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Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are increasingly being used to treat diabetes and obesity. However, their effectiveness and risks have not yet been systematically evaluated in a comprehensive set of possible health outcomes. Here, we used the US Department of Veterans Affairs databases to build a cohort of people with diabetes who initiated GLP-1RA (n = 215,970) and compared them to those who initiated sulfonylureas (n = 159,465), dipeptidyl peptidase 4 (DPP4) inhibitors (n = 117,989) or sodium−glucose cotransporter-2 (SGLT2) inhibitors (n = 258,614), a control group composed of an equal proportion of individuals initiating sulfonylureas, DPP4 inhibitors and SGLT2 inhibitors (n = 536,068), and a control group of 1,203,097 individuals who continued use of non-GLP-1RA antihyperglycemics (usual care). We used a discovery approach to systematically map an atlas of the associations of GLP-1RA use versus each comparator with 175 health outcomes. Compared to usual care, GLP-1RA use was associated with a reduced risk of substance use and psychotic disorders, seizures, neurocognitive disorders (including Alzheimer’s disease and dementia), coagulation disorders, cardiometabolic disorders, infectious illnesses and several respiratory conditions. There was an increased risk of gastrointestinal disorders, hypotension, syncope, arthritic disorders, nephrolithiasis, interstitial nephritis and drug-induced pancreatitis associated with GLP-1RA use compared to usual care. The results provide insights into the benefits and risks of GLP-1RAs and may be useful for informing clinical care and guiding research agendas.

Background: Despite its estimated high prevalence among women and increasing awareness, lipedema remains under-investigated. Ignoring its debilitating nature, surgical treatment for this condition is frequently covered by health insurance only in advanced stages and after the exhaustion of conservative therapies. Methods: A total of 1015 patients with lipedema were recruited via social media platforms. Of these, 860 patients provided answers to at least one complete section of the modified Body-Q questionnaire (response rate 85%). The Mann–Whitney U and Kruskal–Wallis tests were utilized to assess the impact of the surgical treatment by means of patient-reported outcomes on the self-perception of various body areas. Results: The satisfaction scores among conservatively treated patients for abdominal appearance, arms, back, body, buttocks, and inner thighs showed a statistically significant decline with increasing stages of lipedema. The comparison of patient evaluation scores in the appearance domain demonstrated better patient self-perception scores in patients who received at least one session of the surgical treatment for the hips and thighs (p < 0.01), inner thighs (p < 0.01), and excess skin (0.01) scales. On the body scale, the patients who underwent liposuction again reported better satisfaction scores; however, this did not reach statistical significance (p < 0.081). In the health-related quality of life domain, the patients who received liposuction treatment reported a better outcome in the body image (p < 0.01), physical function (p = 0.05), physical symptoms (p = 0.04), and psychological function (p < 0.01) scales. Conclusions: The current study underscores the burden of lipedema of affected patients and its negative impact on self-perception. As the disease progresses, conservatively treated patients experience a decline in satisfaction with various aspects of their appearance. However, surgical interventions, particularly liposuction, does not address esthetic concerns but significantly improve health-related quality of life across multiple domains, emphasizing the comprehensive benefits of surgical intervention in the management of lipedema.

This longitudinal study indicates liposuction is an effective treatment for improving HRQoL and symptoms in lipedema patients, although it may not completely restore HRQoL to normative levels. Limitations include potential selection bias, sampling bias, and the need for longer follow-up. The finding …

