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38 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 1 Lipedema The Skinny on Painful Fat By Ruth Werner education | PATHOLOGY PERSPECTIVES We've all seen them: the ladies at the grocery store with enormous legs who can't walk far enough to do their shopping, so they have to use the motorized carts. Maybe we've wondered, how did that happen? How did it go that far? What is going on for her? And what if she comes for massage? "I can't play with my grandkids. I can't have them sit on my lap, it's too painful. I can't even have my dog on my lap. It just hurts too much." —Anonymous Our culture is brutal to people who don't fit a certain standard of physical appearance. It's easy to be judgmental and to assume that if a person has developed such a distorted, outsized body that she can no longer walk, it must be somehow her fault, and the result of her lack of self-discipline. (These thoughts sometimes occur to me as I wander over to the bakery section to get an apple fritter—my favorite grocery shopping reward.) The truth is so much more complicated. We've already learned that obesity is a notoriously difficult condition to combat, but this situation, which is often a combination of obesity and dysfunctional fat metabolism in the lower extremities (lipedema)—and maybe some lymphedema too—is not a consequence of poor eating and exercise decisions. It is instead a chronic, painful, potentially debilitating condition that drastically affects the person's quality of life. WHAT IS LIPEDEMA? Lipedema (literally, "fat-fluid retention") was first documented in 1940. It was identified as a problem with the deposition of abnormal fat cells, but some specialists now suggest it is a disease of the connective tissue, with the central feature of a loss of elastic recoil in the subdermis. Experts disagree on many things about lipedema: how common it is, whether it is genetic, whether it is progressive, whether edema is even a significant factor, and how to treat it. The topic of lipedema is awash in contradictory observations, inconsistent research findings, and various treatment options that include surprisingly different types of manual therapies.

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