Thursday, June 17, 2004

No Shortcuts

Just as I said, it turns out that liposuction does nothing for one's health. It isn't the sheer presence of bodily fat that's harmful, but what it says about one's level of physical activity.

Having 20 pounds of fat removed by liposuction makes people look better but provides none of the protection from heart disease and diabetes that would result from losing the same amount of weight through diet and exercise, researchers are reporting.

A report being published today in The New England Journal of Medicine challenges several earlier studies, preliminary ones suggesting that liposuction could improve health by lowering blood fats and other risk factors linked to diabetes.

Those studies had led many plastic surgeons to begin promoting liposuction, particularly procedures removing many pounds of fat, as a medical treatment for obesity rather than merely a cosmetic operation, said Dr. Samuel Klein, the first author of the new study and director of the Center for Human Nutrition at the Washington University School of Medicine in St. Louis.

"But what this study tells you is that losing fat itself by sucking it out does not give metabolic benefits," Dr. Klein said.

One reason for the finding may be that liposuction removes fat only from under the skin, whereas dieting and exercise reduce deeper deposits in the organs and inside the abdomen; such deposits are believed to be more dangerous. In addition, while liposuction removes some fat cells, it does not shrink the billions left behind. Dieting does shrink fat cells, making them less prone to release harmful substances.
Now that last paragraph is an example of extremely silly "reasoning" on the part of Denise Grady, the NYT reporter who wrote this story. It's clear that what she's done is reason from the statistical evidence linking certain types of fat deposits with poorer health to the notion that the real problem with liposuction is that it doesn't suck out the "right" types of fat, but this is a nonsensical idea. All this talk about "fat cells" accumulating "harmful substances" is pseudoscientific rubbish, unless one is some sort of seal accumulating DDT in them or something. A better and much more plausible explanation for the association between certain sorts of fat deposits and worse health would be that individuals who tend to accumulate fat in particular areas are also more vulnerable to the consequences of a sedentary lifestyle. To be fair to Ms. Grady, she didn't come to her barmy conclusion by herself, as there's also a Dr. Philip Scherer quoted as saying that
the results were not surprising, because many studies in animals had shown visceral fat to be the culprit behind raised blood lipids, glucose and inflammation.

"Unfortunately, these visceral fat pads cannot be targeted by simple liposuction," Dr. Scherer said.

He added that only in the last decade had scientists come to realize that fat deposits are not inert but act like endocrine organs, secreting a variety of hormones and other chemicals into the bloodstream
Now, I'll state out flat that I don't think this notion Dr. Scherer's pushing will stand up to scrutiny, but even on the assumption that it did, what practical consequences would it have? Are people going to start going under the knife to have fat deposits around their internal vital organs excised as well? Not bl**dy likely. In plain English, what he really seems to be saying is that there isn't a surgical procedure that will confer the benefits of a lifestyle change - which is just as expected.

Anyway, let's get to the meat and potatoes* of the study.
Dr. Klein said that he and his colleagues began their study expecting to find that liposuction would have health benefits, and so they were surprised to discover otherwise.

Their experiment involved 15 obese women who had large-volume liposuction, which vacuumed out about 20 pounds of fat from the abdomen - nearly 20 percent of their body fat, four times the amount usually removed. The surgery sucked out fat only from under the skin, not the deposits well inside the abdomen. Large-volume operations are riskier than the usual type and account for only about 5 percent of all procedures nationwide, but they are becoming more common, and surgeons had hoped that removing so much fat would leave patients healthier as well as slimmer looking.

Ten to 12 weeks after the surgeries, Dr. Klein's team measured the women's blood pressure and their blood levels of cholesterol, triglycerides, glucose, insulin and other substances used to gauge the risk of heart disease and diabetes. They found no improvements.

But many previous studies had shown that the same weight loss, if achieved through dieting and exercise, typically produced significant improvements in most or all of the risk factors.

Dr. Klein said he thought the experiment was definitive and should end debate about what liposuction could accomplish, because the research methods were more rigorous than those used in earlier studies.

In the earlier experiments that found possible health benefits from liposuction, Dr. Klein said, improvements may have occurred because participants began dieting and exercising after they had liposuction, and not because of the surgery itself.

By contrast, the women in Dr. Klein's study, sedentary to begin with, agreed not to begin diets or exercise programs after the liposuction.

Plastic surgeons and researchers not involved with the study praised it, though one surgeon lamented the results.

Dr. Olivia Hutchinson, a plastic surgeon in Manhattan, said, "It's a great study, but it's unfortunate what their findings were, that it doesn't tell us what we would have hoped to see."
Life's like that, always telling us things that aren't what we'd like to hear; wishes, beggars, horses and all that. Still, for the life of me I can't understand why Dr. Klein or anyone else could ever have imagined that the sheer presence of extra adipose tissue would in and of itself be harmful to health, rather than acting as a marker of unhealthy lifestyle traits. Is this just a case of a researcher indulging in a bit of self-dramatization in his hour of glory, or is it that those who work in this field tend to have a hankering for quick and painless solutions that gets to their faculties of reasoning? That definitely appears to be the case with Dr. Olivia Hutchinson, though in her case I'd say there are more concrete pecuniary reasons for her to be disappointed by the outcome of this study.

Liposuction, the Atkins Diet and all the other "cures" touted as express tickets to slimmer, healthier living are to the field of nutrition what cold fusion is to physics, or the search for the philosopher's stone was to early chemistry.

*Awful pun fully intended.