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Lipedema is a lipodystrophic disease characterized primarily by a disproportionate increase in lower body subcutaneous fat. Although moderate weight loss decreases lower body fat mass in women with obesity and lipedema, it is possible that this decrease is due to a reduction in normal subcutaneous fat, rather than lipedema-affected fat. We evaluated the effect of moderate (11%) diet-induced weight loss on body fat mass and distribution, assessed by dual-energy X-ray absorptiometry and magnetic resonance imaging, in a 56-year-old woman with lipedema who was normal weight (body mass index: 23.9 kg/m2) at baseline. Approximately 85% of the decrease in body weight comprised body fat. The relative reduction in upper body fat (abdominal subcutaneous, arm and trunk fat) was similar to the relative reduction in lower body (total leg fat and thigh subcutaneous fat). Accordingly, weight loss did not change the proportion of total body fat comprising leg fat (44.8% and 45.1% before and after weight loss, respectively) or arm fat (9.1% and 9.6% before and after weight loss, respectively). These data suggest weight loss decreases lipedema-affected adipose tissue and demonstrate the therapeutic effect of weight loss on body composition in women with lipedema even if they are normal weight.

Introduction & Objectives Lipedema is a chronic and underdiagnosed adipose tissue disorder characterized by disproportionate lower limb fat distribution, pain, and edema. Despite increasing awareness, diagnostic uncertainty persists due to heterogeneous semiological definitions and limited attention to the patient's subjective experience. Methodology This study aims to explore how patients with lipedema verbally represent their symptoms and bodily sensations, and how these narratives correlate with established semiological criteria. By analyzing spontaneous language, we seek to identify potential linguistic markers that could enhance diagnostic characterization and favor earlier recognition of the condition. We conducted an observational, multicenter qualitative study involving adult women with clinically confirmed lipedema. Semi-structured interviews were recorded and transcribed verbatim. Lexical and semantic analyses were performed using natural language processing software and manual thematic categorization. Semiological assessment included tissue consistency, pain distribution, symmetry, and evolution. Cross-analysis explored correlations between verbal descriptors (pain, heaviness, swelling, injustice, shame, sensitivity) and clinical stage or subtype. Results Preliminary findings from revealed recurrent lexical fields expressing bodily dysmorphia, hyperalgesia, and emotional distress. Distinct linguistic patterns emerged according to semiological criteria: patients with stage II–III lipedema frequently used affective and metaphorical language (“weight anchored in my legs”), whereas earlier stages emphasized mechanical sensations (“tension,” “tightness”). A strong convergence was observed between the richness of expressive language and subjective pain scales. Discussion Linguistic analysis of patient verbatim provides novel insight into the semiological complexity of lipedema. Integrating qualitative linguistic descriptors into diagnostic frameworks may refine clinical classification and improve therapeutic communication. Conclusion Linguistic analysis of patient verbatim provides novel insight into the semiological complexity of lipedema. Integrating qualitative linguistic descriptors into diagnostic frameworks may refine clinical classification and improve therapeutic communication. These preliminary results suggest that the words patients use may serve as semiological markers supporting a more holistic understanding of lipedema.

Background: The aim of the study was to verify the effectiveness of a 5-week intensive protocol of multilayer bandaging alone or in combination with diet, applied to the clinical practice of lipedema. Methods: 114 women with lipedema were studied, divided into three groups: 35 women were treated with multilayer bandaging in biweekly sessions for 5 weeks, 48 were treated with the same bandaging protocol combined with an anti-inflammatory diet, and 31 women received no treatment. The effect on anthropometry, lower limb volume, pain caused by the tissue fold, and subjective symptoms were evaluated. Results: Women who completed the 5-week intensive protocol of multilayer bandaging showed a statistically significant reduction in all observed parameters: body weight, waist and hip circumference, lower limb volume, pain, and subjective symptoms. The group of women treated with multilayer bandaging and diet showed a significantly greater reduction in lower limb volume and body weight. The treatments were effective regardless of age, BMI, clinical stage, and the presence of fovea in both groups. The wearing time with the multilayer bandage had a positive correlation in the group treated with bandage in combination with diet. Conclusion: A 5week intensive protocol of multilayer bandaging of the lower limbs is an effective treatment for reducing the symptoms and clinical signs of lipedema at all stages of the disease, even in the absence of edema. Adding nutritional therapy during the bandaging cycle increases the effectiveness of the treatment on the volume of the affected extremities and body weight.

