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Lipedema and obesity are chronic, frequently progressive disorders that can present with increased adipose-tissue volume, functional impairment and reduced quality of life. Although often approached as differential diagnoses, they frequently coexist and may aggravate one another. This narrative review addresses how lipedema and obesity interact biologically and clinically and what evidence supports a staged interdisciplinary approach to diagnosis and management. Obesity is increasingly conceptualized as an adiposity-based chronic disease characterized by excess adipose, abnormal adipose-tissue distribution or dysfunction, and associated medical or functional impairment. Obesity can impair lymphatic morphology and function, whereas lymphatic dysfunction may promote subcutaneous adipose-tissue expansion and fibrosis. Literature was identified through iterative PubMed searches and focused supplementary searches in Embase and the Cochrane Library. Publications were selected purposively for their relevance to predefined clinical and mechanistic domains; no systematic screening or formal risk-of-bias assessment was performed. This review synthesizes clinical overlap, biological evidence, diagnostic implications, and staged management for predominantly adult women with suspected or confirmed lipedema, including those with coexisting overweight or obesity. The proposed framework is intended to support clinical reasoning rather than serve as a formal guideline.

PURPOSE: Individuals with lipoedema may experience negative impacts that are not often identified through current quality-of-life measures. The aim of this study was to explore the experiences of individuals living with pre-existing lipoedema and their perceptions of how these experiences influence quality of life. METHODS: Participants with a prior diagnosis of lipoedema participated in a single semi-structured interview or focus group. These interviews/focus groups were transcribed verbatim, allowing for an inductive thematic analysis to be conducted. RESULTS: Sixteen participants were included and four main themes were identified. These included: the ongoing work of living with lipoedema, living with a restrictive and overwhelming condition, caught between self-acceptance and social judgement, and forced to navigate lipoedema alone. Across the four themes, 21 sub-themes emerged to convey the quality-of-life concerns experienced by individuals with lipoedema. CONCLUSIONS: Individuals living with lipoedema experience impacts on their quality-of-life across physical, psychological, and social aspects of life. This study highlights how the ongoing burden of physical symptoms, social perceptions, and healthcare-related challenges contributes to reduced quality-of-life for individuals living with lipoedema. Increased knowledge and awareness amongst healthcare providers is needed to improve care received by individuals living with this condition.

This Letter to the Editor documents several verifiable internal inconsistencies in the article by Bruno and D’Antimi, including contradictory statements on study design, a level-of-evidence rating incompatible with the stated methods, contradictory informed-consent statements, and references to a procedure and outcome domain that do not correspond to the study performed. A correction or clarification is requested.

Timely diagnosis of lipoedema remains challenging, with prolonged delays contributing to reduced quality of life. The aim of this study was to analyse the time from first symptom onset to diagnosis, and identify factors associated with diagnostic intervals.

ObjectivesTo investigate the clinical and ultrasonographic changes associated with radial extracorporeal shock wave therapy (rESWT) in women with lipedema.MethodsThis prospective, single-arm study included 40 women with lipedema who completed six sessions of rESWT administered twice weekly to the index lower limb. Treatment consisted of 3000-6000 impulses at 15 Hz and 3-4 bar. Participants were evaluated at baseline (T0), immediately after treatment (T1), and at 4-week follow-up (T2). Outcomes included visual analog scale (VAS) pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, pressure pain threshold (PPT), limb circumference, subcutaneous fat thickness (SCFT), and tissue echogenicity. Patient Global Impression of Change (PGIC) was assessed at T1 and T2.ResultsVAS scores decreased from 8.45 at T0 to 5.45 at T1 and 4.17 at T2, while PROMIS scores decreased from 25.3 to 16.2 and 14.3, respectively (both p < .001). PPT increased significantly at all four evaluated sites (p < .001). Calf and thigh circumferences decreased significantly over time (both p < .001). Medial calf SCFT decreased from 16.5 to 15.2 and 15.1 mm, and medial thigh SCFT from 21.0 to 18.2 and 18.1 mm (both p < .001). Median tissue echogenicity decreased from 3 at baseline to 2 at both post-treatment assessments (p < .001). PGIC scores also improved between T1 and T2 (p < .001).ConclusionsSix sessions of rESWT were associated with improvements in pain, quality of life, mechanical pain sensitivity, limb circumference, and ultrasonographic tissue characteristics in women with lipedema, with most improvements maintained at 4-week follow-up. These findings support further evaluation of rESWT as an adjunctive conservative treatment for lipedema in controlled studies with longer follow-up.Trial registrationClinicalTrials.gov, NCT07683559.

