Lipoedema: a paradigm shift and consensus

More than meets the eye: phenomenological insights into the functioning of people with lipoedema

PURPOSE

The aim of this study was to explore the functioning of people with lipoedema from their perspective.

METHODS

This was a qualitative study following a phenomenological perspective using individual in-depth interviews with a convenience sample of 13 Dutch people with lipoedema. The data were analysed by using an interpretative phenomenological approach.

RESULTS

Two overarching group experiential themes (GETs) were identified: (1) "physical complaints are only a part of their problems", and (2) "longing for improved appearance and functioning". The GETs were composed of the following subordinate GETs: "disproportionate functioning of the lower body", "navigating daily life with lipoedema", "coping with uncertainty", "the toll of shame and stigmatization", "consequences of a very negative self-image", "desire for change and improved appearance and functioning", and "an ongoing journey of acceptance".

CONCLUSIONS

Participants experience that physical complaints affect daily activities, but with adequate adaptability, participation issues are relatively limited. Instead, shame about their appearance and (fear of) stigmatization mainly leads to social avoidance. Additionally, participants long for freedom to do what they want, wear what they want, and desire a different appearance. Therefore, the experienced level of acceptance of the condition is context- and situation-dependent and not straightforward, which is complicated by the burden of knowing that the condition is chronic.

Assessment Tools to Quantify the Physical Aspects of Lipedema: A Systematic Review

Lipedema diagnosis is heavily reliant on patient history. Various objective assessments have been suggested; however, a standardized measurement process is lacking. A systematic review was undertaken to identify which imaging and measurement tools are used in lipedema quantification and to review their protocols. Six databases were searched with two reviewers screening citations for inclusion. Full peer-reviewed publications that included defined lipedema diagnosis criteria, no male cases within comparative cohorts, and used an imaging or measurement tool to quantify lipedema were included. Twenty studies met the inclusion criteria using 13 different tools to quantify individual physical lipedema characteristics to either enable differential diagnosis, and/or quantify treatment effect: tape measure, perometry, durometry, tonometry, bioimpedance spectroscopy, tissue di-electric constant, ultrasound, Dual-Energy X-ray Absorptiometry, magnetic resonance imaging (MRI), noncontrast MRI lymphangiography, Indocyanine green lymphography, lymphoscintigraphy, and dynamic lymphangiography. Eight imaging and five measurement tools assessed lymphatic transport disturbances (n = 8), limb size/volume (n = 4), adipose tissue thickness/mass/volume (n = 3), and tissue fluid presence (n = 2). Multiple tools were only used in studies completed in 2020 or later. A lack of consistency exists in tool protocols, measurement locations, and outcome analysis. Limited reporting of clinimetrics with data derived from small cohorts and heterogenous populations impacted the ability to recommend tools for clinical practice and research. Various tools were used for objective lipedema assessment; however, consistency in approach was lacking. Further investigations are required to establish the validity and reliability of measurement and imaging tools, protocols, measurement points, and outcome reporting/interpretation to quantify the physical attributes of lipedema.

Therapeutic Applications of Ketogenic Diets in Lipedema: A Narrative Review of Current Evidence

PURPOSE OF REVIEW

Lipedema is an abnormal accumulation of adipose tissue, predominantly observed in women, characterised by symmetrical fat deposition and tactile sensitivity in the extremities, affecting both sides of the body. This condition can lead to significant pain, impairing daily activities and causing substantial discomfort.

RECENT FINDINGS

While the etiology of the disease is not yet fully understood, genetic predisposition, hormonal fluctuations, a stressful lifestyle, as well as traumatic events are considered potential triggers. Lipedema remains a condition with low diagnostic awareness as well as is frequently misdiagnosed as obesity or lymphedema. While obesity is a risk factor for lipedema, the abnormal fat deposition characteristic of the disease can occur across a wide spectrum of body weights, from underweight to overweight individuals. Specific patterns of adipose tissue distribution may be associated with signs of inflammation as well as heightened pain perception, as well as individuals with eating disorders, such as anorexia, may additionally be affected. Ketogenic diets have emerged as a promising therapeutic option for lipedema. Characterized by low carbohydrate as well as high fat content, ketogenic diets facilitate metabolic improvements by reducing insulin resistance as well as supporting weight loss. Furthermore, they may mitigate tissue damage associated with lipedema by decreasing inflammation as well as oxidative stress levels.Nevertheless, current scientific data regarding the mechanisms of action as well as therapeutic efficacy of ketogenic diets are limited, necessitating further research to expand their clinical application.

Lipedema awareness and knowledge level among medical doctors in Turkey: A cross-sectional study highlighting the diagnosis and treatment gap

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 medical doctors in Turkey regarding lipedema.MethodsA cross-sectional study was conducted among 508 medical doctors working in different clinical specialties in Turkey. A questionnaire was designed and validated by a panel of physical medicine and rehabilitation specialists. A total of 22 questions were asked to assess physicians' age, specialty, clinical experience, and institutional characteristics, as well as their knowledge of the clinical features, diagnostic criteria, and treatment modalities of lipedema.Results47.6% of the physicians were between 31 and 40 years of age. 29.3% of the participants had been practicing medicine for 0-5 years. 51% were familiar with the term "lipedema", but only 29.9% had seen or referred patients with lipedema. 51.4% of the participants answered "no idea" when asked about the lipoedema clinic and 50.9% answered "no idea" when asked about lipoedema treatment.ConclusionThis study identifies significant gaps in medical professionals' knowledge and awareness of lipedema in Turkey. The findings emphasize the necessity to incorporate lipedema-specific content in medical education and continuing professional development programs. Moreover, the establishment of multidisciplinary models of care, the dissemination of standardized clinical guidelines, and the promotion of public awareness campaigns are imperative to enhance early recognition and effective management of lipedema, which is often overlooked.

