Is fat in the legs lipoedema or obesity?

What is Lipoedema?

Lipoedema (lipohyperplastic dolorosa) is an abnormal accumulation of painful fat in the legs and occasionally in the arms. It usually affects both sides symmetrically and spares the feet and hands. The torso is also relatively spared. It is a longstanding condition that mostly affects women, starting at puberty or other times of hormonal change, such as in pregnancy and menopause.

Misdiagnosis of lipoedema for obesity, oedema or lymphoedema is common. As a result of this, sufferers may embark on an incorrect treatment pathway, such as weight loss surgery. While all of these conditions may be present at the same time to differing degrees, it is recognised as a distinct condition, with its own set of specific treatments.

Sufferers face significant societal barriers because the condition is often misinterpreted as obesity. They often experience weight stigma 1, which may lead to stress, generally poorer health outcomes and reduced levels of productivity.

What is the cause?

The cause remains unclear but it runs in the female members of families and may affect up to 1 in 12 women. One of the main features is discomfort and pain, which often does not match the degree of abnormal fat tissue.

At a cellular level, lipoedema sufferers have a lot more fat cells. For obesity sufferers, the fat cells are larger but often the number of fat cells is normal.

Lipoedema diagnosis

Body appearance, pain symptoms and the pattern of development over time, all determine the diagnosis of lipoedema. Commonly reported symptoms include pain, pressure sensitivity and a tendency to bruise.

There are three stages of lipoedema, based on physical appearance:

• the legs are slim but painful
• legs appear thicker and are painful, with an uneven, wave-like skin surface
• the legs are painful, with bulky, drooping fatty tissue. Sufferers often report increasing difficulties in performing daily tasks, owing to pain and physical limitations.

Investigations

An ultrasound scan is a useful aid to diagnosis. It can distinguish between other causes of leg swelling, such as oedema or lymphoedema. The scan will show a diffuse and consistent deposition of fat under the skin affecting both legs.

Treatment

Treatment of lipoedema generally falls into three categories: massage, compression stockings and liposuction.

A qualified massage therapist should perform this where possible. Compression stockings support the legs and reduce any swelling. They can unfortunately make the pain symptoms worse.

Liposuction reduces the increased number of fat cells found in lipoedema but it may not reduce the associated pain symptoms. In some patients undergoing liposuction, any significant varicose veins may need treatment to avoid bleeding during the liposuction procedure.