Lipoedema is a chronic adipose tissue disorder mainly affecting women with excess subcutaneous fat deposition on the lower limbs, associated with pain and tenderness. There is often a family history of lipoedema, suggesting a genetic origin, but the contribution of genetics is not well studied. We conducted a genome-wide association study (GWAS) for this disorder in a clinically ascertained cohort from Spain and performed a meta-analysis with the UK lipoedema cohort GWAS. We then used the results of this study as a replication of the inferred UK Biobank “lipoedema phenotype” study. Whilst our meta-analysis alone did not identify any genome-wide significant associations, our clinical cohorts provide support for three loci identified through the UKBB study: the chr2q24.3 GRB14-COBLL1 locus (rs6753142, PMETA=1.64x10-6), chr6p21.1 VEGFA locus (rs4711750, PMETA=8.99x10-7) and the chr5q11.2 ANKRD55-MAP3K1 locus (rs3936510, PMETA=1.67x10-5). We identify numerous rare SNPs with strong association signals in our meta-analysis (P<1x10-6) with support in both UK and Spanish datasets, three of which also show nominal support in the UKBB (P<0.05). These findings provide a starting point towards understanding the genetic basis of clinical lipoedema and demonstrate the utility of the interplay of large-scale biobanks genetic data and clinically ascertained cohorts to elucidate the genetic architecture of lipoedema.

Background: Lipedema is a chronic adipose tissue disorder predominantly affecting women and is frequently misclassified as obesity. While its physical manifestations are increasingly recognized, less attention has been paid to eating attitudes and psychological well-being in this population. The objective of this study was to descriptively explore eating attitudes and psychological well-being in women with lipedema.Methods:This exploratory cross-sectional study used an anonymous online survey to describe eating attitudes and psychological well-being in women with lipedema. A total of 47 participants completed the Eating Attitudes Test (EAT-26) and the World Health Organization-5 Well-Being Index (WHO-5). Descriptive statistics were used to summarize screening indicators of disordered eating risk and reduced psychological well-being.Results:Approximately two-thirds of participants scored at or above the EAT-26 screening cut-off, reflecting elevated screening indicators of disordered eating risk. When behavioral risk indicators were included, over 70% screened positive according to EAT-26 criteria. Reduced psychological well-being (as indicated by a WHO-5 score of ≤50) was observed in about one-fifth of the sample.Conclusion:In this exploratory sample of women with lipedema, elevated screening indicators of disordered eating risk and reduced psychological well-being were commonly observed. These findings offer preliminary insights suggesting that eating-related risk and reduced well-being may be prevalent in this population. Further research using larger, clinically verified samples is needed to better understand the psychological aspects of lipedema.