ObjectivesLipedema is a chronic adipose tissue disorder characterized by disproportionate fat accumulation, lower extremity pain, functional impairment, and reduced quality of life. Although pain is a cardinal symptom, its underlying mechanisms remain incompletely understood. This study aimed to characterize sensitization-related pain phenotypes in women with lipedema by examining central sensitization (CS) and neuropathic -like pain features and their associations with lower extremity function, sleep quality, and health-related quality of life (HRQoL).MethodsIn this cross-sectional case-control study, 54 women with clinically diagnosed lipedema and 48 age-matched control participants were enrolled between March and October 2025. Pain phenotypes were assessed using the Central Sensitization Inventory (CSI) and Pain-DETECT questionnaire. Lower extremity function, sleep quality, and HRQoL were evaluated using Lower Extremity Functional Scale (LEFS), Jenkins Sleep Scale (JSS), and EuroQol-5D-3L (EQ-5D-3L), respectively.ResultsWomen with lipedema had significantly higher Pain-DETECT and CSI scores than controls, indicating greater neuropathic-like pain features and CS-related symptom burden (both p < .01). They also demonstrated poorer lower extremity function, greater sleep disturbance, and lower HRQoL. Pain-DETECT scores were positively correlated with CSI, anxiety, depression, and sleep disturbance scores. In multivariable analyses, LEFS independently predicted Pain-DETECT scores (B = -0.171, p = .015), whereas anxiety independently predicted CSI scores (B = 1.980, p = .002).ConclusionsWomen with lipedema exhibit prominent sensitization-related pain phenotypes associated with functional impairment, sleep disturbances, and reduced quality of life. Identification of these pain characteristics may improve clinical assessment, patient stratification, and multidisciplinary management of lower extremity symptoms in lipedema.

ObjectivesTo determine the prevalence of chronic venous insufficiency (CVI) in patients with lipedema, characterize venous reflux patterns and CEAP clinical classes, and evaluate associations with demographic and lipedema-related characteristics.MethodsThis retrospective, single-center observational study included adults with lipedema evaluated between January 2023 and December 2025. Of 120 patients screened, 50 were excluded because of incomplete venous Doppler ultrasonography, clinical, or demographic data, leaving 70 patients for analysis. Demographic and clinical characteristics and lower-extremity venous duplex ultrasonography findings were reviewed. Superficial, deep, and perforator reflux; segment-specific reflux; great saphenous vein (GSV) and small saphenous vein (SSV) diameters; laterality; and CEAP clinical class were recorded. Pathological reflux was defined as reversed flow lasting >0.5 s in superficial truncal veins and >1.0 s in the common femoral, femoral, and popliteal veins. Univariable and multivariable logistic regression analyses examined factors associated with CVI.ResultsCVI was identified in 38 of 70 patients (54.3%; 95% confidence interval, 41.9%-66.3%). Venous reflux predominantly involved the superficial system, with GSV reflux as the most frequent segment-specific finding, whereas deep venous reflux was uncommon. Patients with CVI had greater GSV and SSV diameters than those without CVI (both p < 0.001), while age, body mass index (BMI), and disease duration did not differ between groups. CVI frequency increased across BMI categories, although the overall categorical association was not significant. Lipedema stage was not associated with CVI or individual reflux patterns; however, increasing lipedema stage showed a weak positive association with higher CEAP clinical class. Age, BMI, and lipedema stage were not independently associated with CVI in multivariable analysis.ConclusionsVenous insufficiency was frequently observed in patients with lipedema and predominantly involved the superficial venous system. Greater saphenous vein diameters provided an objective ultrasonographic correlate of venous involvement. Because an appropriately matched local control population was not available, the present study cannot establish whether venous reflux is more frequent in patients with lipedema than in the general population. The observed relationship between lipedema stage and CEAP clinical class should therefore be considered hypothesis-generating and warrants confirmation in prospective controlled studies.

