A Young Woman with Excessive Fat in Lower Extremities Develops Disordered Eating and Is Subsequently Diagnosed with Anorexia Nervosa, Lipedema, and Hypermobile Ehlers-Danlos Syndrome

Abstract

Patient: Female, 31-year-old Final Diagnosis: Lipedema Symptoms: Bruising • leg edema • leg pain Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic • Family Medicine • Medicine, General and Internal • Metabolic Disorders and Diabetics • Plastic Surgery • Psychiatry Objective: Rare co-existance of disease or pathology Background: Lipedema is a loose connective tissue disease that causes disproportionate subcutaneous fat accumulation on the extremities. As a result of the increased subcutaneous tissue accumulation, lipedema is often confused with obesity by both physicians and patients. Poor awareness and limited diagnosis of lipedema contribute to the confusion of lipedema with obesity and can lead to decreased body image acceptance. Patients with lipedema may have anorexia nervosa, an eating disorder characterized by a distortion of body image, incorrect self-identification of being overweight, restricted eating behavior, and a relentless pursuit of weight loss. Case Report: A young woman with disproportionate fat accumulation on the lower half of her body self-identified as having obesity. She developed restrictive eating behavior and became obsessed with weight loss, resulting in anorexia nervosa. Her disproportionate subcutaneous tissue persisted despite losing weight to reach a nadir BMI of 15 kg/m 2 . After a decade-long struggle, her eating disorder resolved, and she maintained a healthy weight and BMI of 21.5 kg/m 2 but disproportionate fat remained in her lower body. She experienced increasing leg tenderness, pain, and easy bruising and was diagnosed with lipedema. Conclusions: Lack of recognition of lipedema by medical professionals and the public as a weight loss-resistant disease can affect body image acceptance. Lipedema was mistaken for obesity by the young woman in this case and likely played a role in her development of an eating disorder. Eating disorders, such as anorexia nervosa, are not rare and may be more common in women with lipedema.

Lipoedema as a Social Problem. A Scoping Review

“…One of the characteristic features of lipoedema is the apparent disproportion between the trunk and the lower limbs [1,4,29,33,34]. It is precisely this initially slight disproportion that is often the first symptom of lipoedema, appearing in adolescence.…”

“…It should be emphasized that there is a group of patients who present symptoms of lipoedema despite having a normal body weight. In these patients, attempts to lose weight are unsuccessful because the subcutaneous tissue accumulated on the lower limbs is resistant to slimming, and losing weight only increases the disproportion between the torso and the limbs [29]. Moreover, due to difficulties in losing weight for many women with lipoedema, eating disorders in the form of anorexia and bulimia develop [29].…”

“…In these patients, attempts to lose weight are unsuccessful because the subcutaneous tissue accumulated on the lower limbs is resistant to slimming, and losing weight only increases the disproportion between the torso and the limbs [29]. Moreover, due to difficulties in losing weight for many women with lipoedema, eating disorders in the form of anorexia and bulimia develop [29]. Survey research carried out by Lipoedema UK showed that out of 250 women with lipoedema, 45% of respondents report having eating disorders such as over-or under-eating, anorexia, bulimia, and binge eating [35].…”

“…The research was conducted using PRISMA methodotogy (Figure 1) The review was conducted according to the PRISMA method and it distinguished 10 papers, which are presented in Table 1. Qualitative research • Subjective self-evaluation of the impact of lipoedema on health [28] Case study • Lipoedema and eating disorders [29] Pilot study • The connection between pain and psychological stress in people with lipoedema [20] Other study • Lipoedema comorbidities [30] • Left atrial and ventricular abnormalities in people with lipoedema [31] 3. Results…”

“…Despite a significant reduction in body weight (BMI 15 kg/m 2 ), the disproportion was still visible, and the woman developed anorexia. When she regained normal body weight (BMI 21 kg/m 2 ), other symptoms appeared in the form of pressure sensitivity and tendency to bruising [29].…”