BIG STORY: Doctors can now remove internal abdominal fat

[Guest guest]

There was a report on Good Morning America this morning about an experimental procedure being used by doctors at Beth Israel Deaconess Medical Center in Boston. They are able to remove deep abdominal fat that is nestled next to internal organs. Dr. said that they have done this procedure on four patients so far.

Here is an article that I was able to find online:

http://abcnews.go.com/sections/GMA/Dr/Abdominal_fat_surgery_040513-1.html

Straight to the Source

Doctors Remove Woman's Abdominal Fat to Help Control Diabetes

ABCNEWS.com

May 13, 2004— Ginny Boddie has struggled with her weight since college, but she'd always considered herself active and healthy. Two years ago, all that changed.

"I was just extremely fatigued and I remember my brother saying some of the symptoms I was feeling were the same that he had when he became a diabetic at the same age," said Boddie, now 50. "And I was worried about it." Blood sugar tests confirmed what Boddie, who lives in Weymouth, Mass., had feared. "I stood over that machine praying that it was going to be within normal limits -- and so I knew when I saw it I was in trouble," Boddie said. "I knew that it was not a good thing." Like 15 million other Americans, Boddie had become an adult-onset diabetic, at risk for complications ranging from heart disease to blindness. But doctors tried something that Boddie says changed her life, and got her diabetes under control. They surgically removed some of her abdominal fat. Danger of Abdominal Fat

Doctors have long known that people who are overweight, like Boddie, are at increased risk for diabetes. But recently, they have learned that fat in the abdomen may be particularly dangerous. "We know that when patients put on that type of fat, the abdominal fat, they tend to run into problems with blood sugar control and diabetes," said Maykel, a chief resident at Beth Israel Deaconess Medical Center in Boston. When a CAT scan was done on Boddie, doctors were able to actually measure the abdominal fat nestled next to her internal organs. Doctors think this "internal" fat releases chemicals that contribute to diseases including diabetes, even heart disease and stroke. So doctors offered Boddie a unique opportunity. They asked her to be the first patient in the United States to have part of her abdominal fat removed surgically, in the hope of keeping her healthy longer. A Life-Changing Removal

Though she understood the risks, she accepted. "I was encouraged that there would be something that might help me that would eliminate some of the complications and I wouldn't have to live on all sorts of medications and be constantly worried about my diabetes," Boddie said. "Heck, anything you could do that was going to prevent later complications of diabetes later in your life was definitely worth the risks involved." Using tiny instruments inserted through small incisions in the stomach, Boddie's doctors were able to enter the abdominal cavity and remove a 3-pound layer of fat that covered her internal organs. Doctors are cautious, but Boddie says that removing some of her internal fat has changed her life. She eats a normal diet and no longer considers herself a full-fledged diabetic. She has lost about 20 pounds. "I know that I have to be concerned, but it isn't a major focus of my life anymore," Boddie said. "I know that it's still out there and I need to be careful, but I don't worry about my diabetes 24 hours a day." Fat Isn't Lazy

Doctors say that growing evidence shows that fat doesn't just sit there in the body. It actually serves as an endocrine organ. "It is now more clear that fat is not just a simple storage depot, but it is an active endocrine organ," said Mun, a surgeon at Beth Israel Deaconess. "Fat cells release enormous numbers of mediators or hormones-and this is essentially the key organ now that controls our appetite and metabolism. It controls our sugar levels as well as cholesterol." As abdominal fat builds up, it is perhaps more dangerous in terms of leading to high-risk diseases such as diabetes or hypertension, Mun said. Ultimately it can lead to something like coronary artery disease, or stroke. Doctors say the advantage of the experimental surgery done on Boddie is clear. "The surgical option is a definitive one -- we know that patients diabetes improve with diet and exercise," Maykel said. "The problem is that people fall off their dietary restrictions, and they fall off their exercise regimens pretty quickly. In general, patients who have made a resolution to make these changes, about 80 percent of them have stopped a year out."

[Guest guest]

Scroll down past my original posting for a different and more detailed story about this. I think this is very interesting -- and I wonder if the procedure could benefit people with large abdomens caused by lipodystrophy.

In a message dated 5/13/2004 9:03:22 AM Eastern Standard Time, Get Well writes:

There was a report on Good Morning America this morning about an experimental procedure being used by doctors at Beth Israel Deaconess Medical Center in Boston. They are able to remove deep abdominal fat that is nestled next to internal organs. Dr. said that they have done this procedure on four patients so far.

Here is an article that I was able to find online:

http://abcnews.go.com/sections/GMA/Dr/Abdominal_fat_surgery_040513-1.html

Straight to the Source

Doctors Remove Woman's Abdominal Fat to Help Control Diabetes

ABCNEWS.com

May 13, 2004 -- Ginny Boddie has struggled with her weight since college, but she'd always considered herself active and healthy. Two years ago, all that changed.

"I was just extremely fatigued and I remember my brother saying some of the symptoms I was feeling were the same that he had when he became a diabetic at the same age," said Boddie, now 50. "And I was worried about it."

Blood sugar tests confirmed what Boddie, who lives in Weymouth, Mass., had feared.