OBJECTIVE: The goal of this study was to test the hybrid technique of combined tumescent liposuction and surgical excision in patients with advanced lipolymphedema of the thigh after compression therapy as a gold standard for treatment. METHODS: Between January 2016 and April 2020, 18 female and 1 male patients with massive thigh lipolymphedema were treated with complete decongestive therapy for the whole thigh followed by selective decongestive therapy to the upper and lower thigh to make a lump on the midmedial region. Then, the patient was prepared for surgery. Skin is refashioned and sutured in a manner that leaves no furrows and a cosmetic contour is obtained. Compression therapy is maintained from the day of the surgery starting by compression bandage until full healing of the wound, followed by well-fitted garments. RESULTS: This study was conducted on 18 female patients and 1 male patient who presented with massive lipolymphedema of the thigh. The age of the patients ranged from 46 to 65 years old with a mean age of 51.38 years. All patients in this study underwent compression therapy as a preparatory stage to turn the massive lipolymphedema into lumpedema, followed by hybrid technique which consisted of combined liposuction and surgical excision. CONCLUSIONS: Conversion of massive thigh lipolymphedema into lumpedema followed by tumescent liposuction and surgical excision has proven to be a safe and effective treatment option with a marvelous cosmetic result and low wound morbidity and should be considered as a solution for all patients with this disorder.

Background/Objectives: Lipedema is a chronic, progressive disorder of the adipo-fascial tissue characterized by abnormal subcutaneous fat accumulation, inflammation, fibrosis, pain, and edema. Despite its considerable impact on patients’ quality of life, it remains underdiagnosed. Recent studies have suggested a potential overlap between lipedema and hypermobility spectrum disorders (HSDs), both involving connective tissue dysfunction. This work explores the shared pathophysiological features of lipedema and HSD, highlighting clinical correlations, comorbidities, and the need for integrated diagnostic and therapeutic approaches. Methods: A cross-sectional observational study was conducted through an online survey targeting individuals with lipedema and a control group with lymphedema. The questionnaire assessed symptoms typically associated with HSD, including musculoskeletal, gastrointestinal, urogynecological, vascular, and neuropsychological manifestations. Descriptive statistics were used to evaluate clinical patterns in both groups. Results: Among the lipedema patients, 44% reported joint hypermobility and 60% recalled being hypermobile during childhood. High rates of pediatric overweight (50%), low muscle tone (55%), and exercise-induced fatigue (70%) were observed. Adult symptoms included joint pain (notably in the ankles, knees, cervical spine, sacrum, and feet), digestive issues (50%), and thyroid disorders (24.4%). Compared with the control group, patients with lipedema showed significantly more connective tissue-related motor deficits and systemic symptoms. Conclusions: Connective tissue laxity may play a critical role in the pathogenesis of lipedema, contributing to multisystemic manifestations through vascular, lymphatic, gastrointestinal, and musculoskeletal involvement. The high prevalence of HSD-like features calls for a paradigm shift in the understanding of lipedema as a systemic disorder. Early identification of connective tissue alterations, especially in children with familial predisposition, could enable timely interventions, potentially mitigating disease progression. A multidisciplinary, evidence-based approach is essential for accurate diagnosis and effective management.

Lipedema, historically underrecognized, has recently gained attention due to advancements in research and growing public awareness. The Brazilian Consensus Statement on Lipedema, developed by the Brazilian Society of Angiology and Vascular Surgery, aims to establish clear recommendations for the diagnosis, treatment, and management of lipedema. Using the Delphi methodology, experts elaborated 90 statements about lipedema, which were then evaluated by a panel of 113 professionals. The statements were analyzed using SurveyMonkey, with a 75% agreement threshold required for their inclusion in the consensus statement. Most statements achieved significant consensus, with only 9 topics requiring further investigation. This consensus statement highlights the complexity of lipedema, the effectiveness of conservative treatment over surgery, the need for multidisciplinary approaches, and the importance of awareness to reduce underdiagnosis and stigma. It also underscores the ongoing need for research to develop more effective management strategies.

