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Lipoedema is painful nodular subcutaneous adipose tissue (SAT) on legs and arms of women sparing the trunk. People with Dercum disease (DD) have painful SAT masses. Lipoedema and DD fat resists loss by diet and exercise. Treatments other than surgery are needed. Six women with lipoedema and one with DD underwent twelve 90-min sessions over 4 weeks. Body composition by dual X-ray absorptiometry scan, leg volume, weight, pain, bioimpedance, tissue size by caliper and ultrasound were analysed before and after SAT therapy by paired t-tests. There was a significant decrease from baseline to end of treatment in weight, 87.6 ± 21 to 86.1 ± 20.5 kg (P = 0.03), leg fat mass 17.8 ± 7.7 to 17.4 ± 7.6 kg (P = 0.008), total leg volume 12.9 ± 4 to 12 ± 3.5 L (P = 0.007), six of 20 calliper sites and tissue oedema. Pain scores did not change significantly. By ultrasound, six women had 22 hyperechoic masses in leg fat that resolved after treatment; five women developed seven new masses. Fascia improved by ultrasound after treatment. SAT therapy reduced amount and structure of fat in women with lipoedema and Dercum disease; studies are needed to compare SAT therapy to other therapies.

Purpose: Lipedema is a common and painful fat disorder affecting the limbs of women leading to obesity; the fat cannot be lost by diet or exercise, called persistent fat. Lipedema is classified by stage. Stage 1: normal skin surface with enlarged hypodermis. Stage 2: uneven skin with indentations in fat and larger hypodermal masses. Stage 3: large extrusions of tissue drastically inhibit mobility. Lymphedema occurs at any stage, especially Stage 3, called lipo-lymphedema. Reduction of lipedema fat is achieved effectively only by removal of fat by lymph-sparing liposuction. Liposuction reduction of fat on the lower body improves mobility. Data from Europe demonstrate quality of life improves for women with lipedema after liposuction. There are no data on liposuction and lipedema in the United States (US). The purpose of this study is to determine how women with lipedema in the United States benefit or not from liposuction. Materials and Methods: Non-validated 183-item online questionnaire answered by women after undergoing liposuction for lipedema in the US. Results: One-hundred and eighty-nine women with lipedema consented and answered the questionnaire; the majority (51%) Stage 2. Women with Stage 1 and 2 had on average two procedures; women with Stage 3 or lipo-lymphedema had, on average, one additional procedure. Improvement in ambulation after liposuction was highest in patients with lipedema Stage 3 at 90.9% and lowest in Stage 1 at 71%, where ambulation pre-surgery tends to be less affected. Weight loss occurred in all groups 2-4 months after liposuction. Women from all stages reported growth of fat post-procedure outside areas of liposuction, highest in Stage 1 (62%) and lipo-lymphedema (70%). Growth of fat in liposuction areas occurred in ~1/2 of participants across all groups, most often in women in lipedema Stage 4 (71%). The complication of lymphedema after liposuction was not reported in Stage 1 but in two women with Stage 2, five with Stage 3, and three with lipo-lipedema. Improved quality of life after liposuction was significant in Stages 1-3 ranging from 81% improvement for Stage 1 to 86% for Stage 3, but only 70% for women with lipo-lymphedema. The perceived success of the procedure decreased with stage. Conclusion: Women with lipedema noticed improved ambulation after liposuction, likely due to removal of excess adipose tissue from the legs. Fat growth after liposuction was reported consistent with published data. Improvement in quality of life after liposuction agrees with European data, and greater perceived benefit in earlier stages emphasizes the importance of early detection of lipedema and earlier intervention with liposuction. Prospective studies are needed to assess quality of life, fat growth, weight loss and ambulation after liposuction in women with lipedema in the US.

Background Lipedema is a common painful subcutaneous adipose tissue (SAT) disorder in women affecting the limbs. SAT therapy is a manual therapy to improve soft tissue quality. Objective Determine if SAT therapy improves pain and structure of lipedema SAT. Design Single arm prospective pilot study. Setting Academic medical center. Patients Seven women, 46 ± 5 years, weight 90 ± 19 kg, with lipedema. Intervention Twelve 90-min SAT therapy sessions over 4 weeks. Outcomes Dual X-ray absorptiometry (DXA) scans, SAT ultrasound (Vevo 2100), leg volumetrics, skin caliper assessment, tissue exam, weight, resting metabolic rate, pain assessment, lower extremity functional scale (LEFS) and body shape questionnaire (BSQ) at baseline and end of study. Results Weight, resting metabolic rate and BSQ did not change significantly. Limb fat over total body fat mass (p = 0.08) and trunk fat over total body mass trended down from baseline (p = 0.08) by DXA. Leg volume and caliper assessments in eight of nine areas (p < 0.007), LEFS (p = 0.002) and average pain (p = 0.007) significantly decreased from baseline. Fibrosis significantly decreased in the nodules, hips and groin. Ultrasound showed improved SAT structure in some subjects. Side effects included pain, bruising, itching, swelling and gastroesophageal reflux disease. All women said they would recommend SAT therapy to other women with lipedema. Limitations Small number of subjects. Conclusion SAT therapy in 4 weeks improved tissue structure, perceived leg function, and volume although shape was not affected. While side effects of SAT therapy were common, all women felt the therapy was beneficial.

Efficacious lifestyle modification programs for children at risk of type 2 diabetes (T2D) have not been well established outside of clinical settings. In this study, the feasibility of a family-focused, YMCA-based prevention program for children at risk of T2D was evaluated between September 2015 and July 2016 in Tucson, Arizona. A 12-week YMCA-led lifestyle intervention was adapted for 9–12-year-old children and their families to encourage healthy eating, physical activity, and supportive home environments. Two YMCA locations were randomized to offer either a face-to-face lifestyle coach-led intervention or an alternating face-to-face and digitally-delivered intervention. Program feasibility and preliminary effects on child anthropometric and behavioral outcomes were assessed at baseline and post-intervention. Changes were assessed using linear regression combining delivery formats, with adjustment for clustering of participants within site/format. Forty-eight children (10.9 ± 1.2 years old; 45% female; 40% Hispanic; 43% White; 87% obese) and their parents enrolled, and 36 (75%) completed 12-week measures. Weekly program attendance averaged 61%. Participants and coaches highly rated program content and engagement strategies. Statistically significant changes in child BMI-z score (−0.05, p = 0.03) and family food and physical activity environment (+5.5% family nutrition and physical activity score, p = 0.01) were observed. A YMCA-led family-focused T2D intervention was feasible for the YMCA and participants and effects on child weight, behavior, and the home environment warranted further investigation., Highlights • Efficacious youth diabetes prevention is not widely available in community settings • The YMCA offers scalable, sustainable delivery of a family-focused T2D prevention • E.P.I.C. Kids was feasible and preliminary effects warrant further investigation