Former Paquita Tatiana Maranhão, 45, shared on her social media that she has been diagnosed with lipedema, a chronic vascular disease that causes abnormal accumulation of fat in the arms and legs. Before discovering the problem, Xuxa Meneghel’s current counselor said she went through dozens of doctors without getting the right diagnosis and heard several fatphobic comments about her body during her youth.
“Have you seen how fat this Paquita is?” or “Marlene [Mattos, que comandava o girl group brasileiro formado em 1984] sent away because she was overweight,” according to Tatiana, were some of the most common. Because lipedema causes localized adipose tissue and sagging, it is commonly considered obesity or overweight. However, the fat associated with the condition and that caused by obesity are not the same.
According to the International Classification of Diseases, ICD11, by the WHO (World Health Organization), lipedema is characterized by a diffuse “fatty” swelling, mostly limited to the legs, thighs, hips and arms but it can also appear on the skin hairy.
It is a much more common condition in women, tending to appear during puberty, during pregnancy, or after menopause.
Lipedema fat is often painful and can also lead to the appearance of some small nodules. The occurrence of bruising, often even without trauma, is common. The patient may also suffer from tenderness to touch, ligament laxity, and severe sagging skin.
Other symptoms include leg/trunk disproportion, cellulite, heaviness in the legs and fatigue. Over time, there is a risk of deformities and mobility problems. However, the disease is not always associated with obesity.
Excess fat is distributed more evenly throughout the body. It is also less difficult to eliminate through diet and physical activity, which is not the case with lipedema. “The truth is that exercise and food never solved my problem,” the former Paquita shared in a post on Instagram.
How does the diagnosis work?
According to SBACV (Brazilian Society of Angiology and Vascular Surgery (SBACV)), the diagnosis of lipedema is clinical. The doctor observes whether there is an accumulation of fat on the buttocks, thighs, knees and legs. This accumulation must have a disproportion between the fat accumulations in the buttocks and upper body, which can also affect the arms, but is easy on the hands, feet and trunk.
The most common complaints from patients include:
- pain (especially when the limbs with fat accumulation are palpated);
- mobility difficulties;
- edema (swelling) and frequent bruising;
- There may be an association with other conditions such as chronic venous insufficiency, lymphedema and obesity.
- A typical sign is the accumulation of fat in the area of the ankle, the socalled “cuff sign”.
Types of lipedema
SACV lists five types of lipedema, depending on the affected extremity areas.
- Type I: involvement from navel to hips;
- Type II: Involvement up to knees with presence of fatty tissue on sides and bottom of knees;
- Type III: Involvement up to the ankles with formation of a ‘cuff of fat’ just above the feet;
- Type IV: arm involvement. Highly associated with types II and III;
- Type V: only from the knee down.
According to the organization, there is another functional classification that refers to the course and/or severity of the disease.
In stage 1, the skin surface is normal, but there is an accumulation of fat in the subcutaneous tissue and there are nodules or balls of fat, as if they were pearls under the skin.
In Stage 2, the skin is irregular, slightly sagging than expected with age and with the appearance of cellulite. The knots are also larger.
In stage 3, the skin is noticeably looser, with “skin folds” that can cause difficulty in walking and moving.
All of the changes described in stage 3 are repeated in stage 4 in addition to involvement of the lymphatic system.
What is the treatment?
Treatment of lipedema requires a multidisciplinary team consisting of an angiologist, a vascular surgeon, a nutritionist, a physical therapist, and in some cases a psychologist. Tests are also done to detect endocrine disorders that could cause similar symptoms.
Liposuction is only indicated as a last option when clinical treatment over time has not shown the expected effect.
In addition to multidisciplinary followup, it is recommended to avoid the abuse of foods such as pork and beef, sausage, soft drinks, alcoholic beverages and industrial products, which can increase the inflammation of lipedema. Practicing exercises, on the other hand, is very welcome.
Why is it more common in women?
The disease almost exclusively affects women and begins at puberty, which is why it is believed that there is a hormonal component to its pathophysiology.
The relationship with estrogen (female hormone) is also increased, since the disease usually occurs during phases in which there is an increased production of this hormone, such as during pregnancy.
There may be a link to genetics, but no genes have been identified yet.
In men, the few cases reported in the medical literature have been in patients with liver problems or testosterone deficiency.
*With information from a report published on 06/27/2021 and from SBACV (Brazilian Society of Angiology and Vascular Surgery (SBACV).