SUMMARY OBJECTIVE: Chronic edema in the lower extremities leads to significant negative effects on the quality of life, body image perception, satisfaction, self-confidence, and self-esteem of affected individuals. The aim of this study was to evaluate body image, quality of life, and related factors in patients with chronic lower extremity edema due to lymphedema and lipedema. METHODS: This cross-sectional study included 14 lymphedema and 12 lipedema patients receiving treatment at the lymphedema unit. Individuals aged 18–65 years with a confirmed diagnosis were enrolled; those with active infections, malignancies, or systemic diseases were excluded. Body image, dysfunctional thoughts about appearance, and quality of life were evaluated using the Body Cathexis Scale, Beliefs About Appearance Scale, and Lymphedema Quality of Life scale. Circumference measurements of the lower extremities were taken before and after 20 sessions of manual lymphatic drainage therapy. Quantitative data were analyzed to compare the two groups and assess correlations between clinical and psychosocial parameters. RESULTS: No significant differences were observed between the lymphedema and lipedema groups in terms of age, body mass index, or pre-treatment Body Cathexis Scale, Beliefs About Appearance Scale, and Lymphedema Quality of Life scale scores (p>0.05). After 20 sessions of manual lymphatic drainage therapy, both groups showed reductions in limb circumference measurements (p<0.05). Reductions in limb size were moderately associated with improvements in Body Cathexis Scale and Lymphedema Quality of Life scale scores (p<0.05). Post-treatment improvements in body image and quality of life scores were observed in both groups. CONCLUSIONS: This study highlights that patients with lower extremity lymphedema and lipedema experience significant body image disturbances and reduced quality of life. Manual lymphatic drainage therapy improves limb circumference, body image, and quality of life.

DiVA portal is a finding tool for research publications and student theses written at the following 50 universities and research institutions.

Lipoedema is a chronic disease with various manifestation of symptoms, related to excessive deposition of subcutaneous adipose tissue in the legs, hips and buttocks. The scale of the problem is enormous and may affect up to one in five women. Lipoedema is often underdiagnosed and misdiagnosed with lymphedema, obesity or lipohypertrophy. In recent years, lipoedema has been diagnosed in an increasing number of younger women, and its first symptoms may manifest already in puberty. Even though it is often perceived as only an aesthetic problem, it has a huge impact on the quality of life, mental health, self-esteem or self-confidence. Moreover, lipoedema causes stigmatization, unfortunately also in healthcare professionals. Nevertheless, recently, diagnostic criteria (also ultrasound) have been created, and lipoedema has been classified in ICD-10 (E88.2). There are also more and more treatment options, with emphasis on the role of psychological care. Awareness and knowledge of lipoedema have also increased despite its underestimation but still is not enough. The multidimensional nature of lipoedema and its impact on many aspects of life highlights the essential role of comprehensive support to patients. Nowadays, in times of caring for mental health, it is crucial to increase public awareness and spread knowledge about lipoedema.

The Ketogenic Diet (KD) is currently the most widely studied nutritional approach for patients with lipedema, although its use may cause important drawbacks especially in case of comorbidities. A Modified Mediterranean Diet (MMed) is more easily adaptable, better tolerated, and can be temporarily replaced by a ketogenic diet for a short period of time if necessary using a sort of "sandwich" approach. We report 10 clinical cases with lipedema and comorbidities subjected to a hypocaloric MMed for 6 months. All patients were properly assessed by anthropometric measurements and body composition before and at the end of nutritional treatment. Only 2 patients needed a short period of KD due to poor response to MMed. At the end of 6-month follow-up, patients showed weight loss with reduction in body circumferences and improvement in body composition. In the two cases where it was necessary to resort to a period of KD, good results were achieved allowing a return to the MMed for the maintenance. In patients suffering from lipedema with associated comorbidities and concomitant pharmacological treatments, the use of MMed as first line treatment allows achievement of better metabolic balance, greater compliance, and improved body composition.

