Rare adipose disorders (RADs) masquerading as obesity
Karen Herbst, M.D., Ph.D.
Department of Medicine,
University of Arizona,
Tucson, AZ, USA.
Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum’s disease (DD) may be misdiagnosed as obesity. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Although lifestyle changes and bariatric surgery work effectively for the obesity component of RADs, these treatments do not routinely reduce the abnormal subcutaneous adipose tissue (SAT) of RADs. RAD SAT likely results from the growth of a brown stem cell population with secondary lymphatic dysfunction in MSL, or by primary vascular and lymphatic dysfunction in lipedema and DD. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone.
In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may be confused. Treatment recommendations focus on evidence-based data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. Associated RAD conditions including depression, anxiety and pain will improve as healthcare providers learn to identify and adopt alternative treatment regimens for the abnormal SAT component of RADs. Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations.
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I have suffered all my adult life with what I now know is Lipedema. There were 3 girls in my immediate family, 2 of us suffered with our weight while the 3rd one didn’t. She took after my dad while we took after my mom. It took me 79 yrs., but I finally got my answer after reading your research article online. Thank you for helping me understand and accept that this is a physical condition and not my fault.
Hopefully in time and effort on the part of the medical community, this too will be a condition that will be eradicated.
I informed my doctor of Lipedema and printed the article I had read. He was astonished that he’d never heard of it and was sure the other doctors in the office never had either. I asked him to please pass it on and to inform some of his patients about this condition. Thank you for your research, I’m still heavy, but my heart is lighter!