Body mass index vs. waist‐to‐height‐ratio in patients with lipohyperplasia dolorosa (vulgo lipedema)

Abstract

SummaryBackgroundLipedema, also known as lipohyperplasia dolorosa (LiDo), is a painful condition affecting women, causing a disproportionate accumulation of subcutaneous adipose tissue in the extremities. It carries a lower risk of diabetes and cardio‐metabolic dysfunctions compared to obesity, but coincident obesity can complicate diagnosis and treatment.Patients and MethodsThis retrospective study included 607 female LiDo patients, ≥ 18 years, stage 1–3, from Germany, the UK, and Spain. Data were collected as part of the standard initial assessment for LiDo patients.ResultsBased on waist‐to‐height‐ratio (WHtR), 15.2% of patients were underweight, 45.5% normal weight, 22.1% overweight and 17.3% obese. There was a significant association between WHtR category and age group. Body mass index (BMI) is often overestimated, leading to misdiagnosis of obesity.ConclusionsThe use of BMI also affects the recent decision of the German Federal Joint Committee on the reimbursement of liposuction costs by health insurance funds. Patients with BMI of more than 40 kg/m2 are excluded from cost coverage, and those with BMI between 35 kg/m2 and 40 kg/m2 must first receive conservative obesity therapy. In conclusion, the sole use of BMI in lipedema is unreliable and, in contrast to WHtR, leads to inaccurate diagnoses overestimating overweight and obesity.

Lipohyperplasia dolorosa – neu betrachtet

“…A LiDo patient of normal weight is rather uncommonat least in the UK and Germanybut by no means a rarity. A recent multicenter study with patients from Germany, Spain, and the UK, which also includes some of the data from previous studies, reinforces this picture [96]. According to the WHtR categorization, 15.2% of the 607 LiDo patients evaluated were underweight, 45.5% were normal weight, 22.1% were overweight, and 17.3% were obese (class I: 15.0%; class II: 2.3%).…”

“…Vergleicht man aber nun die BMI-Klassifikationen [92] soweit im Detail angeführt -, fallen zwei unterschiedli-che Verteilungsmuster ins Auge (▶ Abb. 4): einerseits ein linear ansteigendes Verteilungsmuster [26,41], und andererseits ein annähernd normal verteiltes Muster [58,93,94,95]. Der Grund für diese unterschiedlichen Verteilungsmuster, insbesondere für das linear ansteigende Muster, ist unbekannt, aber es kann ein Selektionsbias vermutet werden.…”

“…Bei entsprechender Bestehensdauer und Progredienz kommt es v. a. im Bereich der Fettschürze am Bauch und ▶ Abb. 4 Prozentuale Verteilung von Studienpatientinnen nach BMI-Klassifikation[26,41,58,93,94,95,96]. Rot-Töne: annähernd lineare Zunahme des Anteils mit zunehmender BMI-Klasse, Blau-Töne: annähernd Normalverteilung der BMI-Klassen.…”

“…Percentage distribution of study patients according to BMI classification[26,41,58,93,94,95,96]. Red shades: almost linear increase in the proportion with increasing BMI class, blue shades: almost normal distribution of BMI classes.…”

Non-obese lipedema patients show a distinctly altered quantitative sensory testing profile with high diagnostic potential

“…Our study-groups are well matched by weight, height, waist, and WtHR, respectively. 1,9,10,16,23,28,44,51 They represented the general population with comorbidities, such as orthopedic problems, hypothyreosis, 5,53 occasional back pain, and migraine. Participants were only excluded if diagnosed as chronic pain patients but not with only anecdotal pain.…”