Lipedema Treatment: Full Guide for Healthcare Providers

Illnesses with a tendency to go mis- or under-diagnosed always present a challenge for healthcare providers and patients. Lack of information on prevalence can limit our understanding of a disease or condition, while creating frustration for a person seeking diagnosis and treatment. One such pathology is lipedema.

Lipedema, a chronic condition that may accompany obesity—or simply masquerade as it—affects an unknown number of people. Because it can look like obesity or overweight, lipedema is likely under-diagnosed. This chronic disorder is characterized by abnormal, symmetrical fat deposits in the arms, legs, and lower torso. It can also cause pain, bruising, and fatigue, and it mainly affects people assigned female at birth. Prevalence is estimated at 10% of the female population.

Managing lipedema symptoms can benefit physical health as well as self-image and quality of life. More than half of people living with lipedema have a BMI above 35. This means that, when treating patients with obesity, lipedema may enter the picture. Understanding care strategies and clinical protocols may help in supporting these patients.

Understanding Lipedema (Symptoms, Causes, & Diagnosis)

It is important to differentiate between lipedema and obesity since they can co-occur, although one does not cause the other. The lipedema diagnosis relates to where in the body fat deposits exist: the arms, lower abdomen, hips, thighs, and/or calves, but not in the hands or feet.

What are the common symptoms of lipedema?

Common symptoms include:

• Fat buildup in the lower abdomen and/or extremities

• Fibrous tissue within the fat that may be palpable and feel like bumps

• Pain, which may occur with pressure on the affected area or continuously

• The sensation, on the part of the patient, that their legs feel heavy

• Swelling or dimpling around the affected area

• Ecchymosis (easy bruising)

• Fatigue

Symptoms may worsen over time and the rate of worsening varies from person to person.

Conditions sometimes confused with lipedema

The general public may mishear or misunderstand the term lipedema. Some people who have it are misdiagnosed—or self-diagnose—with overweight or obesity. It can be helpful, especially when talking with patients, to explain what lipedema is not:

• Obesity: elevated fat levels throughout the body (sometimes more prominent at the midsection)

• Lymphedema: swelling due to a buildup of lymph fluid, often asymmetrical

• Hyperlipidemia: elevated lipids in the blood

• Lipohypertrophy: Skin and fat tissue may look like lipedema, but are not associated with pain and swelling.

Much of the existing information available to lay audiences comes from liposuction clinics and alternative medicine sources. It is important to provide patients with comprehensive, factual information.

What causes lipedema?

The cause of lipedema is unknown, although it can be hereditary. It appears to be linked with female hormones. It can appear or worsen during puberty, pregnancy, menopause, or sometimes when a person takes hormonal birth control.

There is currently no biomarker for lipedema. Proposed underlying causes include altered adipogenesis, microangiopathy, and disturbed lymphatic microcirculation.

What are the different types of lipedema?

Lipedema is divided into five types based on the location of fat deposits. The different types can overlap in a given patient.

• Type I: Between the umbilicus and hips/buttocks

• Type II: Between the pelvis and knees

• Type III: Between the pelvis and ankles

• Type IV: Between the shoulders and wrists

• Type V: Between the knees and ankles

Lipedema also has five stages based on the severity of the deposits and problems they cause.

• Stage 1: Skin is smooth but there are pockets of enlarged fat tissue.
• Stage 2: Skin is uneven with indentations and large mounds of fat tissue can be seen and felt.
• Stage 3: Large amounts of fat tissue cause deformation, typically around thighs and knees.
• Stage 4: Lymphedema (swelling from excess fluid) is present to a significant degree and there are large overhangs of tissue on legs and/or arms.

How do you diagnose patients with lipedema?

Lipedema is often confused with non-lipedema obesity or lymphedema. Patients may misunderstand their condition or have received mixed information from healthcare and alternative health providers.

A consensus guideline was published by a U.S.-based committee in May 2021. Part of diagnosis is eliminating other possible causes of symptoms. Scans including MRI, CT, or ultrasound can help rule out conditions such as lymphedema, cardiovascular disease, and an underactive thyroid.

Other aspects of diagnosis include:

• Family and medical history, to consider heredity

• Symptoms, taking into consideration the location and symmetry of adipose tissue

• Physical exam to check for palpable tissue nodules and/or pitting

• Review of comorbid conditions including obesity, lymphedema, hyper-mobile joints, loss of tissue elasticity, or vascular disease

Lipedema Treatment Plans to Consider

Treatment tends to focus on pain relief, mobility, and lifestyle. Patients are advised to eat a balanced diet, move regularly, and if needed, seek mental or emotional support. The lack of well defined causes or biomarkers makes it challenging to treat directly. However, a few courses of action are available.

Diet and Exercise for Lipedema

General recommendations for healthy metabolism apply here when it comes to diet. In addition, there is some belief that inflammation plays a role in lipedema. Therefore, an anti-inflammatory diet may be worthwhile to try.

Exercise can pose a challenge due to the pain lipedema can cause. In addition, lipedema can cause hyper-mobility of the joints, which may exacerbate joint disease. Low impact exercise and aquatic exercise work best for some patients. Swimming may also reduce fluid buildup and boost mobility.

Unfortunately, the fat tissue that builds up as part of lipedema resists diet and exercise. If obesity is also present, you will need to use judgment, in conversation with the patient, to personalize an exercise plan.

