The Comparative Evaluation of Depression,Life Satisfaction,and Quality of Life Between Female Patients with Lipedema and Lymphedema

Abstract

Introduction:

Lymphedema and lipedema are chronic conditions significantly impacting psychosocial status and quality of life (QOL). However, comparative studies on depression, life satisfaction, functional status, and QoL in these conditions are lacking. This study aims to fill this gap by providing a comparative evaluation of functional status, depression, life satisfaction, and QoL in patients with lymphedema and lipedema.

Method:

Over 12 months, 73 female patients diagnosed with pure lymphedema or lipedema were recruited according to inclusion/exclusion criteria. A range of demographic variables, including age, body mass index (BMI), disease duration, stage of disease, and exercise/smoking conditions, were recorded. The lower-extremity functional scale (LEFS), life satisfaction index (LSI), patient health questionnaire (PHQ-9), and Lymphedema QOL Questionnaire for Legs were used to assess functional status, life satisfaction, depression, and QoL, respectively, in both groups. The relationship between questionnaire scores and demographic variables was carefully evaluated.

Results:

Thirty-six individuals with lymphedema (mean age: 55.1 years) and 37 patients with lipedema (mean age: 50.7 years) were included in the study. Demographical variables were statistically similar between the groups (p > 0.05). Duration of disease was longer (mean: 159.3 months vs. 39.6 months) in a lipedema group than in lymphedema patients. PHQ-9 (mean:11.4 vs. 10.4) and overall QoL scores (mean: 5.06 vs. 5.47) were similar between groups, while LEFS (mean: 44 vs. 62) and LSI scores (mean: 11.5 vs. 14.3) were worse in patients with lymphedema than in a lipedema group. There were correlations between age and LEFS (p = 0.014, r = −0.40) and LSI (p = 0.013, r = −0.41) in the lymphedema group; and between BMI and LEFS (p = 0.013, r = −0.041) and QoL (p = 0.034, r = 0.37) scores; and duration of disease and PHQ-9 scores (p = 0.028, r = −0.41) in the lipedema group.

Conclusions:

Patients with lipedema have similar depression and impaired QoL as lymphedema patients. However, lymphedema patients experience more functional disability and less life satisfaction. As the BMI and duration of illness are correlated with depression and QoL, early diagnosis and early management are essential to improve disability and QoL in patients suffering from lipedema.

Introduction

Lipedema is a chronic and progressive adipose disorder characterized by the abnormal accumulation of subcutaneous fat in the legs and, occasionally, in the arms. The localized fat deposition in a symmetrical manner typically occurs in the limbs, mainly legs and thighs (referred to as two-body syndrome). This condition primarily affects women and is often mistaken for obesity or lymphedema despite being relatively common.^1–15 Research into the pathology of lipedema is still in its early stages. However, promising findings from exosome, cytokine, lipidomic, and metabolomic profiling studies suggest that lipedema is a distinct condition, separate from obesity and lymphedema. While genetics appears to play a significant role in the development of lipedema, the limited number of patients studied thus far makes it challenging to generalize findings on a broader scale.¹⁶

The precise etiology of lipedema remains uncertain, though it is associated with significant morbidity and family history suggesting a genetic origin.^1–15,17,18 The incidence of lipedema in the general population is unknown, but reports of a positive family history range from 16% to 64%. Whole exome sequencing in a family with three individuals affected by sex-limited autosomal dominant nonsyndromic lipedema revealed a missense variant, p.(Leu213Gln), in the AKR1C1 gene. This gene encodes an aldo-keto reductase enzyme responsible for converting progesterone into its inactive form, 20-α-hydroxyprogesterone. Functional analysis suggests that this variant results in partial loss of enzyme activity, potentially leading to reduced efficiency in converting progesterone and subsequent subcutaneous fat deposition in carriers.¹⁷

Further insights into the genetic underpinnings of lipedema were provided by Grigoriadis et al., who utilized an independent cohort from the 100,000 Genomes Project to identify genomic regions suggestively linked to the condition.¹⁸ The expression of microRNAs (miRNAs) in stage 1 and 2 lipedema tissues was analyzed using the nCounter Flex DX CE-IVD platform. Differentially expressed miRNAs were identified, including upregulation of hsa-let-7g-5p and downregulation of several miRNAs, such as hsa-miR-205-5p and hsa-miR-302b-3p. Bioinformatics analyses (KEGG, GO, STRING, Cytoscape) revealed that the upregulated miRNA was associated with pathways related to cell cycle, oocyte meiosis, and inflammatory bowel disease, while downregulated miRNAs were linked to endocrine resistance, insulin resistance, AGE-RAGE hypersensitivity, and focal adhesion. RT-PCR confirmed the microarray results and identified key mRNA targets, including SMAD2, ESR1, and VEGFA. These findings provide insights into the biochemical mechanisms underlying lipedema and may inform future biomarker discovery.¹⁹

