If you google “anorexic lipidema” you’ll find pictures.

No doubt obesity makes it worse but once you gain fat in lipidemic areas it’s very hard if not impossible to lose that fat because that fat tissue is somewhat “shielded” from use by your body. A lot of people don’t even realize they have lipidema until after they gained a little weight at some point and tried to lose it. You’ll lose weight in any areas not affected by lipidema and you can lose a little in the lipidemic areas depending on how bad those areas are (once you get fibrous tissue it’s basically game over) but you’ll never lose all of it without surgical intervention.