An important distinction
Lipoedema, lymphoedema or obesity?
Not all fatty deposits are the same. Find out the key differences between these frequently confused conditions.
Medically reviewed byDr. med. Martin Reifenrath, Specialist in Plastic and Aesthetic SurgeryLast reviewed:
Why the distinction matters
Three conditions – different treatments
Lipoedema, lymphoedema and obesity are often confused or misdiagnosed. Yet each condition requires a different treatment strategy – a misdiagnosis can cost years.
Only specialised doctors can reliably tell them apart. The following overview will help you recognise the first signs and prepare for your conversation with your doctor.
A direct comparison
The three conditions at a glance
See the characteristic differences at a glance.
Lipoedema
- Symmetrical on the limbs
- Hands & feet stay slim
- Very sensitive to pressure and touch
- Stemmer's sign negative
- No effect from dieting
- Frequent bruising
- Only women affected
Lymphoedema
- Usually one-sided or asymmetrical
- Hands & feet may swell
- Usually not painful
- Stemmer's sign positive
- No effect from dieting
- Rarely bruising
- Women and men affected
Obesity
- Evenly across the whole body
- Hands & feet often affected too
- Usually not painful
- Stemmer's sign negative
- Weight loss through dieting possible
- Rarely bruising
- Women and men affected
In detail
Lipoedema
A chronic fat distribution disorder that affects women almost exclusively.
Lipoedema shows itself as symmetrical fat accumulation on both legs or both arms. The torso usually stays slim, while the limbs become disproportionately larger.
A characteristic feature is that the hands and feet stay slim – an important difference from lymphoedema. The diseased fatty tissue responds neither to diets nor to exercise and is very sensitive to pressure and touch.
100%
Female
0%
Diet success
Symmetrical
Distribution
Painful
Sensitive to pressure
In detail
Lymphoedema
A disorder of the lymphatic system that leads to a build-up of fluid.
Lymphoedema is caused by impaired lymphatic drainage and typically appears on one side or asymmetrically. Unlike lipoedema, the hands and feet can also be affected and swell.
An important distinguishing feature is Stemmer's sign: in lymphoedema, the skin on the toes or fingers can no longer be lifted into a fold – in lipoedema, this is easily possible. Lymphoedema is usually not painful.
One-sided
Usually asymmetrical
Positive
Stemmer's sign
Not painful
As a rule
Hands/feet
May swell
In detail
Obesity
Excess weight that is distributed evenly across the whole body.
In obesity (excess weight), fatty tissue is distributed evenly across the whole body – including the torso, hands and feet. There is no characteristic disproportion as in lipoedema.
The crucial difference: obesity responds to diet and exercise. Weight loss can be achieved by reducing calories and exercising more. The tissue is usually not painful and does not show an increased tendency to bruise.
Even
Across the whole body
Possible
Diet success
Not painful
As a rule
All areas
Including hands & feet
An important distinguishing feature
Stemmer's sign
A simple test that can help distinguish between lipoedema and lymphoedema.
Stemmer's sign negative
Typical of lipoedema & obesity
The skin on the second toe or on a finger can easily be lifted into a fold. The tissue is not hardened and the fingers/toes are not swollen.
Stemmer's sign positive
Typical of lymphoedema
The skin on the second toe or on a finger cannot be lifted into a fold, or only with difficulty. The tissue is hardened and swollen – a clear indication of lymphoedema.
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Mixed forms
Combinations are possible
The three conditions can also occur together and influence each other.
Lipoedema + obesity
A common combination. Lipoedema can be made worse by accompanying excess weight. Losing weight does not relieve the lipoedema itself, but it can improve the overall situation.
Lipoedema + lymphoedema
This combination is known as lipo-lymphoedema. Advanced lipoedema can damage the lymphatic system and cause secondary lymphoedema.
Professional diagnosis
With mixed forms in particular, an examination by an appropriately qualified specialist (e.g. in angiology or dermatology) is essential in order to develop the right treatment strategy.