The onset of lipedema has been frequently reported during periods of hormonal change, including puberty, pregnancy, and menopause. Estrogen, a key regulator of adipocyte lipid and glucose metabolism, as well as female-specific fat distribution, is hypothesized to contribute to the pathophysiology of lipedema. Dysregulated adipose tissue accumulation via estrogen signaling likely occurs through two primary mechanisms including; altered distribution of estrogen receptors (ERα/ERß ratio) in adipocytes, leading to disrupted metabolic signaling, and/or increased release of steroidogenic enzymes by adipocytes, resulting in elevated paracrine estrogen levels.²⁰ These disruptions may enhance the activation of peroxisome proliferator-activated receptor γ, promoting free fatty acid uptake into adipocytes, glucose absorption, and angiogenesis, while simultaneously reducing lipolysis, mitochondriogenesis, and mitochondrial function. Collectively, these metabolic changes drive increased adipogenesis and lipid accumulation within adipocytes, ultimately leading to the expansion of adipose tissue mass.²⁰

Clinically, patients initially present with symptoms such as discomfort, easy bruising, and tenderness in disproportionately enlarged legs. Over time, these symptoms may progress to severe pain and restricted mobility. Beyond the physical challenges, lipedema often leads to psychological distress. Affected individuals may struggle with body image dissatisfaction, reduced self-esteem, eating disorders, depression, and other mental health challenges, compounded by failed weight loss attempts and disproportionate body shape.^{1–7,9–15,17,18}

Lymphedema is another chronic, progressive condition caused by an abnormal accumulation of protein-rich fluid within the interstitial tissue. The condition arises from a reduced capacity for lymphatic transport and/or an increased lymphatic load. This condition is characterized by swelling in one or more limbs and can be potentially severe and debilitating. The accumulation of macromolecules, proteases, and proinflammatory molecules due to lymphedema can lead to chronic inflammation, fibrosis, adipose deposition, hardening of the skin, and an increased risk of infections. If left untreated, lymphedema can result in functional disability, psychosocial problems, and impaired quality of life (QoL).²¹

An email survey revealed that QoL was substantially worse in lipedema patients and that all lipedema patients had physical problems, the most common being discomfort (88.3%) and easy bruising (85.9%).³ A literature review demonstrated decreased HRQoL and psychological well-being in patients with lipedema, with pain and tenderness being more common and dominant characteristics.² According to Dudek et al., QoL is significantly impacted by depression and appearance-related distress. Notably, depression emerged as a key factor affecting QoL. They identified that depression was the most potent predictor of QoL.⁴ Psychosocial problems in lipedema and lymphedema patients are usually overlooked in clinical settings.^2,3,7,10 No study has assessed the comparative psychosocial status in patients with lipedema and lymphedema. This study aimed to comparatively evaluate the functional status, depression, life satisfaction, and QoL in female patients with lower leg lymphedema (LLL) and lipedema.

Methods

Approval for the study was granted by the local ethical committee (GO 19/434). The inclusion criteria specified that participants must be adult women aged 18 to 65, willing to take part voluntarily, capable of reading and writing in Turkish, have had symptoms for at least three months, and not suffer from comorbid conditions that could cause swelling. The exclusion criteria encompassed cognitive disorders, psychiatric conditions, pregnancy status, lipolymphedema, and concomitant diseases that may cause pain.

The study retrospectively gathered data from 73 female patients diagnosed with pure lymphedema or lipedema from the Lymphedema Rehabilitation Unit of Ankara City Hospital, Turkey, over 12 months. LLL patients (Group 1:36) were diagnosed using the International Society of Lymphology criteria. Lipedema patients (Group 2:37) were diagnosed using International Consensus criteria.²² The study recorded various demographic and clinical factors for each participant, including age, exercise habits, smoking, height, body weight, body mass index (BMI kg/m²), duration of disease, etiology and stage of lymphedema, and type and stage of lipedema.

