Can Removing Abdominal Fat Fight Disease?

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 Justin 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 Edward 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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