Physiological basis for liposuction
Generally speaking the first reason TO LOSE WEIGHT is to improve the contour of the body. In other words, the basic goal of a program of reduction of weight is cosmetic, and not to take weight off. But in spite of the physical torture and the mental distress that accompanies regimes for weight loss, certainly there are no guarantees that those centimeters will be lost in the most annoying zones. In other words, the success in the scale is not always seen in the mirror the way you wish.
A revision of the evidence available concerning the fatty tissue and the effect of the diet and exercise on its metabolism, shows the deceit with respect to the weight loss, and shows that when seen from the biological and physiological point of view of the fat, Liposuction is really the most rational proposal to the problem body fat modeling and distribution. It is important, for the liposuctor surgeon, to know clearly the bases of fat metabolism, to advise to the candidates of Liposuction about the appropriate nutrition and exercise regimes, although auxiliary personnel could be used for a better educational management in this area.
The interest for body modeling and loss of weight are one of the greater concerns of our society, almost an obsession. A survey to 33,000 women was made, although only 25% of them were really exceeded in weight (the majority minimally), 75% of them felt too fat. The area of greater concern was the thighs, 72% of them were displeased with this part of their body. In addition, 64% were displeased with their abdomens, and 61% with the region of the hips.
The interest for weight loss begins in an early age. A study of young women (before the 20 years) showed that although single 14% were really with overweight, 48% felt that she were very fat. Of this group, 52% became involved with diets and 14% experienced self inducted vomits after eating. Interestingly, a survey indicated that one of each eight women have had one or more symptoms of nervous anorexia.
The real base for the obsession with the obesity is not the weight himself, but the FAT DISTRIBUTION like more important determinant of the corporal modeling. Is useful to review some basic principles that allows the understanding of the effect of the nutrition, exercise, and liposuction in the metabolism and fat distribution.
It is important to understand that the fatty tissue is not merely a passive receptacle for fat deposits, but that is a metabolically active organ that has a fundamental function in the regulation of the energetic balance and its own metabolism. The adipocites or fat cells proliferate quickly during the last trimester of pregnancy continuing their growth until the childhood, diminishing at the end of the adolescence. Nevertheless, its size could be enlarged during the adult life. Once formed, it seems that the fat cells do not die. During life, the cells change of size as it varies the accumulation of fat, but although they lose all their content, they remain metabolically active.
Until now one thought that new fat cells were not developed in the adult life, but recent evidences suggest that under certain conditions, the number of them can increase derived from the mesenquimatic tissue. A previous condition for this increase is the depletion in the filling capacity of the existing cells. The exact magnitude of the required stimulation is not known. Once formed, they persist through life forming part of the population of fat cells of the individual. Since these cells are metabolically active and participate in the regulation of the metabolism and fat storage, the expansion in its number would impair to that patient who looks for reducing the fat content of his body, since they will not disappear spontaneously.
Corporal Composition
Since corporal shape is better correlated with the corporal fat composition and the fat distribution pattern with the corporal weight, is useful to understand the methods to determine the corporal composition.
The standard tables of height/weight to determine the ideal or desirable weight, so widely known, are of little utility by their poor correlation with the percentage of corporal fat. Many athletic individuals register an overweight in these tables in spite of his under percentage of corporal fat, since the muscle weighs considerably more than the fat.
One of the techniques most exact detectors of obesity is the “pinch test”. Nevertheless, the best method of determination is to calculate the percentage of corporal fat. Then, using recommended values (13-15% for men; 25-27% for women), one can determine the amount of kilos of fat that must be lost to obtain the desirable weight.
The most exact method to determine the percentage of corporal fat is the hydrostatic weight. Unfortunately this technique requires techniques of laboratory no available for most of the people. The most usually used technique measures the thickness of skin fold, of course it requires special calibers and the necessary skills.
A simple and reasonably precise method of determination of the percentage of corporal fat is the measurement of the corporal circumference in three areas. With these measurements referred to a table, some constants are obtained to be used in an arithmetical equation and so obtain the percentage of corporal fat.
