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Liposuction Doesn't Help Health, Study Finds By DENISE GRADY
Published: June 17, 2004
aving 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.
Ds. 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.
Dt. 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."
Du. 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.
Dv. 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."
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--
CeeBee
EMH Mark I: "Stop breathing down my neck." EMH Mark II: "My
breath is merely a simulation." EMH Mark I: "So is my neck.
Stop it anyway."