Characterization of Pain in Lipedema: Reliability and Validity of Pain Pressure Thresholds and Hand-Held Sphygmomanometer Assessments in People with Lipedema

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.

Clinical characteristics, comorbidities, and correlation with advanced lipedema stages: A retrospective study from a Swiss referral centre

INTRODUCTION

Lipedema is a chronic condition involving abnormal fat deposition in the lower limbs, often underdiagnosed, and poorly understood. We examined the epidemiological and clinical characteristics of a large patient cohort in Switzerland and their associations with disease severity.

METHODS

We included women aged 18 and over with lipedema at Lausanne University Hospital (CHUV), Switzerland. Demographic and clinical data, including disease type, stage, symptoms, and comorbidities, were collected. Descriptive statistics were used to summarise the data, and logistic regression was employed for analysis.

RESULTS

A total of 381 females (mean age 41.9 years) were included, mostly classified as type III (48.3%) and IV (30.2%) lipedema. In our population, 26.6% of patients were classified as stage 1, 44.5% as stage 2, and 28.9% as stages 3-4. Family history was reported in 49.9%, with symptoms often starting during adolescence (62.2%). Pain affected 87.9%, and quality of life (QoL) was significantly reduced, with 71.5% reporting low physical and 67.4% low mental well-being. Comorbidities were present in 92.1%, increasing with advanced disease stage, with chronic venous disease (86.2%) and obesity (51.7%) being the most common. Univariate analysis showed advanced lipedema was associated with age (OR: 1.07, 95% CI: 1.05-1.09), BMI (OR: 1.24, 95% CI: 1.19-1.29), and comorbidities (OR: 1.59, 95% CI: 1.39-1.81). Multivariate analysis confirmed age (OR: 1.06, 95% CI: 1.04-1.08) and BMI (OR: 1.22, 95% CI: 1.17-1.28) as correlates with disease stage.

CONCLUSIONS

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 BMI suggests potential progression, warranting confirmation through prospective studies.

Comprehensive Needs Assessment for Enhancing Self-Management in People with Lipoedema and the Support Provided by Their Healthcare Professionals

Background

The cause of lipoedema remains unclear, and the condition is currently incurable. Effective self-management is therefore essential for coping with its physical and psychological impacts and the necessary lifestyle adjustments. This study aimed to assess the needs, barriers, and facilitators for enhancing self-management and self-management support from the perspectives of people with lipoedema and the healthcare professionals (HCPs) involved in their care.

Methods

The study used a mixed-methods approach, incorporating a narrative review focused on people with chronic conditions and their HCPs, along with focus groups involving people diagnosed with lipoedema and the HCPs involved in their care. The Core Processes of the Intervention Mapping method guided a systematic approach to address the study's objectives. Qualitative data were analyzed using a grounded theory approach.

Results

Findings revealed unique self-management barriers for people with lipoedema, including limited awareness and expertise among HCPs, as well as stigmatization from both HCPs and society. Participants identified a need for tailored lifestyle plans, guidance, and support for monitoring progress. Key facilitators included self-management skills, supportive networks, and role models. HCPs noted barriers in communication and collaboration due to a lack of specialized professionals and negative attitudes toward lipoedema. They expressed a need for multidisciplinary/interprofessional teams, accurate diagnosis, patient openness, and reliable information resources. Facilitators included fostering trust, encouraging patient participation, and setting achievable goals.

Conclusion

This study underscores the need for tailored self-management interventions for people with lipoedema. The adaptation of existing self-management strategies from other chronic conditions should take into account the specific needs, barriers, and facilitators of people with lipoedema and their HCPs.

An uncertain uphill battle - experiences and consequences of living with lipedema

PURPOSE

To describe and analyse experiences of living with lipedema. Methods: Individual, semi-structured interviews with a purposive sample of 12 women diagnosed with lipedema and analysed by qualitative content analysis utilizing an inductive approach.

RESULTS

The overarching theme, "An uncertain uphill battle against a divergent body and societal ignorance", covers the experiences of living with lipedema and is based on five categories; "Captivated by a disintegrating body", "Face the impairments of a chronic condition", "Experience social exclusion", "Need emotional support to go on" and "Mull over an insecure future". The women felt entrapped within their bodies and experienced social exclusion due to the chronic symptoms and the progressive body shape alteration caused by their illness. Having experienced deficient information on the illness, varying support from other people, and a deteriorating economic situation, the women face an uncertain future.

CONCLUSIONS

Symptoms and restrictions caused by lipedema affect women's livelihood and future, as there are no indications for disease improvement. Preventive work aimed at reducing health deterioration should be a priority. More research is needed to raise healthcare awareness regarding difficulties experienced by patients with lipedema.

Evaluation of the Effectiveness of Compression Therapy Combined with Exercises Versus Exercises Only Among Lipedema Patients Using Various Outcome Measures

The treatment of lipedema remains challenging, largely due to widespread misconceptions. Selecting the appropriate treatment method necessitates the use of accurate outcome measures. This study aims to evaluate the effectiveness of compression therapy combined with exercises versus exercises alone in lipedema patients using various outcome measures. Twenty-four women with lipedema were divided into two equal groups: one group received compression therapy plus exercises while the other group performed exercises only. The effectiveness of the treatment was assessed before and after the intervention using several measures: an SF-36 questionnaire, a symptom severity survey, circumference (via 3D scanning), and body composition analysis. Significant improvements were observed in the SF-36 Physical Functioning and SF-36 Energy/Fatigue scores among participants in the compression group. Additionally, there was a reduction in the heaviness of extremities, the disproportion between the trunk and limbs, and the level of swelling in the compression therapy. Circumferences decreased in both groups. Although more circumferences were significantly reduced in the compression group, the reduction at the point above the knee was greater in the non-compression group. Compression therapy is an effective treatment for lipedema. Various measures, such as quality-of-life questionnaires and symptom severity surveys, can be used as valuable tools for assessing the effectiveness of lipedema treatment.

