Dr. David Katz
Photo: Mackenzie Stroh
Q: If belly fat is a risk factor for heart disease and diabetes—and that's the only place you're really carrying the weight—can liposuction reduce your risk?
Judith Franks-Farah, Buffalo Grove, Illinois

A: There have been a couple of studies suggesting that heart disease risk factors improve after liposuction—the effect seems pronounced when the weight loss is maintained over months. Unfortunately, there is even stronger research suggesting the procedure has very little immediate influence on risk. And while there is some indication that patients are more likely to adopt a healthier lifestyle following surgery—perhaps to protect their investment—I wouldn't advise undergoing the procedure.

Belly fat does raise heart disease risk, but it's not just the visible stuff that's the problem: A spare tire is an outward indication of fat deposits in vital organs—the liver in particular. And a fatty liver seems to spur insulin resistance—a precursor to diabetes—and increases the risk of heart disease. Liposuction takes only the fat just under the skin.

If you lose weight the old-fashioned way—by exercising or cutting calories—you shed fat from both your vital organs and under the skin. My other problem with liposuction is that it's a surgical procedure that carries plenty of risks of its own, such as a bad reaction to anesthesia, infection, puncture of surrounding organs—the list goes on. Liposuction is a cosmetic procedure, not something you do for health.

Let me make one last distinction: Gastric bypass surgery is different from liposuction. Because gastric bypass changes how many calories your body can absorb, it causes fat loss everywhere, including in the vital organs. Recent studies show quite convincingly that gastric bypass extends life in people who are very obese.