Lipoedema is painful fat disorder. It has also been described as a connective tissue disorder and is becoming increasingly recognised and researched – however, it is still very difficult to manage.
It is characterized by disproportionate fat deposition that is painful and bruises easily; existing almost exclusively among women. It may co-exist with lymphoedema and is then called lipo-lymphoedema. Lipoedema may affect up to 11% of women and is a different entity from obesity.
It typically occurs around times of hormonal changes such as puberty, pregnancy or menopause, and it often runs in families.
It differs from obesity, in that it occurs in a gynaecoid distribution (i.e. legs, hips and sometimes upper arms).
Autoimmune dysfunction and nutritional deficiencies are also commonly seen, and most patients have been chronic dieters with little success; most weight loss occurs around the abdomen and chest.
It is characteristically resistant to weight loss from diet or exercise.
Signs and Symptoms
- Symmetrical abnormal fat deposition on legs and less commonly arms. The enlargement of the legs is disproportionate in relation to the upper body
- Oedema (swelling) is non-pitting. The feet are usually spared, except when lymphoedema co-exists (lipo-lymphoedema). This is known as the ‘ankle cut-off’ sign.
- Tenderness, especially of the shins, a tendency to bruise easily, and varicose veins are common.
- Joint hypermobility, demonstrating laxity of ligaments, is often present.
- As the limbs increase in size, joint strain may cause pain and dysfunction, commonly in the hips, knees, ankles and feet.
There is no specific test to diagnose lipodema, but it is rather a clinical diagnosis based on stage and type – this according to fat distribution site and fat texture.
Treatment is lifelong as there is currently no cure.
Decongestive Therapy (CDT)
This is performed by a certified lymphoedema therapist working actively with the patient and aims to reduce swelling, then maintain the optimal size and health of the limb with well-fitting, carefully selected compression garments. This is the mainstay of treatment.
It is unproven whether lymphatic treatment is absolutely necessary – in the more advanced stages of lipo-lymphoedema it certainly is. However, most patients report improvement of symptoms with this therapy.
The components of Complete Decongestive Therapy are:
- Manual lymphatic drainage therapy
- Multi-layered compression bandaging and wound care if required
- Meticulous skin and nailcare
- Compression garments
- Rehabilitative exercises to improve lymphatic function, fitness, strength and general health as required
- Self-management with the ongoing support of the treating doctor, lymphoedema therapist and the rest of the multi-disciplinary team
Compression garments and decongestive therapies are lifelong treatment.
There are centres which have compression machines (and home -based ones) which can be used as another option or, preferably, in conjugation with decongestive therapy.
A healthy diet is really the mainstay of treatment, despite the poor outcomes with weight loss in certain areas. Certain diets and foods have been shown to have improved results and focus on reducing swelling.
Recommended diets include the Keto Diet and the Anti-inflammatory Diet and avoidance of salts and preservatives are a must.
Obesity is commonly seen with lipoedema but it is a completely different entity and this is reversible. It is important in order to reduce to or maintain a healthy weight. This will help to reduce strain on joints, improve energy levels and may help to correct metabolic dysfunction.
Due to chronic and excessive dieting, many lipodema patients are actually often malnourished or underweight as a result. Those who are overweight or obese may also, in fact, be malnourished due to lack of essential vitamins, minerals and fatty acid intake. A dietician may be involved to help with this.
Exercise in any form is advised and promoted to all these patients, to improve lymphatic function and for weight loss.
Lastly, it is very important to ensure one does not have concomitant vein problems in the leg as these may contribute to swelling, and are treatable.