Pain intensity was assessed using a visual analog scale (VAS). On a scale of 0 to 10, VAS 0 indicates no pain, while VAS 10 represents the most intense pain imaginable.

Functional status was assessed using the lower-extremity functional scale (LEFS).¹⁸ The Turkish version of the LEFS was used to evaluate functional disability in the affected extremity. This questionnaire is utilized for patients with disorders affecting one or both lower extremities. It comprises 20 questions regarding an individual’s capability to perform daily activities, rated on a 5-point Likert scale (0 = extreme difficulty or unable to perform activity, 4 = no difficulty). Higher scores indicate better mobility. The LEFS demonstrates adequate reliability and construct validity. The Turkish version of the LEFS exhibited good internal consistency and reliability.²³

The life satisfaction index (LSI) consists of five items with a one-dimensional structure. The Turkish LSI’s internal consistency and reliability were good.^24,25

The patient health questionnaire (PHQ-9) consists of nine questions that assess depression severity based on a 4-point Likert scale. It can be used to monitor depression, with cut-off points as follows: 5–9 = minimal symptoms, 10–14 = minor depression, 15–19 = major depression, and 20 or more = severe depression. The tool has sufficient validity and reliability.^26,27

QoL was assessed using the Turkish version of the Lymphedema QOL Questionnaire for Legs (LYMQOL-Leg). The LYMQOL-Leg, developed by Keeley et al., evaluates lymphedema’s impact on patients’ QoL. This instrument encompasses four domains featuring 28 items: function, appearance, symptoms, and mood. Responses are measured using a 4-point Likert scale, wherein a score of 1 indicates “not at all,” 2 signifies “a little,” 3 denotes “quite a bit,” and 4 represents “a lot.” Each item is assigned a score ranging from 1–4, with higher scores signifying a diminished QoL. In addition, a singular overall QoL rating item is scored on a scale from 0 to 10. The internal consistency and test-retest reliability of the Turkish-LYMQOL-Leg demonstrate strong performance, with a Cronbach’s alpha ranging from 0.85 to 0.90 and a test-retest intraclass correlation coefficient between 0.68 and 0.85.^28,29

Statistical analysis was conducted utilizing IBM SPSS version 22.0 software (IBM Corp., Armonk, NY, USA). Descriptive statistics for continuous variables were reported as mean ± standard deviation or median, while categorical variables were expressed as numbers and percentages. The Kolmogorov–Smirnov test was used to indicate normal distribution. Pearson’s correlation for parametric data was used to determine the association between variables. A p value of <0.05 was considered statistically significant.

Results

The data of 36 lymphedema and 37 pure lipedema patients were included. The etiology was mainly secondary lymphedema due to cancer (41%) and phlebolymphedema (27%). The predominant clinical stage observed in the lymphedema group was stage 2, followed by stages 3 and 1 (55%, 19.4%, and 16.6%). In the lipedema group, stage 2 was the most frequently identified stage, followed by stage 1 (63.7% and 28.1%). The classification primarily consisted of types 2 and 3. Demographical variables were statistically similar between the groups (p > 0.05) (Table 1). Duration of disease was longer in the lipedema group than in lymphedema patients (<0.001). The PHQ-9 and overall QoL scores were similar between groups, while LEFS and LSI scores were worse in patients with lymphedema than in the lipedema group (Table 2).

Table 1.

The Demographic and Clinic Features in Patients with Lymphedema and Lipedema

	Lymphedema (n = 36)	Lipedema (n = 37)	p value
Age(years) (mean) (min–max)	55.1 (22–81)	50.7 (27–74)	0.206
Body mass index (kg/m²)	32.2 (21.5–55.6)	31.8 (20.3–47.5)	0.845
Smoking
Yes	1 (3%)	5 (13.5%)	0.247
No	35 (97%)	32 (86.5%)	0.247
Regular exercise habit
Yes	3 (8.3%)	6 (16.2%)	0.537
No	33 (91.7%)	31 (83.8%)	0.537
Duration of disease (month) (mean ± SD)	39.69 (1–144)	159.31 (12–480)	<0.001
Pain score (0–10) (mean ± SD)	4.43 ± 3.06	5.47 ± 2.29	0.113

Statistically significant results are presented in bold to ensure clear identification and emphasis.

SD, standard deviation.

Table 2.

