- If a positive connection between abdominal liposuction and metabolic syndrome can be confirmed, a paradigm shift with insurance coverage of liposuction could emerge.
INTEREST IN LIPOSUCTION, which today is one of the most commonly requested procedures in the typical cosmetic surgery practice, was particularly sparked in the mid '90s when abdominal obesity was first linked with coronary artery disease. Since then, it has become common knowledge that abdominal obesity is generally associated with glucose intolerance, hyperinsulinemia, hypertriglyceridemia and other disorders associated with metabolic syndrome, such as high blood pressure, decreased levels of high density lipoproteins (HDL) and increased levels of very low density lipoproteins (VLDL).1 This, coupled with the fact that more than half of all U.S. adults are now considered overweight or obese, emphasizes the need, say some public health advocates, for concerted efforts to prevent and treat obesity rather than just its associated co-morbidities.2
INSURANCE COVERAGE FOR LIPO? Obesity-related disorders represent a significant and rising percentage of U.S. health care costs. And, after years of resisting, many private insurers are now picking up the tab for bariatric surgery for morbidly obese patients. If a positive connection between abdominal liposuction and metabolic syndrome can be confirmed, a similar paradigm shift regarding insurance coverage of liposuction could emerge.
Manhattan plastic and reconstructive surgeon, Douglas S. Steinbrech, M.D., is currently at work on a literature review of abdominal liposuction and metabolic syndrome. He tells
Cosmetic Surgery Times
that if abdominal liposuction can ameliorate metabolic syndrome-associated co-morbidities, the impact on cosmetic surgeons could be huge. Speaking purely hypothetically, he says, "if it turns out that it's true and it's proven, it would open up our practices to a patient population for purely health purposes, which, just in terms of insurance reimbursement, could substantially change our practices." More importantly, adds Dr. Steinbrech, "It would enable plastic surgeons to improve lives by providing these services to people who are at increased risk for heart disease and obesity. It would be a way for plastic surgeons to extend their liposuction practice to really help people to not just look better, but to live longer and diminish their chances of heart disease and heart attack and to live longer with healthier lifestyles."
PRO OR CON? Dr. Steinbrech initiated his study because of the "large amount of controversy" surrounding the purported connection between abdominal liposuction and metabolic syndrome. "There have been a number of studies that have been pro and a number of studies that have been con that have negated that hypothesis. We wanted to do a thorough investigation of the literature to find out which hypothesis would be more likely to be correct, and which studies are well controlled and accurate representations of the true physiology," he says.
EARLY EVIDENCE One of the early studies that addressed the relationship between subcutaneous fat and metabolic health risks observed the effect of lipectomy of subcutaneous adipose tissue in hamsters.3 Glucose tolerance, serum triglycerides, leptin and fat, among other parameters, were monitored. Lead investigator, Renata V. Weber, M.D., and colleagues concluded that lipectomy of subcutaneous adipose tissue led to alterations in normal fat accumulation. The study found that, in conjunction with a high-fat diet, these lipectomized hamsters developed a metabolic syndrome with significant hypertrigliceridemia, relative increase in intra-abdominal fat and insulin resistance. The investigators proposed that subcutaneous adipose tissue essentially protects against metabolic syndrome via disposal and storage of excess ingested energy. These findings suggest that removal of subcutaneous fat could actually induce, rather than improve, metabolic syndrome.