"I stood over that machine praying that it was going to be within normal limits -- and so I knew when I saw it I was in trouble," Boddie said. "I knew that it was not a good thing."

Like 15 million other Americans, Boddie had become an adult-onset diabetic, at risk for complications ranging from heart disease to blindness. But doctors tried something that Boddie says changed her life, and got her diabetes under control.

They surgically removed some of her abdominal fat.

Danger of Abdominal Fat

Doctors have long known that people who are overweight, like Boddie, are at increased risk for diabetes. But recently, they have learned that fat in the abdomen may be particularly dangerous.

"We know that when patients put on that type of fat, the abdominal fat, they tend to run into problems with blood sugar control and diabetes," said Maykel, a chief resident at Beth Israel Deaconess Medical Center in Boston.

When a CAT scan was done on Boddie, doctors were able to actually measure the abdominal fat nestled next to her internal organs. Doctors think this "internal" fat releases chemicals that contribute to diseases including diabetes, even heart disease and stroke.

So doctors offered Boddie a unique opportunity. They asked her to be the first patient in the United States to have part of her abdominal fat removed surgically, in the hope of keeping her healthy longer.

A Life-Changing Removal

Though she understood the risks, she accepted. "I was encouraged that there would be something that might help me that would eliminate some of the complications and I wouldn't have to live on all sorts of medications and be constantly worried about my diabetes," Boddie said. "Heck, anything you could do that was going to prevent later complications of diabetes later in your life was definitely worth the risks involved."

Using tiny instruments inserted through small incisions in the stomach, Boddie's doctors were able to enter the abdominal cavity and remove a 3-pound layer of fat that covered her internal organs.

Doctors are cautious, but Boddie says that removing some of her internal fat has changed her life.

She eats a normal diet and no longer considers herself a full-fledged diabetic. She has lost about 20 pounds.

"I know that I have to be concerned, but it isn't a major focus of my life anymore," Boddie said. "I know that it's still out there and I need to be careful, but I don't worry about my diabetes 24 hours a day."

Fat Isn't Lazy

Doctors say that growing evidence shows that fat doesn't just sit there in the body. It actually serves as an endocrine organ.

"It is now more clear that fat is not just a simple storage depot, but it is an active endocrine organ," said Mun, a surgeon at Beth Israel Deaconess. "Fat cells release enormous numbers of mediators or hormones-and this is essentially the key organ now that controls our appetite and metabolism. It controls our sugar levels as well as cholesterol."

As abdominal fat builds up, it is perhaps more dangerous in terms of leading to high-risk diseases such as diabetes or hypertension, Mun said. Ultimately it can lead to something like coronary artery disease, or stroke.

Doctors say the advantage of the experimental surgery done on Boddie is clear. "The surgical option is a definitive one -- we know that patients diabetes improve with diet and exercise," Maykel said. "The problem is that people fall off their dietary restrictions, and they fall off their exercise regimens pretty quickly. In general, patients who have made a resolution to make these changes, about 80 percent of them have stopped a year out."

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http://www.boston.com/news/nation/articles/2004/04/17/visceral_fat_removal_prompts_hope?pg=full

'Visceral' fat removal prompts hope

By Carey Goldberg, Globe Staff - April 17, 2004

The patient was neither obese enough nor desperate enough for stomach-stapling surgery. But he had raging diabetes and a daunting load of the most dangerous fat: the "visceral" kind that surrounds internal organs and swells pot bellies, inviting heart disease and stroke.

So he chose to undergo an experimental operation based on a radical proposition: that simply slicing out a hefty chunk of his visceral fat, by removing a curtainlike fap of internal abdominal fat called the omentum, might help with his diabetes and other health problems. Unlike liposuction, which sucks out fat just under the skin, the omentum operation has no cosmetic effect, and is not aimed at weight loss. Rather, it reflects a mounting push among researchers around the world to understand and neutralize visceral fat, now that a growing body of data is showing that it is more harmful than fat near the surface.

Beth Israel Deaconess Medical Center surgeons, working with obesity specialists at Joslin Diabetes Center, have tried the experimental surgery on four patients in recent months, using a two-hour laparoscopic procedure that involves pulling strips of the yellow abdominal fat out through tiny holes. Their study, still underway, is the first to examine the possible health benefits of removing only the omentum.

Excess fat is the major cause of Type 2, or adult onset, diabetes, which affects about 17 million Americans, more than twice as many as in 1980. If the experiment pans out, it could conceivably give these multiplying millions a one-time surgical solution to replace a lifetime of medication, said Dr. Mun, director of bariatric surgery at Beth Israel Deaconess and the study's leader. But "I think that's a real long shot, and I don't want to speculate that far off," he said.

Doctors have known for decades that top-heavy people -- nicknamed "apples" -- tend to be at greater risk for heart problems and other ills associated with obesity than bottom-heavy people, who are known as "pears." But over the last several years, a spurt of research has built an ever-stronger case against visceral fat, to the point that "we believe that this hidden fat is the most dangerous fat in our body," said Dr. Osama Hamdy, director of the 'Visceral' fat obesity clinic at the Joslin.

