All fat is not the same. Visceral fat is dangerous, subcutaneous fat is clearly not as dangerous. This is the quintessence of fat studies conducted to date where a new surgical sub-speciality, at least in the USA (bariatric surgery, obesity surgery) has contributed greatly to clarification in this area. Fat deposits are known to be located either subcutaneously or viscerally around the greater omentum and in some people on both sides of the abdominal wall. Prof. Arya M. Sharma, formerly Berlin, now Hamilton/Canada pointed this out using example graphic images.
However, the impact of these fatty cushions on both sides of the abdominal muscles on cardiovascular risk are dramatically different. As Sharma demonstrated, liposuction among Type 2 diabetics had no affect on the heart (according to [Klein 2004]). The extraction of subcutaneous fat only reduced weight or took a few centimetres off the hip circumference. Nothing significant happened as regards insulin, glucose, blood pressure or lipids.
Other than the removal of fatty sections from around the large abdominal vessels, there is the option of performing an omentectomy. Dr. Anders Thörne, Stockholm carried out a noteworthy randomised study of 50 patients with a BMI of > 35 ([Thörne et al. 2002]). One group underwent a gastric band operation the other an omentectomy.
After a control period of two years no differences with regard to BMI or hip circumference were identifiable. However, the patients who had undergone an omentectomy displayed glucose tolerance and insulin sensitivity that was two to three times better than in the control group who underwent the gastric banding procedure.
However, the abdominal plastic surgery performed as treatment for obesity was not futile, as ultimately the abdominal deposits were reduced if the patients adopted a sensible approach to their diet. In the long term the patients also benefited as Dr. Henry Buchwald, University of Minnesota, demonstrated in a metaanalysis of 'fat surgery procedures' performed on over 22,000 patients [Buchwald et al. 2004]. The success figures reported are striking: Reduction of
Sharma emphasised the fact that visceral (abdominal) fat is highly metabolically active and also influences blood pressure for example, as proven by the Quebec Heart Survey.