Since October 2025
Liposuction covered by German statutory health insurance – in all stages
In July 2025, the Federal Joint Committee (G-BA) decided: since October 2025, German statutory health insurers have covered the cost of liposuction for lipoedema – regardless of the stage (for patients insured in Germany). The complicated application procedure no longer applies.
No more application
The complicated application procedure with the health insurer no longer applies. The treating doctors check directly whether all requirements are met – we take care of this for you.
All stages
Until October 2025, cost coverage was limited to stage III. Since then, patients in stages I and II have also been covered by statutory health insurance.
In line with G-BA requirements
We carry out operations covered by statutory insurance at NATIONALKLINIK Wertheim, a hospital included in the German state hospital plan – using the tumescent technique, as the G-BA requires.
What you need for statutory cover – we take care of it
6 months of conservative therapy, a BMI of no more than 35, the two-doctor principle (diagnosis and the decision to operate made by different doctors) – sounds complicated? It doesn't have to be. At Lipo Doctors, we coordinate every step: from diagnosis and conservative therapy to surgery and aftercare. You don't have to worry about a thing.
A reliable diagnosis
Only a specialist can give you certainty
This overview can give you initial pointers, but it is no substitute for a professional diagnosis by specialised doctors.
For a medically confirmed diagnosis – especially for cover by German statutory health insurance – a written report from a specialist in angiology, dermatology or physical and rehabilitation medicine, or with additional training in phlebology, is essential. Alongside a detailed medical history, this includes a duplex ultrasound scan.
- Detailed medical history
- Physical examination
- Duplex ultrasound
- Two-doctor principle for statutory insurance
Frequently asked questions
FAQ on telling them apart
How can I check for myself whether I have lipoedema?
There are a few signs you can check yourself: is the fat distributed symmetrically on both legs/arms? Do your hands and feet stay slim? Do you feel pain when pressure is applied or when touched? Do you bruise easily? Does the fat fail to respond to dieting? These features suggest lipoedema – but only a specialist can make a reliable diagnosis.
What is Stemmer's sign?
Stemmer's sign is a simple test: try to lift the skin on your second toe (or on a finger) into a fold. If this is easy, Stemmer's sign is negative – typical of lipoedema and obesity. If the skin is hardened and cannot be lifted, the sign is positive – an indication of lymphoedema.
Can I have lipoedema and be overweight at the same time?
Yes, in fact this is common. Lipoedema can occur together with obesity. This often makes diagnosis more difficult, as the two conditions overlap. Losing weight can improve the overall situation but does not resolve the lipoedema itself – the diseased fatty tissue on the limbs remains.
Why is a diagnosis by a specialist so important?
Each of the three conditions requires a different treatment strategy. A misdiagnosis can mean you receive the wrong therapy for years. In addition, for cover by German statutory health insurance, a written report from a specialist in angiology, dermatology or physical and rehabilitation medicine, or with additional training in phlebology, is required – as is the two-doctor principle (diagnosis and the decision to operate made by different doctors).
Which doctor can reliably tell the difference?
For a medically confirmed diagnosis, the right people to see are specialists in angiology, dermatology or physical and rehabilitation medicine, or doctors with additional training in phlebology. Alongside a detailed medical history, they also use imaging such as duplex ultrasound to reliably rule out other conditions.
Does health insurance cover the cost of lipoedema surgery?
For patients insured in Germany: yes, since October 2025. The Federal Joint Committee (G-BA) decided that liposuction for lipoedema is covered by German statutory health insurance in all stages (I, II and III). The complicated application procedure no longer applies. The requirements are: a BMI of no more than 35, 6 months of conservative therapy and the two-doctor principle (diagnosis and the decision to operate made by different doctors). With a BMI between 32 and 35, the waist-to-height ratio (WHtR) must also be appropriate for your age. We carry out operations covered by statutory insurance at our NATIONALKLINIK Wertheim – preparation and aftercare remain at the location near you. At Lipo Doctors, we coordinate every step for you.
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