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  #1   ^
Old Tue, May-03-11, 03:23
Pilili Pilili is offline
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Default Fat removed by liposuction returns after a year, study finds

Fat removed by liposuction returns after a year, study finds

Quote:
By Jeremy Laurance, Health Editor

Monday, 2 May 2011

It is the quickest way to slender thighs and a pert behind, and has been practised for more than 30 years. But no one knew if liposuction – the physical removal of fat from the abdomen, bottom, hips, or elsewhere – worked in the long term.

Now researchers have conducted the first randomised trial, and come up with an unexpected result. The fat removed all returns – but in a different place.

Liposuction is a simple but crude mechanical process involving the insertion of a tube under the skin attached to a powerful vacuum pump which sucks up the fat like a Hoover sucking up dust.

Thighs and abdomen – the most popular areas – shrink overnight, delivering a result, after the bruising has healed, that would take months of dieting to achieve. Best of all, the treatment is targeted, so fat is lost only from the chosen areas.

More than 3,300 liposuction procedures were carried out by members of the British Association of Aesthetic Plastic Surgeons last year, and hundreds more will have been performed by other surgeons. The cost is from £3,000 to £5,000.

But the trial carried out by researchers from the University of Colorado found that a year after the procedure, the fat suctioned out had all returned and been "redistributed upstairs" – around the shoulders, arms and upper abdomen.

Rudolph Leibel, an obesity researcher at the University of Columbia, told The New York Times that the body controls the number of fat cells as carefully as it controls the amount of fat. When a fat cell dies, it grows a new one to replace it.

Liposuction, however, surgically destroys the fishnet structure under the skin, which may be why the fat cells don't regrow in the place from which they were removed. Instead the body compensates for their loss by growing new fat cells in other areas.

"It's another chapter in the 'You can't fool Mother Nature' story," Dr Leibel said.

The study, published in Obesity, involved 32 women aged in their mid-thirties and of average weight. Just under half (14) had a modest amount of fat removed by liposuction from their hips and thighs, while the remainder (18) acted as controls. They were promised they could have the procedure at a reduced cost, if they still wanted it when they had the results.

Identical measurements of all the women were carried out at six weeks, six months and a year, which revealed how the body "defends" its fat. After six weeks the treated patients had lost 2.1 per cent of their fat, compared to 0.28 per cent in the control group, but this difference had disappeared at one year. Though the women's thighs remained thinner after a year, the missing fat had found its way back to their stomachs.

Despite the questionable results, the women in the study were happy with their treatment, the researchers reported. They had hated their hips and thighs and had successfully got rid of that fat. Those in the control group were also not discouraged - more than half still chose to have liposuction even after learning of the results.

But there are risks. Denise Hendry, wife of the former premiership footballer Colin Hendry, won a six-figure compensation payment in 2006 over a botched liposuction operation. She suffered a punctured bowel during the procedure in 2002, which led to blood poisoning. She died of meningitis in July 2009.
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  #2   ^
Old Tue, May-03-11, 04:01
M Levac M Levac is offline
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When we eat carbs, it drives fat accumulation through glucose and insulin. Fat tissue protects from high glucose level and high insulin level by absorbing both. The more fat tissue, the greater this protection. Conversely, the less fat tissue, the smaller this protection. By removing some fat tissue, we reduce this protection. If we keep eating the same amount of carbs, we'll drive the same amount of fat accumulation through the same amount of glucose and insulin. However, since there's less fat tissue, the fat tissue that is there is less protective and allows glucose and insulin to rise higher than otherwise, and this fat tissue will be that much more affected and will grow proportionately bigger.

We should also consider that when we remove fat tissue, we also remove pre-adipocytes, cells that haven't fully matured yet. So that's why fat tissue doesn't grow back. It's exactly like removing muscle tissue. It doesn't grow back either.

Consequently, this means even if we remove fat tissue physically, we still have to cut down on carbs. Why not just cut down on carbs to begin with?
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  #3   ^
Old Tue, May-03-11, 04:55
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bkloots bkloots is offline
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Quote:
Rudolph Leibel, an obesity researcher at the University of Columbia, told The New York Times that the body controls the number of fat cells as carefully as it controls the amount of fat. When a fat cell dies, it grows a new one to replace it.
I question this. Maybe it isn't the total number of fat cells that changes, but what gets stored in existing ones.

If (or since) fat accumulation is hormone-driven, it seems likely that removing a bunch of fat cells and the supporting matrix in certain areas would not change the tendency of an individual to accumulate fat. Since the fat accumulation can't go to the old places, it goes to new places where (previously less full) fat cells still reside--that is, without dietary intervention.