BACKGROUND: Postoperative fibrosis is a frequent complication following liposuction for lipedema. Serrapeptase, a proteolytic enzyme with purported anti-inflammatory and antifibrotic effects, is used empirically, but robust evidence supporting its efficacy is lacking. This study aimed to assess the clinical effectiveness of postoperative serrapeptase supplementation in reducing fibrosis following lower limb liposuction for lipedema. METHODS: This retrospective, observational cohort study included 50 female patients with a confirmed diagnosis of lipedema undergoing tumescent liposuction. Patients were allocated to either a serrapeptase group (n = 25), receiving 60,000 IU daily for 4 weeks, or a control group (n = 25) receiving standard care alone. The primary outcome was tissue stiffness measured by quantitative ultrasound elastography (QUS). Secondary outcomes included B-mode ultrasonography, patient-reported pain (VAS), and clinical assessment of induration. Evaluations were performed at baseline, 4 weeks, and 3 months. RESULTS: Baseline characteristics were comparable between groups. No statistically significant differences were observed in the primary outcome of tissue stiffness at 4 weeks (14.8 ± 3.1 kPa vs. 15.2 ± 3.0 kPa; p = 0.62) or 3 months (13.7 ± 2.9 kPa vs. 14.0 ± 3.2 kPa; p = 0.78). Similarly, no significant benefits were seen in secondary outcomes, including fibrotic changes on ultrasound, VAS pain scores, or clinical induration (p > 0.05 for all). Serrapeptase was well-tolerated with no adverse events reported. CONCLUSIONS: Oral serrapeptase supplementation did not demonstrate measurable efficacy in preventing postoperative fibrosis or improving patient-reported outcomes following liposuction for lipedema. These findings do not support its routine use in this clinical setting. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Lipoedema is a chronic disorder primarily affecting women. Often mistaken for obesity due to its characteristic build-up of fat cells in the legs and sometimes arms, lipoedema leaves women vulnerable to social stigma. This study investigated the role of fears of compassion and depressive symptoms in the context of weight stigma and internal weight bias in women with lipoedema.

Background Lipedema is characterized by disproportionate gluteofemoral adiposity with anti-inflammatory properties. We hypothesized that this phenotype may confer immunological protection against T-helper 1 (Th1)-mediated autoimmunity ("Immunological Shield Hypothesis"). Objective The objective of this study is to explore whether women with a dual-energy X-ray absorptiometry (DXA)-defined lipedema-like phenotype, characterized by disproportionate gluteofemoral fat accumulation, exhibit distinct immunometabolic profiles and lower prevalence of celiac disease (CD) autoimmunity in a nationally representative sample. Methods The cross-sectional analysis included 3,833 women from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Celiac disease (n=11, 0.56% weighted prevalence) was defined by strict serology (tissue transglutaminase {tTG}-IgA+/endomysial antibody {EMA}-IgA+); lipedema phenotype was defined as leg-to-trunk fat ratio of >90th percentile via DXA. Results Women with celiac disease exhibited 7.4% lower gynoid fat (39.5% versus 42.6%, p=0.0007), persisting in overweight/obese strata. Conversely, the lipedema phenotype demonstrated superior metabolic health: 44.2% lower homeostatic model assessment of insulin resistance (HOMA-IR) (p<0.001) and 7.6% lower neutrophil-to-lymphocyte ratio (NLR) (p=0.012). Conclusions This exploratory population-based analysis identifies phenotypic divergence in fat distribution between the DXA-defined lipedema phenotype and celiac disease autoimmunity, yielding observations consistent with, but not confirmatory of, the "Immunological Shield Hypothesis." While limited by the small number of celiac cases (n=11), a sample size insufficient to detect prevalence differences for a ~7%-9% phenotype, for which approximately 225-600 celiac cases would be required, the observed differences in gynoid adiposity (7.4% reduction, p=0.0007) and the favorable metabolic profile of the lipedema phenotype (44.2% lower HOMA-IR and 7.6% lower NLR) suggest biological plausibility warranting validation in larger, targeted cohorts. These findings motivate targeted studies to evaluate whether dietary exposures, including gluten-related immune activation, interact with gluteofemoral adipose biology in lipedema.

