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Background/Objectives: Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat accumulation and inflammation, predominantly affecting women. While recent evidence suggests a systemic pro-inflammatory state in lipedema, the role of diet in modulating inflammation remains underexplored. This study assessed the anti-inflammatory potential of a Mediterranean-style ketogenic diet and its effects after 7 months of adherence on systemic inflammation markers (CRP and IL-6) in women with lipedema (n = 24) and a control group with overweight/obesity (n = 24). Methods: The Dietary Inflammatory Index (DII) was used to characterize the inflammatory potential of the diet throughout the intervention. Dietary intake was analyzed pre- and post-intervention, and anthropometric, body composition, and biochemical parameters were measured. Results: Beyond its beneficial effects on body composition (significant reductions in body weight, fat, leg circumferences, and visceral fat), the intervention diet also demonstrated anti-inflammatory potential. In lipedema, baseline diet showed a pro-inflammatory DII profile (DII/day = 3.04), which was reduced by about 1.5 points after the intervention (p = 0.008). When expressed per 1000 kcal, the DII values were markedly lower for both baseline (DII = 0.22) and intervention diet (DII = ~0.01). Following the intervention diet, reduction in CRP (-0.39, p = 0.016) and IL-6 levels (-0.33, p = 0.034) in lipedema were observed. A significant positive association was observed between the intervention diet's DII and CRP (r = 0.55, p = 0.005), and between the baseline diet's DII and IL-6 (r = 0.50, p = 0.013) in lipedema group. Conclusions: These findings suggest that ketogenic diet rich in anti-inflammatory and antioxidant nutrients can reduce systemic inflammation in lipedema patients, independently of caloric restriction.

BACKGROUND: Lipedema is a chronic disorder of adipose tissue that predominantly affects women and is frequently misdiagnosed as obesity or lymphedema. Traditionally associated with the lower extremities, lipedema can also involve the abdominal region, although there are currently no established diagnostic criteria for abdominal lipedema. This study aims to propose a diagnostic algorithm for abdominal lipedema based on clinical features, macroscopic observations, and ultrasound findings. METHODS: This retrospective study analyzed data from 327 patients treated between March 2018 and March 2024 for lipedema, including those with abdominal involvement. Clinical evaluations, ultrasound imaging, and surgical outcomes were examined to assess the prevalence and characteristics of abdominal lipedema. Patients were classified based on lipedema severity, and criteria for abdominal lipedema diagnosis were established through clinical and imaging data. RESULTS: The study identified that abdominal involvement increases with the severity of lipedema, with 31% of patients with stage II lipedema and 70% of those with stage III lipedema exhibiting abdominal manifestations. The proposed diagnostic algorithm includes maximum, major, and minor criteria, such as symmetrical fat deposition, pain, and non-responsiveness to diet and exercise. Specific threshold values for each category were defined to establish the diagnosis. The findings highlight the existence of both ascending (from legs to abdomen) and descending (from arms to abdomen) centripetal progression patterns, challenging traditional notions that limit lipedema to the extremities CONCLUSION: Abdominal lipedema is a significant and underrecognized manifestation of the condition, requiring specific diagnostic criteria to ensure accurate diagnosis and appropriate treatment. The study proposes a diagnostic framework based on clinical and imaging features that can improve the recognition and management of abdominal lipedema. Multidisciplinary treatment approaches, including both conservative measures and surgical interventions such as abdominoplasty and liposuction, are recommended to improve patient outcomes. LEVEL OF EVIDENCE IV: 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 .

