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

Lipedema is a chronic, progressive, and often underdiagnosed disease characterized by the pathological, bilateral, and symmetrical accumulation of adipose tissue. This distribution results in disproportionate and painful swelling of the limbs. Typically extending distally from the hips, this predominantly female condition is frequently misidentified as lifestyle-induced obesity or bilateral lymphedema. This review aims to provide a comprehensive overview of the current understanding of structural and functional abnormalities in myocardial dimensions, mechanics, valves, and major arteries in patients with lipedema. According to the existing literature, left atrial enlargement, left ventricular rotational abnormalities, mitral annular dilation, and increased aortic stiffness have been identified in patients with lipedema. These findings suggest latent but significant alterations in left heart physiology. Although current data remain limited and are primarily focused on the left heart and the aorta, the rapid evolution of cardiac imaging technologies suggests that both clinical knowledge and the body of research in this field are poised for significant expansion.

Lipedema is a chronic disorder characterized by the abnormal and disproportionate accumulation of painful subcutaneous adipose fat, primarily affecting the lower limbs and occurring almost exclusively in women. The aim of this controlled cross-sectional study was to compare body image, psychological distress, and psychological well-being in women with (n = 77) and without lipedema (n = 32). Psychological functioning was assessed using validated measures of depressive symptoms (PHQ-9), eating attitudes (EAT-26), perceived stress (PSS), medically unexplained symptoms (M.U.S.), psychological well-being (WHO-5), life satisfaction (SWLS), psychological flexibility (AAQ-II), pain intensity (VAS), together with measures of body image, lifetime psychological burden, maladaptive cognitive beliefs, symptom severity, and anthropometric parameters. Compared with controls, women with lipedema reported significantly greater body image dissatisfaction, perceived distress, M.U.S., depressive symptoms, disordered eating attitudes, and pain, together with lower psychological well-being, life satisfaction, and psychological flexibility (all p < 0.001). Within the lipedema group, PHQ-9 scores were significantly predicted by M.U.S. scores, maladaptive cognitions, and pain intensity (VAS), whereas EAT-26 scores were predicted by PHQ-9 scores and maladaptive cognitions. These findings indicate that lipedema is associated with a substantial psychological burden and support integrating psychological assessment and intervention into multidisciplinary care.

Background: Lipedema is a chronic disorder of subcutaneous adipose tissue characterized by symmetrical fat accumulation in the extremities, pain, and orthostatic edema. Objectives: This study aimed to assess whether high-resolution cutaneous ultrasound can detect measurable tissue-level changes in subcutaneous tissue over six months. Methods: A retrospective, single-center, real-world longitudinal observational cohort study was conducted in 60 women with lipedema followed at three timepoints (baseline, 3 months, 6 months). High-resolution ultrasound (18–20 MHz) measured subcutaneous and dermal thickness at standardized anatomical sites. Results: All primary ultrasound parameters decreased significantly over six months of conservative multicomponent management, which included individualized nutritional counseling and physical activity. Medial proximal thigh subcutaneous thickness declined by 18.7% (48.2 to 39.2 mm; p < 0.001). Edema prevalence fell from 100% to 55.0%. Echogenicity improved significantly between 3 and 6 months, suggesting a delayed structural remodelling effect distinct from early volumetric reduction. Ultrasound reductions were inversely correlated with weight loss, suggesting that ultrasound captures tissue-level information not fully reflected by anthropometric measures alone. Conclusions: Standardized cutaneous high-resolution ultrasound detected consistent tissue-level modifications over six months of routine clinical follow-up, capturing changes beyond anthropometric measures and representing a candidate monitoring tool warranting evaluation in controlled study designs.