Comparing the safety and effectiveness of different liposuction techniques for lipedema

INTRODUCTION

Lipedema is a relatively common, frequently misdiagnosed, chronic condition that is often treated using liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL) are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aimed to assess the efficacy and safety of liposuction in patients with lipedema.

METHODS

Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with post-operative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, and 2 articles used PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity.

RESULTS

A total of 2542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). TTL, PAL, and WAL led to significant improvements in pain reduction P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). However, WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for the studies that used TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%).

CONCLUSION

Liposuction techniques, including TTL, PAL, and WAL, resulted in significant symptom improvement in patients with lipedema with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. To the best of our knowledge, this is the first meta-analysis investigating liposuction data in lipedema treatment.

A retrospective comparative study of patient-reported outcome measures, pre-treatment and twelve months post-treatment using tumescent liposuction for the management of lower limb lipoedema

Background

Lipoedema is a painful adipose tissue disorder, affecting the limbs of women, that is resistant to diet and exercise. The purpose of the study was to evaluate the retrospective health-related quality-of-life (HRQoL) outcomes for patients with lower limb lipoedema (LLL) following tumescent liposuction (TL).

Methods

Forty-seven patients received TL over 5 years from 2015-2020 for LLL. As part of their routine treatment evaluation, each patient completed 4 validated HRQoL questionnaires at initial assessment. The questionnaires examined the patients' experiences relating to anxiety and depression, lower extremity function, appearance, and symptoms. The same questionnaires were posted to the patients after an average of 12 months post-procedure/s to establish the outcomes of the intervention.

Results

The study demonstrated that patients' HRQoL improved at 12 months (average) following TL. The results of all the questionnaires were statistically significant, and patients with stage 3 LLL showed the most improvement in outcomes.

Conclusion

The findings demonstrated that TL achieves positive HRQoL outcomes in patients with LLL; however, long-term follow-up is needed to determine if the benefits sustain. Additionally, larger prospective controlled studies are required to provide robust evidence for this procedure.

Micromassage Compression Leggings Associated with Physical Exercise: Pilot Study and Example of Evaluation of the Clinical and Instrumental Effectiveness of Conservative Treatment in Lipedema

We evaluated the effect of compression leggings with micromassage in association with physical activity on women with lipedema, not previously treated and without recent changes in body weight. The treatment resulted in an improvement in all subjective parameters, in spontaneous and evoked pain, in the volume of the limbs, in the absence of significant changes in body weight, and regardless of the duration of use, age, years of illness, the clinical stage, and body mass index (BMI). Evoked pain did not improve in areas affected by untreated lipedema; foot circumferences did not increase. We found a significant reduction in the thickness of subcutaneous adipose tissue (SAT) and skin evaluated in multiple points of the lower limb. Micromassage compression leggings are proposed as an integral part of conservative treatment. A method is proposed for the clinical evaluation of evoked pain, called the Progressive Pain Check (PPC), which allows for the calculation of a numerical score called the Ricolfi-Patton Score (RPS) and for the ultrasound evaluation of tissues. The method is simple and repeatable and allows for completion of the clinical evaluation of the patient at diagnosis and for an evaluation of the effects of various treatments, even applied to just one side of the body.

Liposuction as a Treatment for Lipedema: A Scoping Review

Background

Lipedema is the progressive symmetrical deposition of subcutaneous fat and fluid in the lower body, ordinarily sparing the trunk, upper limbs, face, and neck. It may follow an autosomal dominant inheritance pattern. The gold standard treatment for lipedema is complete decongestive therapy, consisting of manual lymphatic drainage and compression garments. This scoping review assessed the existing literature on the effectiveness of liposuction as an alternative treatment for lipedema.

Methods

A scoping review of electronically available literature within PubMed, Scopus, and Cochrane focused on liposuction as a treatment for lipedema considering the following inclusion criteria: human studies, case series of 10 or more, controlled trials, randomized controlled trials, patient-reported outcome measurement studies, survey analyses, descriptive studies, retrospective analyses, recurrence included, follow-up of 6 months or more, age 18 years or older, and treatment modality being liposuction.

Results

Thirteen studies were selected. Nine studies reported decreased compression therapy use among patients following liposuction. No studies reported a long-term increase in compression therapy following liposuction. Studies found self-reported improvements in pain, mobility, bruising, and overall quality of life for patients following liposuction, many of whom had previously been on compressive therapy. Studies reported low rates of serious adverse events following liposuction, including deep vein thrombosis, pulmonary embolism, and infection.

Conclusions

These results suggest that liposuction can be a viable treatment alternative to compression therapy for lipedema in patients whose compression therapy has not been helpful. However, there is not enough evidence to say whether liposuction is as effective as compression for patients first presenting with lipedema.