I'm wondering if that fat accumulation process, post-lipo surgery, could be headed off by LC eating, for a much better and long-lasting result.

By the way, cutting down on carbs doesn't allow for targeting specific areas of fat accumulation. The 10-15 lbs. of fat I have left are located, as they have been since puberty, in my butt and thighs. No amount of exercise, dietary adherence, or whining seems to alter the unusual proportions of my body. Lipo would be tempting if it weren't so expensive--and, I believe, hazardous.
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  #4   ^
Old Tue, May-03-11, 06:02
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WereBear WereBear is offline
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This confirms the reports lurking about that men who get lipo grow the fat back; on their pecs.

I'm not trading the fat on my behind for fat on my stomach.
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  #5   ^
Old Tue, May-03-11, 06:51
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katoman katoman is offline
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Quote:
Originally Posted by WereBear
This confirms the reports lurking about that men who get lipo grow the fat back; on their pecs.

I'm not trading the fat on my behind for fat on my stomach.
So very much my opinion as well! What's crazy is even without the above report, I was telling my husband this same information. So, if I ever considered lipo, nearly every other part of my body would need to be tackled in order to focus the fat accumulation to my frontal counterweights.
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  #6   ^
Old Tue, May-03-11, 16:04
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kindke kindke is offline
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Quote:
Originally Posted by bkloots
I question this. Maybe it isn't the total number of fat cells that changes, but what gets stored in existing ones. .



Indeed, Mr Leibel needs to slap "adipocyte apoptosis" into the search field in pubmed.
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  #7   ^
Old Mon, Jul-04-11, 11:09
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Angeline Angeline is offline
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Default Liposuction and Fat Regain

If body fat really is actively regulated by the body, rather than just being a passive result of voluntary food intake and exercise behaviors, then liposuction shouldn't be very effective at reducing total fat mass in the long run. People should return to their body fat "setpoint" rather than remaining at a lower fat mass.

Teri L. Hernandez and colleagues recently performed the first ever randomized liposuction study to answer this question (1 ). Participants were randomly selected to either receive liposuction, or not. They were all instructed not to make any lifestyle changes for the duration of the study, and body fatness was measured at 6 weeks, 6 months and one year by DXA.

Rest of post here

So basically, suck fat out of thighs and it comes back on your belly. The comments were interesting as well.
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  #8   ^
Old Tue, Jul-05-11, 06:09
M Levac M Levac is offline
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Well, Taubes showed us that fat tissue is regulated primarily by insulin.

As insulin does its job, it is cleared from the bloodstream, and its level drops. If there's fewer fat cells, then insulin is cleared more slowly, its level drops more slowly or remains higher than otherwise. Liposuction removes fat cells. The higher insulin level will have that much greater effect on the remaining fat cells, and they will grow bigger as a result.

Lipodystrophy due to injecting insulin in the same spot for years is basically the same thing. Fat tissue where insulin is injected grows bigger due to the higher chronic insulin level locally.
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  #9   ^
Old Tue, Jul-05-11, 10:27
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kindke kindke is offline
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Quote:
Originally Posted by M Levac
Lipodystrophy due to injecting insulin in the same spot for years is basically the same thing. Fat tissue where insulin is injected grows bigger due to the higher chronic insulin level locally.


Alot of people in the blogosphere have abandoned the idea that insulin causes hypertrophy of fat cells and instead have returned to the notion that its all about calories.

However Lipodystrophy at insulin injection sites presents a paradox, if calories really is the bottom line, why does this happen?
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  #10   ^
Old Tue, Jul-05-11, 10:34
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Angeline Angeline is offline
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I think the calories in/calories out has been thoroughly discredited by Gary Taubes. I don't understand how anyone could go back to that. Personally I think there is more to it than just insulin and carbs, and that we simply don't understand the full picture yet. But I am quite certain it's not a question of calories in/out.
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  #11   ^
Old Tue, Jul-05-11, 10:39
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costello22 costello22 is offline
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Quote:
Originally Posted by Angeline
The comments were interesting as well.


I read through the comments and was a little confused. I thought this blogger - Stephen Guyenet? - was pro low-carb. But he was arguing that high insulin - either post-meal spikes or chronically elevated - wasn't the problem in obesity. Someone mentioned his recent change in views. I poked around a bit on his blog, and it seems he's going down the food reward causing obesity road.

