Lipedema and obesity are two different conditions, but they have similar symptoms that can impact your health and quality of life. While the two have things in common, their causes and symptoms also differ in a few important ways.

As one MyObesityTeam member shared, “I found out I have something called lipedema. It’s a fat disorder that presents with abnormally large legs and arms. So ladies, if you think that’s you, do some research, talk to your doctor, and join some support groups.”

Here, we will highlight the key similarities and differences between lipedema and obesity to help you understand the conditions and seek the right healthcare.

Differences in Symptoms: Lipedema vs. Obesity

Lipedema affects 11 percent of women worldwide, according to the journal Plastic and Reconstructive Surgery. Yet it’s often underdiagnosed or confused with obesity. Lipedema happens almost exclusively in women and people assigned female at birth, which suggests hormones may be part of the cause. Lipedema and obesity differ in a few major symptoms, such as fat distribution and whether it causes pain, tenderness, easy bruising, and swelling.

1. Fat Distribution

Lipedema and obesity cause fat deposits in different areas of the body.

Fat Distribution in Lipedema

In lipedema, adipose (fat) tissue is usually distributed evenly on both sides of the body. It occurs mostly in the lower body, but it can also affect the arms. This results in a disproportion between the upper body and lower body.

While lipedema is commonly known as a painful condition, obesity generally doesn’t cause pain by itself.

There are five main types of lipedema, classified based on where fat is located on the body. The categories include:

• Type 1 — Between the belly button and hips
• Type 2 — Between the hips and knees
• Type 3 — Between the hips and ankles
• Type 4 — Between the shoulders and wrists
• Type 5 — Between the knees and ankles

In lipedema, fat tissue usually doesn’t affect the feet. It often feels like small, bumpy nodules under the skin. A person can have one or more types of lipedema at the same time.

Fat Distribution in Obesity

Obesity is diagnosed when a person has a body mass index (BMI) score of 30 or higher, a number that is related to a person’s height and weight. In obesity, fat tissue is spread throughout the whole body, but its distribution can differ from person to person. It’s mainly stored in two places on the body.

The first is called subcutaneous adipose tissue, the fat located between the skin and the muscles. This fat is most noticeable when we lose or gain body weight, because it is near the surface of the body.

The other area is called visceral adipose tissue, which is fat located deep inside the abdomen. Here, the fat surrounds vital organs like the intestines and liver.

For people with class 3 obesity, fat tissue can build up in unusual areas, like around the heart, in the liver, and sometimes in the hands and feet. This is associated with other health conditions, such as metabolic dysfunction-associated steatotic liver disease (MASLD) — formerly known as “fatty liver disease.”

2. Pain and Tenderness

While lipedema is commonly known as a painful condition, obesity generally doesn’t cause pain by itself.

Pain in Lipedema

In lipedema, the affected areas of fat accumulation often feel painful or tender. This can be made worse with physical touch, and it may hurt even without pressure. This painful fat tissue feels different for everyone — for some, the pain may be mild, and for others, it may be severe and greatly limit quality of life. People with lipedema describe this sensation in different ways — including a heavy ache, a tingling sensation, or a pain that worsens with walking.

A low-carbohydrate diet can improve quality of life and reduce pain in people with lipedema, even without significant weight loss.

Pain in Obesity

Adipose tissue in those diagnosed with obesity isn’t known to cause pain. However, other conditions associated with obesity might lead to a painful sensation. For example, people with obesity have a risk of developing blood clots in their legs, causing one calf to be tender, discolored, and swollen. This is often due to venous stasis, where slow blood flow in the veins increases the risk of deep vein thrombosis. If you experience symptoms of a blood clot, go to a doctor immediately.

Another condition that can cause pain is cellulitis, a bacterial infection affecting the subcutaneous fat. It is frequently associated with fever and a red or purple rash. It is a medical emergency that needs urgent care and antibiotic treatment.

3. Swelling

Edema, or swelling, is a common symptom of lipedema — it’s even part of the name. Swelling, on the other hand, isn’t normally seen in obesity.

Swelling in Lipedema

Leg swelling is a common symptom of lipedema. While lipedema itself can cause swelling, it can also lead to lymphedema. Lymphedema is a related condition involving the lymphatic system, which helps drain excess fluid from tissues and fight infections.

Luckily, lifestyle changes can help reduce its impact. Many people with lipedema find that exercise — including swimming, biking, and walking — helps reduce swelling. People with lipedema in their lower legs often wear compression garments, including compression stockings, which can help redirect excess fluids back into circulation. If swelling becomes bothersome, some noninvasive therapies — like lymphatic drainage massage and compression therapy — can be useful to reduce swelling.

