By: Shirlea North, PT, DPT, CLT
Did you know that there are different types of fat? Did you know that 1 in 9 women are diagnosed with lipedema? Not all fat is cellulitis!
June is Lipedema awareness month, and like many other underserved populations, we need more awareness about Lipedema, especially in the healthcare community.
As a Certified Lymphedema Therapist (CLT), I often have the conversation with a client about the differences between lipedema and lymphedema and what we see clinically. My heart goes out the individuals (over 90% are women) that get this diagnosis and are being called fat and are told to “just diet and exercise and it will go away.” Nothing could be further from the truth!
Lipedema, as a medical diagnosis, has been in existence since 1940, and there hasn’t been nearly as much treatment advancement as there should be. Many limitations in research are due to gender disparity but that’s for a different blog. Unfortunately, many medical schools do not address the lymphatic system and what an important role it plays in our bodies. More importantly, many doctors don’t really understand what lipedema is, even within the specialties that should be able to identify and appropriately diagnose it, like cardiologists, endocrinologists, etc.
Lipedema is characterized by an abnormal and chronic fibrotic fat deposition that tends to start and/or exacerbate at times of hormonal changes (Check out this website for a more in-depth explanation and photos - Lipoedema - NHS (www.nhs.uk). It can present bilaterally and symmetrically between left and right sides and mainly affects the trunk and lower extremities. With advanced stages, it can affect the upper extremities as well. There has been links to estrogen changes and skin hypersensitivities like neuropathy with lipedema, as well as connect tissue disorders like Ehler-Danlos Syndrome (Szel, E, et al. Pathophysological dilemmas in lipedema, 2014). This fat deposition is not cellulite and has a harder, fibrotic structure which can physically block the superficial lymphatic system and give rise to secondary lymphedema, an accumulation of protein-rich fluid.
The treatment of lipedema is very similar to lymphedema with complete decongestive therapy via certified lymphedema therapist with manual lymphatic drainage technique, mobility, and appropriate compression garments, in addition to uses of vibration plates, dietary considerations, deep tissue/fibrosis manual techniques, and lymph-sparring liposuction. Yes, surgery, but not any kind of plastic surgery, but a specialized procedure that only a few surgeons in the country, who specialize in lipo-lymphatic conditions, are trained to perform.
In conclusion, lipedema is still a new, uncharted territory for medical professionals, but not for your certified lymphedema therapist. Your CLT can educate you and be your advocate in developing an appropriate self-management and wellness program. They will help incorporate and personalize these techniques based on you and your needs. Don’t accept the “you just need to diet and exercise and it will go away” prescription. Ask you doctor about lipedema, advocate for yourself, and schedule an appointment with a knowledgeable CLT.