ObjectivesTo determine the prevalence of chronic venous insufficiency (CVI) in patients with lipedema, characterize venous reflux patterns and CEAP clinical classes, and evaluate associations with demographic and lipedema-related characteristics.MethodsThis retrospective, single-center observational study included adults with lipedema evaluated between January 2023 and December 2025. Of 120 patients screened, 50 were excluded because of incomplete venous Doppler ultrasonography, clinical, or demographic data, leaving 70 patients for analysis. Demographic and clinical characteristics and lower-extremity venous duplex ultrasonography findings were reviewed. Superficial, deep, and perforator reflux; segment-specific reflux; great saphenous vein (GSV) and small saphenous vein (SSV) diameters; laterality; and CEAP clinical class were recorded. Pathological reflux was defined as reversed flow lasting >0.5 s in superficial truncal veins and >1.0 s in the common femoral, femoral, and popliteal veins. Univariable and multivariable logistic regression analyses examined factors associated with CVI.ResultsCVI was identified in 38 of 70 patients (54.3%; 95% confidence interval, 41.9%-66.3%). Venous reflux predominantly involved the superficial system, with GSV reflux as the most frequent segment-specific finding, whereas deep venous reflux was uncommon. Patients with CVI had greater GSV and SSV diameters than those without CVI (both p < 0.001), while age, body mass index (BMI), and disease duration did not differ between groups. CVI frequency increased across BMI categories, although the overall categorical association was not significant. Lipedema stage was not associated with CVI or individual reflux patterns; however, increasing lipedema stage showed a weak positive association with higher CEAP clinical class. Age, BMI, and lipedema stage were not independently associated with CVI in multivariable analysis.ConclusionsVenous insufficiency was frequently observed in patients with lipedema and predominantly involved the superficial venous system. Greater saphenous vein diameters provided an objective ultrasonographic correlate of venous involvement. Because an appropriately matched local control population was not available, the present study cannot establish whether venous reflux is more frequent in patients with lipedema than in the general population. The observed relationship between lipedema stage and CEAP clinical class should therefore be considered hypothesis-generating and warrants confirmation in prospective controlled studies.

ObjectiveThis study aimed to comparatively evaluate sleep quality in individuals with lipedema and healthy controls. In addition, the relationships between sleep quality and depression, anxiety, fatigue, and clinical parameters were investigated.MethodsThis cross-sectional study included 30 women with lipedema and 30 healthy female controls aged 18-75 years. Pain severity in individuals with lipedema was assessed using the Visual Analog Scale (VAS). Lipedema stage, comorbidities, and symptom duration were also recorded. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), depressive and anxiety-related symptoms were assessed using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and fatigue severity was evaluated using the Fatigue Severity Scale (FSS).ResultsIndividuals with lipedema had significantly higher BDI, BAI, and FSS scores than controls (all p < 0.001 except BDI, p = 0.001). Sleep quality was significantly poorer in the lipedema group (p < 0.001). Among PSQI subcomponents, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, and daytime dysfunction were significantly worse in individuals with lipedema, while sleep medication use was similar between groups (p > 0.05). In the lipedema group, PSQI scores were positively correlated with depressive (r = 0.489, p = 0.006) and anxiety symptoms (r = 0.386, p = 0.035). No significant associations were found between sleep quality and age, anthropometric measurements, education duration, pain severity, lipedema stage, symptom duration, or fatigue severity.ConclusionsThis study demonstrated poorer sleep quality in individuals with lipedema compared to healthy controls. Sleep quality was also associated with depressive and anxiety-related symptoms, highlighting an association between psychological symptoms and sleep problems in individuals with lipedema.

