Wednesday, July 13, 2011

Fat gain after liposuction

I found this paper about liposuction and fat gain. I believe is the
first peer-reviewed paper that has looked scientifically at whether
people will gain weight after liposuction.
Liposuction is very popular in industrialized modern society. It is
often seen as fast-track technique for achieving weight loss and for
cosmetic purposes. Liposuction was "created" in 1974. Since then,
especially with the introduction of the tumescent technique in 1990
(1), suction lipectomy (the medical term for liposuction) has become a
practical solution for eliminating fat spots not responding to
lifestyle modification.
Although people may believe that liposuction will remove fat for ever,
there is anecdotal evidence contrary to that. Now in a what I believe
is the first paper on liposuction and fat gain, titled: "Fat
Redistribution Following Suction Lipectomy: Defense of Body Fat and
Patterns of Restoration (2), there is direct evidence that there is
fat gain after liposuction. Not only that, authors have shown that the
fat gain is reallocated to the waist instead of to the place where it
was removed.
If you are interested you can go and read the details on the paper,
but the indisputable evidence (by different high tech analysis such as
dual-energy X-ray absorptiometry, magnetic resonance imaging.
hyperinsulinemic–euglycemic clamp, blood measurements) is that body
fat% is restored after one year and that the "new fat" is deposited
around the abdominal area. Here is the direct quotation from the

"We conclude that BF (body fat) is not only restored to baseline
levels in nonobese women after small-volume liposuction, but is
redistributed abdominally. The cosmetic effect was retained at 1 year
in the thighs, but a slower return of fat was still apparent. The fact
that the women in this study were healthy and maintained their usual
lifestyle throughout the 1-year followup period makes it even more
remarkable that the patterns of AT (adipose tissue )restoration were
observed across many methods of body composition assessment.
Mechanisms behind restoration of the AT mass following surgical
removal remain uncertain but are of great interest"
Although this study is of great interest for people looking at
liposuction for fat reduction, it is also important from a scientific
perspective on body fat and obesity and more specifically on the
hypothesis of the "body fat set-point". Many scientists (3) believe
that there is a fat set-point (a percentage of body fat) that will be
defended by the body if we try to modify it through diet or exercise.
This paper proves what was seen in animal models. If you physically
remove fat from the body, the body will make more fat probably to
restore its fat set point. It is an intrinsic regulatory system that
must be taken into consideration for any intervention for weight loss.
Also, the fact that fat is reallocated abdominally after liposuction
posses an additional risk for the patient since abdominal fat is
associated with higher cardiovascular risks.
(1) Klein JA. The tumescent technique. Anesthesia and modified
liposuction technique. Dermatol Clin 1990;8:425–437.
(2) Hernandez TL, Kittelson JM, Law CK, Ketch LL, Stob NR, Lindstrom
RC, Scherzinger A, Stamm ER, Eckel RH. (2011) Fat redistribution
following suction lipectomy: defense of body fat and patterns of
restoration. Obesity (Silver Spring). 2011 Jul;19(7):1388-95. doi:
10.1038/oby.2011.64. Epub 2011 Apr 7.
(3) Palatability of food and the ponderostat.

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