The Scores of Functional Status, Depression, Life Satisfaction, and Quality of Life in Patients with Lymphedema and Lipedema

	Lymphedema (n = 36)	Lipedema (n = 37)	p value
LEFS mean (min–max)	0.4455 (0.0625–0.9125)	0.6250 (0.2–1)	0.001
LSI mean (min–max)	11.5 (0–22)	14.3 (4–20)	0.022
PHQ_9 mean (min–max)	11.4 (3–23)	10.4 (4–23)	0.384
LYMQOL-Leg function	2.38 (1–4)	2.01 (0–3.75)	0.063
LYMQOL-Leg appearance	2.47 (1.29–3.71)	2.47 (0–4)	0.959
LYMQOL-Leg symptom	2.72 (1–4)	2.31 (0–4)	0.042
LYMQOL-Leg emotion	2.37 (1–4)	2.02 (0–3.83)	0.073
LYMQOL-Leg overall	5.06 (2–10)	5.47 (0–9)	0.365

Statistically significant results are presented in bold to ensure clear identification and emphasis.

LEFS, lower-extremity functional scale; LSI, life satisfaction index; PHQ-9, patient health questionnaire; LYMQOL-Leg, lymphedema quality of life questionnaire for legs.

The analysis demonstrated a significant correlation between age and LEFS and LSI scores among individuals diagnosed with lymphedema (Table 3). The findings also indicated a significant relationship between BMI and LEFS in the group with lipedema and a correlation between disease duration and PHQ-9 scores in the same group (Table 4).

Table 3.

The Relationship Among Demographic and Clinic Variables and Functional Status, Depression, Life Satisfaction, and Quality of Life in Patients with Lymphedema

Lymphedema group	Age	BMI	Durationof disease	LEFS	LSI	PHQ_9	LYMQOLfunction	LYMQOLappearance	LYMQOLsymptom	LYMQOLemotion	LYMQOLoverall
LEFS	r = −0.406 p = 0.014	NS	NS	—	NS	NS	r = −0.836 p < 0.001	r = −0.466 p = 0.004	r = −0.712 p < 0.001	r = −0.726 p < 0.001	r = 0.551 p < 0.001
LSI	r = −0.411 p = 0.013	NS	NS	NS	—	r = −0.403 p = 0.016	NS	NS	NS	NS	NS
PHQ_9	NS	NS	NS	NS	r = −0.403 p = 0.016	NS	r = −0.403 p = 0.016	NS	NS	NS	r = 0.379 p = 0.025
LYMQOL function	r = 0.370 p = 0.026	NS	NS	r = −0.836 p < 0.001	NS	r = −0.403 p = 0.016	—	r = 0.511 p = 0.001	r = 0.644 p < 0.001	r = 0.637 p < 0.001	r = −0.526 p = 0.001
LYMQOL appearance	NS	NS	NS	r = −0.466 p = 0.004	NS	NS	r = 0.511 p = 0.001	—	r = 0.687 p < 0.001	r = 0.634 p < 0.001	r = −0.471 p = 0.004
LYMQOL symptom	NS	NS	NS	r = −0.712 p < 0.001	NS	NS	r = 0.644 p < 0.001	r = 0.687 p < 0.001	—	r = 0.815 p < 0.001	r = −0.573 p < 0.001
LYMQOL emotion	NS	NS	NS	r = −0.726 p < 0.001	NS	NS	r = 0.637 p < 0.001	r = 0.634 p < 0.001	r = 0.815 p < 0.001	—	r = −0.567 p < 0.001
LYMQOL overall	NS	NS	NS	r = 0.551 p < 0.001	NS	r = 0.379 p = 0.025	r = −0.526 p = 0.001	r = −0.471 p = 0.004	r = −0.573 p < 0.001	r = −0.567 p < 0.001	—

Statistically significant results are presented in bold to ensure clear identification and emphasis.

BMI, body mass index; LEFS, lower-extremity functional scale; LSI, life satisfaction index; PHQ-9, patient health questionnaire; LYMQOL, lymphedema quality of life questionnaire for legs.

Table 4.

