected - so badly that I should have been hospitalised, but I had no one to look after the children. I also suffered terrible backache due to the excess skin at the base of my back.”

She has since had a tummy tuck and reconstructive surgery to her arms to remove the excess.

Like Lucene, father-of-two Francis Rhoades-Brown, 54, from Basingstoke, Hants, also suffered from back problems after massive weight loss. He had a gastric band fitted in June 2009, and went from 28st to 16st. Yet he struggled to sleep at night due to the excess skin on his back.

“I kept feeling this lump when I went to bed. It was actually my skin folding over.

“I had the gastric band for health reasons and the appearance didn’t bother me that much. But the backache and soreness from the skin rubbing was unbearable.”

He, too, underwent surgery to remove excess folds of skin.

Funding for reconstructive work is extremely difficult to find on the NHS, says Mr Soldin, who practises at St George”s and Kingston hospitals in South-West London.

“To get funding, my patients have to go before an exceptional circumstances panel. I’m in an area where the local health authorities are quite receptive. In the North of England, it seems many trusts are refusing to pay.”

Mr Kohler adds: “It seems hard to convince primary care trusts that patients are really suffering. Even if the NHS has paid for the bariatric surgery, it is usually unwilling to fund the aftercare.”

Privately, the average fee for a total body repair is between £20,000 and £30,000.

“What we need to make clear is that there’s a big difference between this and cosmetic surgery,” adds Mr Soldin. “We’re not talking about women who have wrinkly skin around their stomach after having three babies. This is reconstructive surgery for medical reasons, such as infection.

“There are quite strict criteria that must be met before you qualify for reconstructive surgery. It’s essential that the patient is no longer losing weight, as surgery isn’t safe then and wounds will struggle to heal. We say patients must have maintained a stable weight for six months.”

The NHS usually insists that patients remain at a stable weight for two years. Patients must usually have a BMI of 28 or lower and prove that their condition is having a huge impact on their quality of life.

Lucene, Francis and Wendy were all granted NHS funding for their reconstructive work.

“I was fortunate to have an excellent MP who helped fight my case,’ says Lucene. “He argued that the NHS knew this was part of the deal when they agreed to fund me. They know that people who have gastric bypasses develop a lot of excess skin, and that I was only half-way through my treatment.’

Wendy is evangelical about how surgery has changed her life. She has had a lower body lift and skin removed from her arms and legs. “It”s definitely not a quick fix, but I do feel I’ve been given a second chance in life,” she says. - Daily Mail

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