Development of New Predictive Equations for the Resting Metabolic Rate (RMR) of Women with Lipedema

This study aimed to develop a novel predictive equation for calculating resting metabolic rate (RMR) in women with lipedema. We recruited 119 women diagnosed with lipedema from the Angiology Outpatient Clinic at Wroclaw Medical University, Poland. RMR was assessed using indirect calorimetry, while body composition and anthropometric measurements were conducted using standardized protocols. Due to multicollinearity among predictors, classical multiple regression was deemed inadequate for developing the new equation. Therefore, we employed machine learning techniques, utilizing principal component analysis (PCA) for dimensionality reduction and predictor selection. Regression models, including support vector regression (SVR), random forest regression (RFR), and k-nearest neighbor (kNN) were evaluated in Python's scikit-learn framework, with hyperparameter tuning via GridSearchCV. Model performance was assessed through mean absolute percentage error (MAPE) and cross-validation, complemented by Bland-Altman plots for method comparison. A novel equation incorporating body composition parameters was developed, addressing a gap in accurate RMR prediction methods. By incorporating measurements of body circumference and body composition parameters alongside traditional predictors, the model's accuracy was improved. The segmented regression model outperformed others, achieving an MAPE of 10.78%. The proposed predictive equation for RMR offers a practical tool for personalized treatment planning in patients with lipedema.

National survey of patient symptoms and therapies among 707 women with a lipedema phenotype in the United States

BACKGROUND

National survey data exploring the patient experience with lipedema are lacking.

METHODS

We conducted national surveys from 2016 to 2022 of women with lipedema as well as female controls. Surveys collected information on symptomatology, pain, and therapies. We performed logistic regression comparing symptoms among those with lipedema versus controls adjusting for age and BMI.

RESULTS

A total of 707 women with lipedema and 216 controls completed the surveys. Those with lipedema had a mean age of 48.6 years and mean BMI of 40.9 kg/m2. Lipedema symptom onset occurred frequently at puberty (48.0%) or pregnancy (41.2%). Compared to controls, women with lipedema were more likely to report leg swelling in heat (odds ratio [OR], 66.82; 95% CI, 33.04-135.12; p < 0.0001), easy bruising (OR, 26.23; 95% CI, 15.58-44.17; p < 0.0001), altered gait (OR, 15.54; 95% CI, 7.58-31.96; p < 0.0001), flu-like symptoms (OR, 12.99; 95% CI, 4.27-39.49; p < 0.0001), joint hypermobility (OR, 12.88; 95% CI, 6.68-24.81; p < 0.0001), cool skin (OR, 12.21; 95% CI, 5.20-28.69; p < 0.0001), varicose veins (OR, 11.29; 95% CI, 6.71-18.99; p < 0.0001), and fatigue (OR, 9.59; 95% CI, 6.10-15.09; p < 0.0001). Additionally, 70.3% had upper arm involvement, 21.2% reported foot swelling, and 16.6% reported foot pain. Most (52.2%) reported no symptom improvement with diet or exercise. Common therapies used included compression therapy (45.0%), gastric bypass (15.7%), and lower-extremity liposuction (14.0%).

CONCLUSION

In a large, national, symptom survey, women with lipedema reported excess pain, swelling, and fat in the legs along with numerous symptoms beyond those classically described. Symptom responses to common therapies remain understudied.

Observational Study on a Large Italian Population with Lipedema: Biochemical and Hormonal Profile, Anatomical and Clinical Evaluation, Self-Reported History

We analyzed the medical condition of 360 women affected by lipedema of the lower limbs in stages 1, 2, and 3. The data were assessed for the whole population and compared between different clinical stages, distinguishing between obese and non-obese patients. The most frequent clinical signs were pain when pinching the skin, subcutaneous nodules, and patellar fat pads. The most frequently painful site of the lower limbs was the medial lower third of the thigh. The pain score obtained on lower limb points increased progressively with the clinical stage. In all points evaluated, the thickness of the subcutaneous tissue increased with the clinical stage. Analyzing the data on the lower medial third of the leg and considering only patients with type 3 lipedema, the difference between stages was statistically significant after correction for age and BMI. We found higher levels of C-reactive protein at more severe clinical stages, and the difference was significant after correction for age and BMI between the stages. Overall, the prevalence of alterations of glucose metabolism was 34%, with a progressive increase in prevalence with the clinical stage. The most frequent comorbidities were vitamin D insufficiency, chronic venous disease, allergies, dyslipidemia, headache, and depression of mood. Interestingly, in comparison with the general population, we found higher prevalence of chronic autoimmune thyroiditis and polycystic ovary syndrome. Finally, the clinical stage and the involvement of the upper limbs or obesity suggest a worse clinical, anthropometric, and endocrine-metabolic profile.

The value of sonographic microvascular imaging in the diagnosis of lipedema

BACKGROUND

Lipedema is a chronic disease marked by symmetric enlargement of painful nodular and fibrotic adipose tissue, predominantly affecting the limbs. Since there is no specific test or biomarker for this condition, years often pass before the diagnosis of lipedema is established for the first time, thereby causing psychosocial distress, including depression, eating disorders, and social isolation. Over the last few years several advanced Doppler-based technologies have been developed to visualize slow flow blood vessels and superficial microvascular architecture undetectable by traditional color Doppler flow imaging (CDFI).

OBJECTIVE

The aim of this study was to evaluate the superficial microvascular anatomy in lipedema patients compared to healthy controls and investigate the clinical significance of the Ultra Micro Angiography (UMA) technology in the diagnosis of lipedema. This new technique may contribute to reduce the diagnostic delay and, eventually, establish and guide treatment strategies toward a better therapeutic outcome in lipedema patients.

METHODS

25 patients with lipedema and ten healthy controls with no history of lipedema were included in this study. All ultrasound examinations were performed on a novel high-performance ultrasound system (Resona R9/Mindray) using CDFI and the UMA technique.

RESULTS

In all of the patients, Ultra Micro Angiography achieved the excellent visualization of microvascular structures, revealing that most lipedema patients showed grade 3 (n = 13) or grade 2 (n = 8) flow. UMA was superior to CDFI for depicting the microvascular structures.

