What is Lipedema?
Written by Dallas Vein Specialists on December 1, 2017
LIPEDEMA is a disease of excess and abnormal subcutaneous fat deposition that effects millions of women throughout the world (estimate of 17 million in US and 370 million globally). The disease, almost exclusively affecting women, was named in 1940 by 2 Mayo Clinic physicians. It is still a somewhat mysterious disease that is now under intense study at centers around the world. Many physicians have little or no knowledge of the disease despite its wide distribution. It is disheartening to these patients told by their physician to lose weight and despite all they try are unable to do so only to be told to try harder.
The distribution of the lumpy subcutaneous fat (adipose) tissue typically occurs in the hips, buttocks, thighs and legs. The feet are spared. Diet, exercise and other dietary measures have no beneficial effect on these fat deposits. The typical lipedema patient has a relatively small or normal waist and trunk. The arms may be involved (up to 30% of patients) to a varying extent. It is easy to see how these patients are diagnosed as obese, but lipedema is different than the usual obesity.
Important differentiating elements of lipedema are the following:
Exclusively seen in women (rarely in hypogonatal men)
Disproportionate distribution of fat in hips, buttocks, thighs, and lower legs
Symmetrical bilateral manifestations of fat deposition
Sparing (minimal to no fat accumulation) of the feet with fat sharply ending at the ankle
Trunk and hands not involved
A lumpy or nodular feel to the fat
The disease begins at puberty
Totally unresponsive to diet restrictions, exercise or other weight loss measures including obesity operations
A genetic basis with the disease seen in families (may be passed to offspring in genetic code of father or mother)
Often the lumpy fat is painful to pressure, and patients may complain of this symptom
Easy bruising owing to fragility of blood vessels
Unresponsive to treatments of lymphedema such as elevation or external compression (some lipedema patients may have a component of lymphedema)
Telangiectasias (spider or thread veins) are common
Edema (increased tissue fluid) is absent
Lower prevalence of type II diabetes than in patient with other forms of subcutaneous fat deposition
There is no known cure for lipedema. Surgical liposuction with special techniques has been done with some encouraging results. More refinements and research with liposuction may have promise. It should only be done by those with extensive experience in using these techniques in lipedema patients. Basic research into the genetics of the disease may ultimately lead to new treatments and perhaps prevention. Identifying patients in the early stages of the disease, i.e. young postpubertal women, and intervening with early liposuction before the fat becomes extensive and nodular, may decrease the later manifestations of lipedema. Early dietary avoidance of carbohydrates and institution of a ketogenic diet should be considered in young women with a family history of lipedema and early manifestations of the disease.