Where does fat go?

Many years ago I saw a great cartoon of farmer harvesting bales of fat on a tractor with the caption reading, “That’s where they grow fat”. Now let’s fast forward to our current obesity epidemic. The fastest and most popular (although costly) way to lose fat is to simply suck it out of the body. Plastic surgeons have been doing this for the past 40 years. Yet for some reason their patients keep coming back every 12 months needing a new liposuction touch-up, like taking your car in for an oil lube and tire change at your local garage. Maybe these patients simply have no willpower to keep the fat off.

Now a new study in an online pre-publication article (1) indicates liposuction recipients may not be so “weak-willed” after all. After one year compared to a control group (who were promised discount prices for their liposuction if they would agree to wait for the outcome of the study), the females who had liposuction had no change in their body weight or their percentage of body fat 12 months after the operation. All the fat that had been removed by liposuction had returned. More ominously, the new fat appeared in the wrong places. Initially, it was taken from the hips, and 12 months later it reappeared on the abdomen. In essence, the liposuction had transformed the patients from a pear shape (with few long-term cardiovascular consequences) to an apple shape (with greater long-term cardiovascular consequences). While there was no short-term deterioration in their metabolic markers suggestive of future diabetes or heart disease, the change in the body shape is still an ominous predictor for their future health.

Why the body would grow new fat cells in different parts of the body is still a mystery. But it does indicate the body’s ability to defend itself against rapid fat loss. Fat loss must be a slow, continuous process to avoid activating these “fat-defending” systems. It is impossible to lose more than one pound of fat per week. You can lose a lot more weight, but that difference in weight loss primarily comes from either water loss or loss of muscle mass. This is why you see large of amounts of weight loss during the first week or two of any quick weight-loss diet (primarily water loss) followed by a much slower weight loss (now consisting of fat loss but at a much slower rate).

This is also why it is much easier to lose a lot of weight on shows like “The Biggest Loser” but very difficult to lose the last 10-15 pounds of excess weight (which is usually stored body fat). Apparently, it is only through the slow, steady loss of body fat that there isn’t any activation of the hormonal signals that activate the formation of new fat cells in other parts of the body to restore fat levels. Liposuction is rapid fat loss, and hence those hormonal signals are activated, which leads to the increased production of new fat cells in different parts of the body. People don’t like to hear this, but unfortunately it is the truth.

What drives fat gain is cellular inflammation that creates insulin resistance, as I explain in my book “Toxic Fat” (2). To lose excess body fat, you must first reduce cellular inflammation. That can only be done by an anti-inflammatory diet. There is no secret about it. What you must do is eat adequate protein at every meal, primarily eat colorful vegetables as carbohydrate choices, and avoid the intake of excess omega-6 (i.e., vegetable oils) fats and saturated fats by primarily using monounsaturated and omega-3 fats. You have to do this for a lifetime. Of course, if you do, then you will become thinner, healthier, and smarter.

The alternative is to turn yourself from a pear into an apple with liposuction.


  1. Hernandex TL, Kittelson JM, Law CK, Ketch LL, Stob NR, Linstrom RC, Scherziner A, Stamm ER, and Eckel RH. “Fat redistribution following section lepectomy: defense of body fat and patterns of restoration.” Obesity doi:1038/oby.2011.64
  2. Sears B. “Toxic Fat.” Thomas Nelson. Nashville, TN (2008)

Nothing contained in this blog is intended to be instructional for medial diagnosis or treatment. If you have a medical concern or issue, please consult your personal physician immediately.

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About Dr. Barry Sears

Dr. Barry Sears is a leading authority on the impact of the diet on hormonal response, genetic expression, and inflammation. A former research scientist at the Boston University School of Medicine and the Massachusetts Institute of Technology, Dr. Sears has dedicated his research efforts over the past 30 years to the study of lipids. He has published more than 30 scientific articles and holds 13 U.S. patents in the areas of intravenous drug delivery systems and hormonal regulation for the treatment of cardiovascular disease. He has also written 13 books, including the New York Times #1 best-seller "The Zone". These books have sold more than 5 million copies in the U.S. and have been translated into 22 different languages.

22 thoughts on “Where does fat go?

  1. If you ask me, during the early part of “The Biggest Loser”, their weight loss is primarily bloat.
    But to me the show is a huge, well-deserved slap in the face to the medical establishment. After 6-8 weeks on the show, there are people who have not only lost 50+ lbs, but are off 20+ different meds.