The Relationship Among Demographic and Clinic Variables and Functional Status, Depression, Life Satisfaction, and Quality of Life in Patients with Lipedema

Lipedema group	Age	BMI	Durationof disease	LEFS	LSI	PHQ_9	LYMQOLfunction	LYMQOLappearance	LYMQOLsymptom	LYMQOLemotion	LYMQOLoverall
LEFS	NS	r = −0.415 p = 0.013	NS	—	NS	NS	r = −0.786 p < 0.001	r = −0.666 p < 0.001	r = −0.628 p < 0.001	r = −0.405 p = 0.013	NS
LSI	NS	NS	NS	NS	—	NS	NS	r = −0.404 p = 0.016	r = −0.364 p = 0.032	NS	r = 0.362 p = 0.035
PHQ_9	NS	NS	r = −0.415 p = 0.028	NS	NS	—	NS	NS	NS	r = 0.344 p = 0.050	NS
LYMQOL function	r = 0.377 p = 0.034	NS	NS	r = −0.786 p < 0.001	NS	NS	—	r = 0.714 p < 0.001	r = 0.721 p < 0.001	r = 0.477 p = 0.006	NS
LYMQOL appearance	NS	NS	NS	r = −0.666 p < 0.001	r = −0.404 p = 0.016	NS	r = 0.714 p < 0.001	—	r = 0.618 p < 0.001	r = 0.463 p = 0.004	NS
LYMQOL symptom	NS	NS	NS	r = −0.628 p < 0.001	r = −0.364 p = 0.032	NS	r = 0.721 p < 0.001	r = 0.618 p < 0.001	—	r = 0.712 p < 0.001	NS
LYMQOL emotion	NS	NS	NS	r = −0.405 p = 0.013	NS	r = 0.344 p = 0.050	r = 0.447 p = 0.006	r = 0.463 p < 0.001	r = 0.712 p < 0.001	—	NS
LYMQOL overall	NS	NS	NS	NS	r = 0.362 p = 0.035	NS	NS	NS	NS	NS	—

Statistically significant results are presented in bold to ensure clear identification and emphasis.

BMI, body mass index; LEFS, lower-extremity functional scale; LSI, life satisfaction index; PHQ-9, patient health questionnaire; LYMQOL, lymphedema quality of life questionnaire for legs.

Discussion

In this study, we compared functional status, depression, life satisfaction, and QoL in patients with LLL and lipedema. Our analysis indicated that patients’ depression (PHQ-9) and overall QoL scores were similar between lipedema and lymphedema patients, while LEFS and LSI were worse in the lymphedema group than in the lipedema group. There were correlations between age, life satisfaction, and function in the lymphedema group and BMI, function, QoL, duration of disease, and general health scores in the lipedema group. To the best of our knowledge, this is the first article in the literature that comparatively assessed the functional status, depression, and life satisfaction of patients with lipedema and lower limb lymphedema.

Numerous studies have indicated that primary and secondary lymphedema may adversely affect the QoL of individuals diagnosed with LLL, particularly psychological and social well-being.^8,30–32

Lipedema significantly impacts the QoL and psychological well-being of affected individuals. It can be challenging for patients to obtain an accurate diagnosis, leading to delays in treatment and management, which in turn worsens the psychological distress associated with the disease.^2–4,7 Even after diagnosis, managing lipedema is difficult due to the lack of standardized treatment protocols. Physical symptoms such as reduced joint mobility, intense pain, easy bruising, persistent edema, and insufficient lymphatic backflow significantly impair daily functioning and contribute to a decline in QoL. Traditional approaches such as diet and exercise often provide minimal improvement, further discouraging patients and compounding their sense of helplessness. Patients with lipedema frequently experience stigmatization by medical professionals, who may mistakenly categorize them as obese. This stigma deepens their psychological distress. The uncontrollable changes in body appearance and associated weight stigma lead to a range of psychological issues. Internalizing societal stigma contributes to self-blame and negative self-perception. The combination of physical, psychological, and social challenges increases the risk of developing severe mental health disorders such as depression, anxiety, and eating disorders, further deteriorating QoL and daily functioning and creating a vicious cycle of declining physical and psychological health.^{2–7,9–11,14,15,33}

Alwardat et al. published a narrative review that examined four observational cross-sectional studies. The review indicated that individuals with lipedema experienced a decline in their psychological status and HRQoL. In addition, it was found that lipedema patients encounter greater difficulties in psychological adjustment, physical and social functioning, as well as increased anxiety and depression.² In a cross-sectional online survey conducted with 98 female participants diagnosed with lipedema, the findings indicated a significantly low QoL accompanied by a high severity of depressive symptoms. The same trial determined that the severity of symptoms, including pain, heaviness, and swelling, was inversely related to QoL.¹¹ Kempa et al. found that individuals with lipedema exhibited a higher prevalence and severity of depression compared to the control group (p = 0.001). They reported increased pain levels (p < 0.001) and greater pain-related disability in daily activities (p < 0.001).¹³ Furthermore, Kempa et al. demonstrated a positive association between pain severity and depressive symptoms, while a moderate positive correlation was identified with the impairment of health-related QoL (HRQoL).¹³

