Lipedema is abnormality of the subcutaneous adipose [fat] tissue. Let me explain this a bit more. Adipose Tissue is the body principle structure for long term energy / calorie storage. But not all adipose tissue is the same. There are four different kinds of adipose tissue. There is what I call essential adipose tissue which, is the fat that is in your organs, bone marrow and the like that is necessary for proper metabolic function. That is to say there is a minimum amount of fat that is need in organs like liver, kidney and bone marrow for them to function properly. The second type of adipose tissue is visceral fat. Visceral fat, which is the fat that is inside the abdominal cavity is the most metabolically active and sensitive fat depot to calorie balance changes. Visceral fat expands easily when there is excess calories and contracts when the body has a net calorie deficit. The third fat depot is subcutaneous fat, the fat that is between the skin and muscle. This is the layer of fat attached to the underside of the skin, or hypodermis, that is necessary to cushion our bodies and retain heat. It is less metabolically sensitive than visceral fat. The fourth type of fat is hormone dependent subcutaneous fat, also known as gynoid fat which is the fat that females accumulate and creates their secondary sexual characteristics. This is fat that forms breast, hip and inner thigh curves. It starts at puberty under the influence of estrogen and progesterone and is what gives the feminine shape to female’s bodies. This fourth fat depot is even less metabolically active than visceral or regular subcutaneous fat and this the fat that is affected by lipedema.
The Fat of Lipedema is Metabolically Different from other Fat
Lipedema is a disorder that affects the fourth depot of fat. Lipedema usually affects the arms and legs although in later stages it can spread to the rest of the body. There are characteristic areas that are affected are the hips and inner thigh. We don’t know why only certain areas of the body where the hormone dependent subcutaneous fat exists are effected by lipedema, but for example, the breasts are not usually affected by lipedema early in the course of the disease. The fat of lipedema is the least responsive to calorie balance deficits. In other words, this type of adipose tissue is very resistant to weight loss. This means that when weight loss occurs in a patient with lipedema, the other fat depots will be much more affected than the fat deposits where the lipedema exists. An individual will lose visceral fat and subcutaneous fat in areas not affected by lipedema, but very little fat in the lipedema affected areas.
To prove this point, I have attached a picture of a lady who is malnourished and underweight yet still has gynoid fat on her legs consistent with lipedema. This is the clearest visual example of metabolic resistance of the fat of lipedema. We don’t know if the metabolic difference of lipedema fat is the cause lipedema or it is the result of change from lipedema but it is one hallmark of the diagnosis of lipedema.
For more information on Lipedema please visit FatDisorders.org for some valuable information.