Monday, May 24, 2021

Lipedema— the push for medically necessary care

Lipedema is a misdiagnosed fatty disorder, commonly mis-characterized as obesity (Herbst, 2012).  It predominately impacts women, roughly 10% of the female population (Kruppa et al, 2020).  To date, a strong effort is being proposed in the United States for creating an actual diagnosis code for lipedema.

According to Herbst (2012), treatment for lipedema ranges from conservative treatment with lymphatic drainage, aquatic therapy, whole body vibration, compression strategies and some supplements, to an effective surgical intervention known as liposuction.  However, many insurers feel this surgical procedure is cosmetic and not considered medically necessary, resulting in increased out of pocket costs or the avoidance of timely restorative, medical care.

According to a review of several insurance policy handbooks, to be considered as reconstructive and medically necessary, the procedure must be proven to:

1.        Improve or restore normal function, such as activities of daily life, mobility and gait.

2.        Restore the patient to a normal appearance.

3.        Improve the quality of life (QOL) of the patient (ie. pain and fatigue).

Sadly, many liposuction recipients and surgeons are allowing the insurer's definition of this surgical procedure to be misconstrued as experimental or investigative and not being appropriately deemed as a medically necessary intervention.   

Please stay vigilant and pursue the challenge of getting these surgical interventions covered by your insurer by going through their medical review process.  Ask the assistance of your medical team, this is not a tattoo or a haircut, it is a legitimate lipedema treatment for those having tried many years of conservative care.  Remember, lipedema is a progressive disorder and may eventually lead to a comorbidity of lymphedema and/or obesity (Herbst, 2012). 

You have the right to not suffer with pain of a “6” on a “10” scale; you have a right to not feel heaviness in your limbs; you have a right to not panic about cellulitis when bitten by a bug or scratched by your pet; you have a right to feel comfortable in your clothing and so on….. while we do need more good lipedema research (Peprah et al, 2019)  we must continue to gather data in hopes of making these treatment choices irrefutable.  Many medical complications from lipedema can be mitigated if addressed early on.



Herbst KL. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin. 2012;33(2):155–72.

Kruppa P, Georgiou I, Biermann N, Pranti L et al. Lipedema- pathogenesis, diagnosis, and treatment options. Dtsch Arztebl Int. Jun 1, 2020; 117(22-23):396-403.

Peprah K, MacDougall D. Liposuction for the Treatment of Lipedema: A Review of Clinical Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Jun 7. PMID: 31479212.