Introduction:Lipedema is a progressive chronic condition that mainly affects women, and is characterized by disproportionate subcutaneous fat accumulation in the extremities, causing pain, edema, and impaired quality of life.Objective:This study evaluated the outcomes of the lipedema definition technique (LDT) for the treatment of lipedema, focusing on clinical efficacy, quality of life improvement, and patient satisfaction.Methods:A retrospective study was conducted with 67 women who underwent the LDT to treat lipedema (types II to V and stages 1 to 4). Analyzed variables included weight, body mass index, body fat percentage, total body water, InBody score, ideal weight, fat-free mass, basal metabolic rate, waist-to-hip ratio, visceral fat level, and percentage of obesity. The Lipedema Symptoms Assessment Questionnaire and complementary questionnaire were applied to assess satisfaction and clinical outcomes. Study assessments were conducted preoperatively, 90 days after surgery, and completed 2 years later.Results:A total of 34 patients (mean age of 40 years) were included; most had stage 2 lipedema (50.7%) and type IV (49.2%). After 90 days of the LDT, significant reductions were observed in weight (−2.5 kg, P = .001), body mass index (−0.9 kg/m2, P = .001), body fat percentage (−3.1%, P = .001), visceral fat (−1.8 points, P = .001), and percentage of obesity (−4.3%, P = .001). Moreover, fat levels in the upper and lower quadrants were significantly reduced, and bioimpedance analysis showed changes in all 5 body segments after LDT. Improvements in quality of life (89.4%) and pain reduction (87.2%) were reported. High satisfaction rates (91.5%) were observed, with 81.0% of patients reporting positive outcomes and 75.0% maintaining results in the long term.Conclusion:Lipedema definition technique was effective in reducing fat, improving quality of life, and achieving high patient satisfaction. This study reinforces the role of surgery as an intervention for lipedema, promoting important clinical and aesthetic benefits.

Lipedema is a chronic, progressive adipose connective tissue disorder characterized by symmetrical, disproportionate fat accumulation, typically affecting the lower extremities and arms, accompanied by pain, swelling, and a sensation of heaviness. This study introduces intermediate Stages 1.5 and 2.5 to the established lipedema classification (Stages 1, 2 and 3), and other affected areas, based on physical examination, a questionnaire, and photographic documentation. Bioelectrical Impedance Spectroscopy (BIS) was employed to quantify total body water (TBW) across stages. A significant and linear increase in BMI was observed from Stage 1 to 3, correlating with increased reported pain and heaviness in the thighs, calves, and upper arms. Systemic symptoms of brain fog, debilitating fatigue, and hypothermia were significantly prevalent. TBW demonstrated a significant, stage-dependent increase in the lower extremities. Adipose tissue accumulation over the knees and feet significantly increased with lipedema stage. In contrast, shin involvement was evident in early stages and remained consistently elevated throughout later stages. Skeletal Muscle Mass (SMM) exhibited a significant increase across lipedema stages, positively correlating with fat mass (FM) in Stage 3. This study elucidates previously underrecognized clinical features and distribution patterns of lipedema, offering a refined staging system to improve understanding of its progression and burden.

ObjectiveThe incidence of lipedema is poorly described due to its confusion with lymphedema. Patient education is crucial for treatment and prevention strategies but also for improving healthcare outcomes. This study assessed and compared the quality of English and Spanish online resources for patients suffering from lipedema using a multimetric approach.MethodsA deidentified Google search using the terms "lipedema" and "lipedema español" was conducted. The first 10 academic/organizational websites in each language were selected. Quality assessment was performed using the Patient Education and Materials Assessment Tool (PEMAT), Cultural Sensitivity Assessment Tool (CSAT), Simple Measure of Gobbledygook (SMOG), and facticity criteria to evaluate understandability and actionability, cultural sensitivity, readability, and factual quality, respectively.ResultsEnglish webpages scored 73.70% for understandability and 35.0% for actionability, while Spanish webpages scored 75.05% and 21.0%, respectively; no significant differences were found between languages in understandability (p = .970) and actionability (p = .895). A significantly higher proportion of Spanish resources was found to be culturally sensible than English resources (90% vs 70%; p < .001). However, no significant differences were found in the cultural sensitivity score (English 2.87 vs Spanish 3.01; p = .677). The grade reading level for Spanish materials was significantly lower compared to English materials (11.08 vs 13.45; p = .006). Factual quality was low across both languages according to the facticity framework, though English materials scored higher than Spanish (2.20 vs 1.00; p = .051).ConclusionOur results suggest that online English and Spanish materials on lipedema have inadequate actionability, facticity, and reading grade levels for patients. Nonetheless, the levels of understandability and cultural sensitivity are acceptable. Enhancing the quality of online health literature for lipedema patients presents an opportunity to alleviate psychosocial burdens and address misconceptions.