CONCLUSIONS

Here we show that UMA imaging characterizes the subcutaneous microvasculature with an unprecedented accuracy. The method has the advantage of being sensitive to small, slow-flowing vessels. This allows for the assessment of the course of vessels and vascular pathologies in great detail. Thus, UMA as a non-invasive diagnostic method can improve diagnostic accuracy in lipedema.

Ketogenic Diet: A Nutritional Therapeutic Tool for Lipedema?

PURPOSE OF REVIEW

This review aims to provide an overview of the current evidence on the efficacy, also considering the anti-inflammatory properties and safety of very low-calorie ketogenic diet (VLCKD) as a potential treatment for lipedema, particularly in the context of obesity.

RECENT FINDINGS

Lipedema is a chronic disease characterized by abnormal and painful fat buildup on the legs and/or arms. It is often misdiagnosed as obesity or lymphedema. However, although lipedema and obesity can coexist, unlike obesity, lipedema usually affects the legs and thighs without affecting the feet or hands, and the abnormal deposition of adipose tissue in lipedema is painful. The current lifestyle interventions are often unsuccessful in the management of lipedema. There is no consensus on the most effective nutritional approach for managing lipedema. Recent studies have suggested that VLCKD may be an effective treatment for lipedema, demonstrating that it is also superior to other nutritional approaches such as Mediterranean diet or intermittent fasting. Lipedema is a chronic and debilitating disease characterized by abnormal and painful accumulation of adipose tissue in the legs. VLCKD has been shown to be an effective treatment for lipedema, especially in the context of obesity, due to its anti-inflammatory properties. However, further research is needed to determine the long-term safety and efficacy of VLCKD as a treatment for lipedema.

[Searching for Evidence: A Systematic Review of the Pathology of Lipoedema]

BACKGROUND

Lipoedema is a symmetrically localised, painful hypertrophy of subcutaneous adipose tissue in the extremities with marked disproportion to the trunk, and almost exclusively affects females. Despite being first described over 80 years ago, the aetiology and pathogenesis of the disease are largely unknown and are currently the subject of intensive research efforts.

METHODS

To summarise the current evidence-based literature on the cellular pathologies and aetiology of lipoedema, a PRISMA-based systematic review was conducted within the National Library of Medicine and Cochrane databases.

RESULTS

A total of 53 studies were identified and included in this review. The results were classified and summarised into categories.

CONCLUSION

Although there has been a significant increase in research activity and recent publication of extensive studies with a histological and molecular genetic focus, the fundamental aetiology and pathology of lipoedema remains largely unclear. The current data shows discrepancies across studies, particularly with regard to the "oedematous" component of lipoedema. The frequently present comorbidities "lymphoedema" and "obesity", primarily in advanced stages of lipoedema, complicate the diagnostic differentiation and clear definition of study cohorts in scientific research.

The Benefits of Low-Carbohydrate, High-Fat (LCHF) Diet on Body Composition, Leg Volume, and Pain in Women with Lipedema

This study aimed to assess the potential benefits of a low-carbohydrate, high-fat (LCHF) diet on body composition, leg volume, and pain reduction in women with lipedema compared to overweight or women with obesity. The study included 113 female participants, 56 with lipedema and 57 with overweight/obesity (BMI >25 kg/m2) without lipedema. All subjects were prescribed a low-carbohydrate, high-fat (LCHF) diet with anti-inflammatory properties to adhere to for a duration of 7 months. Measurements of anthropometry, body weight, composition, and pain (VAS) were conducted at the study's commencement and conclusion. 52 participants completed the study. Both groups experienced a similar weight reduction, amounting to 12.9% compared to the baseline (-10.8 kg vs. -11.9 kg; p = 0.14, for lipedema and women with overweight/obesity, respectively). The most reduction was in body fat mass. Improvements in various parameters were observed, except for ankle circumferences, which decreased more in the lipedema group. Lipedema participants showed significantly reduced pain levels following the LCHF diet (4.6 ± 2.6 vs 3.0 ± 2.3; p  <  0.001). The LCHF diet holds promise for weight loss, body fat reduction, leg volume management, and pain alleviation in women with lipedema. These findings provide valuable insights into potential therapeutic strategies for lipedema management.

Intracellular and Extracellular Water Balance in Patients with Lipedema

Background: The presence of edema in patients with lipedema has been investigated in many studies. However, no study has been found that examines the amount of intracellular (ICF) and extracellular fluid (ECF) in these patients together. The aim of this study is to examine the amount of ICF and ECF in patients with stage 2 lipedema. Methods and Results: Twenty-four patients diagnosed with stage 2 lipedema were included in the study. Bioimpedance spectroscopy was applied to measure extracellular and intracellular water levels. The mean age of the participants was 44.58 ± 2.95 years. The mean body mass index (BMI) of the participants was 33.9 ± 1.84 kg/m2. It was observed that the amount of ECF in the patients was above the normal values (p < 0.001), whereas the amount of ICF was within the normal range (p = 0.801). In addition, it was observed that there was a moderate relationship between BMI and the amount of ECF. Conclusion: Although the amount of ICF is within the normal range in patients with lipedema, an increase in ECF is observed. The reason why edema is not observed in these patients despite the increase in ECF may be the increase in glycosaminoglycan and proteoglycan synthesis. In addition, the attention of these patients to weight control may contribute to slowing the course of the disease by preventing the increase in the amount of ECF. For a better diagnosis of lipedema, it is considered important to evaluate the amount of ECF in addition to routine evaluations.

