Unifying Concepts

Diagnostic Criteria of Lipedema

Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress.

Diagnostic criteria of lipedema

Medical history (A)
1 Disproportionate body fat distribution
2 No or limited influence of weight loss on fat distribution
3 Limb pain and bruising
4 Increased sensitivity to touch or limb fatigue
5 Nonpitting edema
6 No reduction of pain or discomfort with limb lift

Physical examination (B, C, D, E)

B Proximal part of the lower limb
1 Disproportionate fat distribution
2 Circumferentially thickened cutaneous fat
C Distal part of the lower limb
1 Proximal thickening of subcutaneous fat
2 Distal thickening of subcutaneous fat, accompanied by slender instep (cuff sign)
D Proximal part of the arm
1 Significantly thickened subcutaneous fat in comparison with vicinity
2 Sudden stop at elbow
E Distal part of the arm
Thickened subcutaneous fat, accompanied by slender back of hand (cuff sign)
Extra criteria F
1 Pain when applying bimanual palpation
2 Distal fat tissue tendrils of the knee (popliteus)

Diagnosis is highly probable when present: A (1 to 6)+(B [1+2] or C [1+2] or D [1+2] or E).
In the absence of at most two of these criteria (A to E), the presence of the extra criteria F(1) or F(2) also support the diagnosis.



  1. Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L. Lipedema: A Call to Action! Obesity (Silver Spring). 2019 Oct;27(10):1567-1576. [Medline]
  2. van la Parra RFD, Deconinck C, Krug B. Diagnostic imaging in lipedema: A systematic review. Obes Rev. 2024 Jan;25(1):e13648. [Medline]


Created May 28, 2024.

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