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

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

Lipoedema is a chronic and painful fat disorder that occurs almost exclusively in women. It mainly affects the legs and sometimes the arms. The condition not only causes physical complaints but also has a major impact on daily functioning and quality of life. Despite this, lipoedema is still poorly understood and appropriate care is often lacking. In this dissertation, we reviewed the existing literature on the functioning of people with lipoedema. In addition, we explored how they experience living with the condition, the challenges they face in managing it, and how healthcare professionals can provide better support. The studies show that lipoedema is more than meets the eye. Earlier research mainly focused on the physical aspects, while psychosocial issues such as shame, stigmatisation, and reduced social participation are equally important. Participants emphasised the need for personal guidance, access to specialised care, and reliable, evidence-based information. To address these needs, we developed a new self-management intervention: SELF-MANAGING your lipoedema. This programme helps people cope more effectively with their condition, take control of daily life, and set achievable goals together with their healthcare professionals. This dissertation highlights that good care for people with lipoedema must go beyond symptom management. A holistic approach is needed, alongside better knowledge and training for healthcare professionals, and policies that promote collaboration across disciplines. Such improvements can truly enhance the quality of life of those living with lipoedema.

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

Dr. Allen and Dr. Hines pioneered and first described lipedema in the 1940s, a common subcutaneous adipose tissue disorder characterized by enlargement of both lower extremities. Lipedema is not edema; it is a genetically determined disturbance in adipose tissue mass and adipose tissue distribution. In 1951 a second seminal paper provided more description of lipedema. Fat distribution involves the lower extremities, upper arms, hips, buttocks, thighs, sparing trunks, and feet. Lower extremities are characterized by pain, easy bruisability, firm subcutaneous nodules of adipose tissue, and resistance of fat to traditional diet and exercise.

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.

Liposuction has been shown to be a safe and effective alternative in patients with lipedema. It positively impacts clinical and patient-reported outcomes.

This study addresses the diagnostic challenges of identifying lymphoedema in patients with lipoedema using lymphoscintigraphy. Overdiagnosis of lymphoedema in this patient population is frequent and may result in reduced proposed surgical interventions. We retrospectively analyzed clinical data from …

<span><b>Background:</b> Lipedema is a subcutaneous adipose tissue disorder mainly affecting women. Its progressive nature often requires high-volume liposuction for efficient pain reduction. However, aspiration volumes of more than 5 L within a single session may lead to a variety of complications. Thus,</span> …

This study explored experienced weight stigma, internalised weight bias and depressive symptom severity in lipoedema, a chronic health condition that primarily affects women and involves painful and disproportionate adipose tissue. This study utilised an international cross-sectional online survey i …

Diabetes mellitus (DM) affects 537 million people as of 2021, and is projected to rise to 783 million by 2045. This positions DM as the ninth leading cause of death globally. Among DM patients, cardiovascular disease (CVD) is the primary cause of morbidity and mortality. Notably, the prevalence rate …

Lipedema is a lipodystrophic disease that is typically characterized by a marked increase in lower-body subcutaneous adipose tissue that is purported to have increased inflammation and fibrosis, impaired microvascular/lymphatic circulation and to be resistant to reduction by weight loss therapy. However, these outcomes have not been adequately studied. We evaluated body composition, insulin sensitivity, metabolic health and adipose tissue biology in women with obesity and lipedema (Obese-LIP) before and after moderate (~9%) diet-induced weight loss. At baseline, people with Obese-LIP had ~23% greater leg fat mass, ~11% lower android-to-gynoid ratio and ~48% greater insulin sensitivity (all P&lt;0.05) than women matched on age, BMI and whole-body adiposity. In Obese-LIP, macrophage content and expression of genes involved in inflammation and fibrosis were greater, whereas lymph/angiogenesis-related genes were lower in thigh than abdominal subcutaneous adipose tissue. Weight loss improved insulin sensitivity and decreased total fat mass, with similar relative reductions in abdominal and leg fat masses, but without changes in markers of inflammation and fibrosis. These results demonstrate that affected adipose tissue in women with lipedema is characterized by increased inflammation and fibrogenesis, and alterations in lymphatic and vascular biology. Moderate diet-induced weight loss improves metabolic function and decreases lower-body adipose tissue mass.

