For a long time, the word “fat” was used as if it represented a single condition. However, science shows that different deposits of adipose tissue perform different functions in the body. While some are essential for organ protection and metabolism, others are associated with increased cardiometabolic risk or are part of specific diseases, such as lipedema.

“This differentiation is important because not all fat represents a health problem, and reducing them to the same concept can delay diagnoses and generate mistaken expectations about weight loss and treatments”, explains endocrinologist Dr. Deborah Beranger, with a postgraduate degree in Endocrinology and Metabology from Santa Casa de Misericórdia do Rio de Janeiro (SCMRJ).

According to the doctor, the location of fat directly interferes with its metabolic behavior. “Adipose tissue is a metabolically active organ. It stores energy, produces hormones and releases several signaling molecules, called adipokines, which participate in the regulation of metabolism, the immune response and inflammatory processes. The impact of these substances varies depending on the quantity, the location and the characteristics of this tissue”, he explains.

Among the different adipose depots, visceral fat is considered the most clinically relevant. The endocrinologist explains that visceral fat accumulates in the abdominal cavity, involving organs such as the liver, intestine and pancreas, and is associated with the development of several diseases, including insulin resistance, type 2 diabetes, high blood pressure, fatty liver disease associated with metabolic dysfunction (MASLD) and cardiovascular diseases.

“This tissue presents intense metabolic activity and produces inflammatory mediators, including pro-inflammatory cytokines, such as tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6), in addition to changes in the production of adipokines. When accumulated in excess, the fat visceral contributes to a state of low-grade chronic inflammation, recognized as one of the mechanisms involved in the development of several metabolic diseases”, explains Dr. Deborah Beranger.

Although imaging tests, such as computed tomography and magnetic resonance imaging, are the most accurate methods for quantifying visceral fat, in clinical practice, waist circumference is a simple and very useful measurement for estimating this risk, according to the doctor.

“In general, values ​​above 80 cm in women and above 94 cm in men already indicate an increased cardiometabolic risk, while measurements above 88 cm in women and 102 cm in men are associated with a substantially higher risk for cardiovascular and metabolic diseases. It is not just the weight on the scale that matters, but where this fat is distributed. People with a similar body mass index can have very different risks depending on the amount of visceral fat accumulated”, he explains.

Localized fat: a body characteristic, not a disease

Localized fat, found mainly in the abdominal region surface, hips, thighs, culottes and arms, usually represents a predominantly aesthetic concern. “It is part of the normal distribution of adipose tissue and is influenced by genetics, sex, age and hormonal profile. Its presence, alone, does not mean an increase in cardiovascular risk nor does it characterize a disease”, comments the endocrinologist.

Furthermore, she emphasizes that not all body fat needs to be eliminated. “Adipose tissue performs important functions in the body, such as energy reserve, thermal insulation and mechanical protection. In many people, localized fat represents just an individual characteristic of body composition”, he highlights.

Lipedema: when adipose tissue becomes a disease

Regarding the lipedemait is worth remembering that it is not a type of fat, but a chronic disease that mainly affects women and is characterized by the disproportionate accumulation of adipose tissue, generally in the legs and, in some cases, also in the arms.

“Unlike localized fat, lipedema usually causes spontaneous pain or when touched, a sensation of heaviness, easy bruising and symmetrical enlargement of the limbs, often sparing the feet”, explains plastic surgeon Dr. Rafael Erthal, a reference in lipedema treatment.

The doctor emphasizes that lipedema differs from obesity and localized fat. “It is a clinical condition that involves changes in adipose tissue and microcirculation, with important functional repercussions. Many patients lose weight, but continue to present body disproportion and leg symptoms”, he states.

Therefore, losing weight may not be enough for some patients. “Although people with lipedema can also be obese, losing weight does not always significantly reduce the tissue affected by the disease, which explains why some patients they continue to have pain and body disproportion even after losing weight”, adds Dr. Deborah Beranger.

Impacts of lipedema on health and quality of life

Dr. Rafael Erthal warns that, without adequate diagnosis and treatment, lipedema can progressively compromise quality of life. “Increased volume of the lower limbs, associated with pain, can alter gait, reduce physical activity and increase the burden on knees, hips and ankles, favoring the development or worsening of osteoarticular problems”, he says.

According to the specialist, more advanced cases of the disease can cause significant limitations in daily life. “In more advanced stages, we are not just talking about an aesthetic change. Many patients have functional limitations, difficulty walking, climbing stairs or standing for long periods. When indicated, plastic surgery seeks to reduce this diseased adipose tissue, alleviate symptoms and improve functionality“, says the plastic surgeon.

Correct diagnosis changes treatment

Correctly identifying the predominant type of adipose tissue is essential to define the most appropriate treatment approach. “While excess visceral fat requires priority in controlling metabolic risk factors, localized fat can only be treated if there is an aesthetic desire”, explains Dr. Deborah Beranger.

Lipedema, according to the doctor, requires a specific clinical evaluation, as it is a condition that goes beyond excess body fat. Treatment must be individualized and, in most cases, involves a multidisciplinary approach, with the participation of different health professionals. health. In selected cases, surgical treatment may be recommended to alleviate symptoms, improve functionality and provide a better quality of life for the patient.

“Understanding that not all fat is the same helps to abandon generalist solutions. Each condition has its own biological mechanisms and, therefore, requires an individualized approach”, he concludes.

By Maria Claudia Amoroso