Lipoedema: It's Not Just Fat, and It's Not Your Fault

Here’s the thing: lipoedema is far more common than we’ve been led to believe, yet still woefully underdiagnosed, misunderstood, and often dismissed — both by the medical profession and by those who live with it. Somewhere between 9–11% of women are estimated to be affected globally. That’s a huge number of people walking around feeling uncomfortable, confused, and often unheard, with legs and arms that don’t match the rest of their body and pain that’s labelled as ‘just part of getting older’ or ‘just lose weight.’

Let’s get this clear upfront: lipoedema is not caused by overeating, under-exercising, or failing to manifest your best life. It’s a chronic connective tissue disorder, marked by the abnormal and disproportionate accumulation of fibrotic fat cells, predominantly in the lower limbs (but arms can also be affected). Hands and feet are spared — that’s one of the diagnostic clues. The fat is painful, bruises easily, and stubbornly refuses to shift with diet or exercise.

Clinically, lipoedema is recognised by a few hallmarks: symmetrical limb enlargement, hypersensitivity to touch, increased bruising, and often a ‘cuffing’ effect at the ankles or wrists where the swelling stops abruptly. What you won’t find is pitting oedema in the early stages — that’s more lymphoedema’s territory. Though, in later stages, the lymphatics do tend to get dragged into the picture, leading to lipo-lymphoedema.

Hormonal shifts play a starring role. Onset is typically tied to puberty, pregnancy, perimenopause — any time the body’s hormonal orchestra goes a bit rogue. There’s also a strong genetic component; around 60% of people with lipoedema report a family history of similarly shaped mothers, grandmothers, or sisters.

The pathophysiology is still under investigation, but we do know there’s dysregulation in fat cell metabolism, microangiopathy (that’s small blood vessel dysfunction to you and me), and lymphatic inefficiency on a micro level. It’s a triple threat that creates this stubborn, fibrotic, painful fat that no amount of Pilates will touch.

For those of us in the lymphatic health space, recognising lipoedema early matters. Not only because it impacts body image and quality of life, but because it affects mobility, joint health, venous return, and eventually lymphatic function. Left unchecked, it progresses through stages: from softer tissue enlargement in the early days to nodular, fibrotic, and functionally debilitating changes as time wears on.

It’s also important to acknowledge the psychological toll this condition takes. Most women with lipoedema have spent decades trying to ‘fix’ themselves with diets, exercise regimes, and shame. The ongoing frustration of fighting a body that simply doesn’t respond to conventional weight loss advice breeds disconnection, exhaustion, and often deep distress about body image. Having a diagnosis doesn’t fix everything, but it can be a pivotal moment of self-compassion and clarity.

And let’s talk about management. Despite the fact that internet influencers are now discovering compression tights and lymphatic drainage as ‘hacks’ for aesthetics, the reality is that best-practice care for lipoedema is complex, layered, and rooted in proper clinical management. Manual Lymphatic Drainage (MLD), compression therapy, specific exercise protocols (think low-impact and lymph-friendly, not HIIT), and skin care, make up the gold-standard conservative approach. These don’t ‘cure’ lipoedema, but they improve lymphatic clearance, help manage pain, reduce secondary swelling, and support tissue health.

Surgery? Yes, it’s an option — but not a quick-fix. Lipoedema-specific liposuction, particularly lymph-sparing techniques like WAL (Water Assisted Lipo) or tumescent liposuction, offers promising long-term improvements in function, pain, and aesthetics. However, it’s expensive, often not covered by Medicare in Australia, and requires a foundation of conservative management to achieve the best outcomes.

Why does all this matter? Because too many women are still being told it’s just weight gain, it’s just menopause, it’s just ageing. It’s not. Lipoedema isn’t a failure of willpower — it’s a disorder of tissue physiology. And recognising it earlier opens the door to better outcomes, less shame, and more support.

I’m passionate about getting this message into the mainstream. Not just because I offer MLD, but because this is about understanding bodies better — bodies that are doing their best with what they’ve been given, not bodies that need fixing. Education is a powerful antidote to shame, and good lymphatic care is a powerful support for those who live with lipoedema every day.

If this sounds like you (or your best friend, or your mum), know this: there is help, there is treatment, and there is hope. And none of it requires another 12-week bootcamp.

Helpful Australian Resources for Lipoedema

Lipoedema Australia]( https://www.lipoedema.org.au/ ) — Australia’s leading patient support and advocacy organisation

Lymphoedema Academy of Australia (LAA)]( https://lymphoedemaeducation.com.au/ ) — excellent resource for best-practice lymphatic management

Australasian College of Phlebology]( https://www.phlebology.com.au/ ) — resources for vascular and lymphatic health practitioners

References / Suggested Reading

Kruppa, P. et al. (2020). Lipedema: A Review of Current Knowledge and Future Perspectives. Formation Drainage Lymphatique.

Reich-Schupke, S., Schmeller, W., et al. (2021). Lipedema Guidelines. Phlebologie Journal.

Lipoedema Australia, (2023). [www.lipoedema.org.au](https://www.lipoedema.org.au/)

Földi, M., Földi, E. (2012). Lymphedema: Diagnosis and Therapy.

Health Direct (AUS). [https://www.healthdirect.gov.au/lipoedema](https://www.healthdirect.gov.au/lipoedema)