Marina, 34 years old, has always heard that it was enough to try harder on her diet for her legs to "keep up" with the rest of her body. She would lose weight, but her thighs and calves remained painful, heavy and disproportionate to her trunk. Only after years in this pursuit did she hear, for the first time, the name of the condition that explained everything: lipoedema.

"The data and clinical case cited in this article are fictitious and are merely illustrative, serving to facilitate understanding of the topic addressed."

Stories like Marina's are repeated. Lipoedema is still little known, even though it is relatively frequent, and many women spend years being treated for obesity or cellulite with no improvement whatsoever. Understanding what the disease is, how it is diagnosed and what really influences its progression is the first step towards more effective management.

What is lipoedema

Lipoedema is a chronic disease that causes abnormal and disproportionate accumulation of fat, usually in the legs, hips and, in some cases, also in the arms. A striking characteristic is that it spares the hands and feet, creating a visible difference between the affected area and the rest of the body.

It is not synonymous with obesity or common cellulite. It is its own condition, recognised with a specific code in international disease classifications, which involves changes in adipose tissue, microcirculation and, in more advanced stages, also in the lymphatic system. Because of this, unlike common fat, lipoedema fat usually responds poorly to conventional diets and exercise regimens.

Signs and symptoms

Some signs help to suspect the condition:

  • Symmetric accumulation of fat (equal on both sides) in the legs or arms, sparing hands and feet
  • Pain or sensitivity to touch in the affected areas
  • Sensation of heaviness and fatigue in the legs, especially towards the end of the day
  • Tendency to form bruises easily, even without remembering having bumped into something
  • Over time, changes in skin texture, such as small irregularities or nodules under the skin
  • Disproportion between the volume of the trunk and the volume of the limbs
  • Little or no response of the affected region to diets and exercise, even with weight loss in other parts of the body

How diagnosis is made

There is no blood test that confirms lipoedema diagnosis on its own. It is, above all, clinical: the doctor evaluates the patient's history, symptoms and performs a detailed physical examination, observing fat distribution, sensitivity to touch and a sign called Stemmer's sign, which helps to differentiate lipoedema from lymphoedema.

Imaging tests, such as ultrasonography, can complement this assessment, showing changes in adipose tissue and helping to define the stage of the disease. In Brazil, a national consensus on the subject was published this year, which represents an important advance in standardising diagnosis and patient follow-up.

The disease tends to progress in stages, ranging from more subtle changes, with skin still smooth, to advanced phases, in which lipoedema combines with lymphatic involvement (the so-called lipo-lymphoedema). The earlier the diagnosis, the simpler and more effective management tends to be.

Risk factors

Some factors increase the chance of developing lipoedema:

  • Family history: the disease has a strong genetic component. It is common to find mothers, grandmothers or sisters with the same condition, even if it has never been diagnosed in them.
  • Sex: it affects almost exclusively women, which reinforces the hormonal influence on its origin.
  • Periods of major hormonal variation: lipoedema tends to appear or worsen during puberty, pregnancy or menopause, periods when oestrogen levels change considerably.

It is worth noting that, at present, evidence does not confirm that the use of contraceptives or hormone replacement therapy worsens the disease directly. This is a common concern among patients and it is worth discussing with your doctor if it arises.

What worsens the condition

Lifestyle does not cause lipoedema, but can accelerate its progression and intensify symptoms. Among the main factors that worsen the condition are:

  • Weight gain, which overloads already compromised tissues even more
  • Sedentary lifestyle and long periods standing or sitting
  • Diet rich in ultra-processed foods, sugar and low-quality fats
  • Delayed diagnosis, which allows the disease to progress without any type of management
  • Lack of adequate support (such as the use of compression) in daily activities

What helps to improve and control the disease

The good news is that there is a well-established management pathway, especially when diagnosis occurs early:

  • Regular medical follow-up, preferably with a multidisciplinary team
  • Compression therapy, with stockings or specific garments recommended by a professional
  • Manual lymphatic drainage, performed by a qualified professional
  • Low-impact physical activity, such as walking, water aerobics and swimming, which help circulation without overloading the joints
  • Balanced and anti-inflammatory diet, avoiding ultra-processed foods
  • Psychological support, since pain, limitation of movement and impact on self-esteem greatly affect quality of life
  • In more advanced stages, specific surgical techniques for lipoedema (different from aesthetic liposuction) can be discussed with the specialist

Conservative treatment is the basis in practically all stages, and diagnosing the disease early is what most influences long-term prognosis.

This content is informative in nature and does not replace a medical consultation. Each case should be individually evaluated by a healthcare professional, who can indicate the most appropriate diagnosis and treatment.

Dr. Rebeca Soares Andrade CRM - GO 39335