Unfortunately, a great number of motivated individuals that reached their wished weight find impossible to solve the defects of body shape, even being involved in regimes of diet and exercises. This problem also happens by the genetic differences in the fat distribution (familiar fat distribution pattern), this observation contributes to the base for the biological justification of surgical liposuction.
Little is known about the familiar fat distribution pattern, unless it is under a strong genetic control. It is known that the fat distribution also changes with the sexual hormone levels and with the aging. Four basic patterns are described:
1. Mediterranean type: the fat tends to deposit in hips and thighs.
2. Nordic type: in the inferior abdominal region.
3. Asiatic type: in superior the thoracic and abdominal region.
4. African type: in buttocks.
Nevertheless the great variations and combinations of the familiar fat pattern give to this classification a limited academic use.
In general, it can be classified in two main types:
1. Android or Central Type: the fat is accumulated preferably in the trunk
2. Ginecoid or Peripheric Type: the fat is accumulated preferably in the extremities.
Of great clinical importance it is the finding that the Android or Central Type is associated to a significantly high risk of diabetes, hiperlipidemia, and cardiovascular diseases. Recently, the CAT (Computer Axial Tomography) has proven to be a valuable method of determination of the FAT distribution. Studies using this technique have shown that many men exhibiting a type android of obesity centrally accumulate a considerable percentage of their located fat, as much in the abdominal cavity as in the subcutaneous tissue. This intrabdominal fat, of course, is not accessible to the liposuction cannula, therefore the benefit that liposuction can offer in this type of patients is minimum. The intrabdominal fat seems to deposit itself preferably in the superior abdominal cavity, many men with this problem also develop subcutaneous fat deposits in the infraumbilical region. The deposits of great amounts of intrabdominal fat give like result the laxity of the abdominal musculature, adding another factor that limits a liposuction.
Set Point Mechanism
Many candidates for a liposuction are surprised when finding out that the corporal fat has an important biological function. The function of fat deposits is for providing a reserve of energy to be used during the times of shortage. While this circumstance is rare in the western society, primitive men, as well as other members of the animal kingdom, dedicate a majority of their time to hunt and to look for food to eat. Those individuals that could store great amounts of corporal fat during good times of food, acquired a clear advantage for the survival during times of hunger, pestilence, and contamination.
The fat storage is a so important biological function that the body has a mechanism of Internal Greasy Monitoring which tries to maintain a constant corporal fat level. This system, commonly call Set Point Mechanism, includes complex interactions between a Central Controller, called Fat Thermostat, and the periphery. An important component of the peripheral part of the system is the adipocite itself. Although the method of communication between the central and peripheral components of the Set Point system has not been clarified, is suspected that the adipocitos relay information respect to their degree of satiety by biochemical mediators. Possible chemical messengers include the Lipoproteinlipasa enzyme, which divides the triglycerides stored in fatty acids and glicerol that is freed to the circulation. Some experiments suggest that the glicerol would serve like another chemical messenger.
The Set Point mechanism controls primarily the mobilization and use of fat for the power metabolism by the alteration of the Corporal Power Expense. During the caloric deficiency, the basal metabolic rate (which explains 70% of the daily power use) is diminished until the 25-30% to compensate the reduction of the caloric ingestion. The Mechanism Set Point also directs a reduction in the levels of spontaneous activity in order that additional energy is conserved. This is seen in the fatigue and lethargy that many individuals experiment in a rigorous reducing diet.
Although the Mechanism Set Point this under a strong genetic control, evidences suggests can be altered by the diet and the exercise.
Why Fails the Reducing Diets
An understanding of the concept Set Point gives the biological base of the failure of most of the reducing diets. Statistics show that more of 90% of individuals that lost weight with reducing diets, recovered everything or more within the 2 years. Since the body cannot really distinguish between a strict reducing diet and the hunger introduced by the environment, it does not surprise that the reducing diets imply a useless battle against the Set Point Mechanism. When the body faces a reducing diet, spontaneously lowers the rate of basal metabolism, as much as the levels of spontaneous activity. In the initial stages of a diet the fat deposits are not mobilized, but are really conserved. Initially are used the deposits of corporal glycogen, and as each molecule of glycogen needs 3-4 molecule water, the depletion of both is associated with a fast loss of weight during the first days of the diet. As the glycogen deposits exhausts, the muscular protein is mobilized rather than the corporal fat deposits.
