Effect of Weight Loss on Body Composition and Metabolic Function in Women With Lipedema (Lipedema)

Lipedema is a disorder characterized by massive, bilateral accumulation of fat below the waist and in the legs. Enlargement of the lower extremities is often accompanied by leg pain and accumulation of fluid. Little is known about the functional changes that lead to fat accumulation and pain in women with lipedema. The goals of this project are to conduct a comprehensive characterization of abdominal and femoral fat tissues in lean and obese women with lipedema and to evaluate the potential effect of diet-induced weight loss as a therapy.

Once enrolled in the study, the following tests will be conducted on lean women with lipedema: characterization of body composition (fat tissue distribution), insulin sensitivity (response to insulin) and adipose tissue biology. The following tests will be conducted on obese women with lipedema: characterization of body composition (fat tissue distribution), insulin sensitivity (response to insulin), adipose tissue biology, and immune system function/inflammation. As control groups, we will compare body composition and insulin sensitivity to: i) women with obesity without lipedema who are matched on age, body mass index, total body fat mass, and percent body weight as fat; and ii) women who were lean and healthy to serve as a normal comparator for the 2 groups with obesity. Participants in the 2 control groups will enroll in a different study at Washington University (IRB# 201512086) where the same procedures will be performed to assess body composition and insulin sensitivity.

A second aim of the study is to determine the effect of diet-induced weight loss on body composition, insulin sensitivity, and adipose tissue biology in women with lipedema. The results from this second aim of the study will provide important insights on the efficacy of diet therapy in managing lipedema.

Study Overview

• Status: Completed
• Conditions: Metabolism; Lipedema
• Intervention / Treatment: Dietary supplement: Weight loss

Detailed Description

Once informed consent has been obtained, participants will complete a screening visit that will include a medical history, physical examination, pregnancy test (for women of childbearing potential), blood tests, urine drug test, an oral glucose tolerance test, resting electrocardiogram (ECG), and questionnaires.

Baseline testing will be performed over 2 visits requiring 1 inpatient overnight stay and will require approximately 30 hours in total to complete testing. Testing will include magnetic resonance imaging scans to determine thigh fat mass; abdominal (belly) fat mass and liver fat content; DXA scan to assess whole-body and leg fat mass; blood samples; hyperinsulinemic-euglycemic clamp procedure to assess insulin sensitivity; immune system function/inflammation (performed exclusively in people with obesity and lipedema and BMI-matched controls); and adipose tissue (fat) biopsies.

Once Baseline Testing is completed, participants will start 5-10% dietitian and/or behaviorist guided weight-loss for about 4 to 6 months.

Participant will keep a food diary and have weekly visits (in person or remote) with a study dietitian and/or behaviorist.

After weight loss, the testing completed during baseline will be repeated.

Study procedures:

1. Medical history & physical exam
2. Urine drug/pregnancy Test
3. Blood pressure, pulse, height, weight
4. Electrocardiogram (ECG)
5. Blood tests for routine lab analyses
6. Oral glucose tolerance test (OGTT)
7. Screening Questionnaires
8. Dual energy X-ray absorptiometry (DXA) scan to assess whole-body and leg fat mass
9. Magnetic Resonance Imaging (MRI) to determine the amount of fat in the liver, abdomen (belly), and thigh.
10. Metabolism study (hyperinsulinemic-euglycemic clamp procedure) to assess how well insulin works to control blood glucose (sugar) concentrations.
11. Abdominal (belly) and thigh fat biopsies (women with obesity only)
12. Immune function (performed in people with obesity and lipedema only).

• Study Type: Interventional
• Enrollment (Actual): 19
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Washington University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 68 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Diagnosis of Lipedema
• Lean women with lipedema (BMI >19.5 kg/m² and <26.0 kg/m²)
• Women with obesity and lipedema (BMI >30.0 kg/m² and <50.0 kg/m²)

Exclusion Criteria:

