Liposuccion ?

The only way to prevent weight regain is diet, exercise, and self-discipline.

One possible side effect after liposuction is the possibility of regaining fat back in different areas of the body, including deep visceral fat which is bad. Since fat cells were removed from a specific area of the body, the body compensates by growing fat cells elsewhere in the body. From what I gather, liposuction does not affect the set point of the body. I interpret this to mean that the set point is controlled and directed by the hypothalamus. Obesity may in fact be a neurological disorder at the root.

I’m going to speculate here:
Generally obese people have lower levels of leptin receptors. It could be genetic where some people are born with the tendency to maintain a high amount of receptors, and it could be environmental where excess energy (calories) causes leptin receptors to be down-regulated. In response to lower levels of leptin receptors, the body increases the amount of adipose tissue so it can produce more leptin. Essentially this is leptin resistance which is low leptin sensitivity. Removing the adipose tissue (i.e. liposuction) does not solve the problem with the leptin receptors. You’d think removing the adipose tissue resulting in lower leptin levels would cause the body to up-regulate leptin receptors to compensate, but this doesn’t seem to happen.

Removing fat or treating obesity is similar to to treating an edema (an abnormal accumulation of fluid in the body) by draining:


Of course, this makes no sense. It doesn’t address the underlying cause of edema and it will not help the patient. Yet we apply that exact same logic to fat loss. Since the amount of energy contained in the body (in the form of fat) depends on the amount entering and the amount leaving, the solution is easy: eat less, move more. Well, yes, if you can stick to that program it will cause fat loss. But that’s equivalent to telling someone with edema to drink less water. It will cause a loss of fluid, but it won’t correct the underlying problem that caused excessive fluid retention in the first place.For example, if you have edema because your heart isn’t pumping effectively (cardiac insufficiency), the heart is the problem that must be addressed. Any other treatment is purely symptomatic and is not a cure.

The same applies to obesity. If you don’t correct the alteration in the system that causes an obese person to ‘defend’ his elevated fat mass against changes*, anything you do is symptomatic treatment and is unlikely to be very effective in the long term…

* The body fat homeostasis system. The core element appears to be a negative feedback loop between body fat (via leptin, and insulin to a lesser degree) and the brain (primarily the hypothalamus, but other regions are involved). There are many other elements in the system, but that one seems to set the ‘gain’ on all the others and guides long-term fat mass homeostasis. The brain is the gatekeeper of both energy intake and energy expenditure, and unconscious processes strongly suggest appropriate levels for both factors according to the brain’s perceived homeostatic needs. Those suggestions can be overridden consciously, but it requires a perpetual high degree of discipline, whereas someone who has been lean all her life doesn’t require discipline to remain lean because her brain is suggesting behaviors that naturally defend leanness. I know what I’m saying here may seem controversial to some people reading this, because it’s contrary to what they’ve read on the internet or in the popular press, but it’s not particularly controversial in my field. In fact, you’ll find most of this stuff in general neuroscience textbooks dating back more than 10 years (e.g., Eric Kandel and colleagues, Principles of Neuroscience).

Strategies for reducing body fat mass: effects of liposuction and exercise on cardiovascular risk factors and adiposity [PubMed]

Is there any method known so far to upregulate and increase the density of leptin receptors ?

That’s kind of the million dollar question (ask the pharma industry).Growing research implicates the hypothalamus and the brain in weight gain, making it that much more difficult. DNA provides instructions on how to make proteins. The more operative term is changing DNA expression. Changing the DNA itself should not occur…

If it is more of a genetic cause then the only way is gene therapy. Calorie restriction and exercise do up-regulate leptin receptors but it does not permanently lower the set point. Your best bet at maintaining a lower body fat is to lose the fat and permanently change eating behaviors. As I mentioned before, lowering inflammation is another key aspect.

There is some truth to how you can do stupid things and get away with them when you’re young. When you’re young the body recovers faster and adapts faster, and this naturally decreases as we age. In other words, you can eat junk food and not see any negative consequences (especially during puberty), but it eventually catches up to you and then you have to start cutting out HFCS, trans fats, etc.