To determine the frequency of neuropathic pain in patients with lipedema and to assess the impact of neuropathic pain on quality of life and its correlation with clinical variables.

Objectives To identify research priorities related to the diagnosis, treatment and management of lipoedema. Design This was a research question priority-setting that ensured the involvement of patients, relatives and healthcare professionals in all parts. It consisted of the following steps: identifying research questions through an open survey, seeking input from patients, patient relatives and healthcare professionals. Prioritisation, including a Delphi exercise and a final priority-setting meeting. Setting Swedish healthcare and community. Participants A total of 255 participants submitted research questions. 130 participated in the prioritisation of the submitted questions. Of these, 89 were patients, 10 were relatives, 19 were healthcare professionals and 12 were representatives of patient organisations. Results 1314 potential research questions were submitted; 62 unique questions remained after analysis. 130 and 123 people answered the first and second Delphi surveys, respectively. 20 questions were discussed by 13 participants at the final priority-setting meeting. The following five research questions were selected as a top priority: (1) what criteria should apply for a diagnosis of lipoedema? (2) What outcomes are important in lipoedema research? (3) What effect does manual treatment, such as manual lymphatic drainage have on lipoedema? (4) What effect does liposuction have on lipoedema? (5) What are the effects of hormonal treatment on lipoedema? Conclusions We found a consensus between patients and healthcare professionals on topics that warrant priority in future research into lipoedema. The questions reflect both the diagnosis of the condition and research on treatment effects. We hope the results will inform researchers and research funders, and direct future studies towards important research questions. Data are available upon reasonable request.

ObjectiveTo assess the relationship between disease severity in lipedema and tissue stiffness measured using shear wave elastography (SWE) concerning pain threshold and quality of life as well as determine differences in subcutaneous tissue stiffness between patients with lipedema and healthy subjects.Methods71 participants were subjected to measurements using subcutaneous tissue elastic modulus with SWE imaging of lower limbs at three anatomical levels. The participants were divided into two groups: those diagnosed with lipedema (Group (1) (n = 35) and healthy subjects (Group (2) (n = 36). Patients with lipedema were categorized into three stages based on disease severity. Pain levels were assessed using the visual analog scale (VAS), pain pressure threshold through algometric measurement within lipedema stages, and quality of life using EQ-5D quality of life scale in all groups.ResultsNo statistically significant differences in age, BMI, right and left three-zone elastic modulus averages were observed between the groups within BMI levels of 25-29.9 and ≥30 kg/m2 (p > .05). Same BMI group, according to lipedema stage, the mean elastic modulus of the right pretibial region in stage 2 cases was significantly higher than in stage 1 cases within BMI levels of 25-29.9 kg/m2 (p < .05). The all-region algometric measurements in Group 1 were significantly lower than those in Group 2, within BMI levels of 25-29.9 kg/m2 and ≥30 kg/m2. The average spontaneous VAS scores in Group 1 were significantly higher than those in Group 2 within the same BMI (p < .05). The VAS palpation scores in Group 1 exceeded those in Group 2 for BMI ≥30 kg/m2 (p < .05). No significant difference in VAS palpation scores was observed for BMI 25-29.9 kg/m2 (p > .05). The EQ-5D VAS scores of the control group were significantly lower than those of stage 1, 2, and 3 cases (p < .05).ConclusionsIn lipedema, pain characteristics may be more distinctive than the elastic properties of adipose tissue. Increased algometric measurements may reflect a specific objective sensation.

