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The mature adipocytes secrete BMP4 that triggers preadipocyte differentiation by inducing the separation of Wnt1 inducible-signaling pathway protein 2 (WISP2) and zinc finger protein 423 (ZNF423), allowing ZNF423 to translocate into the nucleus and activate peroxisome proliferator-activated receptors (PPAR) and downstream cascade including CCAAT/enhancer-binding proteins (C/EBP), , and [41, 42] ( Figure 1 )

Many reported that treatment under the guidance of a clinician was preferable to self-medication, but felt they had no other choice to regain quality of life