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).

DEAR DR. ROACH: Is there such thing as a walking seizure? The reason I ask is because my husband was out of his Keppra medicine, and he experienced what I would say was sleepwalking … or maybe a seizure? — L.H.

ANSWER: Walking at night is most likely to be sleepwalking, but it is possible that it could have been seizure activity. The fact that your husband has a seizure disorder and had missed his seizure medication makes a seizure much more likely. It can be impossible to tell the difference by history alone, and a video-EEG (electroencephalogram) may be necessary to be sure.

Sleepwalking generally begins early on during sleep, while seizures can happen at any time. If there was clenching of the muscles on one side of the body, this would strongly indicate a seizure. Seizures normally last for less than 2 minutes, while sleepwalking can last for much longer. Sleepwalkers often go back to bed, while people with seizures do not. Sleepwalking is much more common in children than adults.

I found case reports where experts were unable to tell by history and exams whether the person was having a seizure or sleepwalking. If your husband doesn’t have another event once he is back on Keppra, this would be evidence for seizure activity.