BACKGROUND: Lipedema is an adipose tissue disorder involving mostly women. One of the most characteristic lipedema symptoms is painful accumulation of adipose tissue in lower and upper extremities leading to disproportion. Due to the disproportionate body shape, it is recently thought that BMI (Body Mass Index) might not be fully sufficient to identify the weight ratios among lipedema patients and it is suggested to consider replacing BMI with WHtR (Waist-to-height ratio). PURPOSE: The aim of the study is to present the characteristic features of lipedema patients and the usefulness of BMI and WHtR among lipedema patients in reference to symptoms severity, quality of life and body composition. METHODS: Forty-four women with lipedema were asked to rate their symptoms in a scale from 0 to 10, and to complete SF-36 questionnaire affecting quality of life. Participants also had body composition assessment. RESULTS: Participants experienced various lipedema symptoms such as: heaviness in affected areas (97.7%), pain at palpation (100%), spontaneous pain (82%), disproportionate body shape and tendency to bruising (88.6%). The level of pain was strictly correlated with patients' daily functioning (R = 0.79, p = 1.9*10- 10). The quality of life among participants measured with SF-36 was 57.4/100. WHtR enabled the same group of patients to be divided into three nearly equal groups, while BMI only divided them into two groups. Statistically significant differences could be observed both between BMI and WHtR groups. CONCLUSION: Lipedema symptoms have a direct impact on functioning of patients. Quality of life is decreased among women with lipedema. WHtR should be considered as a tool in identification of obesity among lipedema population.

Background: Lipedema is a chronic disease of subcutaneous adipose tissue that predominantly affects women and is frequently associated with endocrinopathies such as insulin resistance and obesity. Its pathogenesis is still unclear, and treatment, which requires a multi-disciplinary approach, is prolonged over time and is not always effective. There is currently no drug treatment available for this disease. Methods: Five different cases of women with lipedema and insulin resistance, treated with Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) and once-weekly exenatide, in association or not with lifestyle changes (diet or physical activity) for 3 to 6 months are described. Changes in anthropometric parameters, symptoms, clinical findings and the thickness of superficial adipose tissue measured by ultrasound were evaluated. Results: Treatment with exenatide, whether combined with a change in diet or physical activity, resulted in a reduction in the characteristic symptoms of lipedema, in pain evoked by pinching the adipose tissue fold and in the thickness of subcutaneous adipose tissue at the levels of the lower limbs, abdomen and upper limbs. In four out of five cases, a reduction in body weight was observed, particularly during the first three months of treatment and in cases with greater metabolic impairment. Clinical, instrumental and subjective improvements were also observed in cases where there was no reduction in body weight and in patients who had previously undergone lower limb liposuction. Conclusions: The improvement in symptoms and clinical signs of lipedema, in addition to the reduction in adipose tissue in patients with lipedema and insulin resistance with exenatide, suggests a novel pharmacological approach to the disease, which can be combined with other conservative and surgical treatments to promote weight reduction. These results also highlight the association of this disease with metabolic alterations and the fundamental role of an accurate diagnosis followed by the treatment of comorbidities and excess weight in these patients.

Background: Postoperative fibrosis is a common and significant complication following liposuction for lipedema, often leading to tissue induration, pain, and compromised aesthetic results. This fibrosis can jeopardize the overall success of the procedure by reducing skin elasticity and altering the intended body contour.Objective: This study aims to evaluate the efficacy of early shockwave therapy (SWT) initiated 1 week after surgery to reduce postoperative fibrosis and preserve the functional and aesthetic outcomes of liposuction in lipedema patients. Methods: A prospective study was conducted on 50 female patients with stage II–III lipedema who underwent power-assisted liposuction (PAL). Patients received SWT sessions three times per week for 3 weeks, starting 7 days postoperatively. Outcomes were compared to a control group of 25 patients who did not receive SWT. Primary endpoints included fibrosis severity assessed by ultrasound elastography, skin elasticity measurements, and patient-reported outcomes on pain and satisfaction. The SWT group exhibited a significant reduction in fibrosis (2.1 ± 0.3 vs 3.8 ± 0.5, p < .001), improved skin elasticity (1.5 ± 0.2 mm vs 1.0 ± 0.3 mm, p < .01), and lower pain scores (2.3 ± 0.8 vs 4.7 ± 1.2, p < .001) compared to the control group. Results: Patient satisfaction was also higher in the SWT group (92% vs 68%, p < .01). Conclusion: Early postoperative shockwave therapy is an effective and safe treatment to reduce fibrosis after liposuction for lipedema. By modulating fibroblast activity, reducing pro-inflammatory cytokines, and improving tissue perfusion, SWT preserves the surgical outcomes and enhances patient satisfaction. These findings suggest that integrating SWT into postoperative protocols could be a valuable strategy to optimize liposuction results in lipedema patients.

