I’m not sure why this creeps me out, but a new technique for getting rid of unwanted fat, cryolipolysis, has lately been in the news. A company called Zeltiq markets a high-tech device that sucks in the fat-bearing parts of the skin, mostly at the top of the abdomen and above the hips. It then cools the skin down, in effect freezing the fat cells below. The fat cells die and do not regenerate. Hey presto, less fat on the tummy and love handles. And unlike with liposuction, the procedure does not rely on incisions or injections and patients need far less recovery time. Even cooler (all puns intended), their website lists under the name CoolSculpting.com.
The method derives from the practice in cryotherapy spas of using freezing temperatures to tighten the skin. Researchers found that fat cells are very sensitive to cold and that freezing results in the loss of adipocytes (also known as lipocytes or fat cells). According to dermatologist Dr. Arielle Kauvar, in an article for MSN.com, “Fat cells are damaged at a higher temperature than normal tissue and nerves. This device extracts heat and cools the skin so the fat in cells crystallizes, then is slowly eliminated over two months, and the bulge gets smaller. And fat cells do not regenerate.” In all likelihood, the liver processes the results of this cellular carnage. Clinical trials using ultrasound to measure the fat showed that the procedure resulted in an impressive 22.4 percent reduction of the fat layer…when it works. (More on that later.)
The trials were conducted by Dr. Jeffrey Dover, an associate clinical professor of dermatology at Yale University School of Medicine and the chairman of the scientific advisory board of Zeltiq. According to Dr. Dover, “[The treatment is] best suited for women who are close to ideal body weight with specific areas of unwanted fat, like the belly. These candidates can be as fit as possible,” Dover added, “and they’ll still never get rid of that fat.”
Though it is not invasive and requires no surgery, the treatment is not without side effects. (Aw shucks, and I bet you thought this sounded like a free ride.) The procedure can result in numbness, bruising, and cramping. The MSN.com writer, Jennifer Tung, who was treated with the procedure by Dr. Kauvar, reported that “the flesh that had been inside [the machine] looked and felt like a pink, raw, wrinkled, frozen block of beef.” She also said “Once the numbness wore off, the area felt achy. During the second week, the soreness spiked, and the whole area felt so tight that it burned, especially when my pants pressed against it.” But she considered this a small price to pay for the results and was ready to sign up for further treatments. Some voice concern, though, that damaging fat cells could trigger cancer, and given the lack of studies, it’s hard to assess what else it may cause.
Although the FDA has approved Zeltiq’s device for anesthetizing and cooling the skin, it hasn’t given the go ahead to use it as a fat remover. But it seems doctors can legally use it for “off label” purposes if they judge that it’s in the patient’s best interest. (Oh, how I love off-labeling.) And apparently, at least some doctors think it’s in the patient’s best interest to make cosmetic corrections in cases of unwanted flab.
But will using cryolipolysis enhance your health? I’ve commented on weight loss many times before. I always say that weight maintenance is a simple matter of calories “in” versus calories “out” — give or take some subtleties on how you get there. We now consume, on average, an extra 523 calories a day over what people typically consumed 28 years ago. Since we’re taking in more calories, we need to exercise more to burn those calories off. It’s simple math. In fact, to compensate for those 523 extra calories daily, you need to walk an extra 35 to 50 miles a week — just to maintain your weight at its current level. At a peppy 20-minute per mile pace, that adds up to about an extra two hours of breaking a sweat every single day, seven days a week! And again, that’s just to maintain, not to lose weight!
So the real question is the definition of fitness. Even for people like Ms. Tung who maintain belly “pouches” despite healthy eating and exercising, it’s not just what you eat, but the quantity you eat relative to the amount you exercise. It’s possible to be “fit” relative to the general population and still take in too many calories relative to how much you exercise. Granted, it’s far easier to stick your fatty areas into a fat freezing machine than to truly get on top of your calorie intake and output. But freezing your butt off, literally, won’t make you healthier in the long run. And if you don’t alter your habits, you’re bound to put the fat back on in no time.
Quick fixes usually come with all kinds of problems. Plus there are few studies on cryolipolysis, other than the one conducted by Dr. Dover who is on Zeltiq’s advisory board, so who knows what objective research will reveal. For now, I’ll stick with recommending the proven calories “in” versus calories “out” approach for fat loss. Oh, and did I mention that one of the few “other” cryolipolysis studies conducted on 32 patients found that only 18 of those patients showed a 22% decrease in the area treated two to three months after the actual treatment, but 14% did not? Based on that study, the success rate for cryolipolyis is just above 50%, which is not cool.