Study: Lipedema and obesity

Dilated blood and lymphatic vessels, angiogenesis, increased macrophages and adipocyte hypertrophy in the skin and adipose 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?

Eleven percent of adult women worldwide are affected by lipedema. The condition is often misunderstood or confused with obesity – yet the affected fatty tissue differs significantly from ordinary body fat at the cellular level. A new study has now examined more closely how lipedema fat behaves in slim and overweight women – revealing some surprising findings.


What was investigated?

Scientists analyzed the adipose tissue of individuals with lipedema and compared it to that of unaffected women – in both a lean (non-obese) and an overweight (obese) group. The focus was particularly on the structure of the fat cells, the presence of immune cells, and changes in the blood and lymphatic vessels in the affected area – typically the thigh.

Key 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 characteristic of obesity. Interestingly, even slim lipedema patients showed this cellular change. This means that the abnormal fat growth is not due to being overweight, but rather represents an independent pathological change.


Chronic inflammation in adipose tissue

Lipedema fat contains significantly more immune cells (macrophages) than healthy adipose tissue. So-called "crown-like structures" (CLS), an indication of 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)

The skin and subcutaneous tissue of affected individuals showed an increased number and dilation of blood capillaries. Particularly striking was the fact 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, pressure sensitivity, and bruising.


Lymphatic vessels are altered – but only in cases of obesity

While blood vessels showed marked changes in all lipedema groups, changes in the lymphatic vessels occurred only in overweight lipedema patients. The lymphatic vessels were enlarged, indicating impaired lymphatic drainage and a risk for later lipolymphedema.


What do these results mean for therapy?

The study provides strong evidence that lipedema is not simply a "fat distribution disorder" but an inflammatory, vascular process that leads to pathological fat growth – regardless of body weight.


Why is this important? Many patients report that neither diets nor exercise change the affected areas of their bodies – and yet they are often told to lose weight. This research shows that lipedema fat has a different biological basis than normal fat.


Possible causes of lipedema:
  • Leaky capillaries: Due to altered blood vessels, fluid leaks into the tissue and is not adequately removed.
  • Lymphatic congestion: Especially in overweight women, the drainage of lymph can be impaired.
  • Inflammation: The fluid triggers immune responses 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 in the area 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 also:

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


This includes:

  • Lymphatic drainage & compression
  • Exercise therapy (e.g., aqua fitness, walking)
  • Dietary strategies for reducing inflammation
  • Liposuction
  • Possibly medication to support the vascular system


Conclusion:

Lipedema is a serious condition with complex causes that go far beyond simple fat accumulation. The latest scientific findings are helping us to better understand the condition – and offer hope for new, targeted treatment options.