Wednesday, December 7

Lipedema: the problem of ‘fat legs’ that cannot be cured with diet or sport

There are health problems that, despite affecting many people, must wait a long time to be properly assessed. A good example is lipedema, identified as early as the 1940s but recognized as disease by the World Health Organization (WHO) only in 2018.

The lipedema It is a chronic disease that occurs almost exclusively among women and consists of abnormal accumulation of subcutaneous fatty tissue in the legs (although sometimes it also occurs in the arms). The rest of the body – including feet and hands – is not affected.

Such accumulation generates a swelling or “fat” that is symmetrical on both sides of the body and that causes the person to have a unbalanced silhouettesince the lower half of the body is thicker than the upper one.

They are considered to exist three degrees of lipedema. In grade I, the least severe, the skin surface is normal. The adipose tissue is soft, but some fat nodules can be palpated. In grade II, meanwhile, the skin becomes irregular and hardens, due to the increase in the nodular structure.

Upon reaching grade III, the thickening of the legs is already considerable, and the nodules abound. One of the main negative consequences of lipedema is the aesthetic aspectwhich generates significant psychological and social discomfort.

But it’s not just that. There is also a feeling of heaviness, hypersensitivity to pain (caused by the slightest pressure on the skin), mobility problems and capillary fragility, which causes the appearance of bruises spontaneously or with the slightest trauma.

These symptoms become more noticeable as the disease progresses. Therefore, with the passage of time also worsens quality of life of those who suffer from it.

Some figures on lipedema

It is difficult to determine what percentage of women this disease affects, due to the partial and heterogeneous data and the lack of clear diagnostic criteria. Some studieshowever, point out that around 11% of adult women worldwide suffer from some degree of lipedema: that is, one in nine.

One of the big problems related to lipedema is the misdiagnoses. In many cases, this ailment is confused with obesity, lymphedema (inflammation of tissues due to fluid accumulation), lipodystrophies or chronic venous insufficiency, according to a Consensus Document on Lipedema published in 2018.

These misdiagnoses lead many patients to undergo “treatments inadequate and ineffective and, in the best of cases, symptomatic treatments”, indicates the same text.

In Spain, in fact, women with lipedema need an average of five medical visits to get a correct diagnosis. This is how one reveals it poll carried out by experts from the Virgen de la Luz Hospital and the University of Castilla-La Mancha, in Cuenca, which analyzed data from 463 women suffering from the disease.

According to that same work, published in 2020, the symptoms of lipedema begin to appear -on average- at 18 years of age. Almost 80% of the patients tried at least three different types of treatments; the most used was weight loss.

But that is another problem, because the fat cells affected by lipedema have a almost zero response to diets and physical exercise, even if it is intense. Since this form of treatment has almost no effect, it often leads to frustration.

The treatment perceived as most effective -according to the survey- is the use of compression garments, which modify the appearance of the legs and produce an improvement in the aesthetic part of the problem and also reduce pain. That is, they allow alleviating some of the symptoms, but they do not attack the root of the issue.

Causes and aggravating factors

The causes of lipedema are not clear, although there are indications that they involve genetic and hormonal factors. The latter are made visible in the fact that the symptoms “usually appear or worsen at times of considerable hormonal changes”, such as puberty, pregnancy or menopause.

This is explained in an article by the Association of Lipidema Affected in Spain (ADALIPE), an organization founded in 2016 with the aim of making the problem visible. The following year, experts from different Spanish scientific societies met in order to create a clinical practice guide on the matter, they could not.

Why couldn’t they? Well, for “the absence of publications with scientific evidence enough to allow us a systematic review of the subject”, as explained by Margarita Novoa, member of the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE), in a Article published earlier this year.

So recent and scarce are the studies about the topic. What these specialists were able to edit was the aforementioned Consensus Document on Lipedema, published in 2018, almost at the same time that the WHO gave the problem rank as a disease.

The Consensus Document points out -going back to the causes of lipedema- that factors such as obesity, immobility and lymphatic and venous insufficiency are aggravating but not etiopathogenic. That is, they are not linked to their origin or development.

Treatments against lipepema

What is then the most appropriate treatment against lipedema? In addition to the use of compression garments and possibly also analgesics to reduce pain, some physical therapies such as mesotherapy, ultrasound, electromagnetic radiation or infiltrations.

On the other hand, eating a healthy diet, maintaining an adequate body mass index, and being physically active as well it’s profitable for people with lipedema, then helps reduce symptoms -or at least not to increase- and therefore improves the quality of life.

However, as the Consensus Document explains, in recent years surgical intervention “has become the only definitive option treatment of these patients. The most common method is liposuction; but different liposuction techniques are used than those used for purely aesthetic purposes.

To cure lipedema, “devices that remove fat in a way less traumaticsuch as power assisted liposuction (PAL) with a vibrating cannula or water assisted liposuction (WAL).” They are complex surgeries, carried out by plastic surgeons.

Unfortunately, in Spain these operations are not included in social securityl, despite the fact that four years have passed since the WHO accepted that lipedema is a health problem and not just a matter of personal aesthetics.

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