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US Standard of Care for Lipedema

Author Summary:

This is the first US Care Guideline for the Diagnosis and Treatment of Lipedema. The US standard of care committee was formed with the sport of the national institute of health. In April 2019. The multidisciplinary team of experts in diagnosing and treating lipedema from across the US. Over the next two years, all the available scientific and literature medical literature was analyzed and waited based on the quality of evidence. The committee then drafted and revised a consensus document for best practices for diagnosing and caring for lipedema and its related complications. Summary of findings. At the same time, lipedema is still considered a fat disorder. New evidence further clarifies that all of the components of loose connective tissue in the subcutaneous space may be affected by lipedema. These include adipose tissue,  fibrous tissue lymphatic, veins, and arteries of the subcutaneous space. Therefore lipedema should be considered a loose connective tissue disorder, not merely a fat disorder, even though abnormal fat accumulation is a principal characteristic of lipedema. 
The clinical criteria for the diagnosis of lipedema were enumerated and agreed on. Lipedema was divided into stages 1 through 3 stages 1. Stage one is typified by small nodules in the subcutaneous fat stage 2 characterized by larger nodules and visible indents on the surface of the fat stage 3 is characterized by lobules in the skin. The five anatomic types of lipedema or agreed on. Type 1 on the hips, type 2 on the hips and thighs, type 3 on the hips to ankles, type 4 on the arms, and type 5 just the cows and ankles. Common complications of lipedema, including lymphedema non-lipedema, obesity venous disease, and hypermobile joints, were described.   Non-surgical treatment of lipedema. Including compression dietary advice and dietary supplements or described.  Surgical treatment for lipedema with lymphedema reduction surgery effectively increases mobility, reduces pain, decreases the need for compression, and improves the quality of life in patients with lipedema. 



Lipedema is a loose connective tissue disease predominantly in women identified by increased nodular and fibrotic adipose tissue on the buttocks, hips, and limbs that develops at times of hormone, weight, and shape change, including puberty, pregnancy, and menopause. Lipedema tissue may be very painful and can severely impair mobility. Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Lipedema tissue is difficult to reduce through diet, exercise, or bariatric surgery.


This paper is a consensus guideline on lipedema written by a US committee following the Delphi Method. Consensus statements are rated for strength using the GRADE system.


Eighty-five consensus statements outline lipedema pathophysiology and medical, surgical, vascular, and other therapeutic recommendations. Future research topics are suggested.


These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.
This outlines all the recommendations for treating lipedema and included all the evidence for the effectiveness of lipedema reduction surgery. Published in Phlebology. 
Read the full paper here, or the PDF below.
Standard of Care Lipedema in the US
Citation:Herbst KL, Kahn LA, Iker E, Ehrlich C, Wright T, McHutchison L, Schwartz J, Sleigh M, Donahue PM, Lisson KH, Faris T, Miller J, Lontok E, Schwartz MS, Dean SM, Bartholomew JR, Armour P, Correa-Perez M, Pennings N, Wallace EL, Larson E. Standard of care for lipedema in the United States. Phlebology. 2021 May 28:2683555211015887. doi: 10.1177/02683555211015887. Epub ahead of print. PMID: 34049453.