Reflections on High-Intensity Weight Loss Methods: Risks of Marathon Running and Scientific Assessment of Liposuction Surgery

Exercise is a primary means of weight loss, with running being the most popular choice among those trying to lose weight. However, the disproportionate effect of exercise on weight loss, and even weight gain, is a source of frustration for many. A typical example is the marathon-style approach, characterized by long durations, high intensity, and extended distances. Those who engage in this method often believe that the longer the run, the more effective it is for weight loss. In reality, the effectiveness of running for weight loss is greatly influenced by factors such as calorie restriction and the type or form of exercise. The effectiveness of running for weight loss is also related to running speed, intensity, and regularity. Running too fast not only fails to burn fat but also accelerates glycogen depletion, leading to exercise-induced hypoglycemia and reduced athletic performance. Low-to-moderate intensity aerobic exercise at 45%-65% of maximum oxygen uptake (VO2 max) has the highest fat oxidation efficiency, while exercise above 70% of VO2 max actually decreases fat oxidation efficiency. Eating after exercise is also a risk factor. Energy expenditure, decreased blood sugar, and dehydration after exercise can significantly increase appetite. Many people reward themselves with sports drinks or delicious food, which often contain a lot of energy and can easily replenish or even exceed the energy consumed during exercise. Furthermore, if daily physical activity is limited, relying solely on exercise to burn energy is often insufficient to achieve the desired results. Long-distance running is physically demanding and time-consuming, making it difficult to maintain and easily leading to psychological stress. Running on the same route for extended periods causes muscles to adapt quickly, easily resulting in a weight loss plateau. Marathon-style running may not be effective for weight loss and can also place significant physical strain on the body. Even professionally trained marathon runners can experience severe joint damage, muscle tears, and even acute kidney injury such as hematuria and proteinuria after a run. Prolonged running also causes significant changes in body fluid composition; large amounts of water and electrolytes are lost through sweat, leading to thirst, weakness, and even life-threatening shock. Improperly replenishing with excessive water at this time can easily cause hyponatremia, and in severe cases, cerebral edema. Therefore, post-exercise hydration should be combined with electrolyte replenishment. In addition, prolonged, high-intensity exercise can also cause stress-induced damage to the immune system, increasing the risk of infection. Non-professional athletes' improper pre-run preparation and running techniques can exacerbate joint damage and increase the burden on the heart and lungs. Therefore, it is not recommended for ordinary people to choose marathon running for weight loss and fitness; they should proceed according to their own physical condition. Simple aerobic exercise can result in a weight loss of approximately 0.2 kg, requiring extremely high exercise volume to be effective; while energy restriction combined with aerobic exercise can result in a weight loss of up to 9-13 kg, with more significant clinical results. Liposuction, also known medically as fat removal, is a procedure that quickly removes fat cells from certain subcutaneous areas of the body to achieve body reshaping. The main methods of liposuction can be divided into: ① tumescent negative pressure liposuction; ② resonant liposuction; ③ ultrasonic liposuction; ④ water-assisted liposuction. The principles of liposuction are basically the same: first, fat cells are dissolved and broken down using a certain technique, and then the fat is removed from the body using specific suction equipment. Currently, liposuction has become an important auxiliary technique to improve other cosmetic surgeries, including neck reduction, breast reduction, and abdominoplasty. Compared to weight loss methods like diet control and exercise, liposuction's biggest advantage is its speed, and it's the only way to truly reduce the number of fat cells in the body. However, liposuction is not a permanent solution. Studies show that while women who undergo abdominal liposuction may experience significant weight loss within 12 months, this effect disappears within a few months after surgery. Surgical fat removal can trigger fat redistribution and compensatory fat growth, especially a compensatory increase in visceral fat. Furthermore, liposuction does not increase basal energy expenditure, making weight regain more likely for many who don't change their diet and lifestyle after surgery. Although advancements in technology have made liposuction relatively safe, it still carries certain risks. Liposuction can lead to more than 20 complications. Local complications include edema, bruising, wound infection, irregular shape, and pigmentation. The most serious are systemic complications, such as severe blood loss, visceral perforation, fat embolism, pulmonary edema, and pulmonary embolism, the latter having a mortality rate as high as 23%. While liposuction can improve glucose and lipid metabolism to some extent, physical activity is far more effective and safer than liposuction, and complications often outweigh the benefits. For some severely obese patients (BMI > 30 kg/m²) who have developed lower limb osteoarthritis and other fat-related diseases such as lipedema and lymphodystrophy syndrome, significantly impacting their quality of life, liposuction may be a better treatment option. In such cases, it is crucial to consult a professional plastic surgeon for a thorough evaluation and to pay attention to the following: 1. Perform liposuction in small, multiple sessions, not exceeding four areas at a time. 2. Choose safe liposuction areas (chin, upper arm, buttocks, etc.). 3. Emphasize post-operative care, using elastic bandages. 4. Control total dietary energy intake and supplement with protein. 5. Engage in regular post-operative exercise. 6. Liposuction is not recommended during growth spurts, menstruation, or for patients with hypertension. In conclusion, liposuction is not a suitable method for general weight loss.