Lipedema is a condition that causes an abnormal buildup of fat in the legs, thighs, and buttocks. It often affects women and is associated with being overweight or obese. However, some people with lipedema have a normal body mass index (BMI). So can you have lipedema and not be overweight? Let’s take a closer look at this condition.
What is lipedema?
Lipedema causes a disproportionate buildup of fat tissue primarily in the lower body. This excess fat is due to an abnormal increase in the number and size of fat cells. The buildup usually occurs in the buttocks, thighs, and legs but can also affect the arms.
In addition to fat accumulation, lipedema causes fluid retention and swelling in the affected areas. The tissue often feels soft or doughy to the touch. Lipedema fat is different than regular body fat and is resistant to diet and exercise.
Women are much more likely to develop lipedema due to influences of hormones like estrogen and progesterone on fat growth. It often first appears at puberty but can also start or worsen with major hormonal changes like pregnancy, menopause, and taking certain medications.
Key features of lipedema
There are several unique features that help distinguish lipedema from general obesity or being overweight:
- Disproportionate fat accumulation in the hips, buttocks, and legs
- Minimal fat buildup in the feet and hands
- Sudden onset or worsening with hormonal changes
- Generally spares the trunk of the body
- Creates a disproportionate “pear-shaped” body
- Legs feel heavy and swollen
- Skin may feel nodular or bumpy
- Pain, tenderness, or easy bruising in the affected areas
What causes lipedema fat?
The underlying cause of lipedema is not fully understood. Researchers believe there is likely a genetic component that leads to abnormalities in how the body stores and processes fat. The condition runs in families in up to 90% of cases.
Female sex hormones like estrogen, progesterone, and possibly others appear to stimulate the abnormal growth of fat cells. This helps explain why lipedema overwhelmingly affects women.
Secondary factors like major weight gain, injury, surgery, or disease may trigger the sudden worsening of lipedema in someone predisposed to the condition.
Is lipedema always associated with obesity?
Many people with lipedema are overweight or obese. Excess weight typically occurs in the upper body, like the stomach and waist, in addition to the disproportionate lower body fat.
However, some people with lipedema have an otherwise normal BMI. Their excessive lower body fat causes a “pear shape” while their arms, chest, and stomach remain slender.
One study estimated up to 28% of women with lipedema have a normal BMI. So while lipedema often coexists with obesity, not everyone with this condition is overweight.
Differences in fat distribution
Looking at patterns of fat distribution can help distinguish lipedema from regular obesity:
Lipedema with obesity
- Excess fat on legs, hips, and buttocks
- Excess fat on stomach, waist, and upper body
- Weight is difficult to lose even with diet and exercise
Lipedema without obesity
- Excess fat limited to legs, hips, and buttocks
- Minimal fat on stomach, waist, and upper body
- Normal BMI and body proportions above the waist
- Pear-shaped body
Regular obesity
- Excess fat more evenly distributed over body
- Fat accumulation responds better to diet and exercise
- Apple-shaped body if fat primarily around waist
Measuring lipedema fat
Since the legs are often affected, comparing thigh size to waist size can screen for lipedema in someone with a normal BMI. A disproportionate thigh-to-waist ratio may indicate lipedema fat rather than regular fat.
One study found women with lipedema who had a normal BMI still had very large thigh circumferences:
| Group | Average BMI | Average thigh circumference (cm) |
|---|---|---|
| Lipedema | 22 | 64.7 |
| Control | 22 | 55.8 |
This shows women with lipedema can have nearly 9 extra cm of thigh fat compared to women of an equal BMI without lipedema.
Is lipedema always symmetrical?
Lipedema fat usually develops symmetrically and affects both legs. However, in some cases it can be asymmetrical early on and start in just one leg before involving both sides.
One study found 53% of women with lipedema had symmetrical fat while 47% had asymmetry between the legs. So uneven fat distribution does not rule out lipedema.
Can diet and exercise reduce lipedema fat?
The abnormal fat cells of lipedema are very resistant to diet and exercise. Losing weight typically does not meaningfully reduce fat in areas affected by lipedema.
However, maintaining a healthy weight through diet and exercise is still beneficial for overall health and preventing progression of the condition. It just may not improve the disproportionate appearance of lipedema fat.
How lipedema fat loss is different
| Type of fat | Response to diet & exercise |
|---|---|
| Regular body fat | Responds well to calorie deficit |
| Lipedema fat | Minimal response to calorie deficit |
Lipedema requires treatments that specifically target and remove the abnormal fat cells. Options may include lymphatic drainage therapy, medications, and liposuction.
The takeaway
While lipedema often coexists with obesity, it is possible to have lipedema with an otherwise normal BMI. The characteristic disproportionate accumulation of fat in the hips, buttocks, and legs helps identify lipedema – even in someone not considered overweight.
Maintaining a healthy weight through diet and exercise provides overall benefits but does not get rid of lipedema fat. Effective treatments specifically target the removal of these abnormal fat cells.
Catching lipedema early, regardless of overall weight, is important to prevent progression and complications like joint and mobility problems.
Frequently asked questions
What are the stages of lipedema?
Lipedema is often categorized into stages based on the degree of fat and tissue changes:
- Stage 1: Skin has a smooth, normal texture but excessive subcutaneous fat
- Stage 2: Thick nodular and uneven fat deposits develop, causing a “mattress phenomenon” appearance
- Stage 3: Large growths and protrusions of fat tissue like lobes form, often with fibrotic tissue
- Stage 4: Liposclerosis develops as fat hardens, damages lymphatic vessels, and causes severe swelling
Does lipedema always get worse over time?
If left untreated, lipedema does tend to slowly get worse over many years. Without management, it can progress through the stages with worsening fat deposits, swelling, and mobility impairment.
Early diagnosis and prompt treatment are key to halting progression. Options like lymphatic drainage and liposuction can effectively remove lipedema fat cells and prevent future worsening.
Can you have just a little lipedema?
Even a mild or early case of lipedema with minimal fat deposits can cause discomfort and changes to the texture of the skin and tissue. Any degree of lipedema requires treatment to stop it from worsening.
Some people do have very subtle cases that go undiagnosed for years. But catching lipedema early provides the best long-term outcomes before significant fat accumulation occurs.
What health problems are caused by lipedema?
If lipedema progresses to advanced stages, it can cause major health effects including:
- Severe swelling and lymphedema
- Joint immobility and arthritis
- Gait disturbances requiring mobility aids
- Obesity and related problems like diabetes and heart disease
- Cellulitis infections of the legs
- Deep vein thrombosis blood clots
That’s why early diagnosis and management of lipedema is critical, even in milder cases.
Conclusion
Lipedema is characterized by an abnormal accumulation of fat, most commonly in the hips, thighs, and legs. While strongly associated with being overweight, it is possible to have lipedema even with a normal BMI.
Not all lipedema cases will develop obesity. But no matter the degree of fat deposits, lipedema requires treatment to prevent worsening over time. The hallmark “pear-shaped” body, large thighs compared to waist size, and minimal arm fat help identify lipedema – with or without obesity.
Maintaining a healthy weight and active lifestyle provides general health benefits but does not resolve lipedema on its own. Effective treatments like manual lymphatic drainage therapy and liposuction target the removal of lipedema fat cells.
With today’s greater awareness of lipedema, patients and doctors are identifying subtle cases early. Catching it soon after onset and promptly treating provide the best chance to manage lipedema before it progresses.