Lipedema is a chronic condition characterized by disproportionate fat accumulation, primarily in the legs, hips, and arms. Unlike general obesity, lipedema fat is resistant to typical weight loss methods, making it a unique metabolic challenge.
At Lipedema Surgical Solutions, Dr. Thomas Wright and his team are dedicated to advancing research and treatment for lipedema. Recent studies, including collaborative research with Washington University and St. Louis University, have provided groundbreaking insights into lipedema body composition, metabolism, and effective treatment strategies.
How Does Lipedema Affect Body Composition?
Research has confirmed that women with lipedema have a significantly different fat distribution compared to those without the condition:
Disproportionate Fat Accumulation
Women with lipedema have ~23% more leg fat mass compared to age, sex, and BMI-matched individuals. This imbalance persists even with weight loss.
Fat Loss and Lipedema
While 10-15% of leg fat mass may decrease with weight loss, the proportion of leg fat relative to total body fat remains unchanged. This suggests that lipedema fat is biologically distinct from typical fat storage.
Metabolic Differences
Unlike obesity, lipedema is associated with higher insulin sensitivity—nearly 48% greater than in non-lipedema individuals of the same BMI. Furthermore, insulin sensitivity improves with moderate weight loss, showing metabolic adaptability despite fat distribution challenges.
How Is Lipedema Diagnosed?
Because lipedema is often mistaken for obesity or lymphedema, a comprehensive clinical evaluation is essential. Dr. Wright uses a multi-step assessment process to accurately diagnose lipedema and differentiate it from other conditions.
Key Steps in Lipedema Diagnosis:
- Clinical Examination & Symptom Evaluation
Lipedema is identified by its characteristic column-like fat distribution, especially in the legs, which remains disproportionate to the upper body. Patients often report pain, tenderness, easy bruising, and swelling that worsens throughout the day.
- Stemmer’s Sign & Edema Testing
A critical distinction between lipedema and lymphedema is the Stemmer’s sign—an inability to pinch and lift the skin on the toes. Lipedema does not typically involve foot swelling, unlike lymphedema.
- Evaluation of Fat Distribution & Mobility
Dr. Wright carefully examines fat accumulation patterns, assessing:- Column-like leg shape with overhanging fat over the knees
- “Cuffing” at the ankles and wrists (fat deposits that stop abruptly)
- Lobules and a gluteal shelf (excess fat in the buttocks)
- Gait abnormalities (such as circumduction or an unstable, wobbly walk)
- Joint Hypermobility & Knee Angle Assessment
Many women with lipedema have joint hypermobility, which can contribute to knee valgus (“knock knees”) and increased Q-angles that affect movement. - Imaging & Biometric Assessments
Advanced biometric tools and imaging may be used to confirm disproportionate fat accumulation and assess tissue composition in affected areas.
Can You Lose Fat Mass in a Leg with Lipedema?
Yes! This 2024 study, published in the journal Diabetes, showed that fat in the thighs of women with lipedema measured by MRI and DEXA scan can be reduced with a low-carb Mediterranean diet. However, the increased proportion of fat in the leg did not change. This means the disproportionate shape of women with lipedema after weight loss persists even though they were able to lose some of the fat in their legs.
What Causes Lipedema Fat to Be Resistant to Weight Loss?
Studies on adipose tissue gene expression in women with lipedema reveal unique biological markers in thigh fat tissue, indicating:
- Altered fat metabolism compared to individuals without lipedema.
- Genetic differences in how fat is stored and processed.
- Hormonal influences that may contribute to lipedema’s progression.
These factors explain why traditional diet and exercise often do not lead to proportional fat reduction in lipedema-affected areas.
A Comprehensive Approach to Managing Lipedema Fat
While there is no cure for lipedema, recent research supports a comprehensive treatment plan that includes:
Mediterranean-Based, Low-Refined Carb Diet
This diet has been shown to help reduce fat in lipedema-affected areas, improve insulin sensitivity, and support overall metabolic health.
GLP-1 Medications for Weight Management
Medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) can aid in weight reduction and enhance metabolic function, particularly in women with lipedema.
Compression Therapy & Manual Lymph Drainage
Improving lymphatic flow can reduce swelling and discomfort associated with lipedema.
Regular Exercise & Physical Therapy
Targeted exercise improves circulation, mobility, and muscle tone, helping to manage symptoms effectively.
Lipedema Reduction Surgery
For individuals who have tried conservative treatments, lipedema reduction surgery can significantly improve mobility, pain, and quality of life. Dr. Wright has performed over 7,000 lipedema reduction surgeries, contributing to award-winning research in the field.
Why Choose Lipedema Surgical Solutions?
With over 20 years of experience diagnosing and treating lipedema and more than 10,000 patients treated, Dr. Wright and his team are leading experts in lipedema research and treatment. As a recognized contributor to peer-reviewed studies, including recent findings published in Diabetes Journal (2024), we ensure that our treatment recommendations are backed by the latest science.
Reference
Cifarelli, V., Smith, G. I., Gonzalez-Nieves, S., Samovski, D., Palacios, H. H., Yoshino, J., Stein, R. I., Fuchs, A., Wright, T. F., & Klein, S. (2024). Adipose tissue biology and effect of weight loss in women with lipedema. Diabetes, 74(3), 308. https://doi.org/10.2337/db24-0890
