Aug. 25, 2000 -- You already know that liposuction, the fat-removal surgery, can help sculpt a more shapely physique. But what if it also could provide some of the same health benefits as diet and exercise, such as reducing the risk of type 2 diabetes? A government-funded study now under way aims to find out just that.
Type 2 diabetes, which is closely linked to obesity, begins with something called insulin resistance. This means that the pancreas makes plenty of insulin -- the hormone that regulates blood sugar levels -- but the body does not recognize and use it properly. Blood sugar rises dangerously, but can usually be controlled with pills -- although insulin is sometimes required. Type 2 diabetes is by far the more common type, and the number of cases in the U.S. is increasing rapidly.
The good news is that the downward spiral from insulin resistance to type 2 diabetes can almost always be stopped through weight loss and exercise. And now, researchers say, liposuction could offer a quicker fix.
This is despite the fact that liposuction has long been considered a good option only for those who aren't seriously overweight. According to an official policy statement from the American Society of Plastic Surgeons (ASPS), "the ideal candidate for liposuction is a healthy adult with localized areas of fat." The procedure, they say "cannot compensate for deficiencies in diet and exercise [and is] generally not suitable for weight loss." Ironically, the ASPS is one of three sponsors of the study, along with the Lipoplasty Society of North America and the National Institutes of Health.
"Liposuction wasdeveloped for [removing] localized fatty deposits from thin people," agrees study leader Sharon Y. Giese, MD, a clinical assistant professor at SUNY Downstate College of Medicine in Brooklyn, N.Y. But years of experience have convinced her that the procedure can be performed safely on people who are 20-50 pounds above their ideal weight.
What surprised Giese, prompting the pilot study on which this latest research is based, was the fact that "75% of patients maintained their weight loss [from liposuction] without changing any of their eating or exercise habits." To a trained biochemist, she tells WebMD, "it didn't make sense. People should have to eat less and exercise more [to maintain the loss]."
In that initial study, Giese removed "an average of 12 pounds of subcutaneous fat from 14 healthy, overweight premenopausal women, half of whom had some level of insulin resistance" as shown by high insulin levels in the blood. Six weeks later, each "was down one to 2 clothing sizes -- a loss of about 12 pounds and 12 inches" -- and had less insulin resistance.
At the annual ASPS meeting in October, Giese will present data showing that in 75% of the women, "all the four-month findings -- weight, blood pressure decreases, and improved insulin resistance -- were maintained at one year."
Giese is not sure how the surgery helps, but whatever the cause, liposuction "is changing insulin metabolism," she says. And that's why the government "is throwing money at [the research] and endocrinologists are going crazy for it," she says. "Not even a pill can improve insulin resistance like the liposuction does."
He may not be going crazy for it, but Mayo Clinic endocrinology consultant and American Diabetes Association past president Bruce Zimmerman, MD, does "think the premise is interesting." After reviewing the study's design for WebMD, he agrees that the idea, although a bit strange, may just be scientifically valid.
"The association between body fat and type 2 diabetes is strong," he tells WebMD, although several studies suggest that visceral fat -- that stored within the body cavity, rather than the under-the-skin type removed in liposuction -- is the crucial factor. "I wouldn't expect liposuction to have any effect on visceral fat, so it will be interesting to see if the [type of] fat that is removed makes any difference in insulin resistance and [disease] development."
Under-the-skin, or subcutaneous, fat has not been implicated in diabetes before, says Giese, because before large-volume liposuction was available, there was no way to remove large amounts of this type of fat and study the effects. The upcoming study "will tell us how subcutaneous fat acts in the development of insulin resistance, which will give us clues about the development, prevention and treatment of type 2 diabetes," she tells WebMD.
It "will be a more rigorous version of the pilot study," she says, involving five black and five white insulin-resistant women, all between 20 and 50 pounds overweight. The surgery, "a big operation that takes between four and five hours" and requires an overnight hospital stay, will be offered at a discount, says Giese, who is still searching for eligible participants.
Giese tells WebMD that large-volume liposuction will be especially helpful for those who, like her patients in the earlier study, "have gained 20 or 30 pounds at a particular, identifiable time -- during pregnancy, from stress, or after an injury -- and then have trouble losing it."
But according to Zimmerman, surgery "is not a reasonable approach" for preventing a disease that can almost always be avoided through basic lifestyle changes. "It's true that lifestyle modification is not easy for many people, but even if the study is markedly positive, we wouldn't extend that [to recommending] liposuction for all those who fit the characteristics of people in this study."
Even Giese advises liposuction as "a combined approach with diet and exercise." But if the new study is a success, "it might change the current standard for who should get liposuction. This is a new approach and it's nontraditional, but I think it can be incorporated into a weight-loss management program."
Zimmerman says the "major question is whether the expense, risk, and effectiveness of surgery is better than lifestyle modification." Right now, he says, the evidence is that "in terms of overall health and not just body weight and insulin resistance, lifestyle modification would be better." However, he adds, "that may be why this study is important."
Giese holds that no other weight-loss method -- diet, exercise, or even diet pills -- comes close to matching her large-volume liposuction results in terms of lasting effectiveness. "Weight maintenance is rare; that's why Jenny Craig and Weight Watchers don't publish one-year results, because they fail," she says.
That's not so, says Karen Miller-Kovach, MS, RD, chief scientist at Weight Watchers Intl. in Woodbury, N.Y. She tells WebMD that, just this April at a scientific meeting, researchers presented the one-year results from an ongoing study comparing Weight Watchers and self-help weight-loss approaches in more than 400 overweight individuals.
After a year, those in the Weight Watchers group were significantly more likely than the self-helpers to have successfully maintained their weight loss.
"At one year, we have people keeping off about 12 pounds," says Miller-Kovach. "So the benefit is comparable [to large-volume liposuction]. But in the end, it comes down to risk and benefit. I may work for Weight Watchers, but liposuction certainly has more risks than attending our meetings."