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Liposuction Has No Health Benefits For Diabetes or Heart Disease
posted 06/22/04
Liposuction may let doctors extract body fat, but it doesn't trim the risk of heart disease or diabetes the same way losing weight with diet and physical activity does, researchers are reporting.

A new report published in The New England Journal of Medicine challenges several earlier studies, preliminary ones suggesting that liposuction could improve health by lowering blood fats and other risk factors linked to diabetes.

Dr. Samuel Klein, the first author of the new study and director of the Center for Human Nutrition at the Washington University School of Medicine in St. Louis stated that, “Those studies had led many plastic surgeons to begin promoting liposuction, particularly procedures removing many pounds of fat, as a medical treatment for obesity rather than merely a cosmetic operation.” “Sucking it out does not give metabolic benefits," Dr. Klein said.

One reason for the finding may be that liposuction removes fat only from under the skin, whereas dieting and exercise reduce deeper deposits in the organs and inside the abdomen; such deposits are believed to be more dangerous. In addition, while liposuction removes some fat cells, it does not shrink the billions left behind. Dieting does shrink fat cells, making them less prone to release harmful substances.

Liposuction, in which surgeons break up fat deposits and vacuum them out, is the most common type of cosmetic surgery in the United States, with almost 400,000 procedures a year. Most patients are women ages 19 to 50.

Dr. Klein said that he and his colleagues began their study expecting to find that liposuction would have health benefits, and so they were surprised to discover otherwise.

Their experiment involved 15 obese women who had large-volume liposuction, which vacuumed out about 20 pounds of fat from the abdomen - nearly 20 percent of their body fat, four times the amount usually removed. The surgery sucked out fat only from under the skin, not the deposits well inside the abdomen. Large-volume operations are riskier than the usual type and account for only about 5 percent of all procedures nationwide, but they are becoming more common, and surgeons had hoped that removing so much fat would leave patients healthier as well as slimmer looking.

Ten to 12 weeks after the surgeries, Dr. Klein's team measured the women's blood pressure and their blood levels of cholesterol, triglycerides, glucose, insulin and other substances used to gauge the risk of heart disease and diabetes. They found no improvements.

But many previous studies had shown that the same weight loss, if achieved through dieting and exercise, typically produced significant improvements in most or all of the risk factors.

Dr. Klein said he thought the experiment was definitive and should end debate about what liposuction could accomplish, because the research methods were more rigorous than those used in earlier studies.

In the earlier experiments that found possible health benefits from liposuction, Dr. Klein said, improvements may have occurred because participants began dieting and exercising after they had liposuction, and not because of the surgery itself.

By contrast, the women in Dr. Klein's study, sedentary to begin with, agreed not to begin diets or exercise programs after the liposuction.

The results may seem puzzling. If a 20-pound weight loss from dieting can improve health, even in a very obese person, why should a similar weight loss from liposuction not have the same effect? Researchers say one answer, not fully understood, is that people must burn more calories than they eat - exist in a state of "negative energy balance" - to reap the benefits.

The scientists suspect that the answer may also be partly that liposuction removes the least harmful kind of fat - the subcutaneous layer, under the skin. Dieting and exercise, on the other hand, quickly reduce more dangerous fat deposits, those in the liver, muscle and heart, as well as visceral fat, found inside the abdomen. That may be why even a small amount of weight loss can be quite beneficial. There is no standard operation to remove visceral fat from obese people.

The deeper deposits are more likely to raise lipid levels in the blood and to increase the risk of diabetes by making the body less sensitive to insulin, the hormone needed to control blood sugar. Fat cells in those deposits may also be more likely to secrete a nasty array of substances that cause inflammation, also thought to play a role in heart and artery disease. The secretions from visceral fat go directly to the liver and may interfere with the vital roles it plays in helping regulate levels of glucose and cholesterol in the blood.

Another reason liposuction does not lower health risks may be that it does nothing to shrink the billions of fat cells it leaves behind. Not only do obese people have more fat cells than lean people - at least 80 billion to 120 billion, as opposed to 40 billion - but the cells themselves are larger, with as much as 50 to 75 percent more mass than fat cells in a lean person, Dr. Klein said. Studies have shown that larger fat cells are more active metabolically than small ones, and more likely to spew harmful substances into the bloodstream.

Source: Diabetes In Control.com.

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