Liposuction: Merely Cosmetic Relief
]]>Obesity]]> (defined as a body mass index [BMI] of 30 or more) is a complex, chronic disease involving environmental (social and cultural), genetic, physiologic, metabolic, behavioral and psychological components. It is the second leading cause of preventable death in the US. Currently, approximately 127 million adults in the US are overweight, 60 million are obese, and 9 million are severely obese.
Obesity, particularly abdominal obesity (or being apple shaped) increases your risk for developing a number of serious health conditions, including ]]>high blood pressure]]> , ]]>high cholesterol]]> , diabetes, heart disease, and ]]>stroke]]> . This is because obesity significantly alters a number of metabolic factors in your body. For example, changes in your level of insulin sensitivity may lead to ]]>type 2 diabetes]]> . Changes in your cholesterol levels and in the number of inflammatory markers in your blood may directly influence your risk for heart disease.
Research has shown that losing weight the old fashioned way, through diet and exercise, improves the metabolic complications of obesity. However, it is also well known that long term weight loss is difficult to achieve and most obese persons who are successful losing weight regain some or all of it over time, frustrating themselves and their doctors. This frustration with current weight loss therapies has led to increased interest in alternative approaches, such as liposuction.
Liposuction is a surgical procedure in which large amounts of body fat are removed from specific areas, such as the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. It is the most common type of cosmetic surgery performed in the US, at a rate of nearly 400,000 procedures per year. But can the rapid removal of large amounts of abdominal fat alter the metabolic affects of obesity in the same way diet and exercise can?
To answer this question, a group of researchers measured the metabolic markers of obesity in a group of women both before and after their liposuction procedures. The results of their study, published in the June 17, 2004 issue of The New England Journal of Medicine found that when it comes to lowering your risks for obesity-related coronary heart disease, a quick fix is no fix at all.
About the Study
The researchers enrolled 15 obese women (waist circumference more than 100 cm) into the study, all of whom were scheduled to have large volume abdominal liposuction (the removal of more than four liters of fat tissue). In each participant, they measured the insulin sensitivity, the level of inflammatory mediators, and other risk factors for coronary heart disease (blood pressure, plasma glucose, insulin, cholesterol, and triglyceride levels) 10 to 12 weeks before and 10 to 12 weeks after their procedures. Eight of the women had moderate insulin resistance and normal glucose levels while seven of the women had more severe insulin resistance leading to type 2 diabetes.
The researchers found that liposuction reduced the amount of abdominal fat by 44% among participants who did not have diabetes and 28% among those who did. It did not, however, significantly alter the insulin sensitivity or inflammatory markers of any of the participants. Therefore, it did not significantly affect the risk of coronary heart disease in either group.
How Does This Affect You?
The researchers concluded that abdominal liposuction procedures did not improve the obesity-related metabolic abnormalities that affect a woman’s risk for coronary heart disease.
The amount of fat removed from each woman was estimated to be equivalent to what could be lost through optimal behavioral changes and pharmacologic treatments (approximately 12% of total body mass). This amount of weight loss, if achieved the old fashioned way, can be counted on to result in significant improvement in all the metabolic abnormalities associated with obesity as well as many risk factors for coronary heart disease.
The loss of excess weight through diet, exercise, and weight loss medications appears to cause what the researchers term a “negative energy balance.” In short, losing weight by “burning it off” offers many other health benefits that losing weight through liposuction does not. Unfortunately, as with most things, a quick fix is never really the answer. Liposuction appears to offer cosmetic benefits only.
American Diabetes Association
American Heart Association
American Obesity Association
American Society of Plastic Surgeons
Klein S, Fontana L, Young VL, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease.
Liposuction. American Society of Plastic Surgeons. Available at: http://www.plasticsurgery.org/public_education/procedures/Lipoplasty.cfm . Accessed June 16, 2004.
Obesity and overweight. American Heart Association. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4639 . Accessed June 17, 2004.
Obesity in the U.S. American Obesity Association. Available at: http://www.obesity.org/subs/fastfacts/obesity_US.shtml . Accessed June 17, 2004.
Last reviewed June 17, 2004 by ]]>Richard Glickman-Simon, MD]]>
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