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BackgroundEndothermal ablation (ETA) is a well-established treatment for chronic venous insufficiency (CVI). However, its effectiveness in patients with concomitant lipedema remains poorly described. Given the distinct pathophysiological features and symptom burden of lipedema, outcomes may differ in this subgroup.MethodsWe conducted a prospective cohort study of patients with CVI alone and those with CVI plus lipedema. All patients underwent ETA, with adjunctive phlebectomies as indicated. Quality of life (QoL) was assessed using the EQ-5D-VAS and CIVIQ-20 questionnaires before surgery and at 3 months postoperatively. Demographic and clinical variables included age, body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and symptom profile. The primary outcome was the change in CIVIQ-20 score at 3 months. Secondary outcomes included changes in EQ-5D-VAS and postoperative complications (hematoma, paresthesia, superficial and deep vein thrombosis).ResultsA total of 48 patients were included (32 with CVI alone, 16 with CVI and lipedema). Preoperative QoL impairment was significantly greater in the lipedema cohort (median CIVIQ-20: 61.0 [49.5-69.5]) compared with CVI alone (46.0 [33.0-56.0], p = .001). At 3 months, both groups demonstrated significant improvement (p < .001 for within-group change). However, the magnitude of improvement was greater in CVI alone (median reduction: -13.5 [-19.5 to -5.0]) than in CVI plus lipedema (-4.0 [-7.0 to -1.5]; p = .012). Multivariable regression identified higher baseline CIVIQ-20 (β = 0.60; SE = 0.09; p < .001) and lipedema status (β = 12.44; SE = 2.43; p < .001) as independent predictors of poorer postoperative CIVIQ-20 outcomes. Paresthesia was more frequent in lipedema patients (25.0% vs 18.8% at 1 month; 12.5% vs 6.2% at 3 months).ConclusionWhile ETA significantly improves QoL in patients with CVI, those with concomitant lipedema experience smaller gains and a higher rate of postoperative paresthesia. These findings highlight the importance of setting realistic expectations and counseling lipedema patients regarding potential outcomes of venous interventions.

Lipedema is a multifactorial disorder with a negative evolutionary trend, influenced by genetic, hormonal, metabolic, and vascular factors that are not fully understood. Inflammation is a typical feature of lipedema and can be managed by limiting glycemic spikes. Herein, we report the case of a patient diagnosed with lipedema who followed a ketogenic diet (KD) for 6 months, resulting in a weight loss of 12 kg. Afterward, she transitioned to a low-carbohydrate (LC) diet for an additional 6 months, maintaining the good results achieved in terms of quality of life (QoL) improvement, weight control, and pain management. The patient regularly engaged in resistance training, which preserved and improved muscle mass. The primary and new outcome was due to the introduction of the second phase of the nutritional plan, specifically the low-carbohydrate diet, which could be an innovative approach. Often, diets that contain standard amounts of carbohydrates do not yield appreciable results.

BackgroundLipedema is a chronic disorder involving abnormal accumulation of subcutaneous fat, primarily in the lower limbs. Liposuction is an effective treatment, but postoperative complications such as fluid retention and seroma formation are common. While the use of surgical drains is well established in other areas of plastic surgery, their role in lipedema liposuction remains unclear.MethodsThis prospective observational study involved 50 consecutive patients with stage II or III lipedema who underwent lower leg liposuction. A novel passive drainage technique was used, involving glove drains fashioned from sterile, powder-free nitrile gloves and inserted through existing liposuction incisions. Drain duration, postoperative swelling, and complications, particularly seroma formation, were evaluated.ResultsAll patients completed follow-up with no major complications. Glove drains remained in place for an average of 2.4 ± 0.5 days. Only 2 patients (4%) developed seromas requiring single aspiration. No infections, hematomas, or lymphatic complications were recorded. Patients reported reduced swelling and discomfort compared to historical cases without drains.ConclusionPassive glove drains appear to be a simple, safe, and effective method to manage postoperative fluid collections after lipedema liposuction of the lower legs. The technique may lower the risk of seroma formation and promote early recovery, characterized by reduced postoperative edema, improved patient comfort, and an uncomplicated short-term postoperative course. Further controlled studies are needed to validate these findings and establish standardized drainage protocols in lipedema surgery.

