Lipedema: friend and foe

Abstract

Background Lipedema is a chronic disorder presenting in women during puberty or other times of hormonal change such as childbirth or menopause, characterized by symmetric enlargement of nodular, painful subcutaneous adipose tissue (fat) in the limbs, sparing the hands, feet and trunk. Healthcare providers underdiagnose or misdiagnose lipedema as obesity or lymphedema. Materials and methods The benefits (friend) and negative aspects (foe) of lipedema were collected from published literature, discussions with women with lipedema, and institutional review board approved evaluation of medical charts of 46 women with lipedema. Results Lipedema is a foe because lifestyle change does not reduce lipedema fat, the fat is painful, can become obese, causes gait and joint abnormalities, fatigue, lymphedema and psychosocial distress. Hypermobility associated with lipedema can exacerbate joint disease and aortic disease. In contrast, lipedema fat can be a friend as it is associated with relative reductions in obesity-related metabolic dysfunction. In new data collected, lipedema was associated with a low risk of diabetes (2%), dyslipidemia (11.7%) and hypertension (13%) despite an obese average body mass index (BMI) of 35.3 ± 1.7 kg/m2. Conclusion Lipedema is a painful psychologically distressing fat disorder, more foe than friend especially due to associated obesity and lymphedema. More controlled studies are needed to study the mechanisms and treatments for lipedema.

Keywords: gynoid fat; hypermobility; lipedema; lymphedema; women.

Figure 1

Woman with Stage 3 lipedema and genu valgum of the right knee and overpronation of the right foot. The medial thigh and knee lipedema fat tissue likely contributed to stress on both legs. Photo by Dr. med. Josef J. Stutz.

Figure 2

There are three stages and five types of lipedema. In Stage 1, the skin is smooth but there are pearl-sized nodules in the fat underneath. In Stage 2, there is retraction of the skin due to fibrosis of connective tissue fibers surrounding fat lobules and pearl-sized and larger masses in the fat tissue. In Stage 3, there are pearl-sized nodules, larger masses and lobules of the skin and fat. The fourth Stage in lipedema is not shown, as it is the development of lymphedema that can occur at any stage. Lymphedema occurs in Stage 3 more than Stage 2 or Stage 1 and is known as lipo-lymphedema [20]. Five Types describe the location of lipedema fat. Type IV is found often combined with Type II or III.

Figure 3

Body mass index increases with stage of lipedema. Women with lipedema Stage 1 (n = 12), Stage 2 (n = 24) and Stage 3 (n = 10).