I don't know. In the bad old days I could eat macaroni and cheese, for example, until I literally hurt from being too full, but I wasn't "satisfied." I'd keep shoving more in somehow. Now I stop eating with food on my plate. I have that "I couldn't eat another bite" sensation, something I didn't experience before. The food is still there, palatable and "rewarding," I really want to eat it, but I can't. And not because my stomach is distended. I can't quite explain it. It's an entirely different sensation from the old days.

And once I put the rest of the pork chop or whatever into the dog's dish, I don't think about food again. Back in the old days I'd do the distended stomach pain thing, then 30 to 60 minutes later I'd be making myself a big fat pb&j - sometimes two. Or eating a whole pint of Ben and Jerry's.

I can't quite put my finger on it. There's a difference. And it goes beyond the reward or palatability thing.

On the other hand when I stopped using cream and/or Splenda in my coffee at work, I noticed that instead of having two cups of coffee (in addition to the two I have at home), I sip about half a cup and lose interest. Obviously the fat or sweet taste makes the coffee more rewarding. So there's something to the reward idea. On the other hand I suspect that I was eating less for lunch or dinner to compensate for the additional calories when I was having the extra cream. At least I can say for sure that my weight didn't decrease when I stopped the additional cream.

Is this Guyenet guy a clinician working with obese patients? Has he ever been obese himself?

Sorry for wandering off the original topic, Angeline.
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  #12   ^
Old Tue, Jul-05-11, 10:45
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costello22 costello22 is offline
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Quote:
Originally Posted by Angeline
I think the calories in/calories out has been thoroughly discredited by Gary Taubes. I don't understand how anyone could go back to that. Personally I think there is more to it than just insulin and carbs, and that we simply don't understand the full picture yet. But I am quite certain it's not a question of calories in/out.


I agree with you entirely, Angeline. This is hugely complex. We're a long way from unraveling it.

I also think - and I believe Gary Taubes would agree - that saying a person who is gaining weight is eating more isn't very interesting or helpful. The question is 'why?' Why is she eating more?
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  #13   ^
Old Tue, Jul-05-11, 11:04
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costello22 costello22 is offline
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I'm probably going to get myself into trouble here, because I haven't read through Guyenet's numerous posts on the reward-obesity hypothesis, but I keep coming back to the interview on Madness Radio I mentioned on this forum a couple of weeks ago. It was about drug addiction, but I think it's apropos. The interviewee (whose name I can't recall at the moment) said that the psychological is biological and the biological is psychological.

To say that we overeat because some foods are more rewarding isn't to say that insulin isn't the problem. What is the biochemical or hormonal instigation of that reward sensation? Who's to say that insulin isn't part of that reward system? Or that elevated insulin isn't causing the "itch" that creates that rewarding sensation when we scratch it? Can we call that itch "hunger"?

(And you aren't going to convince me that once insulin is elevated, you're going to gain weight and/or have trouble losing.)

We run into problems when we try and separate the mind and the body. They're part of one system, and that system is biological. We like to kid ourselves that we can have mind over matter, but it seems to me that the only way to do that is to use our mind/intellect to try and create the most favorable environment possible for ourselves. Too many of us here can testify to the insatiable hunger that accompanies (over)eating sugar and highly processed carbs.
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  #14   ^
Old Tue, Jul-05-11, 11:23
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Angeline Angeline is offline
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Wander away, this forum is pretty relaxed about such things, and that's a good thing I think.

I don't think Guynenet was ever obese and he's not working with patients. He studies the neurobiology of body fat regulation. So his credentials are pretty good, and I would tend to at least consider what he says, since he doesn't seem to have any agenda.

I think that we are just starting to look at the field of body fat regulation properly, after years of being lost in the ( lipid hypothesis) woods. We have lots of lost opportunities and dead ends to make up for. I know for sure that we don't have the full picture yet. The field is evolving. So I'm keeping my mind open.

So it might be that he is on to something, but that there is more to the story.
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  #15   ^
Old Tue, Jul-05-11, 12:01
Jay1988 Jay1988 is offline
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Quote:
Originally Posted by costello22
I read through the comments and was a little confused. I thought this blogger - Stephen Guyenet? - was pro low-carb. But he was arguing that high insulin - either post-meal spikes or chronically elevated - wasn't the problem in obesity.

Does one have to be pro low-carb and believe the lipophilia hypothesis 100%? I am pro low-carb mainly because it has a good track record for health, whatever mechanism it does so I don't really think is monofactorial (insulin), though I agree that insulin plays a pretty big role in fat storage, but to say that fat storage is an insulin-only issue is something I'm not willing to accept unless you can explain every example of weight loss/gain.
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