Lipedema is characterized by symmetrical accumulation of subcutaneous fat in the lower and upper limbs, sparing the trunk, feet and hands. Although diagnosis is primarily clinical, ultrasound has proven to be a valuable, non-invasive, reproducible, and cost-effective tool for the assessment of lipedema. Ultrasound (US) facilitates diagnosis through quantitative evaluation of subcutaneous tissue thickness and enables qualitative Lipedema Dermal and Hypodermal Classification (LDHC), with morphological changes. The presence of hyperechoic nodules in patients with lipedema has been previously described and classified as LDHC 3; recently, a case report analyzing the microscopic features of such nodules demonstrated hemorrhagic areas and steatonecrosis, resulting from disorganized hypodermal expansion leading to increased pressure within the subcutaneous compartment—causing hypoxia and stimulating immature neovascularization (fragile wall, predisposing to hemorrhage). However, these nodules are not uniform and exhibit different morphologies, enabling subclassification. The first type presents with poorly defined margins; the second is well-defined margins; the third has an anechoic area, and the fourth shows a faint posterior shadow. These different nodule presentations in lipedema may be correlated with evolutionary stages or previously described clinical presentations, requiring future correlation with pathological anatomy or other diagnostic methods.

Objective: Lipedema, a chronic disorder of subcutaneous adipose tissue, is common yet often overlooked in clinical practice and frequently mistaken for obesity. Ultrasonographic (US) imaging methods beyond clinical examination have not been sufficiently studied in the differential diagnosis. The aim of this study is to investigate whether quantitative, AI‑assisted radiomics analysis of lower‑limb US images adds diagnostic value for lipedema. Methods: The study included ultrasonographic scans from four women with clinically confirmed lipedema and four age-matched women with obesity (BMI ≥ 30 kg/m²) referred to Dokuz Eylül University, Faculty of Medicine, Department of Physical Therapy and Rehabilitation outpatient clinic with suspected lipedema. All examinations were performed in the outpatient musculoskeletal US unit by an experienced radiologist. Using fixed depth, sector width and gain settings, eight images per leg were obtained at four standardised sites (2): mid‑anterior thigh, pretibial mid‑shaft, mid‑lateral leg, and medial supramalleolar region (Fig. 1). Also dermal and subcutaneous thicknesses were recorded. The optimal image area (region of interest = ROI) was labeled in these retrospective images, and radiomics analysis (tissue texture) was performed in the system. For this purpose, the LIFEx program (www.lifexsoft.org) was used. With this method, various pattern features were extracted from the determined ROIs. Dimensionality reduction techniques such as feature selection or Principal Component Analysis (PCA) were used to reduce the data size, which increased with the extracted features. The resulting dataset was analyzed for clinically significant results in images with lipedema. Given the small sample (n = 4 per group), group differences were evaluated with an independent‑samples t‑test using sample bootstrapping (100 resamples). Results: Radiomics features were compared between groups using a bootstrapped t-test. Within the intensity‑based category, Mean Intensity (p < 0.001) and Intensity Skewness (p = 0.01) differed significantly between lipedema and obesity images. From the grey‑level co‑occurrence matrix (GLCM), both Contrast (p < 0.001) and Dissimilarity (p = 0.02) showed significant difference. In addition, the grey‑level run‑length matrix (GLRLM) feature High Grey Level (p = 0.003) and the grey‑level size‑zone matrix (GLSZM) feature Grey Level Variance (p = 0.03) were statistically distinct between groups. No statistically significant differences were detected in dermal or subcutaneous thicknesses, except for dermis thickness at site A on the right limb, which reached significance (p = 0.04). Conclusion: This preliminary study suggests that quantitative ultrasonographic analysis enhanced by artificial intelligence–based radiomics may provide supportive diagnostic value in distinguishing lipedema from obesity. Larger-scale studies are needed to validate these preliminary findings. Keywords: Lipedema, Obesity, Radiomics Analysis, Artificial Intelligence