Background: Lipedema is a chronic progressive condition affecting approximately 10% of women, characterized by disproportionate subcutaneous adipose tissue accumulation and pain in the lower extremities. Standardized assessment methods for pain evaluation in lipedema remain limited. The Progressive Pain Check (PPC) method represents a potentially valuable tool for standardized pain assessment in lipedema patients. Objective: To evaluate the inter-rater reliability of the PPC method for clinical assessment of evoked pain in lipedema patients. Methods: Two independent assessors performed PPC evaluations. Inter-rater reliability was assessed using the Intraclass Correlation Coefficient [ICC(2,1), two-way random-effects, absolute agreement, single-measurement] with 95% confidence intervals (CI). Results: This study included 429 women diagnosed with lipedema (mean age 41.2 ± 11.5 years, mean disease duration 27.2 ± 12.6 years). Patient characteristics revealed mean BMI of 29.5 ± 6.9 kg/m2, predominantly Type III lipedema presentation, and disease onset during adolescence (mean age 14 ± 9.3 years). The PPC method demonstrated excellent inter-rater reliability between two independent assessors across all examined anatomical districts. Conclusions: The PPC method shows promise as a simple, repeatable, and standardized clinical tool for evoked pain assessment in lipedema patients. The demonstrated inter-rater reliability supports its potential utility in clinical practice. Further research is warranted to evaluate its intra-rater reliability, concurrent validity, and responsiveness in monitoring treatment effects.

Lower extremity swelling has a broad differential diagnosis, including lymphedema, obesity-induced lymphedema, phlebolymphedema, and lipedema. Although these conditions may appear similar clinically, their pathophysiology and lymphoscintigraphic findings differ. Obesity, venous insufficiency, and abnormal adipose tissue can complicate image interpretation. We present four representative cases to illustrate characteristic imaging patterns across these conditions. These cases highlight the importance of interpreting lymphoscintigraphy in a clinical context.

Hyperechoic subcutaneous nodules in lipedema may mimic angiolipomas but represent an inflammatory and hypoxic-ischemic process rather than a neoplasia, despite tissue expansion. As the painful nodules expand, biopsy is recommended to exclude cancer. In this context, ultrasound (US) has become a pivotal tool for diagnosing and managing these nodules when combined with histopathologic assessment. However, many professionals in the field still have limited knowledge of this topic. In the present case series, the US and histopathologic findings of hyperechoic nodules in two patients with lipedema were compared with those observed in two patients with angiolipoma, with the aim of proposing US criteria to distinguish between these entities and highlighting the importance of accurate differential diagnosis.

BACKGROUND: Lipedema is a chronic adipose tissue disorder primarily affecting women, characterized by abnormal fat accumulation, pain, and reduced mobility. Its impact on sexual function remains underexplored. This study aimed to evaluate sexual function in women with lipedema and examine its associations with anxiety, depression, lower extremity function, and quality of life. METHODS: In this cross-sectional study, 100 sexually active women were recruited: 50 with lipedema and 50 age- and Body Mass Index-matched healthy controls. Sexual function was assessed with the Female Sexual Function Index (FSFI); anxiety and depression with the Hospital Anxiety and Depression Scale (HADS-A and HADS-D); quality of life with the EuroQOL 5-Dimensional 5-Level (EQ-5D-5L) instrument; lower extremity function with the Lower Extremity Functional Scale (LEFS); and pain intensity with the Visual Analog Scale (VAS). Multiple linear regression analysis was conducted to identify the factors associated with the total FSFI score. RESULTS: Women with lipedema had significantly lower total FSFI scores compared to controls (21.58 ± 3.99 vs. 25.86 ± 3.21, P < .001), with 76% having FSFI scores below the cut-off (≤ 26.55) compared to 36% of controls. All FSFI domain scores were significantly lower in the lipedema group (all P < .05). In the lipedema group, there was a significant correlation between total FSFI scores and age (P = .002), pain intensity (VAS; P = .022), depression (HADS-D; P = .010), quality of life (EQ-5D-5L index; P = .027), and lower extremity function (LEFS; P < .001). Multiple linear regression analysis identified depression (HADS-D; P = .047), perceived health status (EQ-5D-5L VAS; P = .033), and lower extremity function (LEFS; P = .011) as independent variables that had a significant relationship with the total FSFI score. DISCUSSION: Lower sexual function is common among women with lipedema and is associated with anxiety and depressive symptoms, lower extremity function, and pain intensity. These findings highlight the importance of incorporating sexual function assessment into the routine evaluation of patients with lipedema and support the need for comprehensive multidisciplinary treatment approaches addressing physical, psychological, and sexual health aspects of care.