    • The Biggest Loser is an inspiring show, but I feel that they place way too much emphasis on exercise. Exercise is NOT the key to weight loss! Following the Zone my husband and I have lost 120 pounds and our exercise is a brisk 45 minute dog walk (WALK, not potty time!) M-F when the weather is OK. No weights, no gym, no exercise classes, NADA. If you want to lose weight/get healthier, start eating right (follow the Zone). You will feel better and THEN you will have more energy to add ENJOYABLE physical activity to your routine. Basing your weight loss plan on a strenuous, time consuming exercise routine is a fast route to failure (from my experience).

    • Maybe the women celebrities with giant chests did not need implants…. they just had lipo all over the rest of their body! :)

    • Unfortunately, it doesn’t work that way. The fat on the hips is composed of healthy fat cells that turn over their fat slowly (that’s good) because you can pull arachidonic acid out of the blood and store it like a toxic waste dump. The fat on waist is composed of fat cells that turnover their fat rapidly and that’s bad if the fat is rich in arachidonic acid.

  2. Hi Dr. Sears,

    You always talk about insulin resistance can you help us understand what that is? Also can cellular inflamation include fat cells or is cellular inflamation something else. Thanks Dr. Sears yours blogs are always so useful.

    • Insulin resistance is the result of the disruption of the intricate signaling mechanism from the exterior of the cell to the interior of the cell. Think of each cell as cell phone. When the communication network goes down, so does communication. Insulin resistance is the result of the biological communication system going down due to increased cellular inflammation. This is true for all cells including fat cells.

  3. Hey Allison, I was thinking the same thing. What a hoot to lose the belly for medical reasons! Really Dr. Sears I think you are right about so many things but belly fat seems to be a female curse especially after child birth. Even if you are not fat you get loose skin where the baby bump was. I vote to give every woman a tummy tuck after her years of child bearing are over. Think of all the happy ladies all over the country, shoot, I could win an election with that platform all by itself.

  4. I have followed Dr. Sears since The Zone was first published and as a research physician think that he is right on target on the hormonal consequences of glycemic foods, including the pro inflammatory consequences. However, I am becoming increasingly concerned about the health consequences of animal protein, especially after reading The China Study by T. Colin Campbell, 2006. I would like to know what Dr. Sears says about the considerable data linking animal protein to cancer and heart disease promotion. That data needs to be addressed. Personally, I have just switched to a low glycemic plant-based diet. It may be time to tweak the Zone in view of those data.

    • Dr Nardell,
      Is it the animal protein or is it what is consumed with the animal protein that determines the health? I would suggest that if you study Chinese who eat wild game and fish, they more than hold their own with plant protein eaters–and pick up a lot of other micronutrients.
      A book on SE Asian ecology reported that the mountain people ate over 180 different kinds of animal protein (deer, mice, bugs, etc) and over 300 different kinds of plants per month! I would be surprised if their EPA/AA ratio was much different from the Aleut 0.75 to the Japanese 1.5. (If you have ever tried to survive in the woods, you can probably envy their skills at finding and catching that much diverse foods!)
      I spent a day several weeks ago searching with different engines for “fatty acids” and (“wild animals” or “wild game” or “domesticated animals” or “range fed” or “farm fed fish” or “wild fish” or . . .) The plants or animals they ate seemed to determine the makeup of their essential fatty acids—which I realize makes sense.
      Zoo veterinarians, pet vets, and agricultural vets seem to have quite a bit of interest in how the ratio of various fatty acids varies among domesticated and wild animals, grain, grass fed, and free roaming bovines, farm and wild fish, seasonal variations for wild animals, and even for herons pilfering from farm fed fish and wild fish! The ratios seem to vary almost as much as they do for Japanese, Aleut, American, and Europeans.
      I have a brother-in-law who loves to fish for salmon [which he doesn’t like to eat :=) !!] and to hunt. When I am living around him, I get three or four 30-40 lb salmon, half an elk, a deer, and maybe an elk—and I am much healthier with much better fatty acids and cholesterol labs.
      I suspect you will find that Sear’s recommendation to eat lean meat, fish, extra virgin olive oil, etc will produce results quite superior to the Chinese study. His “Toxic Fat” os simple and clear wrt to that. But try your veg diets along with the Zone approach, record your EPA/ratios over six months and your health, then perhaps try six months of wild game, wild fish, along with carefully selected sources of fats, lots and lots of greens, berries, and low glycemic load fruits, while again logging your labs and health; then you might try his fish oil and see how that works.
      I know that while fish oil seems to help a lot regardless of what I eat when traveling, the zone 1,2,3 with 5 meals and snacks and lots of water seem to be even more helpful—and the two together synergistically work far better.