Objectives: This study aimed to examine the effects of a multimodal exercise program on edema, pain, exercise capacity, lower extremity muscle strength, and function in patients with lipedema.Methods: The patients diagnosed with lipedema were randomly assigned to either the exercise (n: 11) or control (n: 11) groups. The exercise group participated in supervised group exercises focusing on aerobic and strengthening, twice a week for 6 weeks. The control group received training on physical activity additionally lipedema management. Sociodemographic and clinical characteristics were recorded. Edema (circumference measurements and local tissue water-LTW%), pain intensity (Visual Analogue Scale-VAS) and pressure pain threshold (Algometer), functional exercise capacity (Six minute walk test-6MWT), lower extremity muscle strength (Handheld dynamometer), lower extremity muscle strength/endurance (Sit-to-stand test) and lower extremity function (Lower Extremity Functional Scale-LEFS) were evaluated.Results: In the exercise group, significant reductions in pain during rest, activity, and nighttime, 6MWT distance, quadriceps and hip muscle strength, lower extremity strength/endurance, and function were observed (p < .05). When comparing the groups, no significant differences were found (p > .05); however, clinically, there were differences in limb volumes, pain reduction, muscle strength, and functional improvements, with medium to large effect sizes.Conclusion: The main findings of this study highlight the benefits of structured multimodal exercises for patients with lipedema to improve pain, limb volumes, exercise capacity, lower extremity muscle strength, endurance, and functionality.Clinical trials number: NCT06811961.

Lipedema is a chronic disease in adipose tissue affecting women. The distinctive body appearance in lipedema, often mistaken for obesity, may be detrimental to social life. In our online cross-sectional survey study, conducted from June to September 2021 among 245 women with lipedema, we found significantly more health-related stigma compared to an aged-matched general female population (N = 1872), leading to an overall lower quality of life. Conversely, strong social support was associated with better social and emotional functioning. As such, healthcare professionals must, even in the early stages, recognize this disease and address its impact on psychosocial health and well-being.

Obesity can impair cardiometabolism, but low-carbohydrate diets (LCDs) may be beneficial for mitigating risk. We aimed to investigate the effects of LCDs versus low-fat diets (LFDs), under hypocaloric conditions, on flow-mediated dilation (FMD) in individuals with overweight/obesity. Secondarily, we assessed other cardiovascular markers (systolic blood pressure, diastolic blood pressure, C-reactive protein [CRP], high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides [TG], total cholesterol [TC]), and anthropometric and body composition measurements. PubMed, Scopus, and Web of Science were searched through May 2023 for studies involving hypocaloric LCDs versus LFDs on FMD. Meta-analyses were conducted for LCDs vs. LFDs to calculate weighted mean differences (WMD), including 10 studies reporting FMD (n = 475). Overall, hypocaloric LCDs resulted in a non-significant decrease in FMD compared with hypocaloric LFDs [WMD = −1.04% (95% CI −2.28 to 0.20), p = 0.10], while very-low-carbohydrate diets (VLCDs) significantly reduced FMD when compared with LFDs [WMD = −2.12% (95% CI: −3.35 to −0.9) p = 0.001]. LCDs did not change anthropometric and body composition measurements, nor CRP, blood pressure, HDL, or TC when compared with LFDs. However, LCDs significantly decreased TG [WMD = −19.94 mg/dL (95% CI −31.83 to −8.06), p = 0.001] and increased LDL [WMD = 20.00 mg/dL (95% CI 14.09 to 25.90), p = 0.001] when compared with LFDs. In conclusion, LCDs did not exert superior effects on cardiovascular markers or body composition when compared with LFDs in individuals with overweight or obesity, but LCDs reduced TG and increased LDL levels more than LFDs. Yet, vascular function (FMD) was reduced primarily for VLCDs.

