Lipedema is a chronic condition primarily affecting women, characterized by the abnormal accumulation of fat in the subcutaneous tissue, predominantly in the limbs. It's often misdiagnosed as obesity or lymphedema, and can persist even after significant weight loss achieved through bariatric surgery or other methods. This article aims to provide an overview of lipedema, its distinction from obesity, the challenges it presents after weight loss, and current research directions.
Lipedema: A Distinct Condition
Lipedema is not simply obesity. It is a genetic fat disorder that appears to be linked to the female hormone estrogen. Unlike general obesity, where excessive fat distribution occurs all over the body, lipedema involves excessive fat production only in specific areas, such as the buttocks, thighs, and lower legs. This disproportionate fat distribution often results in the lower body being considerably larger than the upper body, a feature not typically seen in obesity. The onset of symptoms often develops around periods of hormonal change in the body, namely puberty, pregnancy and menopause.
Key Differences Between Lipedema and Obesity
| Feature | Lipedema | Obesity |
|---|---|---|
| Fat Distribution | Disproportionate, primarily in limbs | Generalized, all over the body |
| Response to Diet and Exercise | Minimal improvement in affected areas | Weight loss typically occurs from all areas |
| Capillaries | Fragile, easily damaged, leading to bruising | Normal capillaries |
| Tenderness/Pain | Frequent tenderness and pain in affected areas | No tenderness or pain |
| Cause | Genetic, linked to estrogen | Excessive calorie intake |
The Challenge of Lipedema After Weight Loss
One of the significant challenges in managing lipedema is its persistence even after substantial weight loss. While individuals with lipedema may experience weight loss in other areas of their body through diet, exercise, or bariatric surgery, the fat deposits associated with lipedema often remain resistant. This can lead to a disproportionate body shape and persistent pain in the affected limbs.
Lipedema and Bariatric Surgery
Bariatric surgery, including sleeve gastrectomy and Roux-en-Y gastric bypass, can result in remarkable weight loss and decreases in hip and abdomen circumference. However, some patients with lipedema experience only small decreases in the circumference of their extremities and report persistent limb pain after surgery. A study reviewing 49 female patients who underwent bariatric surgery (sleeve gastrectomy in 51%, Roux-en-Y in 45%, and One anastomosis Gastric Bypass in 4%) found that 48 patients were diagnosed with lipedema after the surgery. The mean excess weight loss was 70.93%, and the mean total weight loss was 36%. This highlights the importance of recognizing lipedema in patients with obesity, as it can significantly impact their post-bariatric surgery outcomes and quality of life.
The Role of Nutrition in Lipedema Management
While lipedema is not caused by poor food choices, maintaining a healthy diet and weight is still relevant. The abnormal build-up of fatty tissue in Lipoedema is typically resistant to conventional weight-loss diets, and women with Lipoedema are at higher risk of developing obesity. Poor nutrition and eating disorders (both over- and under-eating) are not uncommon among women with Lipoedema.
Read also: Managing Lipedema with Nutrition
It’s good for everyone - including people with Lipoedema - to maintain a healthy diet and weight by leading a lifestyle that incorporates a balanced diet. Rather than following a strict regime, it is advisable to avoid highly processed foods (HPF). Several studies suggest that following an anti-inflammatory or Keto diet can be helpful in managing Lipoedema symptoms, but no specific diet has yet been proved to remove Lipoedema fat.
Diagnostic Tools and Considerations
BMI vs. Waist-to-Height Ratio
Body Mass Index (BMI) is a widely used tool to measure a person’s weight in relation to their height. However, for people with lipedema, BMI can be misleading due to the falsely high values in the areas affected by lipedema. Waist-to-height ratio (WHtR) is increasingly considered a more accurate assessment of the disproportionate fat distribution associated with lipedema. A WHtR of 0.5 or higher means you may have increased health risks. Further research is necessary to establish a standardised criteria for its use in distinguishing Lipoedema from obesity.
The QuASiL Questionnaire
Using objective clinical tools for analysis and monitoring of lipedema, such as the QuASiL (Lipedema Symptom Assessment Questionnaire), symptom monitoring questionnaires that are validated and culturally adapted, and volumetric measurements of limbs and bioimpedance, it is possible to quantify clinical progression.
Treatment Approaches
Non-Surgical Treatments
Non-surgical treatment of lipedema is feasible in selected cases, and it can meet the criteria for achieving selected clinical objectives. A holistic approach to the patient is recommended in treatment of lipedema, including psychological support, effective weight loss and compression therapy. Clinical treatment typically includes anti-inflammatory dietary measures, regular aquatic physical exercise, manual lymphatic drainage, and antioxidant phytotherapeutics in regular-usage doses. Although compression bandages or garments are widely recognized treatment, they were not used for the present patients because of high pain patients reported before lowering inflammation. We opted for lymphatic drainage as a strategy the patients would find more acceptable. Clinical treatment of lipedema involves, in most aspects, the search for a healthy lifestyle, including changes in attitudes. These measures are mostly harmless to those who do not have lipedema and can be suggested to all patients who do not have contraindications.
Surgical Treatments
Liposuction surgery for lipedema should be considered a possible tool to be used and not the only available treatment. People with Lipoedema should not expect their symptoms to disappear following successful weight loss after bariatric surgery. The disproportionate distribution of adipose tissue that characterises Lipoedema is often emphasised following weight loss.
Read also: Managing Lipedema with Keto
Weight-Loss Drugs (GLP-1 Receptor Agonists)
Many patients with Lipoedema who have co-existing excess weight (obesity) are keen to try the new weight-loss drugs, as personal testimonials from those who have been able to obtain them report good results in reducing non-Lipoedema excess weight and improvements in other symptoms associated with Lipoedema. There have been no published trials of these medicines for Lipoedema, so there is no clinical evidence as to whether or not they are effective.
The Importance of Individualized Treatment
Currently, there are many described therapies available for lipedema. Treatment objectives should be individualized for each patient. It is imperative to understand each patient’s needs to offer the best therapy attainable that meets patient requirements and induces a better quality of life. Some patients may demand better aesthetics, which in some cases is reachable without surgery. Most patients report pain and discomfort, symptoms that can improve without surgery. Other patients may be concerned about leg volume. Volume and disproportion reduction may seem challenging without surgery, but we have shown it is possible. Complications of lipedema, like ulcers, lymphangitis, and erysipelas, can be the main patient concern and can be treated without liposuction.
Research Directions
Research is ongoing to better understand the pathophysiology of lipedema and the effects of various treatments. Studies have shown that affected adipose tissue in women with lipedema is characterized by increased inflammation and fibrogenesis, and alterations in lymphatic and vascular biology. Weight loss can improve insulin sensitivity and decrease leg fat, but it may not affect adipose tissue inflammation or fibrosis.
Lipedema UK is currently partnering with De Montfort University in a study into the effects of inflammatory foods on Lipoedema. This long-term, ongoing study is led by Dr Yannan (Jessica) Jinn.
Read also: Review: Lipedema and Keto