June 16, 2004 -- Liposuction may help you shrink your girth, but not the health-related risks of obesity such as heart disease, high blood pressure, and diabetes. To improve your health you need to drop pounds the old-fashioned way -- reducing calories with diet and exercise, new research shows.
After removing excess belly fat with liposuction in 15 obese women, researchers found that the sudden weight loss offered no improvements in health-related risk factors associated with obesity, such as insulin sensitivity, high cholesterol and other blood fats, and high blood pressure.
"We were a little surprised because we removed a lot of fat -- an average of 22 pounds in each patient," study researcher Samuel Klein, MD, tells WebMD. "That translated to about 20% of the person's total body fat content."
Still, the fat removed produced no improvement in any of the risk factors associated with obesity -- those which boost risk of heart disease and diabetes, says Klein, the Danforth Professor of Medicine and Nutritional Science at Washington University School of Medicine in St. Louis.
Old-Fashioned Weight Loss Best
"Had these patients lost this much fat by dieting, we would have expected to see marked improvements," he says. "Even losing a little fat by dieting -- far less than what we removed with liposuction -- causes significant metabolic benefits."
A possible explanation: "When you lose weight with dieting or exercise, you shrink the size of fat cells, which improves this metabolic profile," Klein tells WebMD. "With liposuction, you remove the number of fat cells, but you don't shrink the size of remaining fat cells."
The researchers say that dieting which results in fewer total calories on a daily basis shrinks fat cells. You need to achieve a negative energy balance -- burning more calories than you consume -- to achieve the health benefits of weight loss, he says.
The type of fat removed with liposuction may also explain Klein's findings, published in this week's New England Journal of Medicine.
In liposuction, fat is removed from beneath the skin of the abdomen or other areas. But previous studies indicate that excess fat that surrounds internal organs is most likely to increase the risk of obesity-related health problems.
Lessons Learned From Animals
Past research on animals shows that surgically removing this visceral fat yielded "marked and nearly immediate improvements in insulin resistance," notes David E. Kelley, of the University of Pittsburgh Obesity and Nutrition Research Center, who wrote an accompanying editorial to Klein's study. But surgically removing subcutaneous fat -- as done in Klein's research -- has had little effect in those animal studies.
"Unfortunately, the take-home message of our study repeats that sad message: Diet and exercise is the way to reduce health risks associated with obesity," says Klein.
But there is one silver lining to his research, at least for those considering liposuction for quick weight loss: It demonstrates that it's safe to surgically vacuum large amounts of fat. None of his study participants suffered complications as a result of the amount of fat removed. And in this particular study, the amount of fat suctioned was much higher than what is typically removed.
"This shouldn't be seen as an indictment for liposuction because it does provide good cosmetic benefits," Klein tells WebMD. "And it may stimulate people to become more active, which can help them lose more weight or keep it off. If it achieves that, as it often does with people who get liposuction, that is a good thing."