Background: Bioimpedance spectroscopy (BIS) is commonly used for the detection and monitoring of lymphedema and potentially lipedema. BIS measures limb electrical resistance, which decreases with fluid accumulation in these conditions. R0, the index of extracellular fluid and lymph accumulation, is typically estimated using Cole modeling, but technical and biological factors can affect accuracy.Methods: Participants with clinically affirmed bilateral leg lymphedema, lipedema, self-ascribed swelling, and healthy controls were included in this study. Impedance measurements were taken using a stand-on BIS device, and R0 was estimated using both the Cole modeling method and a regression approach. Quality of data fitting was assessed visually and statistically.Results: Control participants were younger and lighter compared with the clinical groups. The regression method was able to analyze 100% of participant data, whereas the Cole method was successful in only 80%–88% of cases in the lymphedema and lipedema groups. Additionally, the regression approach provided better curve fitting accuracy for all participants.Conclusion: The regression method offers a robust alternative for estimating R0 values in BIS data, especially in lower limb assessments where data analysis is challenging. The small difference between methods in absolute R0 values (2.5%) has minimal practical implications, suggesting interchangeability in data analysis. The Cole method showed poorer performance, particularly in participants with lymphedema, possibly due to differences in water proportions and limb size. Overall, the regression method can be effectively used in clinical practice for estimating R0 values in BIS data, offering a more accurate and reliable approach than traditional Cole plotting methods.

Lipoedema is a loose connective tissue disease primarily affecting women characterized by an abnormal build-up of painful fat in the legs and arms. In healthcare, lipoedema is often confused with obesity, and today, diagnostic tools and standardized guidelines for adequate treatments are lacking. Still, research on how affected women manage their health problems and whether they are satisfied with their care remains sparse. Therefore, this study aimed to contribute knowledge on healthcare experiences, and their use and self-reported effects of self-care and treatments among women with lipoedema.

IntroductionLipedema is a chronic and progressive adipose tissue disorder that predominantly affects women. However, despite its high prevalence and severe negative impact on quality of life, it remains significantly underdiagnosed. The aim of this study was to assess the knowledge and awareness of …

Background: Lipedema is an adipose tissue disorder in women, with an abnormal fat deposition in lower limbs and occasionally upper limbs. The condition is characterized by pain, bruising, heaviness, and mobility impairment. Objectives: This study aims to evaluate the effects of a modified Complete Decongestive Therapy protocol using the Godoy Method in the postoperative period following lipedema surgery. Methods: In total, 293 participants who underwent liposuction for lipedema were studied. The postoperative physiotherapy protocol included Godoy cervical stimuli, Manual Lymphatic Drainage based on Godoy maneuvers, mechanical lymphatic drainage with RAGodoy®, compression with bandages, skin care, and therapeutic education. Results: This study found that the number of physiotherapy sessions significantly reduced pain (p = 0.000) and other complications (p = 0.007) and increased mobility (p = 0.003). The number of physiotherapy sessions showed significant differences in pain intensity at 90 days posttreatment (p = 0.000). In total, 47.24% of the participants became functionally independent on the third day of the physiotherapy intervention (p = 0.003). A total of 40.96% of the participants developed some complications, although a relationship between inadequate compression and the occurrence of complications was also found in 36.52% of patients. Conclusions: The success of surgical treatment for lipedema not only depends on the surgery itself but also on the proper management of the patient in the perioperative period to minimize complications and prevent recurrence. The Complete Decongestive Therapy protocol modified with the Godoy Method showed effects on pain reduction, mobility increase, edema reabsorption, and prevention of complications, consequently enhancing functionality and quality of life for patients undergoing lipedema surgery.

Our study highlights frequent comorbidities in patients with lipedema, including chronic venous disease, obesity, and mental health conditions such as anxiety and depression. The distribution of comorbidities supports the need for tailored management. The correlation between disease stages, age, and …