stop using "lipoatrophy" interchangeably with wasting
Sep 17, 2004
I feel very strongly that doctors are abusing this term "lipoatrophy" when the patient's actual problem is simply muscle wasting.
Wouldn't you agree with this construct: if a patient notes a reduction in the size of his butt and thighs, and there is no visible muscle striation under the skin pushing through, that the problem is most likely a loss of muscle?
Lipoatrophy is defined as loss of fat with relative preservation of muscle. Half of the HIV positive men in my gym suffer from a reduction in the size of their butts. These are guys who were larger, more athletic looking people before they were poz. Their thighs were thick and tight, not flabby at all. Now, despite their rigorous training, they have flabby, thin thighs and flattened flabby butts. How could this possibly be lipoatrophy when their body shape change has not only decreased their muscle definition, but has resulted in a flabbier texture altogether?
Look, if these people were losing fat in their thighs and butts, they would be extremely defined down there. But they are not. They have a catabolic/wasted look. Flabby and flattened. Our shape comes from our muscle mass, not fat mass. Fat hangs - muscle pops out. This is basic stuff. When people begin having serious body shape changes, the place to look for changes is in muscle mass. Get suspicious of fat loss when the body becomes overly striated with muscle definition.
Response from Dr. Conway
I definitely appplaud your attempt at trying to make us use the terms precisely. In life, most arguments stem from people not understanding what each other is saying.
For me, lipoatrophy is the loss of subcuraneous fat, such as in the buttocks and limbs (legs more than arms, just because there is much more to lose). It is more often localized and the person can look and feel well, other than the body shape change. Wasting is a more systemic phenomenon, with loss of muscle, fat and everything else. In HIV, it most often occurs in advanced immune disease, often in the setting of opportunisitic infections.
I hope this helps.
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