BACKGROUND: Lipedema is a chronic disorder characterized by excessive, bilateral, and symmetrical deposition of subcutaneous adipose tissue, predominantly in the lower extremities. Despite its prevalence, lipedema is frequently misdiagnosed as lymphedema, and lymphoscintigraphy is commonly used to differentiate between the two. This systematic review synthesizes the available evidence regarding the most common lymphoscintigraphy findings in patients with lipedema. METHODS: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed across the MEDLINE/PubMed, Embase, and Web of Science databases. Studies were included if they reported lymphoscintigraphy findings in patients with lipedema and provided a clear description of the imaging protocol. Extracted data included patient demographics, lymphoscintigraphy protocols, and imaging findings. RESULTS: Seven studies met the inclusion criteria, encompassing 470 patients, of whom 311 had lipedema. The mean age was 47.4 years, and all patients were women. The mean body mass index was 32.6 kg/m2. Lymphoscintigraphy findings were normal in 61.4% of patients with lipedema. Tortuous lymph vessels were the most common abnormality (56.8%), followed by collateral lymph vessels (49.1%) and popliteal node visualization (44.0%). Dermal backflow (3.8%) and secondary lymphedema (11.8%) were less frequent. CONCLUSIONS: Lymphoscintigraphic alterations in patients with lipedema seem to reflect lymphatic overload rather than frank insufficiency. However, significant heterogeneity in study methodologies precluded a quantitative meta-analysis. Future research should focus on establishing standardized, consensus-based imaging protocols to better define the role of lymphoscintigraphy in the diagnosis and staging of lipedema.

Lipedema is a chronic progressive disease characterized by disproportionate and symmetric adipose tissue accumulation, predominantly affecting women, with upper extremity involvement (Type IV) in approximately 30% of cases. This study aimed to evaluate ultrasound measurements of subcutaneous tissue thickness in the upper extremities of women with lipedema compared with matched controls and to establish diagnostic cutoff values for this region.MethodsCross-sectional case-control study including 102 women (51 with clinically diagnosed lipedema and 51 age- and BMI-matched controls). Bilateral ultrasound measurements were obtained at six standardized anatomical points on the upper extremities, and subcutaneous thickness was measured from the dermal-epidermal junction to the deep fascia. Receiver Operating Characteristic (ROC) curves were used to derive diagnostic cutoff values.ResultsSubcutaneous thickness was significantly greater in the lipedema group at all sites, independent of BMI (p < .05). The mid-arm region (10 cm distal to the axillary line) showed the best diagnostic performance (AUC 0.74; sensitivity 82.4%; specificity 51.9%; cutoff >11.4 mm), and four of the six points demonstrated good accuracy (AUC 0.73-0.74).ConclusionUltrasound using standardized anatomical points and defined cutoff values provides good discriminatory capacity for diagnosing upper extremity lipedema and represents an accessible and reproducible adjunct to clinical assessment.

