Weight Gain around the Hips and Legs - Could this be Lipoedema?

Kat H Author

If you are generally slim but the weight seems to pile up around your hips and legs you might be suffering from lipoedema. Find out more in this blog

Have you come across that saying “A moment on the lips; a lifetime on the hips”? It implies that anyone with larger hips and legs is overeating. This may not be the case. Big hips and legs might actually indicate a disease called lipoedema, especially if the rest of your body is comparatively slender - although in some cases lipoedema can affect the whole body.

Now, if you look up lipoedema online don’t get scared. Pictures of lipoedema mostly show the most severe cases. In many people, lipoedema barely shows up and, if it does, it often doesn’t progress into the severe form. It is thought that lipoedema affects around 11%, some even say 38 %, of the population, most of them women, but very few of them ever progress to a severe form. So, if you have been diagnosed with it and are in stage 1 or 2, remember that it doesn’t necessarily get worse.

Because the symptoms are often very minor, and because many of those affected do not seek medical help, lipoedema is under-diagnosed. This means that you have to be really lucky to find a medical doctor who realizes immediately what you’ve got. Many people go for years without a proper diagnosis and instead are often told repeatedly that they just need to eat less and exercise more or, if they are quite slim, that they have a body-dysmorphia. This can be very upsetting when you know that you probably have lipoedema.

Now, eating a healthy diet and doing a healthy amount of exercise is generally good advice for all of us. It supports your general health and helps you maintain a healthy weight. This is important. Whilst exercise and diet will not cure lipoedema, they can help to manage the symptoms. So most of my clients see a nutritional therapist as well as me. They find that exercise, a healthy diet and other complementary interventions help them, ideally in addition to medical care. If you want to know a little more about lipodoema and how I would design a treatment plan, read on.

As a movement therapist and medical herbalist, I like to know more about diseases I work with. I research the pathophysiology, that is, the things that “go wrong”. This helps me to develop a treatment plan that is specifically designed for the disease, or, if there is more than one disease (many of my students with lipoedema also are diagnosed with hypothyroidism, for example), a treatment plan designed specifically for you. So what is lipoedema and what do we know about it?

Quite a few of those affected by lipoedema seem to have a parent or other relative who is also also affected. Whilst we cannot change our genes, we can find out what is known about lipoedema. This can guide us to find the most beneficial form of exercise, nutritional or herbal approaches.

Lipoedema describes a build up of fat cells and usually affects the legs or arms, although it can also affect the face or torso. Now, those fat cells don’t build up because people overeat: lipoedema is actually a connective tissue disease that usually affects the subcutaneous area, that is, the connective tissue just under our skin. Whilst the actual disease process is yet unclear and there is no cure for lipoedema, there has been an increase of information about lipoedema that can help us to support the symptoms of lipoedema.

1. In lipoedema, there is an increase of interstitial fluid, that is the fluid between our cells. This excess fluid causes the build up of fat cells. 

2. Where does this fluid come from? 

Interstitial fluid is actually blood without the blood cells. It is full of nutrients and seeps out of the blood vessels to nourish our cells. This is absolutely normal and healthy. In lipoedema, however, there is an excessive amount. Lipoedema seems to be associated with an increase in blood vessels (angiogenesis in medical terms). It also seems that the blood vessels are a bit more permeable than in a healthy individual. 

3. It appears that there is an inflammatory component to lipoedema, especially an infiltration of white blood cells called macrophages.

4. Lipoedema also seems associated with fibrosis of the connective tissue, that is, a hardening, scarring or overgrowth of extracellular matrix components, including collagen. 

5. Hormones, in particular, oestrogen seem to be a trigger. Times of hormonal changes, like puberty, menopause or pregnancy, can be times when people first notice lipoedema or when their lipoedema worsens. I also recently read that some people are first affected by lipoedema after a traumatic event so there may be a link to cortisol, the stress hormone. This may be because cortisol actually affects our hormones.

6. Lipoedema is often confused with lymphoedema. They are two very different diseases. In lipoedema, the health of lymphatic vessels is actually not impaired unless a person is also obese. So in theory the protocol for managing lymphoedema does not apply to lipoedema.

In practice, however, a healthy amount of exercise and eating well is just as important in lipoedema as it is in lymphoedema. Also, those affected by lipoedema in the later stages are often prescribed the same compression garments as those with lymphoedema. Those affected by lipoedema report that manual lymphatic drainage (a kind of gentle massage that moves lymph) is beneficial and that it improves wellbeing and body image. You see, looking after your lymph is important in lipoedema too as the increase in interstitial fluid results in increased lymph production. This is accommodated in the early stages of lipoedema, but over time can lead to secondary lymphoedema.

Movement and breathing can support lymphatic drainage. Many people affected by lipoedema enjoy and seem to benefit from gentle Yoga, Chi Gong, somatic movement like Feldenkrais as well as dancing, walking and swimming. If you enjoy high intensity exercise, remember that this may increase blood flow and thereby interstitial fluid. Now, that is not a problem as long as that fluid clears again, as it does in healthy individuals. For anyone who is challenged clearing this fluid, lymphoedema studies* suggest that the best way to drain lymph is a combination of streching and contracting muscles. An instructor who knows about lymph can help to develop a programme for you that combines aerobic exercise with movement for lymphatic drainage. Or, if the lymphatic system is severely challenged, maybe stick with slow movement.

Considering all the above information about lipoedema, I design classes that combine Chi Gong, Yoga, Feldenkrais and Pilates as the slow, flowing movements gently move the connective tissue, especially that subcutaneous tissue, support lymphatic and blood flow without overstimulating the fluid system and also promote relaxation and mindfulness which can help reduce inflammation. I also focus on the pelvic floor. The pelvic floor is often called the sump pump as it helps to drain lymph from the lower body. In addition, in my experience, those affected by lipoedema commonly suffer from pelvic floor issues. You can read a bit more about my pelvic floor work for lymphoedema and lipoedema in my series of blogs, click here for the first of these.

I am also a great believer in mindfulness. I initially trained in mindfulness because of my work in intimate health but soon realized that it is beneficial for more or less everything. Mindfulness meditation is useful for those affected by lipoedema and lymphoedema (as well as many other diseases) as it has been shown to improve immunity, pain, inflammation and also support hormonal symptoms amongst much else. 

If you would like to book a session with me, contact me. 

My qualifications: I am a Feldenkrais practitioner, Yoga, Pilates, Chi Gong teacher and gym instructor with specialist qualifications in rehabilitation, including exercise for lymph, diabetes, weight loss and pelvic floor, especially fascial pelvic floor health. As lipoedema is a connective tissue (fascia) disease, this is particularly useful. I also have specialist qualifications in women's intimate pelvic health (you can find several blogs on lipoedema and lymphoedema and pelvic floor health in my free resources) and a certificate in psychosexual counselling.

As a medical herbalist, I am trained to look at each condition in the way described above – even when I design a movement plan. I'm delighted to work in conjunction with other therapists. So if you are already guided by a medical team, a nutritional therapist, herbalist, MLD practitioner or even movement therapist but feel you would like to work with me too, get in touch. 

This blog does not replace medical advice. If you suspect that you have lipoedema or lymphoedema, see a medical doctor for a medical diagnosis and treatment plan.

*there are no studies for lipoedema as far as I am aware

Categories: : lymphatic health, womens intimate health