Background:  Lipedema is a progressive subcutaneous adipose tissue disorder predominantly affecting women. Characterized by painful nodules and inflammation, it impairs mobility and quality of life. Traditional nonsurgical treatments currently offer limited relief and necessitate additional interventions. This study aimed to evaluate the efficacy of SMiLE (Softening, Mobilization, Liposuction, Extraction), a lipedema reduction surgery (LRS) technique. This technique combines lymphatic-sparing liposuction with manual lipedema extraction to comprehensively remove lipedema nodules. Methods:  Sixty-two women who underwent LRS with the SMiLE technique by the primary author participated in the study and completed an online survey. Data were collected on prior medical history related to lipedema development and comorbidities and outcome measures such as pain, activities of daily living, and quality of life before and after surgery. Results:  The findings demonstrate significant improvements in patients’ daily lives following surgery. Pain levels decreased by an average of 73.9%, with the most notable reduction in the buttock shelf (81.3%). Mobility improved for 93% of participants who had faced challenges before LRS, and quality-of-life assessments indicated a 47.5% reduction in the negative impact of lipedema postsurgery. Conclusions:  The SMiLE technique offers an advancement in the surgical management of lipedema by enabling the effective removal of lipedema tissue. Alongside a reduction in pain and improvement in mobility, this method addresses physical and psychological burdens. This study suggested that the SMiLE technique could be considered an option as part of a comprehensive approach to treating patients with lipedema.

Background  The Questionário de avaliação sintomática do lipedema (QuASiL – Lipedema Symptom Assessment Questionnaire) assesses 13 distinct inflammatory symptoms of lipedema, but whether these symptoms resolve and recur simultaneously or follow a consistent order remains unknown. Objectives  To characterize the persistence hierarchy of the 13 QuASiL inflammatory symptoms in a retrospective lipedema cohort under heterogeneous conservative treatment, using 6 complementary rank-order analyses and testing the null hypothesis that symptoms resolve with equal magnitude. Methods  This retrospective longitudinal study included 1,300 patients who were clinically diagnosed with lipedema by a vascular surgeon and who completed the QuASiL on at least 2 occasions (minimum 14-day interval; median follow-up 181 days, IQR 92–380, maximum 1,787 days). A consensus ranking was computed across all analyses. A sensitivity analysis was conducted using the conventional T0 = first visit, T1 = last visit convention, and a Kaplan-Meier survival analysis estimated the time (in absolute days) to ≥ 50% reduction from baseline per symptom. Results  The symptoms did not resolve simultaneously (Friedman χ2 (12) = 168.08, p < 0.001). All 13 symptoms improved during follow-up, showing a consistent order across the 6 analyses. A slower-resolving core was identified: bruising (consensus rank 1.7), swelling (2.0), touch sensitivity (4.3), leg heaviness (4.7), and fatigue (4.7). A rapidly-responding group comprised skin irritation (66.4% proportional reduction), itching (62.0%), and walking difficulty (62.6%). Even the most resistant symptom (bruising) achieved a mean 39.1% proportional reduction, with half of patients reaching ≥ 50% improvement. During worsening, swelling and pressure/tension re-emerged first. The sensitivity analysis (T0 = first, T1 = last) produced an essentially identical ranking (Spearman ρ = 0.945, p < 10−5). The Kaplan-Meier analysis estimated a median of 546 days for bruising vs 207 days for itching to reach ≥ 50% reduction from baseline (log-rank χ2 = 44.6, p < 10−10); the fastest-resolving symptom was heat/burning at 203 days. Conclusions  In this retrospective cohort of patients under heterogeneous conservative treatment, the 13 QuASiL inflammatory symptoms improved following a consistent order across 6 independent analyses, with bruising and swelling as the most persistent symptoms. Keywords: lipedema; inflammatory symptoms; resolution order; bruising; patient-reported outcomes; longitudinal study

Objective: The aim of this study was to identify the demographic and clinical characteristics of patients with lipedema who presented to our outpatient clinic in Çorum, thereby contributing to defining the lipedema case profile in our country. Material and Methods: We included 80 female patients diagnosed with lipedema at the physical medicine and rehabilitation outpatient clinic of our hospital between January 2020-July 2023. Data on age, body mass index (BMI), lipedema type-stage, and symptoms were collected from medical records. Laboratory evaluations, including hemogram, 25-OH vitamin D, vitamin B12, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lower limb venous doppler ultrasound results were also obtained from medical records. Results: The mean age was 46.46±9.72 years and BMI was 32.12±4.84. Type 2 lipedema was the most common, followed by Type 1 and Type 3. Stage 2 lipedema was seen in 63.8% of the patients, stage 1 in 21.2%, and stage 3 in 15%. Common symptoms included pain, swelling, fatigue, and leg heaviness. The mean CRP was 4.88±2.89 mg/L, ESR was 18.58±10.06 mm/h, 25-OH vitamin D was 18.73±12.95 ng/dl, and vitamin B12 was 359.74±155.12 pg/ml. Venous insufficiency was present in 50% of the patients. Lipedema stage showed significant positive correlations with age (r: 0.284, p: 0.011), BMI (r: 0.307, p: 0.006), and ESR (r: 0.271, p: 0.015).Conclusion: Patients presenting with swelling and pain in the lower limbs should always be assessed for lipedema, and it should also be considered that venous insufficiency and vitamin deficiencies may coexist in these patients.

