Lipoedema

Evidence in one minute

• What it is: bilateral symmetrical painful fat of legs (± arms), sparing hands and feet ("cuff"), easy bruising, nodular texture, onset at hormonal change, almost only women; Stemmer sign negative in pure form; normal lymphoscintigraphy early. Pitting or a positive Stemmer sign suggests lipo-lymphoedema. Wounds 2017 · Executive Committee of the International Society of Lymphology 2023 · Lipedema Foundation 2024
• Prevalence is definition-dependent: UK minimum 1 in 72 000 vs German ~10–11% of women. Kruppa 2020
• Phenotype: in 1803 Spanish clinic patients mean BMI 28.6, one-third normal weight, nearly half Schingale IV–V. The near-universal comorbidity rates (hypermobility, “intestinal permeability” 99%, “ovarian dysfunction” 76%) come from unvalidated in-house questionnaires and examiner-devised signs, with arithmetic errors and an undeclared institutional interest — very low certainty; do not quote them (revised 2026-10-09). Simarro 2025
• Conservative care: compression for symptoms and lipo-lymphoedema, movement, weight management for co-existing obesity, psychological support; diet and exercise do not remove lipoedema fat.
• Liposuction — first randomised data (LIPLEG, 12 months): pain reduced ≥2 points in 68% vs 8% with CDT, with more adverse events (196 vs 32 events); German statutory insurance now covers it after ≥6 months of failed conservative care. Weaknesses: CDT arm poorly documented, longer follow-up in the surgical arm, unblinded patient-reported outcomes. NICE (UK) still advises research-only. The figures are second-hand: the critique’s author works at a conservative lymphology clinic and its translation was funded by a compression-industry federation, and several criticisms are contradicted by the protocol (7-month standardised CDT run-in, taped scars for assessor blinding) (revised 2026-10-09). Bertsch 2025 · Podda 2021
• Coding: ICD-11 EF02.2; no ICD-10 code (R60.9, E88.2, E65 used) — relevant for SA medical-aid claims. Lipedema Foundation 2024
• SA case of lipo-lymphoedema with BMI 66: Vivian 2019.