Swelling in Obesity

Obesity can contribute to leg swelling, especially in people with higher body weight. One study showed more than half of those with chronic leg swelling or lymphedema are also affected by obesity, and the swelling worsens as body weight increases. Higher body weight may influence this swelling by putting pressure on the lymphatic system, increasing lymph production, and causing inflammation. If you notice new or worsening leg swelling, talk to your doctor. It may be linked to lymphedema, which can be managed with skin care, compression, weight loss, and exercise.

Another common cause of swollen legs for people with obesity is chronic venous insufficiency. This can be diagnosed through a leg Doppler ultrasound. Unlike swelling caused by lymphatic issues, venous insufficiency causes skin discoloration, which is visible even in the early stages.

4. Bruising

Many people with lipedema experience bruising, which is not traditionally a symptom of obesity.

Bruising in Lipedema

Areas of the body affected by lipedema often have damage to small blood vessels called capillaries. When capillaries burst, they can bleed and cause easy bruising under the skin after the slightest bump.

Bruising in Obesity

Having a diagnosis of obesity is not usually related to bruising. The skin changes most commonly related to obesity include stretch marks and varicose veins.

5. Response to Weight Loss Interventions

Lipedema and obesity respond differently to weight loss efforts. Some people with obesity can lower their body weight through diet and exercise, but the swelling of lipedema doesn’t respond well to these weight loss strategies. This is likely due to hormonal or genetic factors.

Lipedema and Weight Loss

Traditional methods of weight loss, such as diet and exercise, don’t affect the fat deposits caused by lipedema. That’s why many people with lipedema turn to treatments like liposuction, even though it doesn’t treat the root causes of the condition. A series of studies in Germany found long-term benefits from liposuction lasting up to eight years. However, a recent study showed that a low-carbohydrate diet can improve quality of life and reduce pain for people with lipedema, even without significant weight loss.

Obesity and Weight Loss

Every individual with obesity has a different response to weight loss tactics like diet, exercise, medication, and surgery. However, when people diagnosed with obesity do lose weight, it directly reduces the amount of adipose tissue under the skin and in the abdomen.

Similarities in Symptoms: Lipedema vs. Obesity

While lipedema and obesity are clearly different conditions, they also have some things in common.

1. Weight Gain

Both lipedema and obesity involve weight gain. According to the Lipedema Foundation, between 37.6 and 79.6 percent of people with lipedema also have obesity. This connection can make managing both conditions challenging, but with the right support and care, it is possible to improve your quality of life.

Both lipedema and obesity can cause physical limitations and negative mental health effects —challenges that can affect your self-esteem, mobility, and overall quality of life.

2. Impact on Lifestyle

Both lipedema and obesity can cause physical limitations and negative mental health effects. Both conditions, if severe enough, may affect your ability to move around. These challenges can also affect your self-esteem, and you might feel judged or misunderstood by others. Feeling uncomfortable in your own skin may prevent you from feeling confident at work, in the gym, and in the doctor's office. There is support available to help you manage these challenges and take care of your health with kindness and understanding.

3. Diagnostic Challenges

Because differentiating between lipedema and obesity can be a challenging task, it may take some time to receive a proper diagnosis. Most commonly, people are first diagnosed with obesity and then later also diagnosed with lipedema.

Obesity is usually diagnosed based on your BMI score:

• Class 1 obesity — BMI score between 30 and 34.9
• Class 2 obesity — BMI score between 35 and 39.9
• Class 3 obesity — BMI of 40 or higher

While diagnosing obesity is a straightforward calculation based on height and weight, lipedema is a “clinical diagnosis.” This means it is diagnosed based on a doctor’s assessment of a person’s symptoms and physical appearance.

Speak With Your Doctor

There are many gaps in the research about lipedema. Many healthcare providers don’t know enough about this condition, and it is underdiagnosed. If you notice uneven fat distribution, swelling, or sudden weight gain, consult a healthcare provider. With proper care, your symptoms and quality of life can improve.

Talk With Others Who Understand

MyObesityTeam is the social network for people with obesity and their loved ones. On MyObesityTeam, more than 56,000 members come together to ask questions, give advice, and share their stories with others who understand life with obesity.

Have you been diagnosed with lipedema, obesity, or both? Share your comments below, or start a conversation by posting on your Activities page.