BACKGROUND: Women with lipedema have an abnormal accumulation of adipose tissue that leads to pain and reduced quality of life (QoL). The impact of lipedema on body image and QoL remains largely unknown. The aim of this study is to explore Health-Related QoL (HR-QoL) and body image in women with lipedema and compare it to healthy women without lipedema as well as women with advanced cancer. METHODS: This comparative study included women with lipedema (n = 104), healthy women without lipedema (healthy controls) (n = 42), and an exploratory group of women with advanced cancer (n = 44). HR-QoL was assessed using RAND-36, body image concern was evaluated with the Body Shape Questionnaire (BSQ), and symptoms were assessed with Edmonton Symptom Assessment System (ESAS). RESULTS: In total, 190 women were included. Women with lipedema had significantly lower HR-QoL compared to healthy women without lipedema across all eight dimensions (p < 0.001). Women with lipedema had HR-QoL scores comparable to those of women with advanced cancer in four dimensions: physical functioning, bodily pain, and emotional problems. In the general health dimension, women with lipedema had even lower scores than women with advanced cancer (p < 0.05). Body image concerns were significantly greater in the lipedema group than in healthy controls (p = 0.001). Women with lipedema experienced significantly more symptoms than healthy controls, including more pain, fatigue, depression, anxiety, loss of appetite, dyspnea and reduced QoL (<0.001 for all). CONCLUSION: Women with lipedema had as low HR-QoL as women with advanced cancer in several dimensions, significant body image concerns and high symptom burden. These findings underscore the need to develop targeted health care initiatives for these patients.

BACKGROUND: Lipedema is a chronic adipose tissue disorder with disproportionate fat accumulation in the extremities and is often misdiagnosed as obesity. Although women with lipedema appear to be metabolically distinct from body mass index (BMI)-matched controls, their fasting metabolism remains insufficiently characterized. We therefore aimed to define the metabolic signature of lipedema using serum NMR metabolomics and anthropometric profiling. METHODS: We conducted a study with 24 premenopausal women with lipedema and 21 BMI-matched controls. Fasting serum samples were analyzed using NMR spectroscopy and anthropometric data were collected. Regional body composition was additionally assessed in an exploratory matched DXA subset (n=12). To characterize coordinated metabolic differences beyond single analytes, we derived exploratory composite indices and applied multivariate analyses. RESULTS: Despite similar BMI, women with lipedema showed lower waist circumference, waist-to-hip ratio and lower fasting insulin than controls (age-adjusted p = 0.032). NMR profiling revealed lower alanine (p < 0.001), lactate (p = 0.004), pyruvate (p = 0.021), and elevated ketone bodies (3-hydroxybutyric acid: p = 0.009; acetoacetic acid: p = 0.035; acetone: p = 0.006). These alterations were reflected by significant group differences in composite indices for fat distribution (g = 1.26; p < 0.001), glycolysis (g = 0.74; p = 0.018), and ketone metabolism (g = 0.70; p = 0.018). Principal component analysis of the selected indices explained 78% of the total variance and showed partial group separation between lipedema and controls. CONCLUSION: Lipedema is associated with a distinct fasting metabolic profile characterized by reduced glycolytic intermediates, enhanced ketone body signals, and a more peripheral fat distribution despite comparable BMI. These findings support the concept of lipedema as a metabolically distinct phenotype and suggest that multivariate metabolic signatures may help refine future diagnostic and interventional approaches.