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Acquired lipodystrophies Human immunodeficiency virus (HIV)-associated lipodystrophy Acquired partial lipodystrophy, also rare, with a progressive and symmetrical lipoatrophy of SAT starting from the face and spreading to the upper part of the body, sparing the legs, can be confused with the RAD, lipedema, due to a disproportion between upper and lower body SAT (see below).
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Human immunodeficiency virus (HIV)-associated lipodystrophy, is well-known, but familial partial lipodystrophies are rare and therefore less well known, and can go undiagnosed for years or are never recognized. Lipodystrophies or fat redistribution syndromes involve a primary lack or loss of SAT however, increased SAT in other areas can be confused with lifestyle-induced obesity. Non-lifestyle causes of obesity Lipodystrophies Lipodystrophies are also discussed as they may be confused with rare adipose disorders (RADs). This review aims to demonstrate lymphatic dysfunction as a component of rare adipose disorders (RADs) that increases the amount and alters the location of subcutaneous adipose tissue (SAT) while resisting fat loss after lifestyle changes or bariatric surgery. Bariatric surgery has been exceptional in its ability to induce weight loss and resolve the co-morbidities of obesity, though complications rates can be high, many people are still obese by body mass index (BMI) after Roux-en-Y gastric bypass (RYGB), and weight regain occurs. Medications used for the treatment of obesity are severely limited. Numerous published studies validate the weight loss efficacy of lifestyle changes that include decreased amounts and types of food, and improved exercise regimens. The National Health and Nutrition Examination Survey and Pediatric Nutrition Surveillance System reported a tripling of the prevalence of obesity among US school-age children and adolescents over the past three decades. In the United States (US), a third of adults aged 20 years and over are overweight, a third are obese, and over five percent are extremely obese 1. Lifestyle-induced obesity in children and adults has reached epidemic proportions worldwide. Keywords: adiposis dolorosa, Dercum's disease, lipedema, multiple symmetric lipomatosis, familial multiple lipomatosis, familial partial, lipodystrophy, lymph, lymphatics Introduction Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations. 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. Treatment recommendations focus on evidence-based data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. 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. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone. 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. 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. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum's disease (DD) may be misdiagnosed as obesity. This article has been cited by other articles in PMC.