Weight Gain and Weight Loss Surgery

All too frequently women with Lipoedema are told by health professionals that they are just obese, that they need to go away and lose weight. This inappropriate advice often promotes self blame, increases desperation, and denies access to the correct diagnosis, treatment and preventable deterioration. 

Lipoedema is a chronic genetic fat disorder which appears to be linked to the female hormone oestrogen. It develops and often progresses around periods of hormonal change in the body, namely puberty, pregnancy and menopause. Unfortunately obesity can also co-exist and it appears to be more challenging for people with Lipoedema to lose their excess weight. It is important to realise that Lipoedema itself is not caused by poor dietary issues. 

In obesity, excessive fat distribution occurs all over the body. However in Lipoedema, for reasons not yet fully understood, excessive fat production occurs only in specific areas of the body. The distribution of fat can vary from one individual to another as can the severity. The onset of symptoms can develop fairly quickly and the change in body shape may sometimes be quite dramatic. The additional fat deposits predominantly affect the buttocks, thighs and lower legs. Frequently fat pads develop on the outer thighs, just below the hips or on the inner knees. However the excess fat stops abruptly at the ankles, often resulting in the appearance of a fatty cuff, sometimes described as a bracelet or elastic band effect. The feet are normal unless oedema has started to develop. The arms are also frequently affected, but the hands are spared. As a result of the excessive fat deposition, Lipoedema often has a very characteristic feature whereby the lower body is considerably larger and generally out of proportion to the upper body. This feature does not occur in obesity.

Obesity responds well to diet and exercise, and weight loss is experienced usually from all areas of the body, but sadly in Lipoedema this is not the case. Weight loss will occur from the upper part of the body, but absolutely minimal improvement will occur from the areas below the waist affected with Lipoedema. Attempts at weight loss will often only exacerbate the disproportion between upper and lower body.  Unlike normal obesity, Lipoedema fat deposits do not respond to dietary measures or to vigorous exercise and this is another unique and useful tool in distinguishing Lipoedema from obesity.

Lipoedema fat cells also show characteristics that do not appear in general obesity. In Lipoedema the tiny blood capillaries supplying the fat cells are particularly fragile and easily become damaged. As a result bruising readily occurs on the legs often following a minor trauma or sometimes for no apparent reason at all. This tendency does not occur in generalised obesity as there is no abnormality of the blood capillaries.

Finally, the lower limbs are frequently tender and pain may be experienced by only the slightest of touch. Again, this distressing feature does not occur in general obesity. The reason pain develops is that the blood capillaries sur- rounding fat cells are not only fragile in Lipoedema, but they are also hyper permeable. As a result protein molecules leak out of the capillaries into the intercel- lular spaces between the fat cells. Proteins have the ability to attract additional fluid, and this causes the minute lymphatic vessels within the layers of fat to work at a higher level to remove the excess fluid. Eventually the lymphatic vessels become damaged and can no longer cope with the excessive fluid that needs to be transported. Consequently oedema develops between the fat cells, resulting in increased pressure and inflammation in the tissues therefore causing pain and discomfort.

Weight Loss Surgery

Weight loss surgery, also called bariatric or metabolic surgery, is a treatment available to people who are very obese. The most common types of this kind of surgery are:

Gastric band. A band is placed around the stomach so the stomach feels fuller, faster

Gastric bypass. The top part of the stomach is joined to the small intestine, so patients feel fuller sooner and don’t absorb as many calories from food

Sleeve gastrectomy. Some of the stomach is removed, so patients cannot eat as much as before, and they feel full sooner

None of these are in themselves a treatment for Lipoedema. However, they may be appropriate in order to decrease normal fat that is causing exacerbation of symptoms; reduce weight from areas of the body not affected by Lipoedema; or prevent further weight gain in patients who are obese.

Weight loss surgery is a major operation and should not be undertaken lightly, nor before all other options have been ruled out. It is also only available on the NHS for people who meet certain criteria, which include:

A body mass index (BMI) of 40 or more

A BMI between 35 and 40 and an obesity-related condition such as type 2 diabetes or high blood pressure

Exhaustion of less invasive weight loss methods, such as dieting and exercise

Patients must also agree to making healthy lifestyle changes and attending regular check-ups after surgery. For more details see- https://www.nhs.uk/conditions/ weight-loss-surgery.