‘Extreme Weight Loss’: Why Dramatic Weight Loss Is More Difficult After 40

VVartanian on 30 Jul 2013 at 9:00am

Dr. Stoker explains why losing more than 100 pounds may be more difficult if you're over the age of 40.

On last week's Extreme Weight Loss, we meet Trina Miller, a 47 year-old registered nurse from Michigan and mother of three.  At her first weigh in, while trainer Chris Powell and her nursing co-workers look on, she discovers she is 290 pounds.  Trina makes a commitment to change and her co-workers (who also step on the scale after Chris's encouragement) join her in a year-long weight loss journey.

But, despite the fact that Trina starts off strong and organizes an exercise group for her hospital co-workers -- her 365-day journey is a roller coaster ride. Trina is deeply affected by life stress and her mother's on-going criticism, and often flees to food for comfort.  And, the fact that her teenage sons do not fully understand the dangers of her food addiction (and are bringing french fries and hamburgers into her kitchen) doesn't help. 

Trina does, however, come in four pounds shy of her goal weight of 149 at her 90-day weigh in (and qualifies for body lift surgery with LA-based plastic surgeon, Dr. David Stoker).  Although, there is one last shocking turn in her weight-loss tale -- when Trina weighs in at Dr. Stoker's office on the day of her surgery, she's gained 32 pounds and is no longer a surgical candidate. She tearfully admits to Chris that stress eating (and a snowy winter) got the best of her, and fights back to a final weight of 145.

As we traveled alongside Trina and her (topsy-turvy) transformation, we predictably had more than a few questions -- and we went straight to Dr. Stoker to find out more.

RealSelf: Trina was by far the most "senior" of the Extreme Weight Loss candidates we've seen this season -- does age affect how your skin looks after weight loss?

Dr. Stoker: Younger patients are frequently fortunate that the skin on their face and neck snaps back [after extreme weight loss] -- so that the reconstructive surgery needed is primarily the abdomen and the breasts.

For patients over age 40, they commonly no longer have the skin elasticity that they had decades earlier. They can have quite substantial laxity of the neck and jowls which can be even more bothersome [than hanging skin on the body].  After all, many people are able to cover [bodies] up with clothing, but you can't cover up your face.

RealSelf:  Can a facelift and a body lift be done in one surgery?

Dr. Stoker:
If a patient is over the age of 40, we have a discussion about prioritizing their procedures and usually it becomes two separate surgeries.  We may work on the face and neck one day, and the body and breasts at a different time.   Many chose to start with the face. 

Weight loss unmasks the damage that is done from overeating, and it can be very difficult for a patient to feel good about themselves when they look in the mirror and appear a decade or more older.   Fortunately, surgery can erase much of the damage that was done.

RealSelf: It was heartbreaking to see Trina weigh-in on her surgery day and not qualify because of her weight gain.  How often does it happen that someone initially qualifies for surgery - but is declined the day of?

Dr. Stoker: I see that maybe 10% of the time – and it’s significant when somebody flies in from somewhere to see me for the surgery and arrives heavier that they should be.  It is very disappointing to them and it’s disappointing for me – but I try to put a positive spin, give some hard goals and a date in the future for us to review their progress.

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