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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


August 20 2008

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Liposuction and Life Span
Scientists at the Albert Einstein College of Medicine in New York have found that the surgical removal of abdominal fat from rats prolongs the rodents' lives by 20% or more. The news – and its implications for humans – might have some people raising the question: Could liposuction be used to remove abdominal fat in humans, thereby lengthening their life span? The answer is a succinct "no", primarily because we're talking about two different types of fat.

"Not every fat in our body is equal," says lead researcher Nir Barzilai, MD. "There is a good fat and a bad fat, and the bad fat is inside our abdomen and biologically distinct from other fats. So if you want to get rid of fat to affect your health, it's the abdominal fat that matters, even in humans."

In recent years, this abdominal or visceral fat has been linked to an increased risk of cardiovascular disease and Type 2 diabetes, high blood pressure and high cholesterol, breast and colorectal cancers, and premature death. It would follow, then, that losing excess weight around the waist is a good idea. But making the mental leap that using liposuction – instead of diet and exercise – to get rid of the offending flab would be wrong.

Liposuction is used only on subcutaneous fat, the "pinch an inch" variety found just below the surface of the skin. It contours the body surgically by suctioning out these pockets of unwanted fat on the face, neck, chin, abdomen, hips, buttocks, thighs, upper arms, flanks, or anywhere else there's extra subcutaneous fat. Once those cells are removed, they do not return to that particular area, although a subsequent weight gain could be seen as fat deposits in other parts of the body.

As women reach middle age and menopause, their proportion of fat to body weight increases, and those extra pounds often settle in their midsection. The phenomenon also happens in men, but to a lesser degree. This visceral fat is also known as organ fat because it surrounds the internal organs. Too much visceral fat leads to a pot belly, where the abdomen protrudes excessively. It is considered to be the worst kind of fat, in part because it disrupts the normal balance of the hormones leptin, which curtails the appetite, and adiponectin, which influences cell response to insulin. Luckily, visceral fat responds fairly readily to diet and exercise. Liposuction is not used on visceral fat because the procedure would be potentially dangerous to the vital organs and tissues that it surrounds.

Subcutaneous fat is more difficult to get rid of than visceral fat, but it's considered less of a health risk. Dr. Barzilai reports that in an earlier study that he conducted, equal amounts of visceral and subcutaneous fat were removed from lab rats. "Metabolically, the visceral was the one that made the difference," he says.

Those findings were backed up by a study at Washington University in St. Louis that was published in the New England Journal of Medicine in 2004. It reported that liposuction removal of subcutaneous fat in 15 obese women had no effect on their blood pressure, blood sugar, cholesterol, or response to insulin. Weight loss through diet and exercise, on the other hand, did.

To further delineate between visceral and subcutaneous fat, the fat that accumulates around the hips and buttocks (the proverbial "pear figure") is subcutaneous; fat in the abdominal area ("apple figure") is mostly visceral. Where fat ends up is determined primarily by heredity and hormones, including the hormonal changes of menopause.

It's the "apple figure" that has been linked to health problems in several medical studies. In one of the better known – the long-term Nurses' Health Study – researchers from Harvard University and the National Institutes of Health found that women with greater waist circumferences were more likely to die prematurely, particularly from heart disease, than women with smaller waists, regardless of total body fat. A larger waist measurement also predicts the development of high blood pressure, according to a 10-year study of Chinese adults published in the American Journal of Hypertension.

So if liposuction is not the solution to belly fat, what's the owner of a tubby tummy to do? Medical experts, including the American Diabetes Association and the American Heart Association, put the emphasis on lifestyle, which translates to exercise and diet. Food intake should be focused on nutrient-rich sources like vegetables, fruits, unrefined whole-grains, lean meat and poultry, fish rich in omega-3 fatty acids, and fat-free or low-fat dairy products. Beware, however, of drastically cutting calories, which forces the body into starvation mode in which it actually stores fat for later use.

Regular, moderate intensity physical activity that lasts for at least 30 minutes a day is the exercise recommendation heard most often. Researchers at Duke University Medical Center found that subjects who exercised the equivalent of walking or jogging 12 miles a week added no visceral fat; when the exercise level was stepped up to the equivalent of 20 miles a week, subjects lost both visceral and subcutaneous fat. Non-exercisers experienced a nearly 9% gain in visceral fat over 6 months. Strength training (weight lifting) was also proven effective in reducing body fat by another study.

Since plastic surgeons generally want their liposuction patients to be within 20% to 30% of their healthy weight prior to surgery, perhaps the best advice for longer life is to lose the visceral fat first, then lipo away any subcutaneous fat that remains.

"If it's a cosmetic problem, liposuction is okay. But you cannot use the excuse that it's healthy," concludes Dr. Barzilai.