Lipedema vs obesity: Is there a link between these conditions?

While there are some similarities, lipedema and obesity are distinct health conditions. Both conditions might be categorised by excess fat accumulation and those who have lipedema may also have obesity, but ultimately they aren't related conditions.

In fact, while obesity is often caused by a combination of genetics, environmental and lifestyle factors, the exact cause of lipedema is often unknown.

If you're looking to learn more about these health conditions and how they might relate to one another, you've come to the right place. Discover everything you need to know about lipedema fat, the different stages of lipedema, and how it differs from obesity or other types of weight gain.

What is lipedema?

Lipedema is a chronic disease that causes abnormal fat (subcutaneous adipose tissue) accumulation and connective tissue to build up in the legs, hips, bottom and sometimes the upper arms, affecting both sides of the body in equal amounts.

Lipedema presents more commonly among women, only rarely occurring in men. The medical community estimates the condition impacts 7-11% of women in Western countries [5].

Women with lipedema generally have a small waist, large hips and thighs and the upper body is generally sized differently from the lower body. As a result, many women with lipedema find it difficult to shop and wear clothes that are the right fit [6].

What causes lipedema?

The exact cause of lipedema isn't known, but we do know that the chronic disease can be inherited from your family members. The medical community speculates that lipedema fat is caused by changes in hormones as a result of puberty, pregnancy, throughout menopause and when taking the contraceptive pill [7].

Lipedema is not caused by obesity and you can have a healthy lifestyle and be a healthy weight and still get lipedema. However, more than half of patients with lipedema are also overweight patients or obese patients.

Following a healthy diet and increasing your physical activity can help you lose weight in your upper body but the affected areas of lipedema fat remain unchanged among women with lipedema [6].

How do you know if you have lipedema?

Lipedema is an underdiagnosed condition that can easily be misdiagnosed or confused with either lymphedema (swelling in the body) or even dismissed as weight gain and obesity.

Many women with lipedema can experience increased difficulties walking or participating in physical activity and other parts of everyday life and functioning. Other symptoms of lipedema include [6]:

• Enlarged legs and other affected areas which can include your upper arms
• Pain, discomfort or tenderness in areas affected by lipedema fat
• Easier bruising in affected areas of the body for no obvious reasons
• Dimpled legs with lumpy textures and fat bulging at the knees
• Swelling in affected areas
• Spider or varicose veins
• Difficulties walking as a result of changes in your leg shape

What are the stages of lipedema?

Lipedema has 4 different stages, making it a chronic and progressive disease [8].

Stage 1

The early stages of lipedema make it difficult to tell the difference between lipedema fat accumulation and just normal fat tissue on the lower body. But, early stages are categorised by extra fat accumulation in the buttocks, thighs and calves (but not in the ankles or feet).

The early stages are also accompanied by pain as a result of firm pressure on the affected area and skin. And, the fat tissue doesn't indent when a finger is pressed into the affected areas like you would see with normal fat or weight gain.

Stage 2

As lipedema progresses and is left without treatment, signs of stage 2 include fat deposits or nodules under the skin. The skin may also be uneven and bumpy and you might notice discoloration.

Stage 3

As lipedema occurs and progresses into later stages, lipedema patients start to accumulate fat on the lower body which can impact mobility.

Other symptoms in later stages include excess fat from the buttocks to ankles, larger fat deposits around the knees and larger masses of fat and folds of the skin which become more visible.

Stage 4

The final stage of lipedema fat is known as lipo lymphedema which can take years to progress (even taking more than 10 years). But, once lipedema fat reaches stage 4, many women with lipedema experience fat deposition from lipedema fat, which can block or damage lymph nodes and stop lymph fluid from draining.

As a result, these lipedema symptoms can occur:

• Swelling throughout the whole lower body which can include areas that weren't affected to begin with (like the ankles and feet)
• Irregular distribution of fat tissue in the legs which causes mobility issues
• Development of lipedema fat in the arms

It's important to call out that not everyone with lipedema will progress through all the stages and it can look different from person to person.

