The biology of adipose (fat) tissue has recently become an important topic for research especially as it relates to the aging process and hormonal imbalance.  Much has been made recently of using liposuction as a possible treatment for diabetes mellitus type 2 as well as a proposed treatment for high cholesterol and hyperlipidemia.  Even though the research has been effective there is simply no evidence that reducing body fat by liposuction in any way effects blood sugar, insulin, or blood lipid profiles even though it is shown that a significant reduction in external body fat can be achieved with high volume liposuction procedures.  It only makes sense that there must be hormonally and biologically active adipose tissue in parts of the body not accessible with liposuction.  It remains true that when diet and exercise are used for fat/weight reduction one does get an improvement in overall health as well as overall blood chemistry profile.  To reconcile these facts one only has to know that there is a vast store of biologically active fat located within the abdominal cavity known as visceral fat.  Visceral fat is that adipose tissue located around the abdominal organs such as the liver, pancreas, adrenal glands, and kidneys.  As such it is not available for mechanical removal by liposuction and can only be addressed through diet and exercise.  It has been shown that visceral fat is very sensitive to exercise including weight training.  It’s a little uncertain as to the teleological reasoning for the existence of visceral fat, but it seems clear that there is a genetic component as well as a lift-style component to visceral fat.  Visceral fat has been linked to certain metabolic disturbances and an increased risk for cardiovascular disease, type 2 diabetes, and gall bladder disease.

How do we tell the difference between visceral fat and the subcutaneous fat associated with a “fat stomach” or the middle aged spread?  As a rule, subcutaneous fat can be pinched between the fingers while the visceral fat causes the stomach to be round but cannot be pinched.  In fact, one of the reasons for unhappy liposuction patients is that this distinction between subcutaneous fat which can be liposuctioned and visceral fat which cannot be removed is not made clear to patients pre-operatively.  We do ask all of our liposuction patients to diet and exercise post-operatively so an improvement in abdominal shape should follow as visceral fat will be improved by exercise and diet alone.

The complexity of adipose tissue is just now being totally realized including the fact that adult adipose tissue is the body’s largest repository for multi-potent stem cells.

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