Assessment of lipoedema awareness among polish women- online survey study

BACKGROUND

Lipoedema is an adipose tissue disorder that is still not fully understood. The primary purpose of this study is to explore the state of knowledge and understanding of lipoedema among Polish women. The secondary aim is to investigate the possible association between knowledge and factors such as BMI, self-reported symptoms, and age.

METHODS

One hundred seventy polish women took part in an online survey study that was posted to social media groups and forums in January 2022. The survey consisted of 12 questions and aimed at assessing the basic knowledge about lipoedema.

RESULTS

The least proportion of participants (4%) could correctly indicate the methods of lipoedema treatment. The accurate definition of lipoedema was indicated only by 7% of women, 12% identified characteristic features of lipoedema, and 37% correctly evaluated lipoedema curability. The greatest proportion of respondents knew the differences between obesity and lipoedema (50%).

CONCLUSIONS

Awareness of lipoedema among women is deficient. A significant proportion of the respondents report the occurrence of lipoedema symptoms. In order to improve the situation of lipoedema patients, it is crucial to increase the knowledge about this condition both among medical professionals and the general public.

[Lipohyperplasia dolorosa : About facts and fiction, clinical presentation and examination]

Lipohyperplasia dolorosa, also known by the misnomer "lipedema", is a clinical picture first described more than 80 years ago, that in the last 25 years has received increasing attention in medical practices, but also lymphological discussion circles which are otherwise rare in the scientific community. Unfortunately, to put it casually, discussions in social media accelerate the amount of supposed knowledge, an unusual occurrence in the otherwise slow and cautious field of science. Media influences and considerable economic interests resharpen and focus the view, but thus also cloud many women's view of the disease. Combining clinical presentation and a simple clinical examination with a few palpatory findings results in a clear diagnosis that excludes differential diagnoses, in particular obesity. Therapy should only be offered once a precise diagnosis is made. Once the diagnosis is confirmed, it is irreversible and means a lifelong change to the patient's quality of life. Care is, therefore, as always, the first duty of the diagnostician.

[Lipedema pain-the neglected symptom]

Pain, which is a central characteristic of lipedema, allows differentiation from other fat tissue diseases. The analysis of the multiple aspects of pain beyond a quantification of pain scale scores could make molecular disease and therapy mechanisms accessible. Lipedema pain is causally linked to lipedema fat. First robust data show peripheral sensory changes. Tissue weight and systemic inflammation are becoming less likely as causes for the experianced pain. Furthermore, genetics and hormonal influences need to be investigated. Lipedema pain cannot currently be treated with drugs. Physical therapy shows transient relief. Liposuction has been shown to have a long-term effect on pain. The potential of modulating the perception of pain with psychotherapeutic approaches is emerging as a potentially effective new therapeutic approach.

YouTube as a Source of Information on Lipedema: Property, Quality, and Reliability Assessment

Background/Aim: YouTube provides information on several health-conditions including lipedema. The aim of this study was to investigate the properties, quality, and quantity of YouTube videos on lipedema. Methods: We explored YouTube using the key word lipedema and the initial top 50 videos were included to review. The properties comprising informers, target, and domains of videos covering number of views, likes, dislikes, duration, viewing rate (VR), and video power index (VPI) were recorded. A modified DISCERN tool and global quality scale (GQS) were used to assess the reliability and quality of videos, respectively. Results: The top 50 videos had a mean of 35,805 views, 282 likes, 12 dislikes, and 30 comments. The mean VPI (96.4) and VR (63.8%) were high. The videos were generally uploaded by health professionals for patient/public and health professional targets with the same ratio (50%). The majority of video contents was related to general information (68%) followed by surgical treatment (62%). Only a small ratio of their content (22%) was about nonsurgical management. The reliability and quality of the videos were intermediate to low. The median DISCERN and GQS scores were higher in the videos uploaded by health professional group compared with nonhealth professionals, but the number of views, VPI, and VR were similar between the groups with regard to the source. Conclusion: YouTube videos on lipedema are mostly provided by health professionals targeting both public/patients and health care providers but the content is limited and the quality and reliability of them were low to intermediate. Therefore, the lipedema specialists are suggested to work together to create up-to-date, high-quality, accessible online educational content to meet the needs of both patients/public and the health professionals. In addition, control mechanisms and careful peer reviewing of the videos informed by nonhealth professionals are warranted to avoid misleading information.

The Effect of a Low-Carbohydrate High-Fat Diet on Laboratory Parameters in Women with Lipedema in Comparison to Overweight/Obese Women

The aim of this study was to evaluate alterations in blood parameters after a low-carbohydrate high-fat (LCHF) diet in women with lipedema in comparison to overweight or obese women. A total of 115 women were classified into two groups: the lipedema group and the overweight/obesity group. Both study groups followed the caloric-restricted LCHF diet for 7 months. A total of 48 women completed the study. A reduction in body weight was observed in both study groups. A significant decrease in triglycerides and an increase in HDL-C concentrations were observed in both study groups. Despite the increase in the concentration of LDL-C observed in the lipedema group, changes in LDL-C differed between individual patients. Improvements in liver parameters, glucose tolerance, and a decrease in fasting insulin levels were observed, although they were less pronounced in the lipedema group than in the overweight/obesity group. Kidney and thyroid functions were similar before and after the LCHF diet in both groups. The LCHF diet may be a valuable nutritional strategy for lipedema and overweight/obese women, with a beneficial effect on weight, glucose profile, liver function, the concentration of triglycerides, and HDL-C and with no effect on kidney and thyroid function.