Romeijn et al. found that 42.0% of patients with lipedema experienced anxiety or depression, with 1.2% indicating extreme anxiety or depression.³ In addition, their research revealed that lipedema patients frequently have serious complaints and have a lower QoL than Dutch women in terms of their physical, emotional, and social functioning. Patients’ QoL was also significantly poorer in those with comorbidities.³ In a pilot study, it was revealed that 36.7% of 150 lipedema patients had at least one psychological condition, including anxiety, depression, eating disorders, post-traumatic stress disorder, and panic disorder. In the same investigation, it was found that precisely 80% of the study participants demonstrated high levels of psychological stress.³³ An international survey conducted with 1358 participants diagnosed with lipedema displayed that 28% of respondents reported experiencing emotional lability.¹⁰ According to research conducted by Bauer et al. the prevalence of depression among patients with lipedema is notably high, with 23% of the respondents reporting symptoms of depression.¹²

A cross-sectional online survey conducted among Polish women diagnosed with lipedema indicated that 20% of the participants perceived their overall QoL as either poor or very poor. Furthermore, the findings reveal that more than half of the participants reported low satisfaction regarding their health. The analysis showed that Polish lipedema patients had an average PHQ-9 total score of 12.2. In addition, 11% of the participants reported scores that reflected severe depression while more than half of the participants (59.2%) exhibited levels of severity that may suggest they are experiencing symptoms of depression.¹¹ In our study, the mean overall score for the PHQ-9 was 10.4, indicating a moderate severity level.

A literature review indicated the deterioration of HRQoL and psychological status in lipedema, especially in patients with dominant and common features of pain and tenderness.^1,2 Dudek’s research on Polish women demonstrated that an increase in the severity of symptoms associated with lipedema, including pain, heaviness, and swelling, is correlated with a decrease in QoL. Furthermore, a positive correlation was determined between symptom severity and the intensity of depression.¹¹

The accumulation of excess fat in specific areas leads to low-grade chronic inflammation, disrupting the metabolism of adipocytes, causing increased oxidative damage to lipids, and local hypoxia in the affected region. These changes can lead to fragile capillaries and lymph vessels, raising the likelihood of developing bruises and swelling when standing.^5,7,9 Sympathetic and sensory nerves provide innervation to the subcutaneous adipose tissue. Adipocytes synthesize and secrete neurotrophic factors that modulate sensory innervation.^7,9 Estrogen may play a crucial role in the sympathetic nervous system’s specific innervation of subcutaneous adipose tissue. This may contribute to innervation abnormalities and concurrent inflammation of sensory nerves.^3,7,9,15 The cohort analysis indicated significant correlations between the changes in pain and depression levels in individuals diagnosed with lower limb lipedema. The link between changes in pain and depression was stronger when initial levels of both were high.³⁴ Aitzetmüller-Klietz et al. demonstrated that both physical activity and pain are significant predictors of the severity of depression.¹⁵ The average pain score for 511 female lipedema patients was 6.68 on a scale of 0 to 10, while the average PHQ-9 score was 10.84, according to the trial by Aitzetmüller-Klietz.¹⁵ In our study, the mean pain score recorded among participants with lipedema was 5.47, while the mean score on the PHQ-9 was 10.4. In an internet-based cross-sectional study, Dudek et al. found that a small percentage of participants reported nonproblematic pain. However, nearly half described their pain as severe or extremely severe. Moreover, their findings revealed that individuals experiencing more severe symptoms also indicated a diminished QoL. They found that higher psychological flexibility and social connectedness are linked to better HRQoL. Nevertheless, no relationship between the severity of the symptoms and satisfaction with life was observed in their study.¹