ObjectivesThe aim of this study was to compare metabolic status and biochemical indices associated with cardiovascular risk, including the triglyceride-glucose (TyG) index, triglyceride-glucose-body mass index (TyG-BMI), and atherogenic lipid indices, between obese individuals with and without lipedema, and to evaluate the potential effect of lipedema on these parameters.Materials and MethodsThis cross-sectional study included 70 obese patients diagnosed with lipedema and 70 obese control individuals without lipedema. Fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglyceride levels were recorded. Based on these parameters, the TyG index, TyG-BMI, atherogenic index of plasma (AIP), atherogenic coefficient (AC), and Castelli risk indices I (CRI-I) and II (CRI-II) were calculated.ResultsNo significant differences were observed between the lipedema and control groups in fasting glucose, total cholesterol, HDL-cholesterol, triglyceride levels, TyG, TyG-BMI, or atherogenic lipid indices (all p > .05). LDL-cholesterol levels were significantly lower in the lipedema group compared with the control group (p = .008). In the lipedema group, TyG-BMI showed a positive correlation with age and BMI, whereas no significant associations were found with symptom duration or pain severity.ConclusionAlthough LDL-cholesterol levels were lower in obese individuals with lipedema, this difference was not reflected in biochemical indices associated with metabolic status and cardiovascular risk. Importantly, metabolic parameters in patients with lipedema accompanied by obesity were comparable to those observed in individuals with obesity alone, suggesting that obesity rather than lipedema may be a more important determinant of metabolic risk in this population. Therefore, metabolic evaluation should not be overlooked in patients with lipedema, and the management of obesity should be considered in treatment planning.

INTRODUCTION: Recent research suggests that body contouring surgeries may reduce benzodiazepine (BNZ) use in patients with anxiety or depressive disorders. This study explores whether similar benefits occur in women with lipedema-a chronic adipose disorder causing pain, limited mobility, and psychological distress-who are often prescribed BNZ. MATERIALS AND METHODS: We conducted a retrospective observational study on 100 adult female patients with Stage I-III lipedema undergoing tumescent or water-assisted liposuction between 2019 and 2024. All participants were on stable BNZ therapy for at least six months before surgery. The primary outcome was BNZ usage at six months postoperatively. Secondary outcomes included anxiety (GAD-7), pain (VAS), sleep quality (PSQI), and body image (BODY-Q) and assessed pre- and post-surgery using validated instruments. DISCUSSION: At six months, 77% of patients reduced or discontinued BNZ (32% stopped entirely), with average daily dosage decreasing from 3.2 ± 1.1 to 1.4 ± 1.2 mg (p < 0.001). Statistically significant improvements were also observed in anxiety, pain, sleep quality, and body image (all p < 0.001). Reductions in BNZ use correlated with improvements in pain (r = 0.56), anxiety (r = 0.47), and body image (r = - 0.52). Only minor complications occurred (8%), and no major adverse events were reported. CONCLUSION: Liposuction for lipedema not only improves physical symptoms but also supports psychological recovery, reducing dependence on benzodiazepines. These findings highlight the potential of surgical treatment as part of an integrated approach to managing chronic conditions with both somatic and mental health components. Further research is needed to confirm long-term effects and underlying mechanisms. LEVEL OF EVIDENCE I: Level I, therapeutic study using a properly randomized controlled trial. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ObjectivesGenerative artificial intelligence (AI) models capable of producing photorealistic medical images are increasingly proposed for patient education, clinical illustration, and trainee instruction. However, their ability to accurately represent anatomically distinct disease subtypes remains unclear. This study evaluated the diagnostic accuracy of a widely used generative AI model in producing images corresponding to the five anatomical lipedema types defined by the Schmeller classification.MethodsIn this prospective audit, ChatGPT’s image-generation interface was prompted to create 60 images for each lipedema type (Types I–V),yielding 300 images. Prompts were standardized and limited to the subtype label without additional descriptors. Two clinicians independently classified each image into one of the five lipedema types or as indeterminate, blinded to the original prompt; disagreements were resolved by a third clinician. Diagnostic performance was assessed using a confusion matrix and per-type sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV),F1-score,and one-vs-rest receiver operating characteristic area under the curve (ROC AUC). Overall accuracy and Cohen’s κ statistics were also calculated.ResultsAll 300 images were evaluable. The model generated anatomically consistent images for Types I,II, and III (sensitivity = 1.00 for each). Specificity was 1.00 for Types I and II but 0.50 for Type III because all images requested as Types IV and V were classified as Type III. Consequently, the model failed to generate any images consistent with Type IV(arm-predominant) or Type V(calf-isolated) lipedema (sensitivity = 0.00 for both). Overall accuracy was 0.600. Unweighted and quadratic-weighted Cohen’s κ values were 0.500 and 0.667, respectively. Micro- and macro-averaged ROC AUC were both 0.750.ConclusionThe model reproduces severity gradients within lower-extremity lipedema but systematically collapses anatomically distinct subtypes into the dominant Type III phenotype, failing to depict arm-predominant and calf-isolated disease. Current generative AI systems may therefore encode lipedema as a single visual phenotype rather than a distributed anatomical entity, limiting their reliability for medical education and clinical communication.

