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Medical Edge Newspaper Column from Mayo Clinic

SAGGY SKIN LIKELY FOR OVER-30S AFTER BIG WEIGHT LOSS

DEAR MAYO CLINIC: Since my last baby was born two years ago, I’ve lost almost 100 pounds and, so far, been able to keep it off. Even though I feel better — I walk and take a step class three times a week — I still feel fat. I’m 35 years old, 5 feet 8 inches tall and weigh about 155 pounds, which is pretty much where I was before pregnancy and which my aerobics instructor says is just fine for me.

But I feel like no matter how many crunches or triceps exercises I do, I still have this saggy bag-of-skin around my middle and upper arms. How long does it take for stretched skin from formerly obese people to snap back into shape? Can doctors fix it somehow? — Chicago

ANSWER: Congratulations on taking charge of your health and returning to your pre-pregnancy weight. What you are experiencing — sagging skin — is common in people over 30 who have lost more than 80 pounds.

Unfortunately, after about age 30, the skin loses much of its plastic, elastic character. As a result, the “snap back” of skin you’re hoping to see doesn’t generally happen. And more people are discovering this: Last year, more than 100,000 weight-loss surgeries were performed in the United States, significantly increasing the number of people losing 80 to 100 pounds. The result: Plastic surgeons are seeing increased demand for “body contouring” — corrective surgeries to deal with excess skin folds.

Body contouring is major surgery, and, depending on the extent of tissue, can require multiple procedures performed over six to 12 months. Each surgery requires general anesthesia and a short hospital stay. During these procedures, plastic surgeons eliminate baggy, excess skin folds around the upper arms, midsection, thighs, breasts and face.

Ask people at your health club about body contouring. It’s likely you’ll be surprised to learn the number of people who have had it done. If body contouring seems like an option you want to pursue, discuss it with your family physician and with friends who have had a successful experience, in order to find a plastic surgeon who has considerable experience with the procedure.

Paul Petty, M.D., Plastic Surgery, Mayo Clinic, Rochester, Minn.

Additional Resources:
Plastic and Reconstructive Surgery
Appointment Information
More Information on Plastic Surgery

DEAR MAYO CLINIC: I hear so much about diabetes, but I don’t understand the different kinds. What is the difference between type 1 and type 2? How are they treated, and why do we hear so much about them these days? — Clearwater, Fla.

ANSWER: People with type 1 diabetes are no longer able to secrete any insulin, whereas people with type 2 diabetes can secrete some — but not enough for their body’s needs. These two forms of diabetes are caused by different disease processes.

Type 1 diabetes — once called insulin-dependent or juvenile diabetes — occurs when the body destroys all the insulin-secreting (beta) cells in the pancreas. Scientists think an error of the immune system causes the body to kill these beta cells. As a result, people with type 1 diabetes must take insulin shots to stay alive and healthy.

Type 2 diabetes was once known as adult-onset or noninsulin-dependent diabetes. While type 2 diabetes can develop in fit, lean older adults, it is much more common in sedentary overweight people. Unfortunately, it is becoming increasingly common in younger people due to the sharp rise of obesity in children and adolescents. Type 2 diabetes is a real threat to public health, which is why you are hearing more about it.

In terms of treatment, many people with type 2 diabetes can be treated either by decreasing their body’s need for insulin through diet, exercise and/or certain medications, or by increasing the amount of insulin they secrete with the help of other medications.

Type 2 diabetes usually can be prevented with diet and exercise. By balancing healthful food choices with appropriate exercise, you can help guard your body’s amazing inborn ability to produce the right amount of insulin for your needs.

Robert Rizza, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Diabetes
Appointment Information
More Information on Diabetes
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.