      Good luck and let us know if you got even better results overall with your veg approach to the zone.

    • The China Study suffers from exceedingly weak correlations that Campbell assumes are causal. Mike Eades in his July 27, 2010 blog (www.proteinpower.com) does an excellent job in detailing the shortcomings of Campbell’s work.

      Switching to plant-based diet is an excellent strategy as long as you maintain an appropriate protein to carbohydrate ratio as I wrote in The Soy Zone. However, a protein-deficient plant based diet will have significant adverse health consequences

  5. The “pearls of wisdom” that Dr. Sears has given out the course of the past 15 years stretched out would encircle the globe. All, and I mean all of the “new” trends in nutrition are nothing but a ill disguised rehash of the Zone. The Zone works. Period. If it doesn’t do it for you, there must be tile or two in your mosaic that is out of place.
    The statement in this article (not the first time…) that the human body cannot lose more than 500gms of fat a week falls on deaf ears 90% of the time much to the joy of charlatan doctors and scam weight loss programs. People don’t want to hear it.

  6. I am not a Doctor or a PHD and I haven’t written any books about diet or exercise. I was categorized as obese in January 1 of this year and now almost 6 months later, I weigh 177, as of this morning. I have lost a total of 51 pounds and 8 inches off my waist, my beginning weight was 228. I did it through a rapid weight lost program using alternative medicine and the “HGC” diet. Working with a doctor I averaged a pound a day in weight loss. I have been off of the diet for 3 months now and no weight gain. When you have to lose a significant amount of weight, which according to the indexes I should weigh about 160 for a 5’9” male, losing a pound or 2 per week would have taken me 25 or more weeks just to get where I am at now. Don’t get me wrong I am a strong believer in the Zone diet and my diet now consists of a lean protein and 2 vegetables for lunch and dinner and a lean protein and 2 fruits for breakfast. But I disagree with the suggestion that all quick loss is just water weight and I am living proof.

    • The HGC diet tries to maintain 500 calories per day. If maintained, this will result in protein restriction that leads to a extensive muscle and organ mass loss that will take a significant amount of time to rebuild.

      Losing weight is difficult, but the really hard part is keeping it off. This is why retaining muscle mass is essential during any weight program if the goal to keep the lost weight from returning.

  7. Firstly I must once again thank Dr Sears for the health, vitality and energy I have enjoyed for over the last 14 years. Interesting discussion about fat loss, though when I first started eating in the Zone in March 1997 I consistently lost over 2 kilograms (4.4 poundss) of fat a week for several weeks until I started running out of fat to lose at that rate and it continued to slow down until after 6 months I went from 26% body fat to 14%. I have stayed at this for the following 13 and a half years. Agreed in the first week that would have been largely water but not for subsequent weeks. My lean body mass has slightly increased and the fat loss was real.

    Regarding the discussion about caffeine. I avoid it because scientific studies here in New Zealand (Auckland University) have shown that when the body is in fat burning mode (easily achieved in the Zone) significant caffeine will instantly switch the body from fat burning to fat storing. We have water extracted chemical free decaffinated coffee here, wonderful.

    Our company ProZone is a thriving Zone Nutrition business here in New Zealand, teaching Zone Nutrition for over 13 years and we have developed innovations to simplify the process including our Block Builder that makes constructing Zone balanced meals and snacks child’s play, literally.

  8. Wich of Dr. Barry’s book would be the most appropiate if my problem is not to loose weight but cellulite?
    thank you!

    • Actually all of the books, since cellulite is simply excess fat that pushes through the underlying matrix (the dermis) of the skin. You need to reduce your total per cent body to to lose cellulite as there is no such thing as spot fat reducing outside of liposuction. But as I have described in one of my blogs, any loss in fat by liposuction will reappear in other parts of the body with increasing health consequences.

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