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Lipoedema (lipalgia) is a condition that is often underdiagnosed or misdiagnosed as obesity or lymphoedema, which can result in mismanagement of treatment leading to poor mental and physical outcomes. It is a condition that is predominately seen in those assigned female at birth and rarely identified at an early age. Inconsistencies regarding criteria used for diagnosis and staging has led to challenges in the reliability of treatment options available for people with the condition. Poor diagnosis can substantially impact on a person's quality of life in terms of mental health, physical health and finances. Lipoedema has different stages and classifications according to visual characteristics. Recommended developments of practice include the setting up of a diagnostic criteria to identify key symptoms of lipoedema, which can help practitioners consider effective treatment options alongside diet, exercise, compression therapy and skin care as part of the overall treatment plan.

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

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

BackgroundTo evaluate kinesiophobia and its relationship with disease-related characteristics and quality of life in lipedema patients.MethodsIn this descriptive case-control study, 40 lipedema patients and 40 participants in the control group were included. All participants were evaluated in terms of body mass index (BMI), pain numeric rating scale (NRS) and pain threshold (PT) scores, kinesiophobia (Tampa Scale for Kinesiophobia - TSK), lower extremity functional scores (Lower Extremity Functional Scale - LEFS), and health-related quality of life (Nottingham Health Profile - NHP) scores. Additionally, the lipedema patients were evaluated in terms of extremity volumes, and total and mean lower extremity fat mass by dual-energy X-ray absorptiometry.ResultsHigh kinesiophobia was detected in 78% of the lipedema patients and 55% of the control group (p = .033). TSK (p = .048), NRS (p = .001), and NHP total scores (p = .041) were higher and PT scores (p = .007) were lower in lipedema patients compared to the control group. No difference was found between lipedema patients with high and low kinesiophobia in terms of fat mass or extremity volumes. A positive correlation was found between TSK score, NHP total score (r = 0.356, p = .024), NHP physical activity (ρ = 0.403, p = .010) and NHP energy (ρ = 0.436, p = .005) subscale scores.ConclusionKinesiophobia is highly prevalent in lipedema patients, regardless of disease-related data and affecting the quality of life of the patients, negatively.

Lipedema is a chronic adipose tissue disorder traditionally considered to affect almost exclusively women, with recent estimates suggesting approximately 0.2% prevalence in men worldwide; the condition remains underdiagnosed in males due to limited awareness and scarce literature. This retrospective case series from the Amato Institute of Advanced Medicine in São Paulo, Brazil, describes clinical characteristics, diagnostic findings, and treatment outcomes of five male patients diagnosed with lipedema between January 2022 and December 2024. The patients, aged 31-58 years (mean, 42.6 ± 9.7), with a BMI of 29-42.4 kg/m², all presented bilateral, symmetrical lower extremity fat accumulation, sparing the feet, with endocrine comorbidities present in 80% of cases and one participant testing positive for HLA-DQ2/DQ8. Diagnosis was based on clinical criteria requiring bilateral symmetrical fat accumulation, disproportionate fat distribution, negative Stemmer’s sign, sparing of feet, and at least two minor criteria. Conservative management, including dietary interventions over four to eight weeks, resulted in mean weight reduction of 7.0 ± 2.2 kg and lower limb volume reduction of 2.5 ± 1.1 L. These findings demonstrate that lipedema occurs in men with classical phenotypic features, and the presence of HLA-DQ2/DQ8 markers in some cases suggests potential autoimmune components and opportunities for targeted dietary interventions. Conservative management yields significant short-term improvements, warranting larger prospective studies to establish prevalence, investigate HLA associations, and optimize management strategies for male lipedema.

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

BACKGROUND: Lipedema is a chronic, progressive and underdiagnosed condition characterized by bilateral, disproportionate and painful subcutaneous fat accumulation in extremities. Key symptoms include pain, heaviness and easy bruising. Surgical treatment, particularly liposuction, has shown excellent outcomes in symptom reduction and quality of life improvement. This study evaluates clinical outcomes in symptoms and aesthetic self-perception improvements in patients treated with selective combined liposuction (SCL). PATIENTS AND METHODS: A retrospective review of 126 female patients who underwent surgical treatment over a four-year period was performed. Selective tumescent liposuction combining power-assisted liposuction (PAL) with VASER (ultrasound-assisted liposuction) for proximal areas, especially the thighs. Demographic and clinical data, including BMI, medical history and comorbidities were analyzed. Symptoms such as pain, heaviness and edema, and body image perception were assessed preoperatively and six months postoperatively with a structured questionnaire. RESULTS: The mean patient age was 39 years, with a mean BMI of 27.2. The mean aspirated volume was 3270 mL per procedure. In 25.4% of the cases (n=32), a second procedure was required, with an average total aspirated volume of 5150 mL. Significant symptom improvement was observed: 89% reported reduced pain, 92% reduced heaviness, 82% reduced edema. Mobility limitations improved in 91% of patients, while 60% reported enhanced aesthetic perception of their extremities. Additionally, 68% of patients expanded their wardrobe postoperatively. CONCLUSIONS: Selective combined liposuction is a safe and highly effective technique for lipedema treatment, providing substantial symptom relief, improved body aesthetic self-perception, which leads to an improvement in the quality of life.

