Lipedema – a neglected fat disorder

Lipedema is a medical condition, poorly understood and commonly misdiagnosed as obesity, cellulite or lymphedema which is seen almost exclusively in women with an occurrence rate of between 10-15 per centage across the globe. It appears that there is a genetic predisposition as it is commonly seen families and has a hormonal influence as puberty, pregnancy and menopause are found to trigger the onset of the disease. Lipedema is like a lifestyle disease which can be controlled and restricted from progressing.

Lipedema was first identified by Allen & Hines in 1940 in Germany but for reasons unknown was not accepted and entered in the international classification of diseases by WHO until 2019 and was not taught in medical colleges.

Dr V K Srinagesh, Consultant Plastic & Cosmetic Surgeon, Apollo Hospitals says, "Lipedema is also known as "the painful fat syndrome". It is characterised by abnormal deposition of fat around the hips, buttocks, thighs, legs and sometimes in the arms symmetrically while the waist is generally slim. The feet and hands are spared and maybe associated with an ankle or wrist cuff. It is associated with spider veins and varicose veins as the disease progresses and edema and heaviness of the limbs due to lymphatic weakness. There could be easy bruising with little or hardly known trauma. As the disease progresses the condition proceeds from lipedema to lipolymphedema to frank lymphedema. Early identification and intervention helps in delaying or slowing progression of the diseases."

Due to the shape of the individual and the abnormal growth of certain parts of the body lipedema was wrongly included as a type of obesity and classified as "pear shaped obesity". Unfortunately regular dieting, exercises or even bariatric surgery have little impact in the treatment of lipedema.

Commonly also mistaken to be lymphedema various treatments for the same are tried like compression bandages and compression stockings but with little or no benefit.

Lipedema is also mistaken for cellulite due to the dimpling of the skin and the rice grain or nodular irregularities seen in the fat in the buttocks and thighs (orange peel appearance). Some patients due to the pain, heaviness, change in gait, arthritis, easy bruising and gross change in body shape can lead to irritability and depression.

There are 5 types and 4 stages of lipedema and earlier the diagnosis and initiation of treatment the better the long term result and comfortable life they can lead. Depending on the stage of the disease and the rapidity at which the progress takes place one has to be put in a combination of therapies like decompressive therapy, medical management or surgery which could range from lymph sparing water assisted liposuction to treatment of spider veins and/or varicose veins to management of pain and treatment of stasis ulcers.

Lipedema is a team approach consisting of plastic surgeon, vascular surgeon, physiotherapist, psychologist and dietician.