This study aims to present the results and limitations of surgery for lower limb lipoedema and lymphedema in a resource-limited surgical setting. This was a cross-sectional, analytical, prospective, in-hospital study covering 15 years. We surgically treated 119 patients, including 18 with lipoedema (15.1%), 69 with stage 2 lymphedema (57.9%), and 32 with elephantiasis (26.9%). We included 81 women (68%) and 38 men (31.9%). The majority (57.7%) of patients with lymphedema were between 30 and 49 years of age. Plastic and excisional surgery was performed in 42.2% of patients with stage 2 lymphedema and in 87.5% with stage 3 (elephantiasis). Lipoedema surgery consisted primarily of liposuction (77.7%). No lymphatic network reconstruction was performed. Our results, at 2 years' post-surgery, were very satisfactory, with limb symmetry in 83.3% of patients operated on for lipoedema, in 84.2% of patients operated on for stage 2 lymphedema, and in 85% of patients operated on for elephantiasis. Surgery for lower limb lipoedema, lymphedema, and elephantiasis is feasible in a resource-limited setting, although challenges remain. The lack of lymphatic network reconstruction constitutes our limitations. Microsurgery is necessary for optimal results.

BACKGROUND: The etiology of lipoedema remains unclear, making diagnosis and treatment challenging. Current treatment primarily consists of general lifestyle recommendations, with effective self-management being essential for integrating these recommendations into daily life. However, no self-management interventions currently address the unique needs of people with lipoedema. This study aimed to develop an evidence-based, theory-informed intervention to enhance self-management in people with lipoedema using the Intervention Mapping (IM) approach. METHODS: Following the first four steps of the IM approach, this study used a participatory methodology involving stakeholders, empirical data, and theory. Steps included: 1) needs assessment; 2) identification of outcomes, performance objectives, and change objectives; 3) selection of behavioural change methods; and 4) development of program components. RESULTS: The resulting intervention includes a program for people with lipoedema and a training program for healthcare professionals (HCPs). The intervention aims to empower patients to engage in self-management and equip HCPs to provide effective support. Key determinants targeted include self-efficacy, self-regulation skills, knowledge, attitudes, and social facilitation. The program for people with lipoedema consists of seven themes aligned with self-management behaviours and is delivered through 19 sessions: seven one-on-one sessions, one session involving supportive individuals, and 11 group sessions. The program for HCPs is delivered through six group sessions, each focusing on the core skills HCPs need to effectively deliver self-management support to their patients. CONCLUSION: The IM approach effectively guided a systematic, transparent, and reproducible development process. Grounded in established theories and behavioural change methods, the intervention provides a strong foundation for implementation and evaluation among people with lipoedema. The fifth and sixth steps of IM are considered future priorities.

Background: Lipedema is a chronic condition characterized by abnormal deposition of subcutaneous adipose tissue, leading to pain. The lack of internationally recognized diagnostic criteria complicates the characterization of pain. Physiological parameters such as pain pressure threshold (PPT) represent promising prognostic markers for diagnosing lipedema, yet they remain understudied. This study aimed to evaluate the reliability and validity of two pain pressure measurements, PPT and the hand-held sphygmomanometer (HHS) in lipedema.Methods: A total of 28 adult females diagnosed with lipedema were recruited. Both PPT, using a digital algometer, and HHS, using a manual aneroid HHS, were performed to assess pain in the lower limbs. The testing was performed in a standing position with PPT and HHS placed on the calf. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were employed to assess the within session reliability, while the validity between PPT and HHS was analyzed using R2 in a linear regression model.Results: The results showed excellent reliability for both PPT and HHS, with ICC indicating high consistency (ICC = 0.93 to 0.97) and CV showing acceptable scores (CV = 3.62% to 9.06%). In addition, good validity between PPT and HHS was also observed (R2 = 0.69 to 0.74), suggesting that HHS can be a reliable alternative to PPT for pain assessment in lipedema.Conclusion: These findings have important clinical implications, as they expand the knowledge of pain characterization in people with lipedema, potentially aiding in diagnostic refinement. In addition, a cost-effective and accessible method for assessing pain was examined (i.e., HHS), showing promising findings and providing an objective method to help diagnose lipedema.