Background: Lipedema is a chronic disorder that predominantly affects women and is characterized by abnormal subcutaneous adipose tissue accumulation, pain, and vascular dysfunction. However, reliable circulating biomarkers that reflect disease-specific pathophysiology are still lacking. This study investigated serum markers associated with adipose tissue, inflammation, and angiogenesis to further elucidate the pathophysiology of lipedema. Methods: In this cross-sectional observational study, fasting serum levels of adiponectin, chemerin, lipopolysaccharide-binding protein (LBP), proprotein convertase subtilisin/kexin type 9 (PCSK9), soluble CD163 (sCD163), and soluble CD137 (sCD137)—proteins associated with obesity and inflammation—were measured in 23 premenopausal women with lipedema and 23 age-matched healthy premenopausal controls. Serum endostatin levels, an angiogenesis inhibitor, and insulin-like growth factor binding protein 2 (IGFBP2), a potent proangiogenic factor, were also assessed. Results: Patients with lipedema and obese controls had comparable body mass index, glucose, and serum lipid profiles. No significant differences were observed between groups in circulating levels of adiponectin, chemerin, LBP, PCSK9, sCD163, sCD137 and IGFBP2. In contrast, serum endostatin levels were significantly reduced in patients with lipedema (p = 0.038). Additional analyses demonstrated markedly higher endostatin expression in human subcutaneous adipose tissue than in the liver, suggesting that circulating endostatin levels may be related to adipose tissue mass. However, serum endostatin levels were lower in obese compared with normal-weight women (p < 0.001). Conclusion: Lipedema was not associated with altered circulating levels of adiponectin, chemerin, LBP, PCSK9, sCD163, sCD137 or IGFBP2. Reduced serum endostatin levels support a potential role for vascular dysfunction in the pathophysiology of lipedema.

Lipedema is a chronic disorder characterized by disproportionate subcutaneous fat accumulation and pain, with an incompletely understood inflammatory component. It remains unclear whether this inflammatory profile is disease-specific or primarily driven by coexisting adiposity. This study aimed to evaluate systemic inflammatory markers in women with lipedema compared with women with obesity and normal-weight controls. This retrospective study included 229 women aged 30-65 years: 78 with lipedema, 76 with obesity without lipedema, and 75 normal-weight controls. Demographic and laboratory data were obtained from medical records. Inflammatory indices, including the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, C-reactive protein-to-albumin ratio, and C-reactive protein-albumin-lymphocyte index, were calculated. Group comparisons were performed using one-way analysis of variance with appropriate post hoc tests. Age was similar across groups, whereas body mass index was significantly higher in the lipedema and obesity groups than in controls (p<0.001). The erythrocyte sedimentation rate, C-reactive protein level, and CAR were significantly higher in both the lipedema and obesity groups compared with controls, whereas no significant differences were observed between lipedema and obesity groups. The neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, and C-reactive protein-albumin-lymphocyte index did not differ significantly among groups. Inflammatory indices were generally comparable across lipedema grades. These findings suggest that lipedema is associated with low-grade systemic inflammation; however, its inflammatory profile largely overlaps with obesity, indicating shared inflammatory mechanisms rather than a distinct systemic inflammatory phenotype. Among the evaluated markers, C-reactive protein-based parameters, particularly the C-reactive protein-to-albumin ratio, appeared to better reflect inflammatory burden than hematological composite indices.

