Every day, women who are very concerned that they may be suffering from lipedema come to see me during my consultation hours. Their own research on the internet has left them frightened and uncertain, and they are often firmly convinced that they are suffering from lipedema based on the symptoms described.
Lipedema is relatively rare.
First, the good news: true lipedema is quite rare! In fact, most stubborn fat deposits on the legs, hips, and arms that resist exercise and diet are actually lipohypertrophy—completely healthy and normal, but increased fat tissue.
The mere fact that these fat deposits cannot be properly addressed by diet or nutritional changes, nor significantly influenced by exercise, does not make them lipedema. I also hear more and more often from my patients that the slight rippling of their skin is a clear sign of lipedema. This is also not true.
Although diagnosing lipedema is not always easy, visible changes in the skin such as nodules in the subcutaneous fatty tissue or the aforementioned dimpling (cellulite) are not necessarily indicative of lipedema.
What exactly is lipedema?
Lipedema is defined as a symmetrical fat distribution disorder under the skin of the legs, hips, or upper arms, which is associated with pain or a feeling of pressure. The second part of the sentence is important here: lipedema is always accompanied by symptoms. If there are no symptoms, it is not lipedema. These symptoms cannot be explained by other causes such as venous insufficiency or disc problems.
Lipedema causes discomfort
According to current research, this pain is likely caused by chronic and subliminal inflammation of the increased fatty tissue under the skin. This assumption is based on observations of suctioned fatty tissue under a microscope: in contrast to normal fatty tissue, the fatty tissue of lipedema patients shows increased inflammatory cells. The cause of this inflammation of the fatty tissue in lipedema patients is still unclear, but it appears to be responsible for the symptoms. This is why wearing compression garments helps with lipedema: compression generally reduces inflammatory processes, thereby alleviating symptoms. Of course, the compression garments do not reduce the increased fatty tissue.
What are the stages of lipedema?
If the symptoms indicate that lipedema is likely to be present, doctors currently classify lipedema into three stages based on its external appearance. However, it must be clearly pointed out that this classification also contains gray areas and can be very subjective. For this reason, experts have been calling for a reform of this classification for some time now, in order to make it more objective and more relevant to treatment.
The following stages are currently distinguished:
Stage I:
The subcutaneous fatty tissue is increased. The skin appears smooth, with no visible changes.
Stage II:
The subcutaneous fatty tissue is increased. The skin shows slight indentations/dimpling (cellulite).
Stage III:
The subcutaneous fatty tissue is increased. The excess fatty tissue leads to overhanging fat folds (jowls) on the ankles, knees, hips, or arms.
Staging can be subjective
In my daily practice, staging also plays only a minor role, because the transitions—especially between stages I and II—are often fluid, and staging is subject to subjective impressions and is therefore not always possible to determine with precision. It is often the patients themselves for whom the classification is important. In particular, I seem to notice a great fear of stage II, as this is perceived – albeit completely unfounded – as a threat to one's own health. In my lipedema consultations, I most frequently encounter stage II, followed by stage I. I encounter stage III the least.
Is it possible to develop to a higher stage?
Many patients remain permanently at a certain stage; progression to a higher stage is not inevitable, but can occur—especially from stage I to stage II. Progression from stage II to stage III usually requires significant weight gain, which is mostly caused by factors other than lipedema (poor diet, reduced metabolism, lack of physical activity).
Only in stage III can you currently attempt to have the costs of surgery (liposuction) reimbursed by statutory health insurance, provided certain other conditions are met. Surgical treatment in stages I or II is not covered by statutory health insurance, but with private health insurance, you can also attempt to have the costs covered in these stages.
How can lipedema be diagnosed?
Contrary to popular belief, ultrasound and MRI (magnetic resonance imaging) scans show no differences between the fatty tissue in lipedema and normal fatty tissue. Furthermore, nodule formation in the subcutaneous fatty tissue is not a sign of lipedema, even though this is often claimed on the internet. Even body shape (external appearance) or being overweight are not essential criteria. The only things that matter are symptoms such as pain or a feeling of pressure. This is why there are slim patients with lipedema and overweight women without lipedema.
How can I determine whether I have lipedema?
Whether you have lipedema can therefore only be determined on the basis of your medical history/symptoms and a physical examination. Blood tests, ultrasounds, or MRIs are not useful for this purpose. However, an ultrasound examination is used to rule out other causes of symptoms, such as varicose veins (even if these are not visible from the outside), and is therefore an essential part of the diagnostic process.
Phlebologists (vein specialists) diagnose lipedema
For this reason, the diagnosis of lipedema in Germany falls within the area of expertise of phlebologists (vein specialists). Phlebologists can use ultrasound to rule out venous insufficiency and provide patients with lipedema with comprehensive advice on further treatment and the various therapy options (conservative or surgical). Lipedema is always part of phlebology conferences, and research in this area is still in its infancy.
When should you see a doctor?
If you notice or suspect any of the signs described above that may indicate lipedema, I recommend that you consult a phlebologist for further examination and clarification.
You are welcome to visit my practice, as we specialize in the diagnosis and treatment of lipedema.
