Lipedema Myths, Facts & Fixes With Dr. V.K. Srinagesh

“Why do my legs hurt and swell, even though I eat healthy and exercise?” This is one of the most common questions patients ask. Lipedema, a chronic fat disorder, remains one of the most misunderstood and underdiagnosed medical conditions, especially among women. Often mistaken for obesity or lymphedema, lipedema is different—and recognizing the difference is the first step toward effective treatment.

In this patient-friendly interview, Dr. Srinagesh, one of India’s few dedicated lipedema surgeons, breaks down the most frequently asked questions about lipedema. If you’re struggling with unexplained fat accumulation, pain, or swelling in your lower body, this FAQ could be your first step toward clarity. 

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What is Lipedema, and how is it different from regular fat or obesity?

Dr. Srinagesh: Lipedema is a chronic condition where fat builds up in specific parts of the body—usually the legs, hips, and sometimes arms. This fat is painful, doesn’t respond to diet or exercise, and is often symmetrical. Unlike obesity, lipedema fat does not accumulate in the abdomen. And unlike regular fat, it causes pain, bruising, and mobility issues.

Patients often come to me saying, “I lost weight from my upper body, but my legs just won’t change.” That’s the telltale sign.

Who typically gets lipedema?

Dr. Srinagesh: Lipedema primarily affects women, and it often runs in families. It usually starts or worsens at times of hormonal change—like puberty, pregnancy, or menopause. Men can also have it, but it’s rare and often linked to hormonal or liver-related conditions.

We’re seeing more women in their 30s and 40s who’ve spent years being told they’re just overweight or not trying hard enough. It’s not about effort—it’s about biology.

How is lipedema diagnosed?

Dr. Srinagesh: Diagnosis is primarily clinical, which means it’s based on symptoms and physical examination. I look for signs like:

• Disproportionate fat on the lower body
• Tenderness or pain in the fat tissue
• Easy bruising
• Fat that feels nodular or lumpy

We also rule out lymphedema or other vascular conditions. There’s no single test, but tools like lymphoscintigraphy and ultrasound can help assess lymphatic function.

Why is lipedema often misdiagnosed?

Dr. Srinagesh: The main reason is lack of awareness—even among medical professionals. Because lipedema increases BMI, many doctors automatically diagnose it as obesity. Others mistake it for lymphedema, which involves fluid buildup.

But the difference is this: in lipedema, fat is the problem. It’s structurally and hormonally different from regular fat. Unless a doctor knows what to look for, they may overlook it entirely.

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What are the stages of lipedema?

Dr. Srinagesh: We usually describe lipedema in 3 to 4 stages:

• Stage 1: Skin is smooth, but fat is thickened. Symptoms are mild.
• Stage 2: Skin becomes uneven with indentations. Fat nodules are more visible.
• Stage 3: Fat accumulates in large masses, especially around knees and thighs. Mobility may be affected.
• Stage 4 (or lipolymphedema): Lymphedema overlaps with lipedema, causing additional swelling and complications.
  

It’s important to note that staging doesn’t always reflect severity. Some Stage 2 patients have more pain than Stage 3 patients.

What treatments are available for lipedema?

Dr. Srinagesh: There is no cure yet, but treatment can greatly improve quality of life. We use a two-pronged approach:

Conservative Treatments:

• Compression therapy
• Manual lymphatic drainage
• Anti-inflammatory diet
• Low-impact exercise like swimming or walking
  

Surgical Treatments:

• Lymph-sparing tumescent liposuction: This is the gold standard. It removes diseased fat while protecting lymph vessels.
• In severe cases, skin tightening or reduction surgeries may be needed.

Early intervention offers the best outcomes. Many of my patients say they finally feel like themselves again post-surgery.

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Is lipedema painful?

Dr. Srinagesh: Yes, lipedema it can be. The fat tissue is often tender and painful to touch. Patients describe it as heaviness, tightness, or a dull ache. In later stages, pain can be constant and interfere with daily life.

It’s not just cosmetic. It’s a real, physical disease that causes suffering—and it deserves proper care.

Can lipedema be reversed through weight loss or exercise?

Dr. Srinagesh: Unfortunately, no. Lipedema fat is resistant to diet and exercise. You may lose weight in the upper body or face, but the fat in the legs or arms often stays.

This is what makes it so frustrating for patients. Many of them have tried everything—from keto to bariatric surgery—without any relief in the lower body. That’s when they realize they need a different diagnosis.

What advice do you have for someone who thinks they might have lipedema?

Dr. Srinagesh: First, know that you’re not alone. Lipedema affects millions of women, and we’re just beginning to understand how widespread it is.

Second, trust your body. If something doesn’t feel right—if your lower body feels heavy, painful, and unresponsive to exercise—seek out a lipedema specialist.

Early diagnosis means more options and better outcomes. And most importantly, you deserve compassionate, informed care.

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Lipedema is more than a cosmetic issue. It’s a medical condition with real symptoms and real consequences if left untreated. If any of these answers resonated with your experience, it may be time to explore lipedema further. Dr. Srinagesh is one of India’s leading voices in lipedema care, offering both conservative and surgical treatment options tailored to individual needs. At Omega Lipedema Clinic in Hyderabad, he focuses not just on reducing fat but restoring function, confidence, and quality of life.