It's an incredible test of willpower and fortitude for an obese person to lose weight. If you're carrying an extra twenty or thirty pounds, then simple tasks like jogging or swimming become Herculean feats of endurance, and then you have to act contrary to a lifetime of established bad habits. However, there's another part of the fitness journey that most people usually forget about: The leftover excess hanging skin, which can be every bit as difficult to get rid of as the flab itself.

One person who knows this all too well is 35-year-old Sal Paradiso, who lost an incredible 20 stone naturally, and three-and-a-half stone with bariatric surgery, but was been left with hanging skin that he needed surgery to remove. To highlight his plight, Sal uploaded a video to YouTube of himself shirtless, to highlight the toll extreme weight loss had taken on him.

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Sal began piling on the pounds in his teens, and gorge himself on high-carbohydrate snacks and large meals; averaging between 5,000 and 10,000 calories every day. In 1998 his father, Biagio Paradiso, died at the age of 41 from a heart attack when Sal was only 17-years-old, but even this didn't make Sal change his dietary habits.

It wasn't until he was 31-years-old, and studying at home for a master's degree in criminal justice, that he suffered a knee injury caused by his large frame, and doctors at St Joseph’s Hospital North were unable to weigh him due to his size. Sal realised that he had to start losing weight, or he might not live to see 40. To that end, he began working out and managing his calorific intake, and now looks completely different. He uses Twitter and Instagram to regularly update followers about his progress.

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Commenting on his incredible transformation in an interview, Sal stated:

"I’ve climbed a mountain. It’s been a long 32 months. But the days are getting brighter. I swim in my pool and enjoy life. But I need more. No amount of exercise will remove this excess skin. It means my clothes don’t fit properly."

He added:

"After all this hard work, and still some on the horizon, a wrinkling shell of who I once was plagues me. There are nights when I’ve cried myself to sleep with worry about how I can address this. I want to be able to go out and about – I need this surgery ... There is around 80lbs (five stone) of sagging skin. That’s not something I can lose through eating healthily and exercising. The doctors say it has to be cut off. But my medical insurance won’t pay for it."

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Sal has now managed to oat for the surgery and is the slimmest he's ever been. But his video still shows just how much excess skin can be left over after major weight loss. Still, that shouldn't deter anyone from making a big change.

Shocking video shows the reality of extreme weight loss, as obese man exposes sagging skin