Lipedema or obesity: 6 differences worth knowing

Many women with lipedema hear the same advice from doctors and family for years: “just eat less”. They try diets, exercise and fasting — their face, chest and waist slim down, but their legs stay the same. The reason is that lipedema and obesity are different conditions, even though they can look alike.

1. Where the fat accumulates

In lipedema, fat is deposited disproportionately: thighs, buttocks, lower legs and sometimes the arms. The upper body may be much slimmer — top and bottom clothing sizes often differ by two or three sizes.

In obesity, fat is distributed relatively evenly, often mainly around the abdomen.

2. Pain when touched

Lipedema tissue hurts when pressed or pinched, sometimes even from tight clothing. Ordinary fat tissue is not usually painful.

3. Bruising

In lipedema, bruises appear easily, and women often cannot remember knocking themselves. This is linked to fragile small blood vessels in the affected tissue.

4. Feet and hands

A typical sign of lipedema is the “cuff”: the tissue stops abruptly above the ankle or wrist, while the feet and hands stay slim. In obesity and lymphedema, the feet often enlarge as well.

5. Response to dieting

When a person with obesity loses weight, the whole body gets smaller. In lipedema, the affected areas barely change, even after significant overall weight loss.

6. Symmetry and family history

Lipedema is almost always symmetrical and often affects several women in the same family. Changes often begin at times of hormonal change: puberty, pregnancy and menopause.

What if you have both?

Lipedema and obesity can occur together. In that case it is important to treat both: weight management reduces the load on the legs and lymphatic system, while lipedema tissue is treated with compression and, when indicated, lymph-sparing liposuction.

How to get a definite answer

Only a doctor can tell these conditions apart at an examination. At a consultation, the surgeon assesses the distribution of tissue, pain and bruising and performs an ultrasound of the soft tissues and, if needed, the veins. If you recognise yourself in several of these points, fill in our questionnaire — the doctor will review your answers and contact you. For more on the diagnostic criteria, see “Diagnosing lipedema”.