i wish i could do as well as tammy on weight loss, she did an outstanding job. with that said having that much excess skin is a real health issue, try hanging a few bowling balls from your body and try to walk-the force of the sway can throw your back out among other issues like, pinching skin, no air circulation so the skin breaks down to raw oozing fungus in record time. It is easy for people who do not have these issues to be so judgmental but they don't have to deal with the trauma do they. this is not a cosmetic issue it is medical no different than having breast reductions to help with back pain! It is also a mental problem because no one feels good about their body being really -deformed by that much excess skin, and do not kid yourselves-people are very mean and do treat you differently on how you look. for her and anyone else in Tammy's situation they should absolutely get skin removal surgery if they want as long as they are cleared by their Dr's. there is nothing vain about this they are not looking to have surgery like the Kardashians or many people in Hollywood do, these people like tammy just want to look and feel somewhat normal!