Study: Lipedema and Obesity

Dilated blood and lymph vessels, angiogenesis, increased macrophages and adipocyte hypertrophy in skin and fatty tissue of the lipedema thigh

Sara AL-Ghadban, Walter Cromer, Marisol Allen, Christopher Ussery, Michael Badowski, David Harris, Karen L. Herbst

First published: 03 March 2019 https://doi.org/10.1155/2019/8747461

Citations: 84

What makes lipedema fat so special?

11% of adult women worldwide are affected by lipedema. The condition is often misunderstood or confused with obesity – although the affected fatty tissue differs significantly from ordinary body fat at the cellular level. A new study has now examined in more detail how lipedema fat behaves in slim and overweight women – and uncovered astonishing findings.


What was investigated?

Scientists analyzed the fatty tissue of lipedema sufferers and compared it with that of unaffected women—in a lean (non-obese) and an overweight (obese) group. They focused particularly on the structure of the fat cells, the presence of immune cells, and changes in the blood and lymph vessels in the affected area—typically the thigh.

The most important findings at a glance:


Enlarged fat cells – even without being overweight

In all lipedema patients – regardless of BMI – the fat cells were enlarged ("hypertrophic"). This is a typical feature of obesity. Interestingly, slim lipedema patients also showed this cellular change. This means that the abnormal fat growth is not due to excess weight, but represents an independent pathological change.


Chronic inflammation in fatty tissue

Significantly more immune cells (macrophages) are found in lipedema fat than in healthy adipose tissue. So-called "crown-like structures" (CLS), indicating dead fat cells surrounded by immune cells, have also been observed. These are normally only found in pathologically altered adipose tissue (e.g., in obesity).

Conclusion: Lipedema fat is an “inflammatory” fat – even in slim women.


Increased blood vessel formation (angiogenesis)

An increased number and dilation of blood capillaries was observed in the skin and subcutaneous tissue of those affected. What was particularly striking was that these blood vessels extended into the uppermost layers of the skin—a phenomenon otherwise only observed in certain skin inflammations such as psoriasis.

Conclusion: These vascular changes could explain why many patients complain of pain, tenderness, and bruising.


Lymphatic vessels changed – but only in overweight people

While blood vessels were noticeably altered in all lipedema groups, changes in the lymphatic vessels were only observed in overweight lipedema patients. The lymphatic vessels were enlarged, indicating impaired lymphatic drainage and a risk for subsequent lipolymphedema.


What do these results mean for therapy?

The study provides strong evidence that lipedema is not a mere “fat distribution disorder,” but rather an inflammatory, vascular-related process that leads to pathological fat growth – regardless of body weight.


Why is this important? Many patients report that neither diet nor exercise changes the affected areas of the body – yet they are often fobbed off with advice to lose weight. This research shows that lipedema fat has a different biological basis than normal fat.


Possible causes of lipedema:
  • Leaky capillaries: Changes in blood vessels cause fluid to leak into the tissue and not be adequately removed.
  • Lymphatic congestion: Especially in overweight women, the drainage of lymph can be disrupted.
  • Inflammation: The fluid triggers immune reactions that promote fat growth and pain.
  • Fibrosis: The tissue hardens due to chronic inflammation, which makes weight loss even more difficult.
  • Nerve involvement: The fluid and inflammation surrounding the nerves could explain the pain that many sufferers experience.


What can help?

The study emphasizes that future therapies should not only aim at weight reduction, but:

  • improve blood circulation,
  • reduce inflammation,
  • and support lymph flow.


This includes:

  • Lymphatic drainage & compression
  • Exercise therapy (e.g. aqua fitness, walking)
  • Nutritional strategies to inhibit inflammation
  • Liposuction
  • if necessary, medication to support the vascular system


Conclusion:

Lipedema is a serious condition with complex causes that go far beyond mere fat accumulation. The latest scientific findings help us better understand the disease – and offer hope for new, targeted treatments.