In 2005, almost 20 years ago, the first guideline on lipedema was listed in the AWMF register under the number 037/012. The latest version from 2015 was revised this year and will be published shortly.
The main changes are as follows:
- The term lipoedema: The condition is still referred to as lipedema, although experts agree that this is not the ideal term. However, the term is now so well established in language and ICD coding that changing it would only lead to confusion.
- Term Lipohypertrophy: Lipohypertrophy is the term used to describe abnormally increased fat tissue in the extremities WITHOUT pain. Lipohypertrophy may be a precursor to lipedema.
- Staging: Current staging should not be used as a measure of disease severity, as it is based only on changes in body shape and not on symptoms such as pain. A staging system for symptoms does not yet exist. This is a task for research.
- BMI: BMI should no longer be used alone to differentiate between lipedema and obesity. The use of waist to height ratio (WHtR) and the Herpertz lipohypertrophy ratio is recommended.
- Treatment of overweight and obesity: The treatment of overweight and obesity should be included in the overall treatment concept for lipedema, as both can lead to the progression of limb volumes and a worsening of the clinical picture.
- Conservative treatment: The treatment option using compression and manual lymphatic drainage is set out in the catalog of remedies and aids. This means that there is a legal entitlement if the treatment is indicated and prescribed by a doctor.
- Compression fitting: In Stage I, a circular knit may be prescribed. However, if this is constricting, then a flat knit must be used, and there is a plausible reason for this - the very constriction, i.e., the round knit, cannot work and is not effective.
- Surgical therapy: Surgical therapy by liposuction is recommended for all stages. The PAL or WAL technique is approved. The procedure can be performed under tumescent local anesthesia (TLA) or general anesthesia. The number of sessions should not exceed 4 for legs and 2 for arms. The amount of liposuction should not exceed 10 percent of body weight.
- Self-management: Special emphasis is placed on self-management. It is the basis for the implementation of a comprehensive treatment concept consisting of 6 pillars: Nutrition - Exercise - Compression - Lymphatic drainage - Liposuction - Psychological support.
- Self-help groups: The exchange with other affected people in self-help groups can offer valuable support and make it easier to deal emotionally with the disease
The LipoCheck app also offers a practical guide to the lipedema guideline.