In a study conducted online with 329 participants, Dudek et al. found that appearance-related distress and depression significantly accounted for more variance in the QoL when added to the symptom severity and mobility. The study revealed that lower QoL was associated with higher symptom severity, lower mobility, higher appearance-related distress, and higher depression severity. This suggests that appearance-related distress and depression are important factors in the psychological well-being of women with lipedema.⁴ Al-Wardat et al. reported that individuals affected by lipedema experience considerably more significant difficulties in emotion regulation and exhibit higher levels of anxiety when compared to individuals without lipedema. Their research revealed that individuals with lipedema demonstrated notably higher scores on the Difficulties in Emotion Regulation Scale (DERS), as well as increased anxiety levels, in comparison to those without lipedema. In addition, all subscales of the DERS highlighted notable differences between the two groups.¹⁴

Erbacher found that almost 70% (69.3%) of individuals surveyed reported a maximum VAS score of 6 or higher. In addition, more than half (51.3%) of the participants noted experiencing a maximum pain score of 7 or higher.³³ In our study, the mean scores of VAS were 4.43 ± 3.06 in the lymphedema group and 5.47 ± 2.29 in the lipedema group. Our analysis revealed no statistically significant difference in pain scores between the two groups.

Dudek’s study reported a mean total score of 38 on the LEFS. In comparison, our research identified a mean total score of 35.6, which aligns closely with Dudek’s findings and reflects similar outcomes.⁴

Confusion about lipedema and its treatment, conflicting advice found on the internet, unsuccessful attempts at diet and exercise, weight stigma, and uncontrollable changes in body appearance over time can lead to learned helplessness, self-stigmatization, feelings of shame and guilt, and dissatisfaction with one’s body.^1,10 Lipedema management involves accurate diagnosis, psychological support, edema management, skincare, and weight management to prevent progression.^{4,5,7,9–11,13,15} Most lipedema patients are relieved to learn that their complaints and appearance are caused by a medical condition rather than a lack of self-control. Acknowledging the severity of the complaints and providing optimal information and education about lipedema is crucial in managing patients with this condition. Some patients may benefit from psychological counseling. Obesity prevention is crucial because weight gain in lipedema-affected areas resists diet and exercise.^{4,6,7,9,10,12,13,15} While there’s limited clinical evidence, compression can alleviate lipedema symptoms, halt lymphatic progression, and improve mobility and function.³ Lipedema treatment aims to prevent or reduce obesity, improve patient mobility, reduce complaints, and enhance overall QoL.^6,7,9,13,15 Clarke et al. highlighted the significance of addressing the physical aspects of lipedema and the social and emotional well-being of individuals and encouraging support-seeking behaviors in the international, cross-sectional trial.¹⁰

Depression can lead to a lower QoL, as well as poor adherence to treatment, reduced physical activity, increased social isolation, and overall worse health. Therefore, health care professionals treating lipedema should consider preventing and treating depression as a part of the treatment plan. This may involve social support groups, individual and group therapy, bibliotherapy, web-based support groups, and other interventions.^4,10,15

The primary limitations of this study are the relatively small sample size and the hospital-based, cross-sectional design, which may limit the extent to which the findings can be generalized to the broader population. In addition, a control group was lacking as the main objective was comparatively to evaluate the psychosocial and QoL status in these patient groups, and due to the difficulty of performing some disease-specific questionnaires for healthy control, the QoL instrument was not specific for lipedema, but as the questions cover the majority of disease characteristics, and as it was used for lower limb edema before, we preferred to use it. Another study indicating the validity of this instrument in patients with lipedema would add value to the literature.

This study is important because it is the first one in the literature to comparatively assess functional status, depression, life satisfaction, and the QoL of patients with lipedema and lower limb lymphedema.

Conclusion

Lipedema is a complex condition that requires a multifaceted approach to managing its physical and psychological impacts. Patients with lipedema have similar depression and impaired QoL as lymphedema patients, who have a serious progressive, sometimes life-threatening condition. However, lymphedema patients experienced more functional disability and less life satisfaction. As the BMI and duration of illness are correlated with depression and QoL; we would like to emphasize that early diagnosis and early management are important to improve disability and QoL in both patients suffering from lipedema and lymphedema.

Health professionals should be aware of the aforementioned psychosocial issues and functional status and consider them when assessing patients and planning treatment approaches. Furthermore, it may be essential to include these issues in future research studies.

Authors’ Contributions

Concept, design: P.B., A.Y., E.G.K.; Analysis and/or interpretation: P.B., A.Y.; Literature review, critical review: A.Y., P.B.; Supervision: P.B., A.Y.; Data collection and/or processing, materials, manuscript writing: A.Y., P.B., E.G.K., A.B.A., A.U.K., C.Ş.P.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

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