When finally the fat deposits are mobilized, the empty fat cells are first in storing fat when an excessive caloric exceeding. Experiments demonstrated that laboratory animals without caloric ingest, can create fat deposits 20 greater times, compared with satiated ones of the same genetic constitution. These findings provide the physiological bases for the yo-yo syndrome that is the loss of weight followed with a fast recovery.
Due to the metabolic changes induced by the Set Point Mechanism, participants of a program of weight reduction do not experience the loss of weight arithmetically foretold by the equation of the power balance (ingested calories - lost calories = grams of stored fat, divided 9). Unfortunately, the weight loss of is slower.
Although many diets give as result an important loss of weight, in many cases this does not have relation with an improvement in the corporal shape, which is generally the main factor of motivation. Recently differences explained in the fat metabolism in different subcutaneous deposits clarify these clinical observations. There are noticeable differences in the metabolic activity of the abdominal and femoral fat cells in women and the differences in this metabolic activity are more pronounced during fast. The result of these differences is the preferred fat mobilization from the abdominal region preserving the femoral fat deposits. This evidence suggests that fat deposits can be of two different types, metabolically active sites and reserve sites.
The resistance of the fat of reserve to the regimes of weight reduction provides the greater biological justification for the alteration in the distribution of the corporal fat by means of Surgical Liposuction.
The role of the Exercise in the Programs of Weight Loss
The second component of most of the programs of reduction of weight is the exercise. Until recently, the exercise played a secondary roll the diet in the loss of weight because of two erroneous basic concepts:
1. - the exercise must be strenuous and prolonged to be effective in causing the loss of weight.
2. - the exercise increases the appetite and this way it annuls some gained benefit of the caloric use.
The Renaissance of the medical fitness, nevertheless, has precipitated a number of investigations respect to the exercise, and the results have proven that this ideas are false. In fact, the exercise probably is the component of greater importance of a reducing regime for successful weight loss. Without paying attention to the extension or duration of the exercise, it consumes calories and in addition is cumulative. Although the strenuous exercise and prolonged increases the food ingestion, studies of participant individuals in such activities showed that although they ingested an average of plus 20% calories per day, its weight is 25% less than its sedentary counterparts.
Perhaps, the most important benefit of the exercise from the point of view of the reduction of weight is that it produces an increase of the rate of basal metabolism. The importance of this increase is the one to counteract its descent induced by the caloric deprivation. The exercise preserves (and in many cases it increases) the thin muscular mass. The regular aerobic exercise produces an increase in the number of burning fat mitochondrias by gram of muscular tissue, observations that have been proven by muscular biopsies. There is considerable evidence that the regular aerobic exercise, lowers the mechanism Set Point.
An important part of the benefit of the regular aerobic exercise in a program of reduction of weight is the increasing of the cardio respiratory capacity.
To be effective in the increase of the fat consumption and in the improvement of the cardio respiratory state, the exercise must be of aerobic type. This implies a rhythmical prolonged activity of long muscles of the legs and arms, like a fast long walk, jogging, swimming, oar or cycling. Investigations demonstrated that to induce to the cardio respiratory state, the exercise must elevate the cardiac rate for 12 to 15 continuous minutes. Nevertheless, it must be prolonged to induce to the required metabolic changes for the increase of the fat oxidation. Investigations demonstrated that to benefit in the reduction of weight, the exercise must be the sufficiently long and intense to demand 300 calories if done 3 times per week, or 200 calories if done 4 times per week. Exercises that demand more calories, of course, will increase the rate of loss of fat.
An important aspect of the fat reduction by means of the exercise is the findings that in laboratory animals, the internal fat deposits can quickly be mobilized than the subcutaneous ones. This is particularly significant in men who have great intrabdominal deposits.
