Dear Dr. Roach: I had several abdominal surgeries decades ago. Now that I’m approaching 70, I cannot seem to lose my tummy. My waist is approaching 35 inches despite a strict Mediterranean-style diet, walking or biking for over 30 minutes daily, and weight lifting daily.

I would like to consider a more aggressive approach. My goal is to reduce my waist size, and nothing seems to help. I’ve been eating healthy and exercising for years. I am happy with my health (low blood pressure, normal bone density, and normal labs).

Could you enlighten me on procedures such as CoolSculpting, laser treatment and liposuction with the long-term effects and longevity of each treatment? — P.O.

Answer: The most important message is that these treatments are cosmetic treatments to make people look slimmer. They do not have a significant effect on overall health as they do not remove enough fat to have an impact. However, if your goal is to have a thinner waist, all of them are effective at doing so. There are no trials that compare these modalities directly, so I will summarize from the available trials of each treatment.

CoolSculpting is a brand name for a device that uses the cold to damage fat cells, causing them to gradually shrink over time. It is effective for most people (a circumference loss of 2 centimeters after three months and 4 centimeters after six months), and the overall satisfaction rate is high — at about 80%. Unfortunately, there are the occasional people who have a paradoxical reaction where the fat cells actually increase in size with the treatment; this leads to poor cosmetic results.

Laser treatments seem to have slightly less effectiveness than CoolSculpting, with an average circumference loss of 2.5 centimeters. I was not able to find much information on their long-term results.

Liposuction has a greater reduction in circumference and higher satisfaction rates (85% even after nine years) but does involve surgery. The long-term durability is shown to be up to a decade, especially for people who improved their diet and exercise (as one would expect).