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Conquer Your Weight

Episode #61: Do You Have "Cankles" or "Saddle Bags"? It Might Be Lipedema.

Show Notes

February 14, 2024

In this week's episode, we're talking about the common and frequently undiagnosed medical condition, lipedema. We'll talk about the features that distinguish lipedema from "regular" obesity and from lymphedema. We'll also discuss treatment options available.

To learn more about lipedema, please visit the Lipedema Foundation at and the Fat Disorders Resource Society at

To connect with Dr. Sarah Stombaugh to discuss medical weight loss, including evaluation and treatment for lipedema, please visit


Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast, episode number 61. Announcer: Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Welcome to today's episode of the Conquer Your Weight podcast. I am excited to talk to you about a medical topic called Lipedema. This is a very commonly undiagnosed and not even talked about medical condition, and so today we are going to shed some light on this medical condition. Before we do, I want to invite you into my medical practice. If you are a patient who lives in Virginia or Illinois, I would love to have you as a patient in my practice at this point. We are halfway through February, six or seven weeks into the new year, and if you are not hitting your 2024 weight loss goals in the way that you had hoped, I would love to help you. We know that losing weight on your own can be really challenging, so whether you are interested in using medications to support your journey or not, it's so great to be able to bounce different diet ideas, exercise ideas, realize the areas that you're having challenges and get some feedback in that. And I would love to be that person who helps you. I do a free 30 minute meet and greet with any of my patient potential patients. If you are interested in getting signed up for that, go to my website at, fill out the form on the individual visits page, and you and I will connect on that 30 minute Zoom meeting is a great opportunity to learn about you, what your goals are for you to learn about my medical practice and if and how we can best support you in your weight loss journey. It is a no pressure situation, and so if we are ending the call, realizing we are not the right fit for one another, no big deal, I love to send people on their way with tips and tricks or maybe even suggestions about who would be a good fit for them. And so please reach out today. I would love to support you in your weight loss journey, however I can. Now, it is time for us to talk about lipedema. If you're like Dr. Stombaugh, I have never heard of that. Say it again. It is lipedema, L-I-P-E-D-E-M-A, and if you have never heard of it, that's okay because most people have not, and that is why we are talking about it today. Lipedema is a very common medical condition. We know that it affects about 10% of Caucasian women, 10%. That is a huge, huge, huge number. And we do not have great prevalence data for other populations, but we know that it is most common in Caucasian women, in people of Northern European descent, although we do see it across other ethnicities as well. So what is it? Lipedema is an uncontrolled abnormal fat distribution, most commonly in the bilateral lower extremities, also known as our legs and into the buttocks. It does sometimes affect women in their upper arms, but it is most common that it affects people in their buttocks and their legs. This is a condition that only affects women, so we do not see it in men, and it is very commonly driven by genetics. So there may be people who have it on their own and do not have family members with it, but more commonly there's a story of sisters or mothers or grandmothers that everybody in the family also struggles with it. The problem is, is that people do not even know that it is a medical condition, and so they just describe theirselves as, oh, these are just the Jones ladies all have these big thick legs, or these are the Smith family buttocks or whatever it is. This is just the way our bodies are built, which is true, and it can still be a medical problem for them. So this abnormal distribution of fat, it's not that there's just excess fat. It is that actually these abnormal fat cells behave in ways that are different from regular fat cells. So they accumulate in this uncontrolled fashion, and there's often a really big increase at times of hormonal shifts for women. So times where we often see that this happens is during puberty, oftentimes during pregnancy or sometimes even during menopause, where there's these major hormonal shifts. And women sometimes notice the onset of symptoms around that time. It is often described as things like cankles or saddle bags or sometimes a shelf sort of at the top of the buttocks. Women may describe that they have these columnar legs or tree trunk legs. And then sometimes, as I mentioned, we see it in the upper arms as well. There's about five different distributions of fat that we recognize as five different ways in which it may impact people. And some people have very mild disease, some people have very moderate or severe disease. For those with mild disease, it really may look like just sort of thicker legs and it may not be causing any problems, but we know that it can be a progressive disease and for many women it can actually cause problems. So it's very common that it is associated with things like easy bruising, with sensitivity of the skin or sensitivity of the fat cells. If you press on it, it's painful. If a cat or a dog or a child were to sort of land on your legs or walk across it, it might be like, Ooh, ouch. In a way that shouldn't be painful. Otherwise, the cells, the fat cells themselves actually feel really firm. And sometimes people describe it like a bag of beans. If you imagine pouring beans into a cloth bag and then pressing on that, what that would feel like or pouring marbles or something into a bag, it is a sort of globular. You can feel the globules and they are hard and firm and different compared to a normal fat cell and the way that that would feel, and one thing that's really important to note is that the hands and feet are completely spared. So a lot of times people have this condition that almost looks like a cuff where they will have completely normal slender hands and feet, and then starting at the level of the wrist or at the level of the ankle, there will be a fat distribution that starts above that, such that it almost looks like some people describe it as wearing a fat suit, which you could imagine feels like a very uncomfortable thing. And the interesting thing here is that the distribution of fat, because it is in the limbs primarily the lower limbs, but sometimes in those upper limbs, women tend to have a very pear shaped body when they have this. Now, that is not to say that every woman who has a