By Chris Wise – Lipoedema UK Nurse Consultant

All too frequently women with Lipoedema are told by health professionals that they are just obese, that they need to go away and lose weight. This inappropriate advice often promotes self blame, increases desperation, and denies access to the correct diagnosis, treatment and preventable deterioration. However if you have this condition, you are not to blame and this cannot be emphasised enough.

Lipoedema is a chronic genetic fat disorder which appears to be linked to the female hormone oestrogen. It develops and often progresses around periods of hormonal change in the body, namely puberty, pregnancy and menopause. Unfortunately obesity frequently occurs as a result of this condition, and not the other way around. It is important to realise that you have not caused your Lipoedema by poor dietary issues or from being overweight.

In obesity, excessive fat distribution occurs all over the body. However in Lipoedema, for reasons not yet fully understood, excessive fat production occurs only in specific areas of the body. The distribution of fat can vary from one individual to another as can the severity. The onset of symptoms can develop fairly quickly and the change in body shape may sometimes be quite dramatic. The additional fat deposits predominantly affect the buttocks, thighs and lower legs. Frequently fat pads develop on the outer thighs, just below the hips or on the inner knees. However the excess fat stops abruptly at the ankles, often resulting in the appearance of a fatty cuff, sometimes described as a bracelet or elastic band effect. The feet are normal unless oedema has started to develop. The arms are also frequently affected, but the hands are spared. As a result of the excessive fat deposition, Lipoedema often has a very characteristic feature whereby the lower body is considerably larger and generally out of proportion to the upper body. This feature does not occur in obesity.

Obesity responds well to diet and exercise, and weight loss is experienced usually from all areas of the body, but sadly in Lipoedema this is not the case. Weight loss will occur from the upper part of the body, but absolutely minimal improvement will occur from the areas below the waist affected with Lipoedema. Attempts at weight loss will often only exacerbate the disproportion between upper and lower body.  Unlike normal obesity, Lipoedema fat deposits do not respond to dietary measures or to vigorous exercise and this is another unique and useful tool in distinguishing Lipoedema from obesity.

Lipoedema fat cells also show characteristics that do not appear in general obesity. In Lipoedema the tiny blood capillaries supplying the fat cells are particularly fragile and easily become damaged. As a result bruising readily occurs on the legs often following a minor trauma or sometimes for no apparent reason at all. This tendency does not occur in generalised obesity as there is no abnormality of the blood capillaries.

Finally, the lower limbs are frequently tender and pain may be experienced by only the slightest of touch. Again, this distressing feature does not occur in general obesity. The reason pain develops is that the blood capillaries sur- rounding fat cells are not only fragile in Lipoedema, but they are also hyper permeable. As a result protein molecules leak out of the capillaries into the intercel- lular spaces between the fat cells. Proteins have the ability to attract additional fluid, and this causes the minute lymphatic vessels within the layers of fat to work at a higher level to remove the excess fluid. Eventually the lymphatic vessels become damaged and can no longer cope with the excessive fluid that needs to be transported. Conse- quently oedema develops between the fat cells, resulting in increased pressure and inflammation in the tissues therefore causing pain and discomfort.