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Doctors have long suspected that excess fat around the belly—as opposed to the thighs or hips—increases the chances of developing heart disease, high blood pressure and diabetes. Apparently, abdominal fat doesn't just lie there and jiggle. It actively promotes ill health by, among other things, pumping out inflammatory proteins and interfering with the body's ability to use insulin.

So it seemed plausible to many physicians that surgically removing belly fat by liposuction could give patients a double benefit: a slimmer physique and a better metabolic profile.

That's why there was such disappointment with the news, reported recently in the New England Journal of Medicine, that unlike losing weight the old-fashioned way—by eating less and moving more—liposuction makes no difference in a person's biological risk factors.

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Researchers in St. Louis, Missouri, and Rome, Italy, conducted extensive tests on 15 obese women before and three months after they underwent liposuction. "We removed 20 to 22 lbs. [9 to 10 kg] of fat from each patient," says Dr. Samuel Klein, director of the Center for Human Nutrition at Washington University in St. Louis. That's twice as much fat as is usually removed. The women were instructed not to diet or exercise more until the experiment was over. All reported that they felt better and could move more easily after surgery. But with respect to their metabolic risk factors, Klein says, "the data after the procedure were identical to the data before the procedure."

How is that possible? Liposuction does not remove the fat cells found in the liver or the muscles, or the so-called visceral fat that surrounds internal organs. Nor does liposuction reduce the size of any remaining fat cells; large fat cells appear to produce more harmful proteins than do small ones. Some doctors believe the results would have been better if the patients had been only a few pounds overweight. In any case, the best way to shrink fat cells is still to create a negative energy balance by—you guessed it—eating fewer calories than you burn.

Disappointing as this study might be, there is hope for folk who struggle with weight. It's becoming increasingly clear that even modest weight loss—even as little as 5%—can lead to real improvements in your health. The more you lose—and keep off—the better. But you don't have to get all the way back to normal weight. Most of us will never see a model-slim figure in the mirror. But we can all lead healthier lives.

• Christine Gorman
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