Assessing Lipoedema: What to Expect

Lipoedema is a chronic condition characterised by abnormal fat accumulation, primarily in the lower body. Assessing lipoedema is not an easy task because is often underdiagnosed or misdiagnosed; and despite an estimated prevalence of 11% in the overall female population, its cause is still unknown. Proper assessment is crucial for timely management and improving patients’ quality of life. Below is a detailed guide on how to assess lipoedema.

Questions to Ask the Patient (or you as patient keep them in mind)

To assess and diagnose lipedema, healthcare professionals typically ask specific questions and look for certain symptoms (physical exam). Here is a list of the different factors and inquires your GP will ask during the assessment.

1.Family History:
Is there a family history of lipoedema or other fat disorders?

2.Hormonal Triggers:

Do you note any onset or worsening during hormonal changes (menstruation cycle)?

3.Previous Interventions:

Have you already had: dieting, exercise, or surgery (no success)?

4.Symptoms Onset:

When did you first notice symptoms?
Do you feel tenderness, heaviness, fatigue, and brain fog?
Did symptoms start after puberty, pregnancy, or menopause?

5.Fat Distribution:

Do you notice an unusual or disproportionate fat accumulation in the legs, thighs, buttocks, or arms?
Is the fat accumulation symmetrical (same on both sides)?

6.Pain and Tenderness:

Do your legs, thighs, or arms feel tender or painful to the touch?
Do you experience a feeling of heaviness or fullness in the affected areas?

7.Response to Diet and Exercise:

Have you noticed that diet or exercise does not significantly reduce the fat in certain areas, such as the thighs or arms?

8.Swelling:

Do you experience swelling or puffiness in the affected areas, especially in the legs or arms?
Does the swelling worsen throughout the day or after standing for long periods?

9.Bruising:

Do you bruise easily, particularly in areas where fat has accumulated?

10.Skin Changes:

Have you noticed any skin changes, such as a rough texture, increased sensitivity, or appearance of cellulite?

11.Painful Movement: functional impact

Do you experience difficulty with movement, such as walking, due to the heaviness or pain in your limbs

12.Other Conditions:

Do you have any other underlying conditions, such as varicose veins, obesity, or chronic venous insufficiency?

Assessing lipoedema-Physical examination: What to Look For

1.Symmetrical Fat Distribution:

Lipoedema usually affects both sides of the body equally, particularly the hips, thighs, buttocks, and sometimes the arms, with a “column-like” appearance of the limbs.

2.Fat that is Soft and Nodular:

The fat feels soft, but with a nodular texture or lumpy appearance, especially when pressure is applied.

3.Skin and Fat Boundary:

A clear boundary between the normal skin and the swollen fat, especially around the knees, ankles, and elbows, can be a sign of lipoedema.

4.Painful to Touch:

The affected areas may be painful to touch, and patients often report discomfort, tenderness, or a heavy feeling in the limbs.

5.Lack of Fluid Retention (in Lipoedema):

Unlike conditions like lymphoedema, which is caused by fluid retention, lipoedema fat is not typically caused by fluid accumulation.

6.No Improvement with Diet and Exercise:

Unlike typical fat accumulation, the fat in lipoedema does not respond well to traditional weight loss methods (exercise, dieting).

7.Other Signs of Progression:

In more advanced stages, the condition can lead to skin changes such as cellulite-like dimpling or lumpy skin.

How to diagnose Lipoedema: Diagnostic Tools

Ultrasound: To rule out lymphoedema or assess tissue composition.
MRI/CT Scan: To examine fat distribution in more detail.
Physical Examination: A visual inspection combined with physical tests like palpation to check for tenderness, nodularity, and symmetry.
Stemmer Sign Test. This test helps differentiate lipoedema from lymphoedema. Follow the steps bellow:

Pinch the skin on the second toe or finger.
If a fold can be pinched, the Stemmer sign is negative (lipoedema likely).
If no fold can be pinched, the Stemmer sign is positive (lymphoedema likely).

How to differentiate Lipoedema from other conditions: Differential Diagnosis

This condition must be distinguished from:

Obesity: Fat distribution remains disproportionate despite weight loss.
Lymphoedema: Includes swelling in hands/feet and may present with pitting edema.
Other Conditions: Such as venous insufficiency or lipohypertrophy.

Lipoedema Stages: What stage am I in?

Lipoedema progresses through stages, they are:

Smooth skin surface with enlarged fat deposits.
Uneven skin texture with nodular fat deposits.
Hardened connective tissue with significant deformity.
Development of secondary lymphoedema (lipo-lymphoedema).

Assessing lipoedema: A final word…

Assessing lipoedema requires a combination of detailed history-taking, clinical examination, and awareness of its unique features. Early diagnosis can improve management outcomes, stop progress and enhance patients’ quality of life. These are common questions and signs that can help in identifying lipoedema. It’s always important for a healthcare professional to make the final diagnosis through a combination of clinical assessment and diagnostic tools.

We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!