At least 2 months of this combined plan of diet and exercise are necessary to improve the muscular metabolic capacity. When this combination is made, the loss of weight is 85% of fat, when it is by expenses of diet solely, 70% of fat and 30% muscle. The importance of this is in which once loss, is difficult adult them to recover the muscular mass. Most of the weight recovered after diets in adults is fat instead of muscle, so after a series of no successful diets, the percentage of corporal fat in adult frequently increases. Given for sure that the muscular tissue is the predominant one used for energy, this has serious meanings for adults who try to lose weight by diets solely.
In spite of considerable scientific evidences for the opposite, the myth that is possible to mobilize selectively greasy from corporal areas by exercises of those located regions, persists in the mind of many people. Abdominal fat biopsies, after vigorous and prolonged exercises of abdominal muscles, demonstrated that the fat was not mobilized on those muscles. Others made in arms of tennis players, did not show fatty tissue differences between dominant and the no dominant one. These studies prove that for the subcutaneous fat mobilization the exercise must be aerobic instead of regional. This does not clear value to him to the located exercises which improve the tone of the exercised muscles, specially the abdominal ones, improving the corporal shape.
Unfortunately, although the exercise is of considerable value for the reduction of the corporal fat, such percentage of reduction often is not transferred to cleared centimeters of the areas problems. At the same time, in the cases of lost fat induced by diet, the pattern or sequence of subcutaneous fat mobilization from several regions is under a strong genetic control. These observations give the physiological justification for Surgical Liposuction.
Effect of the Diet and the Exercise in the Set Point Mechanism
Although the Seth Point is under a strong genetic control and this varies from person to person, evidences suggest that an appropriate nutrition and exercise plan, low the Set Point. While the effect of the nutrition on the Set Point varies from person to person, it is important that individual with intentions to make programs of reduction of weight understand the basic operation of the Set Point System and made an effort to be in harmony with this, instead of fighting against his powerful defenses.
Present evidences suggest that not all calories are created same way. One of the basic principles of old nutritional theories, maintains that without paying attention to the type of the ingested food, the organism deals with one calorie indifferently form of its source. In other words, eating 100 calories in fresh vegetables would produce the same effect as eating 100 calories a pizza form loaded of fat. Experiments demonstrated nevertheless, that animals can efficiently extract and store calories from rich fat meals more efficiently that from other sources. Animals showed that an increase in the fat content of the diet results in increase of the weight compared to others fed with low fat diets both with an identical number of calories. The animals that stabilize these elevated weights by means of increasing their corporal fat deposits, under experimental stress eat spontaneously the precise amount of food necessary to maintain this new weight. That is to say, these animals elevate the Set Point and they maintain it by alteration of his nourishing and metabolic answers to the changing conditions of the environment.
Which is the biological intention to elevate the Set Point induced by diet? The animals dedicate a great percentage of their daily activity to hunt to have food, and if a possibility offers them the possibility to consume an excess of calories, particularly of high density, like fat, they willingly do it. If in his natural environment had found food with greater caloric density than its normal food, it would be very valuable for its survival if the Set Point Mechanism of the animal could rise to allow consuming more food than he would normally eat.
Animal laboratory studies showed that the regular aerobic activity lowers the Set Point. The exact mechanism is not known, but in animals and men who made moderate exercises in regular form the stored corporal fat was reduced, therefore lowering the weight. Individuals that make regular aerobics exercises (walking), at least 30 minutes per day, 5 times per week, gradually lose weight although they do not make diet.
The effect of the exercise on the Set Point, nevertheless, seems to vary significantly from a person to another one just like other biological variables. In other words, the fat mobilization due exercise varies tremendously between individuals even when they follow similar programs of diets.
Some investigations suggest that the number of fat cells accumulated by any person could be an important factor to determine the effect of the exercise on the Set Point, those with more fat cells require more vigorous or sustained activity to produce a remarkable effect. This attractive theory although has not been proven.