Background Lipedema often remains undiagnosed in patients with obesity, leading to mismanagement of treatment. Because of this, despite remarkable weight loss after bariatric surgery and decreases in hip and abdomen circumference, some patients show only small decreases in the circumference of the extremities and report persistent limb pain. We present the first scoping review to systematically explore the reported patient characteristics, clinical outcomes, and diagnostic challenges of lipedema in patients undergoing metabolic bariatric surgery, to identify gaps in current practice and promote earlier diagnosis and tailored treatment. Methods A search in PubMed, Embase, Medline, and Cochrane was conducted, from inception to December 19th, 2023. We consider as inclusion criteria original articles, case reports, and case series of lipedema after metabolic bariatric surgery. Results Among the included studies, a total of 49 patients were reported, and all were female. The mean age of cases was 42.43 (range 24–63) years old, and the mean BMI was 49.92 kg/m2. In the majority of the included patients, a sleeve gastrectomy was performed (25 patients, 51%), Roux-en-Y in 22 patients (45%), and One anastomosis Gastric Bypass in 2 (4%). Forty-eight patients had lipedema diagnosed after bariatric surgery. The mean excess weight loss was 70.93%, and the mean total weight loss was 36%. The mean pain score increased after surgery with 7.92 compared to 7.30 before surgery. Conclusion Recognizing the presence of lipedema in females experiencing extremity pain and disproportionate fat distribution is crucial. Bariatric surgery alone does not appear to significantly improve lipedema-related symptoms, based on currently available evidence, and even significant excess weight loss of more than 70% often fails to alleviate its associated pain.

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

Lipoedema is a disease that affects women and is characterised by an abnormal accumulation of fatty tissue, with pain and a feeling of heaviness in the lower limbs. Approximately 30 % of patients also have involvement of the upper limbs. The cause of lipoedema is unknown, but familial clustering of the condition suggests an underlying genetic cause. Oestrogen and hormonal changes appear to be involved, as the condition occurs predominantly in women and is linked to hormonal fluctuations. In Norway, women with lipoedema have had limited access to treatment within the public health service, and the condition is relatively unknown among Norwegian healthcare personnel. Internationally, the diagnosis and treatment of lipoedema are largely based on consensus, as there is a lack of definitive scientific evidence in relation to pathophysiology and treatment. This clinical review presents lipoedema diagnostics and treatment based on clinical experience and international published consensus statements.

Lipedema, a chronic and progressive adipose tissue disorder, is characterized by disproportionate fat accumulation, primarily in the lower extremities, often leading to pain, bruising, and mobility impairment. Despite its significant prevalence and impact on quality of life, diagnosis remains challenging, frequently relying on clinical examination and patient history. Ultrasonography holds promise as a non-invasive diagnostic tool, offering insights into subcutaneous tissue characteristics. However, developing a standardized qualitative ultrasonographic classification for lipedema presents considerable challenges due to the heterogeneous nature of fat tissue, variability in disease presentation, and the subjective interpretation inherent in qualitative assessments. This article reviews the current diagnostic landscape of lipedema, explores the potential and limitations of ultrasonography, and critically examines the complexities involved in establishing a robust qualitative ultrasonographic classification. By outlining these challenges, we aim to guide future research towards more objective and standardized imaging criteria, ultimately improving the accuracy and consistency of lipedema diagnosis.

This study investigates long-term volume reduction after microsurgical autologous lymphatic vessel transplantation (LVT) in patients with chronic lymphoedema. Lymphoedema is caused by inadequate lymphatic drainage and leads to swelling, pain, and a reduced quality of life. Conservative treatments often show only limited success, which is why surgical procedures such as LVT are increasingly gaining in importance. In a retrospective long-term analysis, patients who underwent LVT between 1988 and 2010 were examined on average 21.7 years after surgery. The examination included pre- and post-operative volume measurements, which were supplemented by modern 3D body scanner analyses and lymphoscintigraphy. The results show a significant volume reduction both in the short term (p < 0.01) and at the follow-up examination (p = 0.04). There was no significant difference between manual volumetry with circumferential measurements and 3D volumetry (p = 0.775). The improvement in lymph transport capacity was considerable (p = 0.078). This study provides valuable insights for the further development of lymphatic surgery. While preferred surgical methods change over time, this study demonstrates that LVT can make a decisive contribution to improving the quality of life of lymphedema patients.