Lipedema is a chronic disorder of adipose tissue marked by disproportionate fat accumulation in the extremities and persistent pain, which significantly impairs quality of life. Although liposuction has been adopted as a therapeutic intervention beyond aesthetic purposes, the extent and long-term persistence of pain reduction after surgery have not been fully quantified.

BackgroundThere are no validated Norwegian disease-specific patient-reported outcome measures (PROMs) assessing quality of life (QoL) in females with lipedema, limiting evaluation of treatment effect in clinical practice and research.ObjectiveTo translate and validate a Norwegian translation of the LIPQOL questionnaire.MethodsA cross-sectional validation study was performed in 432 females with lipedema in Norway. Descriptive statistics and floor and ceiling effects were assessed. The psychometric properties of the questionnaire were assessed using confirmatory factor analysis (CFA). The overall goodness of fit was evaluated using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker–Lewis index (TLI). Internal consistency was assessed using composite reliability from the CFA. Associations between LIPQOL subscales and RAND-12 physical component score (PCS) and mental component score (MCS) were examined using Spearman correlations.ResultsThe LIPQOL questionnaire comprises four subscales, Function, Body image, Symptoms, and Feelings. No subscales was affected by floor or ceiling effects. The unmodified CFA shows CFI = 0.929, TLI = 0.922, standardized root mean square residual (SRMR) = 0.073, and RMSEA = 0.079 (90% CI: 0.073 to 0.084). All composite reliability were considered reasonable (ranged from 0.890 to 0.916). Modification indices were evaluated, and two modifications were performed between items 5 and 8, and between items 17 and 18. With modification indices, the overall structure validity showed reasonable, but not unequivocally support for the four factor structure with CFI = 0.944, and TLI = 0.938, SRMR = 0.068, and RMSEA = 0.070 (90% CI: 0.064 to 0.075). Correlation between RAND-12 and LIPQOL subscales were large. Function, Symptoms, and overall quality of life show large correlation with PCS (Spearman's rho = −0.682, Spearman's rho = −0.550, and Spearman's rho = 0.554, respectively) and the subscales feelings and overall quality of life shows large correlation with MCS from RAND-12 (Spearman's rho = −0.685 and 0.608, respectively).ConclusionInitial findings suggest that the Norwegian version of the LIPQOL is a reasonably valid instrument for assessing quality of life in females with lipedema, although the findings do not provide unequivocal support for all aspects of its measurement properties.

ObjectivesThis study aimed to determine the frequency of probable lipedema among women with lower extremity pain (LEP) using a validated screening questionnaire and to examine its associations with neuropathic pain (NP) characteristics, functional status, psychological symptoms, and health-related quality of life (HRQoL).MethodsThis prospective questionnaire-based case-control study included 133 women, comprising 68 women with LEP and 65 age-matched healthy controls. Participants were evaluated using the Lipedema Screening Questionnaire (LSQ), Lower Extremity Functional Scale (LEFS), Hospital Anxiety and Depression Scale (HADS), PainDETECT questionnaire, and 12-Item Short Form Health Survey (SF-12). An LSQ score of ≥8 was classified as probable lipedema, whereas a score of ≥12 was classified as high-probability lipedema. These categories indicate screening probability rather than a confirmed clinical diagnosis of lipedema. Group comparisons, correlation analyses, and multivariable regression analyses were performed to examine factors associated with LSQ and LEFS scores.ResultsWomen with LEP had significantly higher LSQ scores and a greater proportion of probable lipedema (36.8% vs 12.3%, p = .001) and high-probability lipedema (19.1% vs 3.1%, p = .003) than controls. Compared with controls, women with LEP had poorer lower extremity function, greater anxiety symptoms, more prominent NP characteristics, and lower physical and mental HRQoL scores (all p < .05). Higher LSQ scores were positively correlated with PainDETECT scores (r = 0.446, p < .001), whereas pain intensity was not significantly correlated with the evaluated clinical outcomes. In multivariable linear regression, PainDETECT score was independently associated with LSQ score (β = 0.382, p = .004). For functional status, both the SF-12 physical (β = 0.352, p = .001) and mental component scores (β = 0.362, p = .002) were independently associated with LEFS scores.ConclusionsProbable lipedema was more frequently identified by LSQ among women with LEP than among healthy controls. NP characteristics were independently associated with greater lipedema-related symptom burden, whereas lower extremity function was independently associated with both physical and mental HRQoL. These findings support the use of lipedema and NP screening as complementary components of the clinical assessment of women with LEP. However, LSQ findings should not be interpreted as a clinical diagnosis of lipedema and require confirmation through appropriate clinical assessment.

