Distinguishing obesity from lipedema can be accomplished by noting (a) whether the fat deposits in the arms and legs spare the feet and hands, (b) whether the adiposity is predominantly in the extremities or it exists in the extremities and the trunk, and (c) by whether diet and/or physical activities reduce truncal adiposity but not extremity adiposity. Easy bruising is often noted. Pain upon pressure is universal in patients with lipedema and is commonly described an "aching dysesthesia.
Photo creditThe Stemmer's sign is the inability to pinch a fold of dorsal skin at the base of the toes and will be positive in patients who have developed secondary lymphedema. In patients with pure lipedema, the Stemmer's sign is negative. In lipedema patients, edema is minimal and relieved by elevation. In lymphedema patients, the edema is persistent.
Lipedema: A Frequently Misdiagnosed and Misunderstood Fatty Deposition Syndrome; Advances in Skin & Wound Care, February 2010 - Volume 23 - Issue 2 - pp 81-92; Fife, Caroline E. MD; Maus, Erik A. MD; Carter, Marissa J. PhD, MA
Lipedema; Lymphedema Therapy Website