Getting an initial Lipedema diagnosis is a challenge for many women suffering from it. In fact, an overwhelming majority of patients seeking treatment are well into their forties, fifties, sixties, or later in age, simply because they had never heard of lipedema or been diagnosed with it. After decades of being diagnosed with a high Body Mass Index (BMI) followed by a general obesity diagnosis or misdiagnosed as lymphedema, some of these women with lipedema sought alternate explanations for their pain, discomfort, and unsuccessful weight loss, despite regular diet, exercise, and in some advanced cases even after undergoing bariatric surgery.
Fat cells, (also referred to as adipose tissue) provide the human body with both cushioning and insulation. Lipedema affects the accumulation of these fat cells in the body, resulting in bulging, irregular fat in the affected areas. The legs are the most commonly affected area, and in many cases, excessive clustering of fat cells is noticed in the arms as well.
Lipedema vs. Obesity Using BMI
Body Mass Index (BMI) is a calculation that illustrations the relationship between a person’s weight and height, and equips healthcare providers with one tool in evaluating a patient’s overall health. Specifically, these ranges are used to categorize whether a person is underweight, in a normal weight range, overweight, or obese. While BMI does not provide the full picture of a patient’s health or the full body composition breakdown, it is a commonly used factor in diagnosing numerous diseases. Dr. Wright and fellow Lipedema expert Dr. Karen Herbst discuss this in greater detail with Vein Magazine here.
Body Mass Index (BMI) is simply an overall numerical score (like height and weight) which is not a biological representation of a person’s overall health. While the World Health Organization (WHO) defines a BMI over 25 as overweight and over 30 as obese, this is actually an inaccurate and incomplete assessment. Overall, obesity is a condition where fat mass affects patients metabolically, chemically, and mechanically (for example, in your joints).
However, Lipedema causes fat in a different proportion on the body and has a different metabolic, chemical, and mechanical effects. Both obesity and Lipedema have increased BMIs, but they are not one and the same. When we use BMI as a blanket diagnosis, it’s an unfair and incomplete assessment.
As seen below, a female bodybuilder may have a higher BMI, but looking at their BMI number alone and diagnosing them as obese would be inaccurate. Similarly, while Lipedema will affect the BMI number, this BMI measure will not accurately pinpoint the cause of the higher measurement.
Lipedema is metabolically the opposite of obesity – both are associated with excess fat accumulation, however, obesity presents with fat accumulated in the central area of the body, primarily in the abdomen, and is associated with diseases such as diabetes, high blood pressure, high cholesterol, and cardiovascular disease. However, lipedema presents with peripheral fat in the extremities, while the abdomen and/or waist are typically unaffected. But because both diseases increase a patient’s BMI, misdiagnoses are common and destructive. This illustrates one reason why BMI is not a biologically valid way to diagnose obesity or lipedema.
Lipedema vs. Lymphedema
Another misdiagnosis that many women with lipedema experience are that of lymphedema. Lymphedema is another lymphatic disease that shares similarities with lipedema diagnosis, but ultimately requires different treatment for successful patient care. Women with lipedema and lymphedema both experience excessive fluid in the affected areas, namely the limbs in both diseases, however, lymphedema patients tend to have much more fat in the body. Lymphedema presents early on with excessive fluid in the affected areas, and as muscles atrophy over time, they begin to turn into fat. Additionally, the tell-tale sign of lymphedema is that the limbs are affected disproportionately – the slide of the arm cross-section below shows the left vs. right arm, with the right affected by lymphedema and experiencing a higher fat level than the left. The second slide of MRI is that of a patient with lipedema. Not only is the fat content lower, but the legs are affected proportionately, rather than one greater than the other.
Picture of Crossection of Left [ lymphedema ] and Right-arm [ normal]. Notice the muscle atrophy and increase subcutaneous fatty tissue on the arm with lymphedema
MRI image of two legs with Lipedema. Notice the thickened subcutaneous fatty tissue on both legs. Notice how the lipedema looks much like the above crosssection of lymphedema.
Find more from Dr. Wright’s AVLS 2021 Lipedema and BMI Presentation and Reports of Interest.