BACKGROUND: Liposuction is a standard treatment for advanced-stage lipedema, often involving large volumes of tumescent fluid infiltration and aspiration. These shifts raise concerns about postoperative electrolyte imbalances, though systematic data are limited. METHODS: This retrospective single-center study analyzed 116 women with stage 2 or 3 lipedema who underwent liposuction between 2019 and 2023. Pre- and postoperative (within 24 hours) laboratory values including hemoglobin, hematocrit, leukocytes, and electrolytes were compared using paired t-tests, and correlations with clinical variables were assessed. RESULTS: Postoperatively, lower hemoglobin (13.6 ± 0.9 to 11.8 ± 1.2 g/dL, p < .0001) and hematocrit (40.9 ± 2.5 to 35.1 ± 3.5%, p < .0001) levels were observed, alongside higher leukocyte counts (7.6 ± 3.1 to 13.1 ± 5.9 × 109/L, p < .0001). Electrolyte shifts included higher chloride (104.7 ± 2.2 to 106.0 ± 1.9 mmol/L, p < .0001) and slightly lower calcium (2.3 ± 0.1 to 2.2 ± 0.1 mmol/L, p < .0001), sodium (140.8 ± 2.1 to 140.2 ± 2.1 mmol/L, p = .01), and potassium (4.1 ± 0.35 to 4.0 ± 0.4 mmol/L, p = .02). All parameters remained within physiological ranges and were not associated with adverse outcomes. Calcium correlated with hemoglobin (r = 0.49) and hematocrit (r = 0.51) and inversely with aspirate volume (r = -0.41, p = 0.001). CONCLUSIONS: Post-liposuction electrolyte and hematologic changes are mild and clinically insignificant, reflecting predictable hemodilution rather than metabolic disturbance. Routine postoperative testing appears unnecessary for most patients, supporting selective monitoring in those with abnormal baseline values, high aspirate volumes, or relevant comorbidities. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ObjectivesThere is a deficiency in awareness and knowledge of lipedema disease among the general public and healthcare professionals. This situation may lead patients to waste time on getting the correct diagnosis and treatment. Currently, information regarding women's awareness and knowledge level of lipedema in Turkey is limited. This study aims to examine women's awareness, knowledge level, and desire for information concerning lipedema in Turkey.MethodsA total of 502 volunteer women participated in this online cross-sectional survey study. The survey, constructed by the authors of the study with the assistance of guidelines, systematic reviews, and current literature, consisted of sections aimed at determining demographic data, lipedema awareness, knowledge level, lipedema symptoms and suspicion, as well as individuals' health behavior and desire for information. The primary outcome of the study was lipedema awareness, which was defined by having previously heard the term lipedema.ResultsDespite 76.1% of participants reporting awareness of lipedema, the average knowledge score about the condition was a low-to-moderate level of knowledge. The vast majority of participants (71.3%) indicated that they were willing to learn more about lipedema, and their preferred source of information was healthcare professionals (80.3%). Yet, only 19 participants (3.8%) think that lipedema is sufficiently regarded within the healthcare system.ConclusionThis study reveals that, despite relatively high awareness of lipedema among women in Turkey, the level of knowledge remains limited. The strong willingness to receive further knowledge and the preference for healthcare professionals as the principal source of information garner attention. However, the low confidence in the recognition of lipedema within the healthcare system may suggest that healthcare professionals have insufficient knowledge or do not prioritize this issue. Improving awareness and knowledge of lipedema among the public and healthcare professionals might facilitate early identification and minimize treatment delays.