pear shaped body has lipedema, but we know that people who have lipedema are more likely to have a pear shaped body. And what that also means is that interestingly, most people with this condition are metabolically healthy, meaning that we are not seeing signs of insulin resistance like type two diabetes. We are not seeing signs of high blood pressure or high cholesterol or any of those things. There's these abnormal fat cells and they are causing problems, but they are not necessarily causing metabolic problems. So that is as opposed to a central adiposity where people are carrying a lot of weight around their midsection, we know that people who carry weight around their midsection have an increased risk of metabolic disease, increased risk of cardiovascular disease. And so a lot of times when we're talking about losing weight, the reason that we're trying to support people in doing that is so we can reduce the risk of these other diseases in a condition like lipedema. They are not necessarily at risk of those conditions. And unfortunately, traditional weight loss does not help for patients with lipedema. So let's talk about that a little bit. One of the things that can happen where you maybe wondering, okay, well, what is the difference between lipedema and obesity? So there can be some overlap, but obesity is a generalized distribution of fat that is a normal accumulation due to many, many, many different factors, may include lifestyle, may include exercise, may include hormonal shifts, may include sleep pattern disruption, may include medication use that are triggering overeating behaviors or binge eating disorder, all of these other things that can contribute to an excess of fat distribution throughout our body that is normal and physiologically, while that can cause problems, it is a normal thing for our bodies to accumulate fat distributed throughout our body everywhere, including the hands and feet, including the face and the chest, and throughout the body, lipedema exclusively affecting the limbs, and again, primarily the lower limbs. So this abnormal fat distribution is such that you can be eating well, you can be exercising, you can be sleeping well and taking really excellent care of your health and still be impacted by this really significant fat distribution in the lower limbs and in the upper arms. So interestingly, obesity and lipedema, while there are two different conditions, you can actually have both. And one thing that we've started to see is that because of the prevalence of obesity, as we're seeing more people who struggle with obesity, they may have lipedema also underlying their obesity, and we don't necessarily see the lipedema as clearly until they start losing weight. So a very common story is that people who have chronic excess weight, who whether they are doing medical weight loss, whether they're doing surgical weight loss, people who have all of a sudden lost really significant amounts of weight, and now they feel like, oh, I've just got the last 20, 30, 40 pounds to lose. But when you look at their body, they may have slender face, chest, arms, and then you're seeing this distribution of fat in the buttocks and in the lower legs. That fits this definition of lipedema, especially because some of the other things like the way the cells feel on palpation, if you're pressing on them the way it feels to the patient in terms of having pain from that. And so it's interesting because they may have had both obesity and lipedema, but only as they lost weight were we able to see, oh, wow, there's actually something else going on here. The other thing I want to clarify is that this lipedema is completely different than lymphedema. The two things sound very similar to one another, but they are completely unrelated. So lymphedema has to do with irregularities disruptions, injuries to the lymphatic system, which causes swelling. So this can be common after an injury after surgery, for example, where the lymphatics are disrupted and we see swelling. So the interesting thing about this is it is usually unilateral, meaning it affects one side or the other side. It certainly could affect both sides, but it's very, very, very statistically unlikely that you would have lymphedema that would affect both sides of your body equally. So if you imagine someone who's had breast cancer, for example, and they've had surgery on that, maybe they've had lymph nodes removed under their arm, and they are likely or more likely to have lymphedema in that arm as a result of the lymph nodes that have been removed, but they're going to have that on one side of their body and not their other. And even let's say they had lymph nodes removed on both sides of their body, they may have even. So even if the same number of lymph nodes were involved, the swelling is still unlikely to be equally distributed between the two sides. You're more likely to have this unilateral or unequal distribution of this swelling. The swelling of lymphedema tends to be more of a coming and going thing. It's related to fluid that's held there, fluid that your body is not removing properly. And so because of that, we see it all the way distally, meaning all the way down as far as the limbs can go. So we will see swelling in hands, we will see swelling in feet. And one of the key features of lip edema is that it does not affect the hands and feet. So the hands and feet are especially normal. They are thin. There are no concerns there at all. And so when we're seeing swelling in the hands or in the feet, we are concerned about lymphedema. So lymphedema, lipedema, it's very confusing because the two sound very familiar, and we have gotten some treatment principles from lymphedema that we've applied to lipedema, but they are really completely different disease processes. And so I really just wanted to point that out because they are completely different. So now that we've spent a little bit of time talking about lipedema, maybe you're thinking, huh, is that something that I have? Or maybe thinking about a woman in your life and realizing she may have this. The question that comes next is, what can I do about it? And this is where the science is really evolving, such that I know 5, 10, 20 years from now, we are going to have very different answers than what I am sharing in this podcast today. But there are tools that we have available to us that can be really supportive for patients with lipedema. So one of the most important and easiest tools to apply is compression. So when we think about compression, we're talking about things like compression socks, compression stockings. They make compression leggings or compression capris, things that are not just waist high, but even sort of high rise, such they come up across the buttocks fully. That can allow to compress the abnormal fat that is in the lower legs into the buttocks and can be very helpful for minimizing some of the pain that people get from