The stages of lipedema are used as a general rule of thumb to understand the severity and clinical presentation of the chronic disease and distinguish lipedema fat between normal fat and obesity.

Why can't I lose weight in my legs?

One of the most common experiences linked with lipedema is abnormal levels of fat cells in specific areas of the body, such as the legs.

But there are actually a bunch of reasons why you might not be losing weight in your legs, including:

Genetic conditions

Weight gain, obesity and being overweight can be linked to genetics where your chances of being overweight are increased if one or both of your parents are also overweight or obese. Your genes may also impact the amount of fat you store in the body and where you carry fat including the legs [1].

Lipedema

As we've mentioned, lipedema is a medical condition that affects women more commonly than men. This chronic health condition causes abnormal fat accumulation in the legs and sometimes the upper arms [2].

Hormonal factors

Hormone imbalances including imbalances in oestrogen levels and thyroid functioning can impact how your body burns and stores. This can lead to fat accumulation in certain areas of the body including the legs [3].

Lymphedema

Lymphedema condition where swelling in different parts of the body occurs, impacting the lymphatic system which collects excess fluid, proteins and toxins from cells and tissue. This is brought back into your bloodstream which can cause swelling in your arms, legs and in some cases other parts of the body [4].

Are there treatments for lipedema?

While there is no cure for lipedema fat, if your healthcare professional gives you a proper diagnosis, you may be referred to a specialist for treatment.

Some treatments can help ease symptoms of lipedema and prevent it from getting progressively worse. But, treatment depends on the severity of symptoms and how they affect your body [6].

The main treatments for lipedema are [7]:

• Following a healthy diet: It's important to follow a healthy lifestyle by consuming a healthy diet and exercising as much as possible to maintain a healthy weight.
• Compression therapy: Compression garments like compression stockings can be used to reduce pain and make it easier to walk.
• Decongestive therapy: Manual lymphatic drainage therapy is a light, skin-stretching massage that helps to move lymph fluid out of the swollen limbs.
• Taking care of your skin: Regularly moisturising your skin to help prevent your skin from drying.
• Invasive therapies: In some cases, liposuction or bariatric surgery may be recommended by your doctor if your symptoms are very severe. Liposuction can be used to decrease the size of fat deposits and wet-jet-assisted liposuction causes less damage to the lymphatic vessels. For obese patients with lipedema fat as well, bariatric surgery is an additional treatment option.

What is obesity?

Obesity is a health condition categorised by abnormal and excess fat accumulation that causes adversity and risk to your health. A body mass index of over 30 is considered obese and a body mass index of over 25 is considered overweight [9].

Aside from using a body mass index to determine obesity, waist circumference is also used where men with a waist circumference of 94cm or more and women with a waist circumference of 80cm or more are at an increased risk of developing obesity-related health conditions [10].

Being overweight and obese is caused by various factors, from unhealthy eating patterns, lack of physical activity, and sleep issues and can also be caused by certain medications, genetics and a family history of obesity. Obesity also increases the risk of other health conditions like heart disease, high blood pressure, type 2 diabetes and cancer.

Can obesity look like lipedema?

Obesity can oftentimes look similar to lipedema fat, especially in the lower body which can make it difficult to understand and distinguish between lipedema and obesity. But, it's important to see your healthcare professional so they can evaluate the characteristics that are in line with a lipedema diagnosis.

Lipedema and obesity do have some similar symptoms. However, while lipedema fat generally affects the legs, hips, thighs and lower legs (but not the feet), obesity generally affects the whole body.

If you have lipedema or think you might have lipedema, chat with your doctor or healthcare professional to discuss treatment options and ways of managing the condition.

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While lipedema and obesity may look similar, the conditions are quite different. It's important to seek professional medical advice if you suspect you have lipedema to receive a proper diagnosis and seek the right treatment for your body.