Amer Ismail could hold the excess skin on his stomach like a swaddled baby.

The skin weighed more than 15 pounds, and it threw off his balance when he exercised. When he was training for his first marathon, his stomach flap would routinely hit his torso and left him feeling sore.

Finding clothes that fit was the hardest part for the 27-year-old Houstonian who has dropped 235 pounds in four years.

There are no clothes for loose skin either you have your pants under your belly or you have to tuck the skin under your pants, Ismail said. It got caught, and it was constantly pinched. I ended up with lots of cuts and scrapes. It was unavoidable.

After loose-skin surgery in May, Ismail can finally see the progress he has made since he began his healthy lifestyle. The surgery didnt change the amount of work he had done, but he could finally see the results.

On HoustonChronicle.com: Losing nearly half his bodyweight, Houston man has no plans to stop

He now fits in a Large size T-shirt. And when he puts the shirt on, it falls straight down rather than getting caught on the skin around his belly. He cant grab his stomach at all anymore.

Standing at 6 foot 3 inches and 235 pounds, Ismail remembers what it was like to be close to 500 pounds in his early 20s. All the jokes and unfriendly looks are gone, and he feels just like everyone else.

Hes just a guy whos half the guy he used to be.

Its not typical for a person to lose so much weight they require skin removal unless they had bariatric surgery or another type of weight loss procedure, said Dr. John LoMonaco, a plastic surgeon based in Clear Lake who performed Ismails surgery.

These people have great stories to tell; its the reason I do what I do, LoMonaco said. If youre into these peoples journeys to fight the disease that was destroying their quality of life, you know its not a vanity surgery. He just wanted to be normal, and hes still fighting to keep that weight off.

The last year has been full of incredible highs and unexpected lows for Ismail.

After months of training, he ran his first Chevron Houston Marathon in January, finishing in 6 hours, 8 minutes and 6 seconds.

He hated the act of running while he was doing it. He had never really run before, so every week was a new unlocked achievement. For months, he ran four times a week and lifted weights on off days; some weeks, he pulled two-a-day workouts at the Memorial Hermann Ironman Sports Medicine Institute.

He went from barely being able to run two miles to finishing a full 26.2 miles within six months of training. It was a slow, but constant progression.

The hardest part was surviving all the weather conditions; it would be so hot, I felt like I was drowning in the humidity, Ismail said. It was tough because I felt like there were weeks with no progress, and that I was stalling. But if you keep doing it, keep trusting yourself, eventually you see how far youve come.

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Ismail took the high of his marathon finish into his next athletic endeavor: Brazilian Jiu Jitsu. In February, he tore his ACL during a regular takedown move while sparring with another person.

The injury has pushed back his running goals for 2020. But he hopes to get the OK to start running again soon. He has been exercising twice-a-week with Blaine Schmidt, strength and conditioning coach with Athlete Training in Health, an affiliate of the Memorial Hermann Ironman Sports Medicine Institute.

To go through all the stuff he went through and to keep the same attitude he had thats something you dont see a whole lot nowadays, Schmidt said. He had his skin surgery all set before he had that injury and that was a little setback. But he was still straightforward on his goals. Nothing was going to stop him.

This was Ismails second ACL surgery in the last four years. He has also had a spleen rupture, which needed to be surgically repaired and resulted in a hernia. Then, he had the first part of his skin removal surgery in May; hell have another surgery next year.

I am so done with surgeries; I want to retire, he said.

The knee surgery coincided with the beginning of the novel coronavirus pandemic, which gave him a much-needed reason to slow down and recover.

Thats where his commitment to healthy eating or as he calls it, boring eating comes into play.

During the pandemic, Ismail stuck to the same four or five dishes, usually including lean chicken, rice with sweet potatoes and a salad mix. Sometimes, he opts for ground turkey or steak. Every now and then, he eats a slice of chocolate cake or buys a chocolate bar.

He estimates that he eats about a pound of meat every day, especially on the days he works out. Lean protein satisfies his hunger, he said, after years of a carbohydrate-loaded diet of pizza, cheese burgers and fatty junk food.

Plastic surgeons have to figure out whether a person has overcome his negative relationship with food before committing to a weight-loss or skin-removal surgery, LoMonaco said. Plastic surgery does not cure food addiction, he added.

Many times, patients will develop a new addiction to exercise or a healthy lifestyle and they can be compulsive about their routine, LoMonaco said. (Ismail) had done a ton of research and slowly and steadily progressed on his weight loss. He wasnt doing a fad diet or a quick pill.

The doctor agreed to perform Ismails surgery after he described his lifestyle, which is regular exercise and healthy eating habits. LoMonaco said he does not operate on 20 percent of the people seeking skin removal because they havent found a stable program to maintain their rapid weight loss.

When he first started losing weight, Ismail knew how to pour a bowl of cereal and make scrambled eggs. He bought pre-packaged foods that were often full of preservatives.

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Now, he buys fruits, vegetables, dairy and a lot of lean protein. He drinks a fair amount of coffee and admits to a slight Coke Zero addiction.

I am less restrictive on my diet than I used to be, and I learned from my mistakes in the past, he said. I was so serious about losing weight that I gave myself no freedom. Now that I know I can eat healthy 95 percent of the day, I can have ice cream or a cookie.

A healthy lifestyle is a marathon, not a sprint. It took Ismail a while to understand that, though. The work is nowhere near done, he said.

Its just putting in the work, its like second nature now, he said. I can do anything as long as I put the hours into it. Mentally, its a weird feeling because after doing all this, everything is relaxed now. I dont worry about weight loss I dont have to think about it anymore.

julie.garcia@chron.com

Twitter.com/reporterjulie

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After losing 235 pounds, Houstonian commits to the marathon of healthy living - Houston Chronicle