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

Rare adipose disorders are abnormal subcutaneous adipose tissue diseases that present as a spectrum of soft tissue abnormalities that may be encountered by plastic surgeons. Presentation ranges from distinct subcutaneous masses in characteristic distributions in the body to large generalized fatty deposits. It is imperative to recognize these rare adipose disorders, as they are typically refractory to standard treatment approaches to obesity, such as weight loss, lifestyle modifications, pharmacologic therapy, and bariatric surgery. In this review, we provide a complete and updated review of lipedema, Madelung disease, familial multiple lipomatosis, and Dercum’s disease as well as present a case series highlighting our surgical approach to rare adipose disorders.

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

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

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

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

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

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

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

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

The aim of this study was to compare serum adiponectin, leptin, resistin, irisin, and galectin-3 levels between patients with lipedema and healthy controls, and to examine their relationship with subcutaneous adipose tissue thickness.

Lipedema is a chronic adipose tissue disorder characterized by pain and disproportionate fat distribution. Although exercise is an important component of lipedema management, evidence regarding exercise behavior, physical activity, and related barriers remains limited. This study aimed to investigate exercise behavior, physical activity level, and perceived barriers in women with lipedema compared to healthy controls.

Background: The clinical course of lipedema in women receiving hormonal treatment for concomitant estrogen-dependent gynecological disorders remains insufficiently characterized. This study aimed to describe gynecological and lipedema-related manifestations during routine follow-up in women receiving subcutaneous gestrinone implants for gynecological indications. Methods: This retrospective, descriptive case series included 50 women with stage II or III lipedema and concomitant estrogen-dependent gynecological disorders treated between May 2024 and May 2025 at a specialized multidisciplinary outpatient clinic in São Paulo, Brazil. Participants received two biodegradable subcutaneous gestrinone implants (35 mg and 50 mg; total dose: 85 mg) exclusively for gynecological indications. Clinical outcomes were extracted retrospectively from medical records and analyzed descriptively. Improvement proportions were calculated using the number of patients presenting each manifestation at baseline as the denominator. Outcomes were based on patient reports and qualitative clinical assessments without standardized instruments. Results: Among gynecological manifestations, improvement was documented in 43 of 50 patients with menstrual pain (86%), six of 13 with menorrhagia (46.2%), and two of 50 with premenstrual symptoms (4%). Among lipedema-related manifestations, improvement was documented in 35 of 39 patients with edema (89.7%) and 33 of 41 with spontaneous pain (80.5%). Qualitative improvement in skin appearance and clinically assessed tissue fibrosis was documented in 31 of 50 (62%) and 28 of 50 (56%) patients, respectively. Overall clinical status was reported as improved by 42 patients (84%), stable by six (12%), and worsened by two (4%). Conclusions: Improvements in pain and edema, alongside qualitative changes in skin appearance and clinically assessed tissue fibrosis, were documented during routine follow-up. Given the retrospective design, absence of a comparison group, and nonstandardized assessments, these observations cannot be attributed to gestrinone or interpreted as evidence of its efficacy for lipedema. Prospective controlled studies using standardized outcome measures are warranted.

Lipedema is a chronic fibro-adipose disorder associated with pain, disproportionate limb enlargement, functional limitation, and impaired quality of life. Surgery has shifted toward technology-assisted approaches, but interpretation across platforms remains limited by inconsistent terminology, diagnostic criteria, outcome reporting, treatment-course definitions, and stage stratification. This review mapped reported outcomes across technology-assisted surgical platforms, emphasizing stage patterns, treatment burden, volume-related outcomes, complications, and lymphatic-related reporting.

To comprehensively characterize pain in women with lipedema and evaluate its relationship with central sensitization, neuropathic pain characteristics, pain sensitivity, sleep quality, and quality of life.: A cross-sectional controlled study.Department of Physical Medicine and Rehabilitation, Ankara Bilkent City Hospital.59 women with Type 2–3, Stage 1–3 lipedema and 59 age-matched healthy controls.Pain intensity, neuropathic pain characteristics, symptoms related to central sensitization, pain catastrophizing, sleep quality, health-related quality of life, and pressure pain thresholds were assessed using validated questionnaires and pressure algometry.Compared with healthy controls, women with lipedema had significantly higher pain intensity, painDETECT, Central Sensitization Inventory, pain catastrophizing, and sleep disturbance scores, whereas pressure pain thresholds and all Short Form-36 domain scores were significantly lower (all p < 0.001). Clinically significant symptoms related to central sensitization (Central Sensitization Inventory ≥40) were present in 78.0% of patients versus 8.5% of controls. These associations remained significant after adjustment for age and body mass index. Although pain intensity, painDETECT scores, and pressure pain thresholds were associated with disease stage, Central Sensitization Inventory scores were not.Pain in lipedema extends beyond local adipose tissue changes and is associated with widespread pain sensitivity, symptoms related to central sensitization, impaired sleep, pain catastrophizing, and reduced quality of life. These findings support a multidimensional approach to pain assessment in lipedema.

This cross-sectional and descriptive study was conducted with 395 women to assess lipedema awareness, lipedema symptom levels, and the screening probability of lipedema. Data were collected using an Introduction Form, and the Questionnaire and Screening Model for Lipedema. The mean score on the lipedema screening questionnaire was 6.05 ± 4.58. It was determined that 15.4% of women had a high probability of developing lipedema. We found that participants demonstrated awareness regarding lipedema and that sociodemographic characteristics were associated with lipedema risk.