<p>The average values of CR-PCSS (T1), CR-PCSS (T2) and CR-PCSS (T3) over all participants were 2.22±0.82, 1.18±0.77, and 0.84±0.77, respectively, which corresponded to the skin improvement between T1 and T2 of 0.93±0.27 (p < 0.0001) as well as between T1 and T3 of 1.38±0.47 (p < 0.0001). Assessm</p> …

Routine cold-water immersion (CWI) is typically suggested to reduce inflammation, a hallmark property of lipedema. Lipedema is a connective tissue disorder with a genetic component that presents with a disproportionate distribution of nodules in the extremities. This case report explores the impact …

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.

We were able to reduce the rate of postoperative complications to 3.07% in the Lymphological Liposculpture™ regime for the surgical treatment of LiDo. In their meta-analysis on liposuction, Kanapathy et al. reported an overall incidence of major surgical complications of 3.35%. The overall incidence …

This case report explores the use of radio electric asymmetric conveyor (REAC) technology for chronic pain management, functional limitations, and metabolic dysfunction in a 67-year-old female with rheumatoid arthritis, advanced lipedema, and ...

BACKGROUND: Ketosis seems to attenuate, or prevent, the rise in both ghrelin concentrations and subjective hunger ratings that follow weight loss. However, most of the previous studies have employed very-low energy diets (VLED) and are therefore limited in terms of generalizability. OBJECTIVES: To compare changes in ghrelin plasma concentrations after a low-carbohydrate (LCD) versus an isocaloric low-fat low energy diet (LED) in females with lipedema. Secondary objectives were to determine potential differences between diets in changes in satiety hormones, and subjective ratings of appetite. METHODS: Females with obesity and lipedema were randomized to either an LCD (75 g carbohydrates) or low-fat diet (180 g carbohydrates) for 8 weeks. Plasma concentrations of ghrelin, peptide YY, cholecystokinin (CCK), and glucagon-like peptide 1 (GLP-1), and subjective ratings of appetite were measured in the fasting and postprandial states, pre and post intervention. RESULTS: 55 females (30 in LCD) were included (age 47.9 ± 11.3 years, BMI 36.8 ± 5.1 kg/m2). Both LCD and low-fat groups lost weight (10.3 %, P < 0.001 and 7.3 %, P < 0.001, respectively), but the LCD lost significantly more. No within or between groups differences were found for ghrelin in the fasting state. A reduction in postprandial (tAUC) ghrelin was seen only in the LCD group (P = 0.002), and this change was significantly different from the low-fat group (P = 0.046). The LCD group also reported an increase in postprandial (both iAUC and tAUC) fullness ratings (P = 0.035 and P = 0.005, respectively), but this was not significantly different from the low-fat group (P = 0.703 and P = 0.365, respectively), despite the latter experiencing no change (P = 0.127 and P = 0.152, respectively). Conversely, only the low-fat group reported increased hunger in fasting (P = 0.046), but changes were not significantly different from the LCD group (P = 0.711). A decrease in postprandial (both tAUC and iAUC) CCK was observed in both LCD and low-fat diet groups (P ≤ 0.005 for all). CONCLUSION: Despite no changes in fasting ghrelin concentrations in either of the diet groups, a reduction in postprandial ghrelin and increased fullness was seen in the LCD group. These favorable changes in appetite in the LCD group might have contributed to the greater weight loss observed in this group. CLINICAL TRIAL REGISTRATION: NCT04632810, Effect of Ketosis on Pain and Quality of Life in Patients With Lipedema (Lipodiet).

Lymphoedema and lipoedema can present similarly however have different aetiologies and should be considered as distinct clinical entities. Pain is a distinguishing feature of lipoedema. Liposuction can be used in both conditions to reduce bulk and enhance quality of life. Analgesia requirements for …