Cut the Waist

Cut the Waist

Illustrative photo for 'Cut the Waist'
The philosophy of Cut the Waist is to prevent obesity related ill health through education resources

Liposuction

A cosmetic procedure rather than a therapeutic approach

Liposuction is a surgical procedure which involves removal of subcutaneous fat via the introduction a trochar under the skin and applying suction to reduce the amount of adipose tissue stored under the skin.

Although it has been proposed that liposuction may be a potential treatment for the metabolic complications of obesity, it is important to appreciate liposuction involves reduction in the subcutaneous depot only and should therefore be viewed as a cosmetic procedure rather than a therapeutic approach to obesity management [Fig 1].

Fig 1: Illustration of liposuction as a cosmetic procedure rather than a therapeutic approach to obesity management
Fig 1. Liposuction involves removal of low risk subcutaneous adipose tissue and should therefore be regarded as essentially a cosmetic procedure. Animal studies suggest that removal of subcutaneous adipose tissue may have deleterious metabolic consequences as a result of depletion of the "metabolic sink". Loss of subcutaneous fat may have the detrimental impact of increasing propensity to store fat in high risk depots, causing visceral fat expansion and storage of fat in non-adipose ectopic sites such as the liver and skeletal muscle.

As liposuction does not reduce high risk fat depots, it is not surprising that liposuction does not appear to have any appreciable effects on reducing insulin resistance or improving risk factors for coronary heart disease.

A lack of medical benefit of liposuction is borne out by the results of a study involving 15 obese women who underwent large-volume abdominal liposuction1. Eight women in this study had normal glucose tolerance and seven had type 2 diabetes.

Liposuction decreased the volume of subcutaneous abdominal tissue by 44% in the subjects with normal glucose tolerance and 28% in the subjects with type 2 diabetes. Those with normal glucose tolerance lost an average of 9.1kg of subcutaneous fat and those with type 2 diabetes lost an average of 10.5kg of subcutaneous fat.

Baseline blood tests were taken prior to the liposuction surgery and 10-12 weeks after surgery. The study results indicated that liposuction did not alter insulin sensitivity or improve blood glucose levels, and did not alter risk factors for coronary heart disease such as blood pressure, and lipid concentrations in either group.

Possible deleterious impact of liposuction: Depleting the "Metabolic sink"

Recent studies suggest that individuals with a large proportion of subcutaneous fat, particularly in the gluteofemoral distribution, can clear triglycerides from the blood and store absorbed dietary fat via accumulation of the subcutaneous depot. In this way that subcutaneous depot may have a protective effect as a "metabolic sink", sequestering fat storage subcutaneously and reducing storage in alternative, more detrimental high risk sites such as the visceral compartment.

Animal models appear to support this idea. It is interesting to find that lipoatrophic mice whom are unable to store subcutaneous fat, have an increased tendency towards visceral and ectopic fat storage. These lipoatrophic mice develop metabolic consequences of obesity such as diabetes, dyslipidaemia and fatty liver disease. Importantly these metabolic aberrations are reversed following transplantation of subcutaneous tissue2. Thus addition rather than subtraction of subcutaneous tissue results in positive health benefits, presumably by transplantation of a functional "metabolic sink". Furthermore experiments involving surgical removal of subcutaneous adipose tissue demonstrate subsequent adverse metabolic disturbances in hampsters3. These findings from animal studies may have important health implications, raising concerns regarding the wisdom of surgical removal of a potentially useful subcutaneous fat depot in humans for cosmetic reasons.

References

1 Klein S, Fontana L, Young V, Coggan A et al. Absence of Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease. NEJM 2004; 350: 2549-2557

2 Gavrilova O. Marcus-Samuels B, Graham D et al. Surgical implantation of adipose tissue reverses diabetes in lipoatrophic mice. J Clin Invest 2000; 105: 271-278

3 Weber RV, Buckley MC, Fried SK, Kral JG. Subcutaneous lipectomy causes metabolic syndrome in hampsters. Am J Physiol Regul Integr Comp Physiol 2000; 279: R936-943