Confused with obesity and lymphedema, lipedema tends to put more weight on the lower limbs. Photo: Bigstock
Having panties and both thick but painful and constantly swollen legs can be a condition not associated with obesity but rather with a condition called lipedema.
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Characterized by an abnormal deposition of subcutaneous fat, this pathology of adipose tissue is considered a hereditary, chronic and progressive disease. “It has a high incidence in women (11% of this population) and is generally underdiagnosed to the detriment of other morbid conditions, such as lymphedema and obesity,” says vascular surgeon Antonio Trigo Rocha, president of the Brazilian Society of Angiology and Vascular. Surgery in Regional of Paraná.
The mechanism of accumulation, according to vascular surgeon Rodrigo Gomes de Oliveira, is still unknown, but in addition to hormonal causes, a genetic cause is suspected. “Other possible causes of lipedema include metabolic and inflammatory changes, and it’s been proven not to be caused by inadequate diet or excessive food intake,” he explains, professor of medicine at the ‘Pontifical Catholic University of Paraná.
Difference in fat accumulation
Lipedema differs from obesity because in it excess fat is not distributed throughout the body, which is visible during diet and exercise and there is no loss of weight in the affected region, generating a disproportion. “For example: the waist gets thinner, while the affected area remains with little reduction in fat deposited,” says Trigo Rocha, also professor of angiology and vascular surgery at the Unioeste medical school.
To the aesthetic effect, says Trigo Rocha, is added the progressive limitation of mobility and, if there is no proper diagnosis and treatment, and without the necessary care, the evolution to lymphedema (lipolymphedema ), which obstructs the circulatory system and affects the immune system. “There are no specific tests, either imaging or laboratory, to detect lipedema, so the diagnosis requires a physical examination and analysis of the patient’s history, as well as tests ruling out other conditions. , such as tomography, fat testing, lymphoscintigraphy, and lab tests, “he says.
the beginning of everything
In addition to being almost exclusively a female disease, lipedema usually appears at the end of puberty, during pregnancy, or throughout menopause. “In men, when it does appear, it is usually linked to liver disease,” says Oliveira.
It is very common for the disease to begin with a localized accumulation of fat in the legs and ankles; then involve the thighs, hips or buttocks, and can also affect the arms, usually bilateral and symmetrical, without involving the hands and feet.
Treatment consists of several therapeutic approaches which should be combined as needed. There are no drugs or creams to treat this condition yet, but they do help relieve the symptoms. “In general, the use of phlebotonics helps with veno-lymphatic drainage, providing good results. However, it is a procedure that must be indicated by a professional specialized in the subject and according to the particularities of each patient and the problem presented ”, specifies Trigo Rocha.
Elastic compression stockings reduce or control edema and should be worn every day, or at least three days a week, as Oliveira explains, who also recommends lymphatic drainage physiotherapy, which helps activate the vessels and to ensure faster drainage of fluids, reducing swelling.
Keeping your weight under control and avoiding inflammatory foods, he says, also helps prevent fat from building up in your legs. “Exercising for at least 45 minutes about three times a week, such as walking, swimming, aqua aerobics and cycling, stimulates the lymphatic system, improves circulation and reduces edema,” says Oliveira.
Surgery may be indicated
Liposuction surgery is indicated if symptoms persist and localized fat accumulation worsens. “Although this can help patients, especially in the advanced stages, few surgeons have specific training in the techniques used in lipedema,” warns Oliveira.
According to Trigo Rocha, the amount of fat aspirated should also be within the limitations of each patient, usually the procedure being performed by a plastic surgeon. “During the postoperative period, the use of compression and lymphatic drainage stockings to remove fluids and reduce swelling is always indicated. These are practices that help the patient to recover during this period, favoring his return to daily activities ”.
See what are the signs that together may require a visit to the doctor:
Main complaint is “fat legs” Positive family history Swelling and heaviness in the legs, especially at the end of the day. temperature of the limb Pain on pressure on the limb The texture of the limb is rubbery Sometimes there are pockets of fat / fluid below the knee
Lipedema: a disease of adipose tissue characterized by an abnormal deposition of subcutaneous fat in the buttocks and legs, sometimes with swelling of the legs.
Lymphedema: characterized by the interstitial accumulation of protein-rich fluid, which may have a primary or secondary etiology
Obesity: defined in adults by the World Health Organization as a body mass index (BMI = weight / height squared) equal to or greater than 30