Does adipocyte hypercellularity in obesity exist?

Adipose tissue samples were biopsied from three subcutaneous sites in 80 obese and 27 non-obese patients. Additional samples were taken from intra-abdominal sites in 44 of the patients. There was a small increase in the calculated number of fat cells in the more obese patients, but there was no relation between fat-cell number and obesity of childhood onset. Omental fat cells were one-third the size of subcutaneous cells. Thus the calculated number of fat cells, usually based solely on subcutaneous samples, is an underestimate of the true number, and most obese patients can accommodate their fat without needing to recruit new cells. The diagnosis of "hyperplastic" obesity--that is, an excess number of fat cells--is unreliable and its relation to infantile obesity doubtful.