Differentiation of lipoedema from bilateral lower limb lymphoedema by imaging assessment of indocyanine green lymphography

Lipoedema is characterized by disproportionate painful fat accumulation mostly in the lower limbs. The presence of lymphoedema in lipoedema remains controversial. This study aimed to assess the presence or absence of lymphoedema in the lower limbs of women with lipoedema using indocyanine green (ICG) lymphography. A cross-sectional retrospective study was undertaken in women with a clinical diagnosis of lipoedema whose lower limbs were examined with ICG lymphography. MD Anderson Cancer Center (MDACC) ICG staging was used to determine lymphoedema presence and severity. Patient characteristics, ICG lymphography findings, Stemmer sign, body mass index, waist-to-hip ratio, limb volume and bioimpedance spectroscopy measures were recorded. Forty women with lipoedema underwent ICG lymphography for the lower limbs from January 2018 to July 2022. Thirty-four women (85.0%) were determined by ICG lymphography as MDACC ICG Stage 0 representing normal lymphatics. Of the six women who demonstrated dermal backflow on ICG lymphography, all were determined as ICG Stage 1, four had localized traumatic dermal backflow area at their ankles, one had previously diagnosed with primary lymphoedema and one was classified as lipoedema stage 4. ICG lymphography findings suggested the absence of lymphoedema in a clear majority of women with lower limb lipoedema.

Summary document on safety and recommendations on liposuction for lipoedema: Joint British association of aesthetic plastic surgeons (BAAPS)/British association of plastic reconstructive and aesthetic surgeons (BAPRAS) expert liposuction group

Liposuction plays an important role as a surgical treatment option for lipoedema. This article serves to critically review the evidence in the literature, as well as explain the differences between the lipoedema population compared with the aesthetic surgery population undergoing liposuction. It is not a comprehensive text on lipoedema management but serves to guide surgeons. This guidance was produced on behalf of the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) by the expert liposuction group. The guidance is based on the evidence available in the literature, along with a specialist expert opinion on liposuction for lipoedema, to provide plastic surgeons with a consensus recommendation for surgical treatment. The aim is to identify best practice to maximise the safety of patients. This article summarises current practices and safety considerations and outlines recommendations covering various aspects of patient care.

Functioning of People with Lipoedema According to All Domains of the International Classification of Functioning, Disability and Health: A Scoping Review

Lipoedema is a painful non-pitting diffuse "fatty" swelling, usually confined to the legs, that occurs mainly in women. This scoping review aimed to provide an overview of the available research on the functioning of people with lipoedema, according to the International Classification of Functioning, Disability and Health (ICF) framework. Relevant publications and gray literature were retrieved until October 2022. The results sections of each publication were organized using a thematic framework approach. All included studies reported at least one outcome fitting within the domains of body functions and body structures, with most studies focusing on the categories of "sensation of pain", "immunological system functions", and "weight maintenance functions". The ICF domains of activities and participation and environmental factors were mentioned in a small number of the included studies (17 and 13%, respectively), while the domain of personal factors was studied in half of the included studies. In conclusion, the emphasis of lipoedema research is on its description from a disorder-oriented point of view in the form of body functions and body structures, with a lack of information about the other domains of functioning.

The Usefulness of the Application of Compression Therapy among Lipedema Patients-Pilot Study

(1) Background: Although lipedema has gained more interest among researchers, specific treatment methods are still unknown. This study aims to identify the effects of compression therapy combined with exercises compared to exercising only. Moreover, the aim is to assess the methodology and outcome measurements before conducting a larger study. (2) Methods: Six women with lipedema were enrolled in the study; three were undergoing exercise program and compression therapy using compression leggings, and the remaining three were undergoing exercises only. During the first 4 weeks, intervention was under the supervision of a physiotherapist, and in the remaining weeks, participants were exercising independently. Measurements of circumference, weight, thickness of the skin and adipose tissue, symptom severity, and quality of life were taken at baseline, after 4 weeks and after 6 weeks; (3) Results: There was a significant decrease in the subjectively reported tendency for bruising and pain at palpation among patients that received compression therapy. Additionally, there was a tendency to reduce or maintain the circumference of the legs in patients using compression, while it tended to increase in patients without compression. (4) Conclusions: Preliminary results indicate that compression therapy, combined with exercises, could improve the quality of life and decrease the severity of lipedema symptoms. Further studies on a large clinical group are advisable.

Lipedema Research-Quo Vadis?

When studying the current literature, one might get the impression that lipedema is a "modern" disease, with increasing incidence and augmenting prevalence throughout Western countries during the last decade. However, a quick look into older textbooks shows that disproportionate accumulation of fat in female bodies has long been known without being recognized as an independent disease. Nevertheless, it was not until 1940 that Allen and Hines described a "syndrome characterized by fat legs and orthostatic edema" in a seminal publication. The mere awareness that people who have lipedema are not just overweight but suffer from a yet poorly defined pathological condition, may be considered a decisive leap forward in the understanding of lipedema. A number of comprehensive publications have since dealt with the clinical presentation of lipedema and have provided the first clues towards the potential pathological mechanisms underlying its initiation and progression. Nevertheless, despite all effort that has been undertaken to unravel lipedema pathology, many questions have remained unanswered. What can be deduced with certainty from all experimental and medical evidence available so far is that lipedema is neither a cosmetic problem nor is it a problem of lifestyle but should be accepted as a serious disease with yet undetermined genetic background, which makes women's lives unbearable from both a physical and psychological point of view. To date, results from clinical inspections have led to the categorization of various types and stages of lipedema, describing how the extremities are affected and evaluating its progression, as demonstrated by skin alterations, adipose tissue volume increase and physical and everyday-behavioral impediments. There is accumulating evidence showing that advanced stages of lipedema are usually accompanied by excessive weight or obesity. Thus, it is not unreasonable to assume that the progression of lipedema is largely driven by weight gain and the pathological alterations associated with it. Similarly, secondary lymphedema is frequently found in lipedema patients at advanced stages. Needless to say, both conditions considerably blur the clinical presentation of lipedema, making diagnosis difficult and scientific research challenging. The present literature review will focus on lipedema research, based on evidence fromex vivo and in vitro data, which has accumulated throughout the last few decades. We will also open the discussion as to whether the currently used categorization of lipedema stages is still sufficient and up-to-date for the accurate description of this enigmatic disease, whose name, strangely enough, does not match its pathologic correlate.

