Background for Lipedema Diagnosis and Weight Loss
The metabolic effects, tissue biologic effects, and distribution of weight loss in lipedema is not well understood. Over the years, individuals with lipedema and clinicians have noticed that with weight loss appears to be to greater on the abdomen and trunk and less on the legs and arms in patients with a lipedema diagnosis. Others have claimed the weight loss is evenly distributed and others have claimed no weight loss occurs in areas affected by lipedema. However, these claims and observations have not been studied in a prospective controlled trial. So whether individuals with lipedema can lose weight and the distribution of body fat prior to weight loss and after weight loss has been often discussed but not well studied. The rest of this page is devoted to sharing some preliminary results of a study done at Washington University Medical School under the direction of Samuel Klein MD.
Scope of lipedema weight loss study: Obesity vs Lipedema
The study is a comprehensive whole-body organ system and cellular metabolic and immune system characterization of people with Lipedema. It was set up to compare a population of women diagnosed with lipedema with elevated BMI [Body Mass Index] and with an age matched population who also had equally elevated obese BMI. Since both populations had a BMI greater than 30 they are both technically obese using a world health BMI definition, but the control group had just classical obesity, which is where accumulates most of the fat deposit centrally internally in the abdomen and the lipedema group may or may not have had excess fat deposits in the inside the abdominal wall. Thus, the study compared “classical obesity” which individuals with increased BMI centrally to the population diagnosed with lipedema who meet the BMI criteria of obesity partly as the result of their unique and separate fat disorder. The study was set up to determine the therapeutic potential of diet-induced weight loss in this patient population.
Lipedema Weight Loss Study Design
The study starts with the diagnosis by Dr. Wright of lipedema. All of the women in the study group had at least stage 2 lipedema in their legs. After the diagnosis, comprehensive baseline testing was performed. The baseline body composition was performed using Dual Energy X-ray Absorptiometry (DEXA}, and Magnetic Resonance Imaging (MRI). The baseline metabolic function of the participants was determined using, lipid studies, blood sugar levels, fasting and in response to glucose challenge and a Hyperinsulinemic- Euglycemic Clamp. The adipose tissue biology was determined by using Heavy Water: Turnover of Collagen and Fat, Measuring gene expression, Tissue Oxygenation and markers of immune function.
After the baseline testing them participants met with dietitians who created individualized meal plans to assist in 8- 10 % of body weight loss over a 6 to 8-month time period. After the 8-10% weight loss was achieved, the patients were re-studied with all the same test which were done at baseline enrollment.
Weight Loss Meal Plan for lipedema individuals
Calorie needs were calculated by a dietitian and reduced by 25% with modifications to calories made as needed. All meals and snacks provided by Washington University Metabolic Kitchen. Dietitian created meal plan is gluten, dairy, and egg-free as needed. Participants meet with the dietitian weekly to review the week prior, plan for the week ahead, and pick-up food for the next week.
Characteristics of Lipedema Subjects and Control Group
The average measurement of multiple metabolic characteristics of the lipedema study group and the control group which age and BMI matched. The metabolic parameters measured were as follows: BMI, Body Mass Index, Body fat percent measure by MRI, liver fat content measured by MRI, average blood sugar measured by HgBA1C, plasma glucose concentrations, plasma lipid levels including cholesterol and triglycerides using reference laboratories. The glucose levels were measured fasting and after oral glucose loads.
Diet Induced Weight Loss Graph with Lipedema
The graph below tracks the weight loss of the patient with lipedema. The graph shows that following a low carbohydrate diet, individuals with lipedema can lose up 10% or more of their body weight.
Changes in Body Fat Composition in Lipedema with Weight Loss
On the left side of the image below you can see graphs that show individuals with lipedema have a greater percentage of total body fat measured by DEXA scans compared to BMI matched individuals who meet the classical definition of obesity. The individuals with lipedema were able to lose weight and decrease the percent of total body fat. However, the change in percent of total body fat was significantly less in individuals with lipedema compared to BMI matched obese controls with weight loss. In other words, obese individuals with weight loss are able to significantly decrease their percent total body fat but lipedema individual did not with the same amount of weight loss.
On the right side of the image below graphs the changes in leg fat measured by DEXA scans in classically obese compared to individuals with lipedema. The top right graph shows that the both classically obese and individuals with lipedema lost fat in their legs. The decrease in fat was a statically significant in individual with classical obesity. The percent of fat in the legs was not significantly changed in individuals with lipedema.
MRI Changes in Thigh Volumes with lLipedema
The image below shows graphs the changes in the volume of the leg as measured by MRI. The graphs show that both the total thigh volume and the volume of subcutaneous fat in the thigh decreased in classically obese individuals and individuals with lipedema. The contribution of leg fat mass to the change in total fat loss with weight loss was similar in classically obese individuals and individuals with lipedema. This shows that fat loss occurs in the thighs of women with lipedema weight loss and the contribution of leg fat mass is similar in both obese individuals and those with lipedema. However, it is important to note that the individuals with lipedema are starting with and persist in having a much greater percentage of fat in their legs. The overall percent of greater percent of fat in the legs is not changed with weight loss in individuals with lipedema.
Changes in Plasma Glucose with Weight Loss in Lipedema
The image below shows graphs of plasma glucose level fast and after an oral glucose challenge. OGTT]. Prior to weight loss individuals with lipedema have a slightly lower fast blood sugar 95 compared to BMI matched classically obese individuals 106. The patients with lipedema also had lower blood sugars 2 hours after consuming a high glucose drink 146 compared to matched classically obese individuals 179. After weight loss the lipedema patient’s blood sugars were lowered further. With weight loss the obese matched individuals lowered and improved their blood sugars, but didn’t quite reach the level of lipedema individuals even prior to their weight loss.
Insulin Sensitivity in Lipedema
Using a Hyperinsulinemic- Euglycemic Clamp is the best way to measure insulin sensitivity. While the insulin is infused at a fixed rate, the more glucose taken up to keep the blood sugar level constant the more insulin sensitive the individual being studies is. The graphs on the left side of the slide below shows normal weight individuals Metabolic Normal [MNL] are the most insulin sensitive or allow the highest rate glucose infusion. Metabolically Abnormal Obese [MAO] on the other hand allowed the lowest rate of glucose infusion. The lipedema individuals showed a good deal of insulin sensitivity allow a rate of glucose infusion nearly as high as normal weight metabolically normal individuals. The lipedema group insulin sensitivity improved with weight loss. On the far right the graph shows that BMI matched “Classically Obese” controls had the least insulin sensitivity and had the lowest rate of glucose infusion.
Triglyceride Content in Lipedema
Triglyceride (IHTG) Content measured by MRI is a reliable metabolic marker of insulin sensitivity and visceral adipose deposition. The slide shows that women with lipedema have low content of triglycerides in their liver compared to BMI matched classically obese individuals.
The information on this page is preliminary data for a study being conducted at Washington University in St Louis, Missouri under the direction of Samuel Klein MD. We are still looking for study participants. Please contact us through the contact page if you think you may have lipedema or have been diagnosed with lipedema and are interested in participating in the study with Dr. Wright on Lipedema. The preliminary data were presented by Thomas Wright, MD at the Fat Disorder Research Society, FDRS, 2019 Annual Conference in Baltimore Maryland.