Adipose tissue retains an epigenetic memory of obesity after weight loss

Well, yeah. Adipocytes multiply when you get fat. But when you lose weight, they don't apoptose, they just shrink in volume by giving up their lipid stores.

I kinda went down a rabbit hole a while back with certain treatments that can kill adipocytes, as there's actually some significant research backing both heat-generating and cold-generating treatments. They do kill fat cells, and they are flushed out of the body. But people who undergo such treatments do not lose fat. At best, these devices can reshape your fat, pulling it out of one area and distributing it more evenly in other areas.

The problem is that when you kill an adipocyte, it releases all of its triglycerides, which are then free to move around the blood stream. But when blood triglyceride levels are high and there isn't significant oxidation, other metabolic processes are triggered to start to store them. So you kill an adipocyte, release the triglycerides, which get reabsorbed into still living adipocytes, which now get engorged and then multiply again, replacing the fat cells that have been killed.

After learning quite a bit about these processes, I think these devices might actually be useful, not for losing fat, but by eliminating this sort of fat memory. In other words, they should be used after significant weight loss, because adipocytes are relatively empty and externally triggered apoptosis can kill the cells without releasing significant quantities of triglycerides which can be reabsorbed and trigger adipocyte mitosis. I think this would effectively reset that person to a state as if they had never been fat in the first place. Thoughts?

Interesting!

Why can't we just remove the triglycerids from the blood before they trigger adipogenesis? Basically we need a form of dialysis.

I have no real or deep knowledge, just some casual pop news reading.

Isn't ketosis the state, in which the body switches to fat as the primary fuel?

It is. But it's hard to maintain. I was in ketosis for a month via diet (verified with urine strips twice a day) and it was a struggle to figure out what to eat. Camembert, bacon-wrapped chicken and eggs gets boring after a while. Our civilization runs on carbohydrates, for better or worse.