Introduction

Lipedema is a condition that involves swelling of certain parts of the body and can often be confused with other conditions, including obesity and lymphedema. Due to the similar body composition present in the three conditions, it can be difficult to tell them apart after only a first glance; therefore, more detailed investigations into causes and body changes are required to accurately come to a diagnosis. Obtaining an accurate diagnosis is essential because treatment and management options for each of the conditions are different.

Lipedema

Causes

Lipedema is seen exclusively in females and is thought to be driven by changes in female sex hormones. The causes are mainly unknown but most findings have shown that there is a link between hormones and fat accumulation and inflammation.It can be linked to pregnancy, menopause and puberty as there are changes to oestrogen hormone levels during these times.¹ It is thought that oestrogen has a large role in the metabolism of lipids and in reducing the risk of cardiovascular disease in females.² 

Presentation

Lipedema typically has four different stages of disease presentation. These range from quite mild symptoms limited to only a few areas of the body to widespread symptoms that can greatly reduce quality of life.³ Lipedema can begin as very small ‘pearl sized nodules’ in the subdermal layer of the skin, mainly affecting the limbs; this can progress to much larger masses that can be felt on palpation of the skin and can become quite painful. In very severe and advanced cases, skin can appear very inflamed and swellings in the limbs, hips, thighs and knees could develop.⁴ Overall, there is often a complete loss of skin elasticity and can progress to lipolymphedema.³

Obesity

Obesity is a medical symptom defined using the body mass index (BMI) of an individual. In the U.K the BMI cut off that is used to classify someone as obese is 30. People can become obese by consuming an increased amount of calories in comparison to their activity levels for a long period of time, eventually collecting increased levels of body fat.⁵ Obesity is thought to be a chronic, low grade state of inflammation that can contribute to the development of many other chronic health conditions including type 2 diabetes, hypertension, and cardiac issues. Extra fat collects around important organs and within the abdomen as visceral fat, putting those with higher ratios of visceral fat at further risk of ill health.⁶

Lymphedema

Lymphedema is described as an increased amount of fluid within tissue due to changes to the lymphatic system. Secondary lymphedema is associated with certain types of cancer, most commonly breast cancer, and after having a small surgery called an axillary lymph nodes clearance because fluid can build up in the armpit regions.⁷ Fluid can build up due to a disruption in the lymph nodes network within the body, either from surgical removal or from overloading a specific lymph node with too much fluid. 

People with lymphedema can experience an increase in the width of their limbs and develop pitting of the legs and arms. It is advised that people experiencing these symptoms should elevate the affected limbs or seek compression stockings treatments to help with the removal and easing of fluid buildup.⁸

Differentiating between the three

The three conditions have some similarities, especially when looking at the presentation from afar. The swelling and increase in the size of body parts, particularly of limbs, can be seen in all of the conditions, however, other features are specific to only one condition. Obesity is one of the associated risk factors of lymphedema, therefore, people with higher BMIs can present with symptoms of lymphedema.⁹ Both obesity and lymphedema can occur in females and males, whereas lipedema is seen exclusively in females due to interactions and changes in the female sex hormones. Additionally, post-cancer patients are most affected by lymphedema.⁸ Whilst lipedema and lymphedema affect certain areas of the body, mainly the limbs, obesity occurs in a much more symmetrical distribution, targeting central areas and organs.⁶ 

Summary

Lipedema is a relatively uncommon medical condition that affects females of reproductive age. It has a range of symptoms that involve the swelling of limbs, fat accumulation, and daily pain. These symptoms impact the quality of life of the females with this condition. In comparison, obesity and lymphedema occur without different stages of the conditions and without intense pain. Both lymphedema and obesity can affect males and females, unlike lipedema, and can occur at any stage of life. It is important to distinguish between the three conditions to ensure appropriate diagnosis and management to improve patient quality of life. Additionally, there are useful organisations and support groups that can facilitate lifestyle adaptations if necessary and to share experiences.

FAQs

What are the common symptoms of lipedema?

The most common symptoms of lipedema are swellings of the limbs, very commonly seen in the legs and hips. Small raised lumps often begin to form under the skin in the affected regions and, in very severe cases, it can become very painful to move and use the affected limbs.

What are the common symptoms of lymphedema?

There is often swelling and pitting seen in the limbs and armpits due to fluid accumulation. Often, there is no pain or mass development in those with lymphedema.

What are the common symptoms of obesity?

Obesity is actually a symptom in itself and isn’t an actual medical diagnosis. A person must have a BMI of above 30 to be classed as obese, however, this can develop in many different ways. Most importantly, there will be fat build up around the abdomen, which is very dangerous for human health and can lead to many chronic illnesses. Obesity affects the whole body and is usually symmetrical in comparison to lipedema and lymphedema.