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Plastic Surgeon researchers at the University of Sao Paulo in Brazil followed 36 normal-weight women who had liposuction to take away a small amount of superficial tummy fat. Beginning 2 months after surgery half of these women were placed on an exercise program (walking on a treadmill and doing light strength training 3 times a week), while the rest stuck with their usual lifestyle. None exercised regularly before surgery.
Four months later the women who did not exercise still had flatter tummies, but they had 10% more fat around the organs inside the abdomen. The women who did exercise had no such gain in this visceral fat. This the the first study showing increases in visceral fat after liposuction if you do not exercise.
Visceral fat is particularly undesirable because it's more closely connected to the risks of type 2 diabetes and heart disease, versus the superficial abdominal fat just under the skin. Visceral fat is by its very nature more resistant to insulin than superficial fat under the skin. That means it more readily releases its fat in the form of free fatty acids into the blood stream. These free fatty acids then clog the arteries creating atherosclerosis, heart disease and high blood pressure and make the body insulin resistant over time. Since even thin people who are not overweight can accumulate fat around their internal organs this explains why some diabetics are not overweight. Other studies have shown that removal of large amounts of subcutaneous fat from the abdomen by liposuction in diabetic and non-diabetic individuals does not improve insulin sensitivity in muscles, liver or fat, and does not change the blood levels of circulating inflammatory proteins. It also does not change blood pressure, blood sugar or insulin levels or the profile of fat/cholesterol in the blood. Lifestyle changes involving dieting and exercise however have been proven to incite these healthy changes in the internal milieu of the body.
You can also conclude from this that patients who are obese and try liposuction for weight control are actually endangering their health if they do not exercise or change their diets after liposuction because they will end up with even more fat around their organs. The best candidates for liposuction are normal weight to moderately overweight, and already regularly exercise. It is very important, if not essential, that patients exercise after liposuction.
In the U.S., about 204,700 people underwent liposuction in 2011, according to the American Society of Plastic Surgeons. That was down 42 percent from a decade before.
Aaron Stone MD - Plastic Surgeon Los Angeles
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