Rare adipose disorders (RADs) masquerading as obesity

Area of Science:

• Endocrinology
• Genetics
• Dermatology

Background:

• Rare adipose disorders (RADs), including multiple symmetric lipomatosis (MSL), lipedema, and Dercum's disease (DD), are frequently misdiagnosed as common obesity.
• While lifestyle changes and bariatric surgery manage obesity, they are ineffective in reducing the characteristic abnormal subcutaneous adipose tissue (SAT) in RADs.

Purpose of the Study:

• To differentiate RADs from obesity and other lipodystrophies by presenting diagnostic criteria, histology, and pathophysiology.
• To recommend evidence-based treatments targeting RAD-specific SAT and associated conditions.

Main Methods:

• Comparative analysis of diagnostic criteria, histology, and pathophysiology of RADs versus obesity and lipodystrophies.
• Review of evidence-based treatment strategies for RADs, including lymphatic decongestive therapy, medications, and supplements.

Main Results:

• RAD SAT is hypothesized to stem from brown stem cell proliferation with lymphatic issues (MSL) or primary vascular/lymphatic dysfunction (lipedema, DD).
• Caloric restriction and increased physical activity alone do not reduce RAD SAT.
• Specific treatments beyond weight loss are required for RAD SAT reduction.

Conclusions:

• Improved recognition of RADs is crucial to distinguish them from obesity, enabling targeted interventions.
• Lymphatic decongestive therapy, medications, and supplements show promise for managing RAD SAT.
• Addressing RADs effectively can improve associated symptoms like depression, anxiety, and pain, enhancing patient quality of life.