Dr. Ben Bikman

At around 60 years old, 60 to 70, a person... So during infancy, childhood, puberty, we're making fat cells.

And then for the most part, the number of fat cells we have is set.

Now, women have a little buffer, like I said earlier, but even then, you could have a person who gains 100 more pounds or 200 more pounds in adulthood.

For the average individual, that's hypertrophy, not a result of hyperplasia.

But then when we get to older age, then the number of fat cells stop turning over.

So as they start dying at their 10-year lifespan, we don't replace them.

And so at the end of life, we have a little drop-off in the number of fat cells.

So weight loss is shrinking the size, not changing the number.

And in fact, if you force artificial weight loss by sucking out fat cells, where you are just sucking out the fat cells and reducing fat cell number,

then you don't improve any cardiometabolic outcome whatsoever.

So there's many studies that show that you can have people lose a significant amount of fat through liposuction and not a single outcome has improved.

Whereas if that same person had lost that 20 pounds of fat through normal lifestyle interventions like you'd mentioned, they would have had improvements in every cardiometabolic outcome.

But you don't do that with liposuction because you haven't changed the size of the fat cell.

The size of your fat cells is the same.

You've just sucked out a lot.

But the remaining ones are still there.

And now, in fact, you've put a greater pressure on them because an adult doesn't make new fat cells very readily.

So what will happen is the remaining fat cells will be forced to grow through size because they can't share the burden with their other neighbors that you've sucked out already.

So when a person starts to regain weight,

the cardiometabolic outcomes are amplified.