"The amount of fat that people accumulate in the central abdominal area is the best correlation" to obesity side effects including diabetes, high blood pressure, heart disease, and high cholesterol, he said.

One of the best ways to detect visceral fat turns out to be the simple tape measure. Men with waists over 40 inches, and women with waists over 35 inches, are likeliest to have problems. "Interestingly, the average American waist has gone up by about 1 inch over the last six years," Hamdy added ominously.

Exercise and weight loss are known to help reduce visceral fat, Hamdy said. But otherwise, there is no established medical strategy for fighting it, he and others said; and except for the omentum, which is relatively free-hanging and makes up roughly one-third of a person's visceral fat, most of it is in hard-to-get-at spots that do not lend themselves to the scalpel. Surgery to reduce visceral fat has been tried in rodents, however, and studies have indicated that when it is cut out, the animal's diabetes improves, the researchers said.

In humans, the most intriguing clues come from gastric bypass surgery: after having the operation, which reduces the patient's stomach to a small pouch, most patients with Type 2 diabetes have been cured. The reason is unclear, but the operation does reconfigure the digestive system to bypass areas heavy on visceral fat. The cure usually comes so quickly that it cannot be attributed to weight loss.

And a 2002 Swedish study indicated that among 50 patients who underwent gastric banding surgery, which also limits the stomach, the half who also had their omentum removed showed much more improvement in their blood sugar readings than those who only had the basic operation. Gastric bypass surgery is radical and a bit risky, however, and is generally approved only for patients who are more than 100 pounds overweight.

The omentum operation could eventually offer a less radical alternative for people who would not qualify for gastric bypass, said Dr. Maykel of Beth Israel Deaconess, who initiated the omentum study.

It has been enrolling diabetic patients with a body mass index between 30 and 40 -- for someone 5 foot 8, that would translate to a weight between 197 and 262 pounds -- and who have heavy visceral fat, as revealed in a CAT scan. The study will track everything from blood sugar levels, an indicator of diabetes, to fat-related hormones in patients, and the researchers hope it will advance basic understanding of visceral fat.

It is increasingly clear, they say, that such fat is not a passive repository of energy, but rather functions as an active organ that emits hormones and other chemicals, some of them harmful. Visceral fat appears to be more metabolically active than surface fat, but much of how it works remains mysterious. The researchers are seeking a total of six patients for this initial pilot study, but they hope the results will be promising enough that they can undertake a larger, longer study to test the operation. The results of the current study have not been analyzed yet and any conclusions are months away, said Maykel.

The researchers believe, he said, that any decrease in the volume of visceral fat should bring benefits. "The question is, what benefit, what degree of benefit, and what will be the long-term impacts?" he said. "It may be the wrong area of visceral fat or not enough -- that's what makes science interesting."

Obesity researchers unconnected with the omentum experiment offered mixed assessments of its chances.

Dr. Walter J. Pories, a professor at East Carolina University and a gastric bypass surgery pioneer, said he believed the omentum operation would prove "an important piece of work" in terms of advancing the understanding of how fat acts on an individual's metabolism.

As for the diabetic patients, "My guess, and it's a straight guess, is that their insulin resistance" -- meaning their bodies do not properly respond to insulin -- "will diminish and that the patients will do better," he said. "Of course, the question is, 'How much?' "

Dr. Nir Barzilai, director of the Institute for Aging Research at Albert Einstein College of Medicine in New York, sounded more skeptical, though certainly intrigued. "I do have a lot of questions," he said.

One of them is, "Can they take enough fat to make an impact?" said Barzilai. His work in aging rats has shown that removing large amounts of their visceral fat could prevent the rats from developing diabetes, but, he cautioned, "The fat in rats and the fat in humans is not in the same place."

The patient with raging diabetes who underwent the operation said his blood sugar fell dramatically as a result and has remained lower, but he has gained back most of the 20 pounds or so he lost in the weeks following the surgery. A 52-year-old Boston Web producer, he asked to remain anonymous to keep his medical details private.

The operation went uneventfully, and he recovered fully within days; there have been no complications with any of the four patients, Mun, the study leader, said. But, the patient said, "It's not a panacea, unfortunately." These days, he is taking drugs for lingering diabetes, high cholesterol, and appetite control, but still carrying about 215 pounds on his 5-foot-7-inch frame.

"I think the jury is out in terms of the long-term benefits," he said. But one thing is clear to him, he said: "I don't think there's an easy way around this. We as a society have to eat differently, eat less, and get off our butts."

Carey Goldberg is reachable at goldberg@....

Dangerous signs

Q. Who should worry?

A. Men with waists over 40 inches and women with waists over 35 inches are considered at particular risk, but even people with seemingly healthy weights may have a problem.

Q. How can you tell if it's a problem?

A. One telltale sign of visceral fat is that it tends to make a belly feel firm, rather than flabby. Doctors generally use a simple tape measure to check waist length, though researchers can use high-tech methods like CAT or MRI scans to examine the innards of an abdomen.

Q. What should you do about it?

A. Exercise helps greatly. Also, weight loss helps, and initial weight loss is often heavy on visceral fat.