Validation and reliability of the Turkish version of the lipedema screening questionnaire - Turkish Journal of Physical Medicine and Rehabilitation

Background/Objectives: Lipedema is an adipose tissue disorder associated with body-related burden. This study compared orthorexic eating tendencies between women with and without lipedema and examined associations with body-shape concern and psychological symptoms. Methods: This controlled cross-sectional study included 44 women with lipedema and 44 women without lipedema. Participants completed the Düsseldorf Orthorexia Scale (DOS), Body Shape Questionnaire (BSQ), and Hospital Anxiety and Depression Scale (HADS). Associated variables were examined using multiple linear regression. Results: Women with lipedema had higher DOS scores than women without lipedema (25.07 ± 6.55 vs. 20.48 ± 5.05; Cohen's d = 0.79; p < 0.001). BSQ, HADS-Anxiety, and HADS-Depression scores were also higher in the lipedema group (all p ≤ 0.001). DOS and BSQ scores were positively correlated in both groups. In the multivariable model, which included group status, age, BMI, BSQ, HADS-A, and HADS-D scores, BSQ score was independently associated with DOS score (B = 0.067; 95% CI 0.025-0.108; p = 0.002), whereas group status and the other covariates were not. The model's adjusted R2 was 0.234. Conclusions: Women with lipedema exhibited greater orthorexic eating tendencies, body-shape concern, and psychological symptoms than controls. Body-shape concern was independently associated with orthorexic eating tendencies. The group difference in DOS scores is largely explained by the higher BSQ scores accompanying lipedema; this should not be interpreted as indicating that lipedema is unrelated to orthorexic tendencies. These findings support consideration of body image when addressing eating behavior in lipedema care.

Aim: This narrative review summarises evidence on pathogenetic mechanisms of adipose tissue remodelling and adipokine dysregulation in lipedema, focusing on adipocyte hypertrophy and hyperplasia, fibrosis, microcirculatory and lymphatic dysfunction, immune-cell alterations, and diagnostic biomarkers. Methods: We conducted a narrative search in PubMed, Scopus, and Google Scholar from database inception to September 2026, including publications from 2001 to 2026. Search terms included “lipedema”, “lipedema adipokines”, “lipedema biomarkers”, “adipose tissue remodelling”, “fibrosis”, “adipocyte hypertrophy”, and “adipocyte hyperplasia”, combined with specific molecules. Bibliographies were screened. This review was not registered and did not follow a systematic-review protocol. Results: Lipedema involves pathological subcutaneous adipose tissue remodelling, including adipocyte hypertrophy and hyperplasia, extracellular matrix fibrosis, vascular alterations, and lymphatic dysfunction. Adipose tissue macrophages are enriched in CD163+/CD206+ populations, although the M1/M2 framework inadequately represents their heterogeneity. Individual adipokines (leptin, adipocyte-type fatty acid-binding protein) show limited diagnostic value due to dependence on total adipose mass and BMI. Multicomponent signatures (adiponectin, adipocyte-type fatty acid-binding protein, fibroblast growth factor 21, chemerin, afamin, growth and differentiation factor 15) demonstrate promising performance. Additional markers include reduced tissue adipsin expression, altered endostatin, and elevated interleukin-11, interleukin-28A, and interleukin-29. Most studies are limited by small cohorts, cross-sectional designs, inconsistent controls, obesity-related confounding, and lack of external validation. Conclusions: Lipedema involves coordinated metabolic, inflammatory, vascular, and extracellular-matrix alterations. Single adipokines are unreliable diagnostic biomarkers. Multicomponent panels may improve differentiation from obesity, but remain exploratory. Larger multicentre studies with standardised phenotyping and external validation are needed before clinical implementation.