Noninvasive Treatment Plans: Compression, Massage, and CoolSculpting

Compression is another common and relatively low-cost treatment. People can wear specially made garments, such as leggings, to reduce pain and boost confidence in their appearance. A very small study (six women) showed a decrease in pain and bruising through a combination of compression and exercise. Most results on this therapy are anecdotal, but some patients find it effective.

Another little-studied treatment is lymphatic drainage massage. This mild form of massage provides relief for lymphedema, for example after breast cancer surgery, but its effectiveness for lipedema is less clear. It uses specific massage techniques designed to drain excess lymph fluid from swollen tissues. Some patients also find relief with self-massage.

Moisturizing the skin helps some patients manage symptoms of lipedema. Support groups or therapy may be beneficial for managing self-esteem, disability, and quality of life challenges.

Medications and Supplements

While none of them cure the condition, various medications and supplements are sometimes used to treat lipedema. “Fat burning” ingredients such as caffeine, green tea, or chromium are purported to help boost the effectiveness of calorie restriction and exercise. However, studies have proven inconclusive or contradictory.

Some weight loss drugs, including amphetamines, diosmin, metformin, phentermine, and resveratrol may help with inflammation and swelling. They are not, however, indicated for lipedema.

With the popularity of GLP-1 and GIP receptor agonists, a question on many minds is whether these might treat lipedema. An opinion article published in the Journal of Pharmaceutical International Research proposed that tirzepatide, a dual GLP-1 and GIP receptor agonist, holds promise. The authors state:

“Beyond its well-documented effects on weight loss and glycemic control, tirzepatide exhibits anti-inflammatory, antifibrotic, and thermogenic properties that target key mechanisms of lipedema. It modulates macrophage polarization, inhibits fibrosis-promoting pathways, and enhances energy expenditure via UCP1 activation in brown adipose tissue. However, despite its potential benefits, tirzepatide has yet to be formally evaluated for this condition.”

This is a research area that we at the Obesity Medicine Association will be watching.

Advanced Treatment Plans: Surgical Intervention

Liposuction holds more promise for lipedema, as it can be used to remove localized fat. A small 2023 study showed improvements in quality of life, as reported by patients who underwent liposuction for lipedema. Water jet-assisted and vibration-assisted liposuction are the recommended methods.

Bariatric surgery would become an option only in patients with a BMI over 35. It does not treat lipedema, but can be effective for obesity in someone experiencing both conditions. A 2022 study described patients in whom lipedema was only diagnosed after they underwent bariatric surgery. This finding underscores the complicated relationship between obesity and lipedema and the risk for misdiagnosis.

Treating Lipedema for Patients with Obesity

While lipedema and obesity are two distinct diseases, it is critical to recognize their frequent co-occurrence. Although the fat deposits that result from lipedema may persist, pursuing a more healthy weight remains important to reduce the risk of type 2 diabetes, cardiovascular disease, and other metabolic issues.

Obesity, especially class III obesity, can mask lipedema. Reducing excess weight can allow for greater mobility, for exercise and overall health, while also revealing the presence of lipedema. It is important to support the patient in understanding the difference and what to expect from any proposed treatment.

Emerging Knowledge on Lipedema

As the medical community learns more about the underlying causes of lipedema, we may become more equipped to diagnose and treat it. For now, the area to watch is the new classes of weight loss medications, which could have implications for lipedema as well.

In order to keep professionals as current as possible on this condition, OMA Academy offers courses and recorded webinars for members and non-members:

• Emerging from the Shadows: Recognizing and Treating Lipedema

• Proposed Framework for Research Case Definitions of Lipedema

• Obesity Medicine 2024 - Treating Lipedema and Obesity for Optimal Outcomes

Our most recent update to the Obesity Algorithm® also includes information on lipedema.

The Lipedema Foundation provides information on clinical trials in lipedema care and many other resources. It is also building a lipedema biobank to support scientific research.

FAQs

How can I tell the difference between lipedema and obesity in my patients?

Lipedema is noteworthy for the location of the fat deposits and their resistance to diet and exercise, the presence of fibrous bumps/nodules, and pain and bruising. Keep in mind that it often co-occurs with obesity or overweight.

Does Ozempic work for lipedema?

Ozempic, Wegovy, Zepbound, and other weight loss drugs in their class are not indicated for lipedema. However, there is some limited evidence that these medications can help reduce inflammation and pain associated with lipedema.

What are the most effective non-surgical treatments for managing lipedema symptoms?

With no cure for lipedema, a holistic approach makes sense for managing symptoms. A combination of anti-inflammatory diet, compression therapy, and mental health support can benefit many patients. If obesity or overweight is also present, these conditions can be treated as they always would be.

How should I approach lipedema treatment differently in patients with a high BMI or metabolic disease?

Patient education is critical. It is important to help people understand that reducing excess weight present due to obesity will not necessarily alleviate their lipedema. Also, lipedema, like obesity, is not their fault. Addressing excess weight and metabolic diseases—either to treat or try to prevent them—is always important, with or without lipedema. These diseases are connected with risk for a wide variety of other conditions, many of which may be prevented through intervention.

Is CoolSculpting beneficial for lipedema?

There is little research on CoolSculpting as it relates specifically to lipedema, but a 2021 paper presented five case studies of women ranging in age from 34 to 90. The authors suggest that treatment choices should be made on a case-by-case basis, but that CoolSculpting may be effective for some people.