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When paired with behavior modification, can liposuction have a positive impact on obesity and on metabolic syndrome?

Key iconKey Points

  • Estimates indicate 70 percent of US adults are overweight or obese.
  • Only 20 percent of these people do not demonstrate effects of metabolic syndrome.
  • Large numbers of self-selected patients nationwide seek abdominal liposuction to defend against cardiovascular risks associated with apple-shaped physique.

EDITOR'S NOTE

This is the second installment in CST's three-part series on the implications and current research findings on the potential linkage of abdominal fat and metabolic syndrome — and what role liposuction might play in its treatment. The incidence of metabolic syndrome and its cascade of resultant co-morbidities, from cardiovascular disease to diabetes, is on the ascent, with the latest U.S. Census figures putting the number of metabolic syndrome sufferers at some 47 million. Perhaps within the cosmetic surgeon's treatment armamentarium, there lies potential to battle this growing menace to public health.



LAST MONTH, IN PART ONE of our three-part series, we reviewed studies that distinguished between visceral fat and subcutaneous fat and their connection to metabolic syndrome. We discussed the effect that health insurance coverage of liposuction procedures would have on cosmetic surgery practices. Here, in Part Two, a comprehensive review of liposuction/metabolic syndrome clinical studies is offered; cosmetic surgeons talk about how liposuction can — and cannot — help their obese patients, and the endocrinology community weighs in on the good, the bad and the ugly of fat. Estimates indicate that 70 percent of adults in the United States are either overweight or obese. Disturbingly, only about 20 percent of these people do not demonstrate the effects of the metabolic syndrome, according to Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America and vice president of the American Association of Clinical Endocrinologists. "Eighty percent of overweight and obese people have insulin resistance. Practically all people with metabolic syndrome have insulin resistance, but not all people with insulin resistance have metabolic syndrome. The rate of metabolic syndrome in the U.S. adult population is 40 percent to 70 percent," Dr. Handelsman tells Cosmetic Surgery Times . With numbers like these, it's easy to see why, unfortunately, metabolic syndrome is becoming as American as apple pie.

Dr. Handelsman
The state of America's waistline is as relevant — if not more so — to cosmetic surgeons as it is to any other health care practitioner according to Florida plastic surgeon Thomas Fiala, M.D. "Metabolic syndrome is probably even more common among my patients than in the general public because the patients I see for liposuction and tummy tucks are self-selected; they are seeing me specifically because they have an increased waist size, which is the most obvious part of the syndrome."

Dr. Fiala
Dr. Fiala routinely evaluates these patients for other metabolic syndrome symptoms. "Almost every month, we find men and women who never knew they had untreated diabetes or cholesterol abnormalities or the whole package — metabolic syndrome — and they are invariably thankful that we discovered the problem early, rather than after a heart attack," he says.

SELF-DEFENSE Large numbers of these self-selected patients across the country seek out abdominal liposuction in an effort to defend themselves from the well-documented and highly publicized cardiovascular risks associated with an apple-shaped physique. "It's a tricky issue [because clearly] the problem isn't so much the external fat that we can remove with liposuction, but internal fat that relates more to hormones, menopausal status and genetics," says Seattle-based plastic surgeon Richard Baxter, M.D. "Having said that, there has been some research indicating that large-volume liposuction can improve certain metabolic parameters, but whether that is successful long-term is debatable and large-volume liposuction is risky," adds Dr. Baxter who is a member of the Emerging Trends Committee of the American Society of Plastic Surgeons.


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