People get fat because they eat too much (not including congenital disorders). Why do people eat too much? I think it has a lot to do with the obesogenic environment and the idea of reward circuits in the brain, which is why losing weight without changing eating behaviors will eventually fail. Trying to be fit and healthy in our modern world requires a strong psychological component as well, probably why Lyle wrote A Guide To Flexible Dieting. Unfortunately, with the current trend it will only get harder. There is a lot of profit to be made from people getting fat, but also negative consequences for society.

Psychological aspects (both are talking about the same study):

The National Institute on Aging did some very interesting analysis on a group of people they have been following for 50 years and tied a few key personality traits to measurements of adiposity: BMI score, waist size, body fat and hip size. They found some interesting, if not unexpected, correlations: impulsive and extroverted people tend to be fatter; and conscientious, disciplined, organized people tend to be skinnier. This makes sense because people who are impulsive tend to eat more, as do social butterflies since so many social events are based around eating and drinking. Disciplined people however, will have either the will power or coping mechanisms in place to navigate their daily life without over-indulging in calories or exercising enough. Note however, that the two sides aren’t mutually exclusive: disciplined people can be extroverted, and vice-versa.
Although weight tends to increase gradually as people age, the researchers, led by Angelina R. Sutin, PhD, found greater weight gain among impulsive people; those who enjoy taking risks; and those who are antagonistic – especially those who are cynical, competitive and aggressive.
“Previous research has found that impulsive individuals are prone to binge eating and alcohol consumption,” Sutin said. “These behavioral patterns may contribute to weight gain over time.”

Social aspects:


Obesity can spread from person to person, much like a virus, according to researchers. When one person gains weight, close friends tend to gain weight too.Their study, published Thursday in the New England Journal of Medicine, involved a detailed analysis of a large social network of 12,067 people who had been closely followed for 32 years, from 1971 until 2003. The investigators knew who was friends with whom, as well as who was a spouse or sibling or neighbor, and they knew how much each person weighed at various times over three decades.

That let them watch what happened over the years as people became obese. Did their friends also become obese? Did family members? Or neighbors?

The answer, the researchers report, was that people were most likely to become obese when a friend became obese. That increased one’s chances of becoming obese by 57 percent.

There was no effect when a neighbor gained or lost weight, however, and family members had less of an influence than friends. It did not even matter if the friend was hundreds of miles away – the influence remained. And the greatest influence of all was between mutual close friends. There, if one became obese, the other had a 171 percent increased chance of becoming obese too.

The same effect seemed to occur for weight loss, the investigators say, but since most people were gaining, not losing, over the 32 years, the result was an obesity epidemic.

This does not necessarily mean you should not be friends with fat people as « social health » is just as important. The implication of this is monkey see, monkey do; the influence of other people’s behavior on each other. It just means a higher self-awareness is needed.


6 réflexions sur “Liposuccion ?

  1. Je comprends maintenant pourquoi tu affirmais que les relâches se produisaient notamment a cause de la famille , des amis etc..Les sportifs qui sont on va dire « marginalisés«  de la société y ont moins souvent recours alors.Merci et superbe article Höf.

    • Je laisse à chacun son libre arbitre. Ma définition et compréhension des « écarts/relâches » est complexe et propre à moi même.

      Et oui, un bel article.

  2. Merci pour cet article. Je me demandais depuis un moment si la liposuccion déplaçait le set point vers le bas… Et effectivement, quand on pense que c’est la leptine produite par les cellules graisseuses qui régule le poids, on se rend compte que la réponse est non… J’en arrive à la conclusion que rien n’abaisse le set point… Un avis sur la question ?

  3. Je ne parlais pas de diminuer son poids lorsqu’on est obèse. Je précise donc ma question : peut-on abaisser son set point (et non juste son poids temporairement) lorsqu’on a déjà un poids santé (IMC 18,5 – 25), que l’on fait déjà du sport et que l’on a déjà une alimentation saine. L’idée, c’est d’éviter d’augmenter la sensation de faim, les troubles du comportement alimentaire qui vont avec.

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