A Scoping Review of Available Tools in Measurement of the Effectiveness of Conservative Treatment in Lipoedema

(1) Background: Due to insufficient knowledge of lipoedema, the treatment of this disease is undoubtedly challenging. However, more and more researchers attempt to incorporate the most effective lipoedema treatment methods. When assessing a new therapeutic method, choosing correct, objective tools to measure the therapeutic outcome is very important. This article aims to present possible instruments that may be used in the evaluation of therapeutic effects in patients with lipoedema. (2) Methods: The data on therapeutic outcome measurements in lipoedema were selected in February 2022, using the Medical University of Gdansk Main Library multi-search engine. (3) Results: In total, 10 papers on this topic have been identified according to inclusion criteria. The tools evaluating the therapeutic outcomes used in the selected studies were: volume and circumference measurement, body mass index, waist-to-hip ratio, ultrasonography and various scales measuring the quality of life, the level of experiencing pain, the severity of symptoms, functional lower extremity scales, and a 6 min walk test. (4) Conclusion: The tools currently used in evaluating the effectiveness of conservative treatment in women with lipoedema are: volume and circumference measurement, waist-to-hip ratio, body fat percentage, ultrasonography, VAS scale, quality of life scales (SF-36, RAND-36), symptom severity questionnaire (QuASiL), Lower Extremity Functional Scale and 6 min walk. Choosing a proper tool to measure the treatment outcome is essential to objectively rate the effectiveness of therapeutic method.

Management of Lipedema with Ketogenic Diet: 22-Month Follow-Up

Lipedema is a pathology of adipose tissue, still of unclear etiology and challenging to diagnose. For these reasons, a therapeutic approach is also complex and sometimes controversial. The inflammation state present in lipedema can be limited by controlling the glycemic peaks. Specifically, the ketogenic diet (KD) seems to have the right conditions to be effective. Herein, we reported a subject diagnosed with lipedema who, with only KD nutritional intervention, achieved a significant weight loss (-41 Kg), with a net decrease in body circumferences, and also reporting an improvement in pain, and therefore in the overall quality of life. She refused other types of intervention and kept KD for two years. This case could represent the first step to organize a KD nutritional protocol specifically applied to lipedema.

Physical Therapy in Women with Early Stage Lipedema: Potential Impact of Multimodal Manual Therapy, Compression, Exercise, and Education Interventions

Background: Lipedema is a distinct adipose disorder from obesity necessitating awareness as well as different management approaches to address pain and optimize quality of life (QoL). The purpose of this proof-of-principle study is to evaluate the therapeutic potential of physical therapy interventions in women with lipedema. Methods and Results: Participants with Stage 1-2 lipedema and early Stage 0-1 lymphedema (n = 5, age = 38.4 ± 13.4 years, body mass index = 27.2 ± 4.3 kg/m²) underwent nine visits of physical therapy in 6 weeks for management of symptoms impacting functional mobility and QoL. Pre- and post-therapy, participants were scanned with 3 Tesla sodium and water magnetic resonance imaging (MRI), underwent biophysical measurements, and completed questionnaires measuring function and QoL (patient-specific functional scale, PSFS, and RAND-36). Pain was measured at each visit using the 0-10 visual analog scale (VAS). Treatment effect was calculated for all study variables. The primary symptomatology measures of pain and function revealed clinically significant post-treatment improvements and large treatment effects (Cohen's d for pain VAS = -2.5 and PSFS = 4.4). The primary sodium MRI measures, leg skin sodium, and subcutaneous adipose tissue (SAT) sodium, reduced following treatment and revealed large treatment effects (Cohen's d for skin sodium = -1.2 and SAT sodium = -0.9). Conclusions: This proof-of-principle study provides support that persons with lipedema can benefit from physical therapy to manage characteristic symptoms of leg pain and improve QoL. Objective MRI measurement of reduced tissue sodium in the skin and SAT regions indicates reduced inflammation in the treated limbs. Further research is warranted to optimize the conservative therapy approach in lipedema, a condition for which curative and disease-modifying treatments are unavailable.

Lipoedema as a Social Problem. A Scoping Review

(1) Background: Lipoedema is a disease characterized by excessive bilateral and symmetrical accumulation of subcutaneous tissue in the lower extremities. It is a poorly understood condition, and low awareness of its existence often leads to incorrect diagnosis Initially, lipoedema was considered to be completely independent of lifestyle Currently, however, more and more cases of the coexistence of lipoedema and obesity are described in the literature as additionally affecting the severity of the disease The aim of the review is to present lipoedema as a social problem. (2) Methods: Materials on lipoedema in the social context were selected from 2018-2021. The PRISMA-Scr checklist was used in the review. (3) Results: Research has shown that more than 3/4 of patients with lipoedema are also overweight or obese. Patients with lipoedema have many comorbidities, and their presence negatively affects the quality of life. The quality of life in patients with lipoedema is lower than in healthy patients. (4) Conclusions: The number of studies available on lipoedema is low. Obesity is common in patients with lipoedema. Mental disorders increase the level of experienced pain. Lipoedema significantly reduces quality of life. A healthy lifestyle in patients with lipoedema could be helpful for prevention of complications and disability.