Background/Objectives: Gender bias in healthcare remains a persistent challenge, partly due to gaps in gender-related knowledge among professionals. While existing instruments assess gender sensitivity and gender-role ideology, there is a lack of generalizable tools specifically designed to evaluate gender-related health knowledge. This study aimed to develop and validate the Gender Knowledge Scale in a sample of 591 nursing students from the University of the Basque Country (Spain). Methods: The 10-item multiple-choice instrument was created using the Nominal Group Technique with a multidisciplinary panel of experts. Results: Psychometric analyses supported a unidimensional structure with acceptable fit indices (CFI = 0.928, RMSEA = 0.025), and items displayed a diverse range of difficulty levels. Knowledge scores were moderately correlated with gender sensitivity but not with gender-role ideology, suggesting that knowledge may influence attitudes but is insufficient to challenge entrenched stereotypes. Knowledge differences emerged across academic years, though not by gender. Misconceptions, particularly regarding menstruation, cardiovascular risk, and pain, were prevalent. Conclusions: The Gender Knowledge Scale is a practical and psychometrically sound tool for assessing gender-related health knowledge among nursing students. While further validation is needed in other populations, the scale may support educational interventions aimed at reducing gender bias in clinical care.

INTRODUCTION: Lipedema is a chronic and progressive disease that predominantly affects women, characterized by a disproportionate increase in subcutaneous adipose tissue (AT), particularly in the lower limbs. It is associated with significant physical disability, chronic pain, thromboembolism, and psychosocial distress. Despite its profound impact on women's health and quality of life, lipedema remains underrecognized and insufficiently studied, with an estimated prevalence of approximately 10% among women worldwide. Although the exact etiology of lipedema remains unclear, emerging evidence suggests a multifactorial origin involving genetic predisposition, hormonal influences, and vascular dysfunction-all contributing to its development and progression. Current therapeutic options provide only partial symptom relief and remain noncurative, highlighting the urgent need for expanded research and improved management strategies. METHODS: A systematic review was conducted to assess the current understanding of lipedema pathophysiology and current treatment options. Research articles were sourced from PubMed, Web of Science, ScienceDirect, and Scopus databases. Over 100 studies were incorporated. RESULTS: This review provides a comprehensive overview of lipedema, encompassing its clinical features, pathophysiological mechanisms, diagnostic challenges, and current treatment modalities. Additionally, the review discusses whether the molecular and metabolic differences between abdominal and femoral AT depots mirror those observed in classical obesity. CONCLUSIONS: Multidisciplinary, research-informed care is essential for managing lipedema, combining conservative therapies, tailored exercise, and liposuction for advanced cases. More research to better understand the underlying pathophysiology is critical to developing targeted treatments, improving diagnostic accuracy, and informing standardized, evidence-based care.

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.

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

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

Aims Lipedema is a condition often mistaken for other causes of limb swelling including lymphedema and obesity. Lipedema may have a unique metabolic profile. Interrogation of the metabolome is a strategy that could reveal unique biomarkers to distinguish lipedema from lymphedema and obesity. Methods Unbiased metabolomics was utilized to examine 38 BMI-matched overweight patients compared with patients with lipedema, lymphedema, and lipolymphedema. Machine learning identified biomarkers to distinguish diseases, and further examined in a validation cohort of 198 patients with each disorders. Adjustments were made for baseline clinical and demographic variables. Results Plasma metabolomics firstly revealed uric acid as a biomarker that performs well to distinguish between phenotypically similar diseases in patients with elevated BMI. In a validation cohort of 64 patients with lipedema, uric acid (5.05 mg/dL) was compared with 64 patients with lymphedema (5.4 mg/dl), and 70 overweight patients without these conditions (4.6 mg/dL, p<0.05). Uric acid-to-cystatin c ratio distinguished between all three groups (Lipedema: 5.2; Lymphedema: 6.3; overweight: 4.0, p<0.01); however, significance was lost after adjustment for renal function. Conclusion Metabolomic analysis revealed uric acid may differentiate between lipedema, lymphedema, lipolymphedema and obese individuals without those conditions. In a validation cohort, while uric acid was higher in lipedema and lymphedema, uric acid adjusted by cystatin c clearance revealed uric acid to be a less useful marker to distinguish lipedema from lymphedema in the context of renal insufficiency.