Liposuction does not achieve metabolic benefits of weight lossBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7454.1457-a (Published 17 June 2004) Cite this as: BMJ 2004;328:1457
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A recent study of liposuction did not find an impact on blood
pressure, plasma glucose and lipid concentration (1), whereas these
effects are obtained by weight loss following exercise or diet. The
scientists argue that the discrepancy reflects that a negative energy
balance has the main effects on the metabolic risk factors (2).
We offer another interpretation. Intra-abdominal fat can be centrally
involved in the pathogenesis of the metabolic syndrome and its metabolic
coronary risk factors. This interpretation explains both why weight loss
have effects, and why they are absent following liposuction that only
reduces subcutaneous fat.
This interpretation is supported by our own research (3). We undertook a
cross-sectional study of the relation between four measures of obesity
(body mass index, waist-hip ratio, body fat percentage measured using a
DEXA scanning, and extent of intra-abdominal fat measured using a slice of
a CT scanning of the abdomen) and metabolic coronary risk factors of the
metabolic syndrome (systolic and diastolic blood pressure, fasting serum
concentrations of high-density lipoprotein (HDL) cholesterol,
triglycerides, glucose, and plasminogen activator inhibitor 1. In multiple
regression analyses, only the extent of the intra-abdominal fat had a
significant association with these metabolic coronary risk factors. The
association was linear over the whole range of values for the
intraabdominal fat. The difference for the median values of systolic blood
pressure and HDL cholesterol between small and large values for the intra-
abdominal fat was clearly clinically relevant (1 mmol/L for HDL
cholesterol, 20 mm Hg for systolic blood pressure). The intra-abdominal
fat explained 10 to 25 percent of the variation for the metabolic coronary
risk factors. In this study, measurments of the subcutaneous abdominal fat
tissue had no significant impact on the metabolic coronary risk factors.
Thus, intra-abdominal fat had robust effects on the metabolic
abnormalities. It remains speculative whether a negative energy balance in
itself will provide additional effects.
1. Klein S, Fontana L, Young VL, Coggan AR, Kilo C, Patterson BW, et al.
Absense of an effect of liposuction on insulin action and risk factors for
coronary heart disease. NEJM 2004;350:2549-2457.
2. Gottlieb S. Liposuction does not achieve metabolic benefits of weight
loss. BMJ 2004;328:1457.
3. von Eyben FE, Mouritsen E, Holm J, Montvilas P, Dimcevski G, Suciu G,
et al. Intra-abdominal obesity and metabolic risk factors: a study of
young adults. Int J Obes Metab Rel Disord 2003;27:941-949.
Competing interests: No competing interests
Editor - It is hardly surprising that weight loss following
liposuction has no measurable metabolic benefits, and it did not require a
study to show this.1,2
Although a BMI above 30 is a risk factor for many diseases, equally
important is the distribution of that fat. It is well known that central
obesity is much more of a problem than peripheral obesity. The overweight
male is more likely to be “apple-shaped” whereas the overweight female
tends to be “pear-shaped”.
Waist circumference alone is a good measure of obesity risk, i.e.
measuring the “apple-shape” fat distribution. Central obesity is not just
subcutaneous fat that can be reduced by liposuction, it also comprises
intraperitoneal fat that only dieting and exercise can reduce.
It was therefore naive to have considered that liposuction could be
of value in such patients, other than altering their cosmetic appearance.
The problem though is that liposuction in obese patients can actually be
harmful. It gives the message that there is a “quick-fix” surgical
solution for obesity. When a patient puts on yet more weight, there are
reduced peripheral lipocytes to store it so it will preferentially be
stored in sites where lipocytes are still present, i.e. intra-peritoneal.
Liposuction in obese patients is potentially harmful – the only
person it helps is the surgeon. We should know we are Plastic Surgeons.
Philip M. Gilbert Consultant Plastic Surgeon,
Simon P. Mackey SHO in Plastic Surgery
McIndoe Burns Centre, Queen Victoria Hospital, Holtye Road, East
Grinstead, West Sussex, UK.
1. Klein et al. Absence of an Effect of Liposuction on Insulin Action
and Risk Factors for Coronary Heart Disease. N Eng J Med 2004; 350:2549-
2. Liposuction does not achieve metabolic benefits of weight loss.
BMJ 2004;328:1457, (19 June)
Competing interests: No competing interests