their lip edema. This is something that they actually recommend wearing most hours per day, including during exercise, including during sleep, is it can be very supportive for anyone. And then especially for people who've had surgery, who've had liposuction in order to reduce the abnormal fat distribution, using that compression can be one of the best tools to keep those effects of surgery in place for longer. So compression is a first lane treatment that is recommended for anyone. If you're thinking, oh gosh, that might be me, what kind of compression garments should I get? You can Google lipedema compression garments, and there are some really great things that come up, some really great resources from the Lipedema Foundation as well as from the Fat Disorders Resource Society, some good things that are on there or schedule an appointment with m. You and I can talk through what are some of the options that are available. We also know that there can be a role in our diet. So we know that while diet does not cause this, having the right type of diet can help support and minimize the symptoms. So there is a diet. The RAD diet stands for the Rare Adipose Disorder Diet. This is a diet where they recommend avoiding sugar, avoiding flour, really avoiding any processed carbohydrates and choosing things like low carbohydrate veggies, healthy fats, proteins, and then fruits, beans, and other moderate carbohydrate veggies in moderation. We know that a diet like this can support the reduction of inflammation, which can be helpful for reducing the symptoms, particularly the pain that can be associated with lip edema. There are also some supplements that can be used as well, things like vitamin D, selenium, diosmin, and guaifenesin, and those things that can be used in order to reduce symptoms. We know that exercise is one of the best tools that we have. Low impact exercise is going to be best. So those are things without pounding. So things like biking, things like doing the elliptical water is amazing, so if you have access to particularly a warm water therapy pool. But the reality is any pool will do where you can do exercise where that water is helping to compress the body, support the body that can both feel good and be very helpful for strengthening the body without having excess pain. Stretching is important as well, so doing a lot of type of movement exercises can be good as well. We know that some of the principles of lymphatic drainage, so some of the massage manual lymphatic drainage techniques that are used in lymphedema may actually be helpful in lipedema as well. And so those are often taught towards patients. There's also techniques like dry brushing, which is sort of like a variation of manual lymphatic drainage, and that is something that patients can be taught to do in order to improve their symptoms. And then we know that surgery may be a good option for patients with lipedema. There is an abnormal distribution of these abnormal fat cells, and one of the best things that we can do is simply to remove them. So surgeries like liposuction, for example, are something that can be considered for the right person in order to support them in simply removing those fat cells. Now, liposuction sounds easy to some people, but we do know that it is actually a fairly major surgery and it isn't important that if considering to have liposuction for the condition of lipedema that you were talking to a plastic surgeon and asking them, have you ever treated a patient with lipedema? Are you familiar with techniques that should be used because there may be different techniques that are applicable to a person who has lipedema compared to someone who is getting liposuction for a different indication. Plastic surgeons do liposuction all day long is one of the more common procedures that they do. It's often done in combination with a lot of other procedures like tummy tuck, for example. So it's very, very common, but there are certain principles that should be applied to the lipedema patient. And so if that is something you are considering, you want to make sure to talk to a plastic surgeon, ask them if they have expertise in that area so that you know are getting someone who can best support you in that. Unfortunately, there's still a lot of things just in terms of how we as a medical society diagnose it, how we code it. So even things like liposuction, which makes a lot sense to do this as a treatment, are not always covered by insurance. So there's a lot of nuance there that again, I'm hopeful over the next 5, 10, 20 years that we'll see a lot of evolution in that. So we are better able to support patients with lipedema with better treatment options, whether that is liposuction that is covered by their insurance or whether that is other treatment options. I am so, so helpful. So at this point, 2024, when this podcast is recorded, the world of lipedema research is really exploding. There are clinicians, there are basic scientists who are being funded to explore and understand why is it that lipedema happens? What are the genetic linkages here? Are there biomarkers that we could do to identify patients who do indeed have this condition rather than just relying on the clinical exam, which is how we diagnose it at this time, and then what can we do for treatment Right now, we do have some tools that can be supportive for patients, and they are just that they are supportive. We do not have a cure for this condition. We just have principles for how we can manage this condition. So stay tuned because the field is rapidly evolving. There are people who are learning about this, studying about this, and as I learn about it as well, I will share that information with you. But if you have listened to today's podcast and you're realizing, oh my gosh, this might be me, I might have lipedema reach out to me, I would love to connect with you. Learn about if that is something that is impacting you, how I can support you in that journey. If you think of someone who you're like, oh, gosh, I wonder if she's dealing with this, do not reach out to the coworker you don't know super well that if you were thinking of your absolute best friend in the entire world and oh my gosh, she may have this medical condition, send her this podcast episode. Encourage, maybe Google it yourself, encourage her to Google it, because right now the most important thing that we can do is educate our population so that people are aware that this is a condition. And then as we have an awareness, as we are starting to diagnose it, we will start finding more and more treatment options that will be available for people. So I'm really excited for the evolution of this over the years to come. If you have questions, please, please reach out today. Thank you so much for joining me. It was really great to share this new topic with you today. I'll see you all next week. Bye-Bye.
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