Posted on 06/17/2004 7:55:40 PM PDT by summer
Liposuction Doesn't Help Health, Study Finds
By DENISE GRADY
Having 20 pounds of fat removed by liposuction makes people look better but provides none of the protection from heart disease and diabetes that would result from losing the same amount of weight through diet and exercise, researchers are reporting.
A report being published today 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.
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, said 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.
"But what this study tells you is that losing fat itself by 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.
Plastic surgeons and researchers not involved with the study praised it, though one surgeon lamented the results.
Dr. Olivia Hutchinson, a plastic surgeon in Manhattan, said, "It's a great study, but it's unfortunate what their findings were, that it doesn't tell us what we would have hoped to see."
Another Manhattan plastic surgeon, Dr. Gerald H. Pitman, said: "In terms of metabolic consequences, we found out liposuction doesn't matter. I think it's wonderful."
Dr. Philipp Scherer, an associate professor at Albert Einstein College of Medicine who studies fat cells, said by e-mail that the results were not surprising, because many studies in animals had shown visceral fat to be the culprit behind raised blood lipids, glucose and inflammation.
"Unfortunately, these visceral fat pads cannot be targeted by simple liposuction," Dr. Scherer said.
He added that only in the last decade had scientists come to realize that fat deposits are not inert but act like endocrine organs, secreting a variety of hormones and other chemicals into the bloodstream.
Dr. Klein said that women were studied only because they are far more likely to have liposuction than men and so were easier to find as research subjects. But the findings, he said, should apply equally to men.
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, but researchers in Boston are trying an experimental procedure. Their results are not yet available.
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.
Cheryl Strahm, a 44-year-old-nurse who participated in the study, said she was disappointed to learn the results but glad nonetheless that she had been involved. The surgery became a catalyst for her to lose more weight once the study was done, Ms. Strahm said, and she has now dropped a total of 80 pounds. She hopes to lose an additional 50.
"I got lots of compliments," she said. "I didn't necessarily tell everybody how I got there. People think I just look like a different person."
Hell, I could have told you that.
That totally makes sense. I don't know why these reseachers assumed otherwise.
Well, I wonder if insurance companies will now change the way they classify this surgery, from medical to cosmetic. Right now about half a million people per year in the US are getting this surgerical procedure, believing it has health benefits -- when in fact it is only cosmetic.
Good fat, bad fat; scat, bad fat!!!
For reference purposes, someone should post the price of liposuction per pound. It would surely lend substance to the expression "my dear".
Interesting article.
I can understand why liposuction wouldn't reduce other types of fatty health risks, it still seems there would be some health benefits just by not carrying around the extra weight.
For instance, you would not have the extra weight on joints, feet, and you would think it would reduce strain on the heart.
By contrast, the women in Dr. Klein's study, sedentary to begin with, agreed not to begin diets or exercise programs after the liposuction.
...
Cheryl Strahm, a 44-year-old-nurse who participated in the study, said she was disappointed to learn the results but glad nonetheless that she had been involved. The surgery became a catalyst for her to lose more weight once the study was done, Ms. Strahm said, and she has now dropped a total of 80 pounds. She hopes to lose an additional 50.
Obviously, liposuction can be a part of a very effective weight-loss plan to improve the health of the individual. The only reason these particular women from this particular study did not receive health benefits is because they were told, after receiving the liposuction, not to exercise. Once they started to exercise, they made dramatic gains, possibly much more than they would have been able to achieve without the liposuction.
The liposuction provided the first step towards their health. Losing 20 pounds probably made it much easier for them to exercise, especially psychologically if for no other reason.
To dismiss the benefits of liposuction because of this study would be not just absurd, but stupid. To prove that liposuction provides no benefit, researchers would have to show that obese women who do not receive liposuction were able to lose as much weight and benefit their health as much as the women who did receive the liposuction. Then they would have to show that women who received liposuction were no more likely to stick with their diet/exercise plans than the women who did not have liposuction.
That's what I was thinking. The loss of weight would certainly be good for your feet and knees and what-not, but I think you'd have to be a quack to assume that the other benefits of being thinner (cardio stuff) would be found through the surgery.
I don't think I agree with you. There are people who are motivated to get liposuction - and undergo substantial risk - because they think it will immediately improve their blood pressure, cholesterol, etc., etc. But, this is not what happens due to that surgery. What health benefits may exist happen only due to a change in diet and the inclusion of exercise, according to this newest study. I think it is MAJOR news. Many people may decide NOT to get this surgery as a result, because the benefits they are seeking are actually not available due to the surgery. If you are willing to exercise, why do you need the surgery?
If you're a former college athlete and want to get buff, I don't see anything wrong with committing yourself to the gym again and sucking out some nasty fat. If you've got a few dollars burning a hole in your pocket anyway, why not?
~ Blue Jays ~
However, what if liposuction will reduce your weight to the point where it is safer to exercise? Seems to me it might be a good starting point, because the loss of weight should reduce heart strain when one starts exercising.
And for accounting purposes, batter fried french fries are vegatables.
And remember, liposuction is not just about direct health benefits of not being obese. It could be argued that not being obese is a health benefit in its own right, given that fat people are treated like subhumans by the majority of Americans. They would instantly find many of their friends and family to be more friendly towards them, and they would have a much better time of their love life. I'm willing to bet that obese people are more likely to kill themselves than skinny people.
I was thinking the same thing. If someone lessens their weight by the equivalent of getting rid of a 20 lb. barbell off their body, it should reduce some stress on the heart, joints, bones, and muscles. However, if you still have an awful diet and don't get any exercise then you would still have problems related to that.
Actually, if I remember correctly, there is the little known fact that it is far from uncommon for people who have had liposuction to put the weight back on. For exactly the reasons you list.
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