Observations of the relation between the weight and the inactivity, suggest that physical activity is necessary for a normal power balance. In general, wild animals get fat when they are prepared to hibernate or to emigrate. While they are prepared they diminish his activity noticeably while they eat as much as they can. It seems as if this inactivity served like a signal to accumulate corporal fat. In a similar way, these animals in captivity get fat when their levels of activity diminish. Many scientists suspect that the organism perceives that the inactivity means that a new food source has been and responds rising the Set Point increasing the deposits of this fat energy available as to increase the energy stored for the use during times when the food is scarce.
Certain drugs as nicotine and amphetamines were considered as an aid for reduction of weight by direct influence and descent of the Set Point. The individual that quits smoking experiences increases the weight in an average of 8 10 kilos. In the case of amphetamines, so soon they discontinue its use, returns quickly to the previously normal point, suggesting that the Set Point returns to the normal levels after quitting. The possible adverse effects of these agents, of course, prevent their use as a help in reducing the corporal weight.
Diets
Even though the discussion of an appropriate nutrition and diet is beyond of the reach of this report, patient surgeons who advise to their respect to liposuction would have to be found out its basic principles. The key word is balance. To be successful, it must be a commitment of all the life, and like most of the popular diets are not balanced, they are sentenced to fail. Most of these novel diets variations are just “remakes” of previous diets describe by professionals based on "new scientific advances".
In opposition to this, there are no evidences that no food or combination of these has some effect in burning fat. Unfortunately, most of these diets finally fail for being dull or boring. The goal of the diets would have to establish persistent healthful nutritional habits by life. This requires to be flexible and tasteful, that is to say, balanced. In the popular diet average, the amount of ingested calories is the 40-50% in fats, the 40-50% in carbon hydrates, and the 10-20% in proteins. Most of the specialists on the subject agree that the best composition is the 60-70% in carbon hydrates, 20-30% in fats, 10-15% in proteins. Experimental observations demonstrated that the composition of the diet is as important as the number of ingested calories. The originated calories from fats or refined carbon hydrates are easily stored in the organism like fat, and evidences suggest rich fat diets elevate the Set Point.
Nutritionists recommended saturated fats only in a third of the total fat ingest. Recent evidences indicate that monosaturated fat (olive oil, etc.) are so effective or perhaps more, in descending the relation from lipoproteins of low to high density, that the polisaturated fats. Most of carbohydrates would have not to be refined since, are quickly absorbed to the circulation, elevating in the same way the levels of glucemia stimulating the Insulin release, which descends the levels from glucose and stimulates the triglycerides synthesis, stimulating hunger. The compound carbohydrates are digested and absorbed of slowly, varying the levels of glucose and the insulin liberation. Fibers that accompany refined carbohydrate help the satiety production, accelerating the gastrointestinal pass, facilitating the diminution of the absorption of calories. The level of calories of an appropriate diet would have to be calculated in such a way that the loss of weight does not exceed 1 or 2 kg. per week. A faster weight loss, would stimulate the defenses that produces hunger.
Conclusions
Many individuals can change the form of their body by means of the accomplishment of a rational program of diet and exercise. Many more, nevertheless, will never be completely satisfied with the results on these attempts and will experience a constant battle with the recurrent located fat. The resulting frustration causes that they are easily victims of the schemes of loss of weight and programs of corporal modeling, with which the society constantly is bombed. Even and educated, intelligent and rational people succumb to the temptation of those promotions, because of the general obsession with the corporal form and a powerful desire to model the body quickly to make it attractive.
Surgical Liposuction is really justified from a biological and physiological point of view regarding the disposition of the located fat and its answer to the plans of diets and exercises. In contrast with diet them in which the fat cells shrink in accordance with the fat mobilization, the success of Liposuction sets in the extraction of the adipocites. Thus, Liposuction offers an extraction located and controlled of fat cells, in opposition to the certain pattern biologically of greasy mobilization induced by diet and programs of exercise.
But Liposuction must be located in an appropriate perspective. Without a doubt, it is not a license to eat everything wanted for the rest of the life. On the contrary, it would have to be part of a triple attack to the fat location, together with an appropriate diet and a program of exercises. For many people it is a powerful factor of motivation to make and to maintain such program.