Introduction

Lipedema is a chronic, progressive, and painful condition characterised by fat accumulation in the legs, thighs, hips, and sometimes the arms. It is important to understand the cause of lipedema and to diagnose it correctly. Lipedema is confused with obesity and lymphedema. 

Lipedema differs from obesity in that it causes tenderness and bruising. The lipedema fat is resistant to exercise and diet, unlike general obesity. The prevalence of lipedema is higher in females than in males, and it worsens during times of hormonal change like puberty, pregnancy, and menopause.¹

Incorrect diagnosis of lipedema often leads to late and inaccurate treatment, which can create anxiety and stress in people suffering from it. People usually blame themselves for not being able to lose weight, whereas the real problem lies in an incorrect diagnosis.²

Current studies are concentrating on two interconnected theories: inflammation and microvascular dysfunction (injured blood vessels). These theories explain why lipedema fat becomes painful, resistant to traditional weight-loss attempts, and progressively worsens over time.³

What causes lipedema?

The exact cause of lipedema remains unknown. However, several contributing factors have been identified: 

• Hormonal influences: it often begins when there are significant hormonal changes in the body, such as during puberty, pregnancy, and menopause 
• Genetic predisposition: research suggests that lipedema can be inherited 
• Lymphatic or microvascular factors: swelling may arise due to the involvement of the lymphatic system 

Two recent theories propose that lipedema originates from:

1. Chronic inflammation in fat tissue: due to increased immune activity
2. Vascular issues: because of fragile, leaky blood vessels and overburdened lymphatic drainage

These reasons help explain why lipedema causes pain and swelling even when diet and exercise cannot correct it.^1,2,3,4

Inflammatory theory: when the body’s defences go too far

In lipedema, immune cells remain constantly active in fat tissue, resulting in chronic inflammation, even in the absence of injury. Our immune cells are harming our bodies instead of helping.^1,2,5,6

Signs of inflammation in lipedema:

• Pain and tenderness: the fat tissue is tender on touching, which is a sign of inflammation
• Increased number of immune cells: lipedema fat is filled with macrophages and mast cells, which are usually seen in cases of inflammation 
• Increased number of chemical messengers: increased cytokines and interleukins have been seen in fat tissue and blood, which suggests continuous immune activity in the body 

How inflammation explains symptoms

The inflammation of the affected fat becomes tender, swollen, and stiff. Even after creating a caloric deficit and proper exercise regimen, this fat tissue does not melt away. The continued inflammation makes these cells even bigger and may form a rubbery texture, which many people with lipedema experience.^2,5

Why does inflammation matter?

Research has shown that calming down these immune cells helps reduce inflammation, which in turn helps alleviate pain and swelling. These findings suggest that treatment targeting inflammation, such as anti-inflammatory diets, gentle exercise, and medications, could be effective in managing lipedema.⁶

Vascular theory: leaky pipes under the skin 

The small blood vessels in our body, called capillaries, become weak and start leaking, which may cause swelling and fluid retention. This leakage allows fluids and proteins to seep into adjacent tissue, which in turn leads to chronic swelling and fluid retention.¹

What is going wrong in the blood vessels

• Fragile capillaries: blood capillaries become weak and leaky. They leak, and fluids and proteins seep into the adjacent tissues²
• Poor circulation and fluid pooling: blood flow in arms and lower body becomes slow and sluggish, leading to fluid pooling³
• Microscopic vessel damage: studies reveal weak capillaries with increased permeability²

Mechanisms behind abnormal fat growth

Leaky capillaries

The leaky capillaries allow fluids and proteins to seep into the adjacent tissues, resulting in oedema. This oedema activates the defence system as if something is wrong in the body.⁶

Hypoxia-driven angiogenesis

Poor blood flow leads to tissue hypoxia, characterised by lower oxygen levels, which in turn stimulates angiogenesis (the formation of new fragile vessels). This further contributes to inflammation, leakage, and oedema.²

Lymphatic drainage issues

The lymphatic system, which serves as the body’s natural drainage system, clears excess cells, proteins, and fluid from tissues and returns them to the bloodstream. This system gets overburdened, leading to increased oedema as the fluid retention keeps on growing not just by capillaries but also by the lymphatic system.⁷

Linking to inflammation

The fluid leakage ruptures cell walls and activates immune responses, leading to swelling. This leads to a lack of oxygen, or hypoxia, which in turn causes the formation of new blood vessels that are weak and leaky. This further creates the loop of swelling and increased immune activity.

To combat this, therapeutic techniques such as compression therapy and specialised clothing are recommended for the treatment of lipedema.⁶

Is inflammation and vascular damage linked? 

The inflammatory and vascular theories are strongly interconnected, forming a biological feedback loop.^1,3,6

The connection

• Inflammation causes the weakening of blood vessels, which in turn leads to leakage
• Leaky vessels cause leakage of fluids and proteins, further causing inflammation
• Continuous leakage and inflammation cause swelling, and abnormal fat tissue progressively increases the problem 

Why this matters: from theory to treatment 

There is no proper treatment to cure lipedema, but there are ways to slow the progression of the disease. After understanding the causes, we can target them to stop their progression and provide relief.

Anti-inflammatory strategies

• Diet: includes anti-inflammatory foods like omega-3 fats, leafy greens, and antioxidants may to ease the symptoms⁶ 
• Gentle exercise: may help improve blood flow drainage and, therefore, reduce swelling¹
• Medication: drugs targeting immune activity, such as antihistamines have shown great results⁷

Vascular support

• Compression garments: they provide external pressure to give strength to capillaries and reduce oedema¹
• Circulation-enhancing therapies: gentle massages can improve fluid movement and reduce leakage³

FAQs

Is lipedema the same as lymphedema or obesity?

No, lymphedema is caused by failure in the lymphatic system, while lipedema is caused by inflammation and leakage in the vascular system. Obesity is caused by excessive fat deposits resulting from increased calorie intake, whereas lipedema is not.¹

Why does it hurt so much?

In lipedema, the fat is painful because it originates from inflammation and the formation of fibrotic tissue. There is significant fluid retention in the body, resulting in pain and tenderness.²

Can anti-inflammatory foods help?

Yes, they can help because the possible reasons for lipedema are vascular and inflammatory changes; therefore, anti-inflammatory foods can help calm down inflammation.⁶

Is there a cure?

There is no complete cure, and lipedema is a progressive disorder. However, combination treatments such as compression, diet, gentle exercise, and surgery can improve quality of life. Targeted medications are also in development.⁷

How can I support someone with lipedema?

Empathy towards people affected by lipedema can help them recover and better accept the condition. We must provide non-judgmental acceptance and care to them.²

Are people assigned male at birth (AMAB) affected?

Lipedema mainly affects people assigned female at birth (AFAB). There is a very negligible number of people assigned male at birth (AMAB) affected by lipedema. The reasons are possibly hormonal and genetic changes.³

Summary

The real cause of lipedema is not clearly understood, but the latest treatments revolve around two main theories: Chronic inflammation and vascular dysfunction are emerging as the main reasons for lipedema. Inflammation makes fat painful and fibrotic; leaky blood vessels trigger swelling and immune activity. This combination forms a vicious cycle that exacerbates pain, swelling, and fat deposition - a cycle that is not broken by dieting and exercise alone. By understanding these root causes, researchers and clinicians are seeking more effective and targeted treatments. The journey from myth to medical truth is gaining speed, and better treatments and support therapy are being given to people suffering from lipedema.