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Fat cell research sets stage for future chemical intervention

New Orleans — Abdominal fat, once considered little more than a benign source of annoyance to the average middle-aged woman, is actually quite a hard worker.

Fat metabolism research shows that estrogen synthesis in women who are post-menopausal occurs almost exclusively in adiposites, and that estrogen formation is done by pre-adiposites.

Significant findings According to lipoplasty veteran Gregory P. Hetter, M.D., those are significant findings.

"This shows that fat cells, in fact, function as an endocrine organ," Dr. Hetter tells Cosmetic Surgery Times. "As an endocrine organ, fat cells make steroids and hormones; they make leptin, angiotensen 2, adiponectin and prostaglandins. So it's clear that the adipose tissue — especially inside the abdomen — plays a very big role in obesity related disorders."

Prophylactic perspective Dr. Hetter, who is the author of the best selling textbook of the 1980s on lipoplasty, Lipoplasty: The Theory and Practice of Blunt Suction Lipectomy, (Little Brown and Co. 1984 and 1989), is looking at the removal of fat from a prophylactic perspective these days.

He's asking, "Why does over-feeding children in their developmental years seem to lead to an apparent irreversible propensity toward obesity, and can we intervene in this process?"

In a session on the history of body contouring and fat metabolism research, at the recent American Society for Aesthetic Plastic Surgery (ASPS) meeting, Dr. Hetter suggested that pharmaceutical intervention into the deposition of fat is probably no more than 10 years away.

"I think that within five years we're going to be able to provide people with outside chemical mediators or signal substances that will influence some of these processes so that we will be able perhaps to intervene in diabetes. I think we may be able within 10 years to intervene in the deposition of fat. While not enough information exists today to do more than make suppositions on these topics, and I staunchly maintain my skepticism about all medical theories, there's enough evidence to say that this appears true," he says.

Dr. Hetter cited several papers that support his supposition, including particularly germane reports by Weisberg and Klannemark, (Weisberg SP, et al: Obesity is associated with macrophage accumulation in adipose tissue. J. Clin Invest 2003, 112:1796-1808. Klannemark M. et al: The putative role of the hormone sensitive lipase gene in the pathogenesis of type 2 diabetes mellitus and abdominal obesity. Diabetologica 1998, 41:1516-22).

"Overfeeding children early on appears to turn off some genes and turn others on, and once that happens ,the effect is permanent. It's not that they have necessarily inherited the tendency to be fat, but that we all have genes that can either keep us skinny or make us fat and they are switched on and off by some molecular function that occurs during the first eight or nine years of life. Once they are turned on or off it appears that it's irreversible," Dr.Hetter explains. "While we are not at the stage where this information is directly applicable to the cosmetic surgeon's role in fat removal, the research is nonetheless relevant."

While he maintains that it is currently highly speculative, Dr. Hetter says, "We may soon see that in certain cases removal of that second layer of abdominal fat can have some influence in improving people's sugar metabolism."

Dr. Hetter is currently retired from active surgical practice, but continues research at the Medical College of Wisconsin and lectures in the United States and abroad. He was in private practice in Las Vegas for 25 years.

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