What's the Difference Between Lipedema and Cellulite?
It's really hard to tell the difference
I frequently get asked, “How do I know I have Lipedema and it’s not just cellulite?”.
I think this is mainly because women are often misdiagnosed with Obesity since the medical industry doesn’t know about Lipedema. But also, they’ve been trained to refer to a woman with a higher BMI and a larger body as being overweight.
Unfortunately, most women diagnosed with Obesity are told the fat they have on their body is metabolic fat. They make it the woman’s responsibility to diet and exercise it off. If the woman can’t get rid of the fat through her motivation, she must be a failure.
And so the outcome is that women have been seeking help for years, even decades, only to be told they are fat and need to diet and exercise.
Most of us who’ve been diagnosed and become familiar with the signs and symptoms of Lipedema might be able to immediately tell just by looking at a woman that she has Lipedema. But we aren’t able to medically diagnose a woman with one or the other because that’s in the hands of the medical provider.
And if you ask me to tell you if you have Lipedema or not, I’m not able to diagnose because diagnosing is out of my scope of practice. However, I’ve written past articles about self-diagnosis:
But before I go further, let’s clarify: there is Lipedema fat and metabolic fat. Metabolic fat is the brown and white fat that may be much easier to manage with HAES and exercise.
Simply put, 'regular fat' is the normative adipose tissue found throughout your body. Fat comes in two main types: brown and white (there is also yellow and beige fat, but that is a version of white and brown fat). Brown fat burns energy, while white fat stores it. White fat stored viscerally (around the midsection) is more dangerous than white fat stored subcutaneously. Brown fat is an energy store that protects internal organs, insulates the body, and regulates hormones. It can accumulate and reduce in response to diet and exercise. Too much white (visceral) fat can lead to high blood pressure, high cholesterol, and insulin resistance.
Now, Lipedema fat is a different beast entirely. Lipedema is a chronic medical disorder characterized by the symmetric enlargement of the legs due to fat deposits beneath the skin, often extending from the hips down to the ankles.
Unlike regular fat, Lipedema fat is diseased fat that hardens and holds in fluids. This type of fat can not be reduced through diet and exercise.
The fundamental differences between lipedema fat and regular fat lie in their physiology, behavior, and distribution:
Physiology: Lipedema fat has a unique microscopic structure, unlike regular fat. It's composed of large fat cells (hypertrophic adipocytes) that can increase in size rather than number. These cells are also inclined to inflammation, fibrosis (hardening), and fluid accumulation (edema), which regular fat cells are not.
Behavior: Unlike regular fat that can be burned off with a caloric deficit, lipedema fat is highly resistant to diet and exercise. This resistance is a hallmark of lipedema and contributes significantly to the frustration and misconceptions surrounding this condition.
Distribution: Regular fat can be deposited anywhere in the body. In contrast, lipedema fat has a particular pattern: it accumulates in the lower body, mainly the legs and sometimes the arms, but it typically spares the feet and hands, creating a 'bracelet' effect at the wrists and ankles. It's almost always symmetrical, too.
Lipedema often comes with pain or tenderness, easy bruising, and other physical symptoms not associated with regular fat. It’s a progressive disease that can lead to mobility issues and have significant psychological impacts due to its persistent and advanced nature.
How can you tell the difference in your own body? Here are a couple of identifiers:
Appearance:
Cellulite: Cellulite appears as dimples, lumps, or a "cottage cheese" texture on the skin's surface. These surface irregularities are often more visible when the skin is pinched or when muscles in the affected area are contracted.
Lipedema: Lipedema typically presents as symmetrical swelling and enlargement of the lower limbs. The skin in these areas may appear smooth and tight initially, but lipedema fat accumulates beneath the skin and may not always manifest as surface irregularities.
(This is the most difficult to tell the difference, especially with Stage 1 Lipedema, because they can present similarly to each other.)
Texture:
Cellulite: When you touch an area with cellulite, you may feel a distinct, dimpled texture on the skin, similar to an orange peel.
Lipedema: The affected areas often feel soft and spongy to the touch. This is due to the accumulation of enlarged fat cells beneath the skin.
Pain and Discomfort:
Cellulite: Cellulite is usually not painful to touch, though it can be a source of cosmetic concern and self-consciousness.
Lipedema: Lipedema can cause pain, tenderness, and discomfort in the affected areas. This pain may be experienced due to pressure on the enlarged fat cells and can impact mobility.
Other factors: Lipedema will have other signs too: easy bruising, fat distribution is generally more in the lower body than the upper body, and/or a comorbidity of hEDS.
If you’ve read to this point, you can see the two are very nuanced and challenging even for a physician to tell the difference.
This is why it’s essential for a woman having questions to see a diagnosing clinician to determine if they have Lipedema.
If you’re still wondering if you have Lipedema, Here are a couple of articles I’ve written in the past about the Lipedema signs and symptoms:
Understanding these differences can empower those with Lipedema to seek appropriate medical assistance and inform discussions around health and weight that go beyond the 'eat less, move more' paradigm. Lipedema is not a failure of willpower; it's a medical condition that requires understanding, awareness, and targeted treatment strategies.
Take care,
Michelle
Sources:
Herbst, K.L., 2012. Rare adipose disorders (RADs) masquerading as Obesity. Acta Pharmacologica Sinica, 33(2), pp.155-172.
Forner-Cordero, I., Szolnoky, G. and Forner-Cordero, A., 2012. Lipedema: an overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome - systematic review. Clinical Obesity, 2(3-4), pp.86-95.
Buck, D.W. and Herbst, K.L., 2016. Lipedema: a relatively common disease with extremely common misconceptions. Plastic and Reconstructive Surgery Global Open, 4(9).