Lipoedema is a painful adipose tissue disorder marked by disproportionate limb fat and often misclassified as generalized obesity or lymphoedema. This review examines its metabolic phenotype and implications for cardiometabolic assessment and management. PubMed/MEDLINE was searched from inception through May 2026 for studies on lipoedema, obesity, body composition, metabolic risk, insulin resistance, diabetes, lifestyle interventions, pharmacotherapy and liposuction. Relevant clinical, mechanistic, review and consensus literature was narratively synthesized. Evidence is limited and heterogeneous, consisting mainly of observational cohorts, referral‐centre series, mechanistic studies and consensus guidance, predominantly involving women. Some studies report fewer metabolic abnormalities in women with lipoedema than in women with BMI‐matched lifestyle‐related overweight or obesity. These findings do not establish metabolic protection and may reflect differences in central adiposity, disease stage, diagnostic criteria, body composition, inflammation or referral patterns. Obesity and glucose‐lowering therapies, including glucagon‐like peptide‐1 receptor agonists, remain appropriate for established indications, but direct modification of lipoedema has not been demonstrated. Cardiometabolic risk in lipoedema should be assessed using a phenotype‐based approach that distinguishes painful limb adiposity from central and ectopic fat while considering age, sex, menopausal status and established risk factors. BMI should be interpreted with waist measures, metabolic screening, body composition and muscle mass when relevant. Prospective studies using standardized diagnostic criteria, direct measures of insulin sensitivity, detailed body composition and clinically meaningful outcomes are needed to clarify long‐term risk and distinguish lipoedema biology from coexisting central obesity., Clinical recognition of the lipoedema phenotype and principal differential diagnoses.

Lipedema is a chronic disorder of subcutaneous adipose tissue characterized by symmetrical fat accumulation of the extremities and resistance to conventional weight loss. Therapeutic options remain limited, and clinical data on nutritional interventions are scarce. A 37-year-old woman with stage II lipedema underwent a ten-day medically supervised fasting program embedded in a multimodal intervention that also included physical activity after limited response to standard conservative management. Body weight decreased from 78.7 to 73.7kg, and C-reactive protein from 22.5 to 0.82mg/L. Limb circumferences decreased at the calves (48 to 44–44.5cm) and thighs (65 to 58cm). Subcutaneous tissue thickness, measured by ultrasound, decreased at the medial malleolus (22 to 12–15mm) and at the mid-thigh (44 to 34.5mm), while remaining stable in the gluteal region (98mm). Elastography showed a persistent heterogeneous fibrosclerotic pattern. The patient reported a marked reduction in pain (approximately 80% during fasting, sustained at ~50% for over one month). No adverse events occurred. Altogether, this case is notable because objective ultrasound measurements and inflammatory biomarkers improved after a structured fasting intervention in a condition usually considered resistant to weight loss. Because the intervention was multimodal, the contribution of fasting cannot be isolated and controlled studies are warranted. This suggests that medically supervised fasting may improve inflammatory status and tissue structure in lipedema and warrants further investigation in controlled studies.