• Medical, surgical or biological menopause
• Previous bariatric surgery
• Diagnosis of Type 2 Diabetes
• HbA1C <5.7%
• Structured exercise >2 days/week for ≥35 minutes of intense exercise (e.g., jogging, activity that cause heavy breathing and sweating) or ≥150 minutes per week of structured exercise (e.g., brisk walking)
• Unstable weight (>4% change in weight during the last 2 months before entering the study)
• Significant organ system dysfunction (e.g., diabetes, severe pulmonary, kidney or cardiovascular disease)
• Cancer or cancer that has been in remission for <5 years
• Polycystic Ovary Syndrome
• Major psychiatric illness
• Conditions that render participant unable to complete all testing procedures (e.g., severe ambulatory impairments, limb amputations, or metal implants that interfere with imaging procedures; coagulation disorders)
• Use of medications that are known to affect the study outcome measures (e.g., steroids, non-statin lipid-lowering medications) or increase the risk of study procedures (e.g., anticoagulants) and that cannot be temporarily discontinued for this study
• Smoke cigarettes >10 cigarettes/week
• Consume >14 units of alcohol per week
• Pregnant or lactating women
• Persons who are not able to grant voluntary informed consent
• Persons who are unable or unwilling to follow the study protocol or who, for any reason, the research team considers not an appropriate candidate for this study, including non-compliance with screening appointments or study visits.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Lean women with Lipedema; Body composition, adipose tissue biology, insulin sensitivity assessed before and after low-calorie diet therapy to achieve 5-10% weight loss.	Dietary supplement: Weight loss; Participants will lose weight by utilizing a low caloric diet and meeting with a study dietitian and/or behaviorist weekly for ~4 months.
Experimental: Women with Obesity and Lipedema; Body composition, adipose tissue biology, insulin sensitivity and immune function/inflammation assessed before and after low-calorie diet therapy to achieve 5-10% weight loss.	Dietary supplement: Weight loss; Participants will lose weight by utilizing a low caloric diet and meeting with a study dietitian and/or behaviorist weekly for ~4 months.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in thigh subcutaneous adipose tissue volume	Thigh subcutaneous adipose tissue volume assessed by magnetic resonance imaging.	Before and after 5-10% weight loss (3-4 months)
Whole-body insulin sensitivity	Whole-body insulin sensitivity determined by using the hyperinsulinemic-euglycemic clamp procedure between women with obesity and women with obesity and lipedema.	Baseline testing

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Thigh subcutaneous adipose tissue volume	Thigh subcutaneous adipose tissue volume assessed by magnetic resonance imaging in women with obesity and lipedema, women with obesity and lean women.	Baseline testing
Change in whole-body insulin sensitivity	Whole-body insulin sensitivity determined by using the hyperinsulinemic-euglycemic clamp procedure.	Before and after 5-10% weight loss (3-4 months)
Leg fat mass	Leg fat mass will be assessed by dual-energy x-ray absorptiometry (DXA) in women with obesity and lipedema, women with obesity and lean women.	Baseline testing
Change in leg fat mass	Leg fat mass will be assessed by dual-energy x-ray absorptiometry (DXA).	Before and after 5-10% weight loss (3-4 months)
Adipose tissue immune cells	Immune cell numbers in upper and lower body subcutaneous adipose tissue stromal vascular fraction content assessed by flow cytometry in women with obesity and lipedema only.	Baseline testing
Change in adipose tissue immune cells	Immune cell numbers in upper and lower body subcutaneous adipose tissue stromal vascular fraction content assessed by flow cytometry.	Before and after 5-10% weight loss (3-4 months)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adipose tissue transcriptomics	Gene expression in abdominal and thigh subcutaneous adipose tissue will be analyzed and compared by using RNA sequencing in women with lipedema.	Baseline testing
Change in abdominal subcutaneous adipose tissue transcriptomics	Gene expression in abdominal subcutaneous adipose tissue will be analyzed by using RNA sequencing.	Before and after 5-10% weight loss (3-4 months)
Change in thigh subcutaneous adipose tissue transcriptomics	Gene expression in thigh subcutaneous adipose tissue will be analyzed by using RNA sequencing.	Before and after 5-10% weight loss (3-4 months)

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: Lipedema Foundation
• Investigators: Principal Investigator: Samuel Klein, MD, Washington University School of Medicine

Publications and helpful links

General Publications

• Cifarelli V, Smith GI, Gonzalez-Nieves S, Samovski D, Palacios HH, Yoshino J, Stein RI, Fuchs A, Wright TF, Klein S. Adipose Tissue Biology and Effect of Weight Loss in Women With Lipedema. Diabetes. 2025 Mar 1;74(3):308-319. doi: 10.2337/db24-0890.

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2017
• Primary Completion (Actual): March 28, 2023
• Study Completion (Actual): March 24, 2025

Study Registration Dates

• First Submitted: August 29, 2017
• First Submitted That Met QC Criteria: August 31, 2017
• First Posted (Actual): September 1, 2017

Study Record Updates

• Last Update Posted (Actual): March 28, 2025
• Last Update Submitted That Met QC Criteria: March 24, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Immunology; Body Composition; Metabolism; Lipedema; Fat Distribution
• Additional Relevant MeSH Terms: Body Weight; Connective Tissue Diseases; Body Weight Changes; Weight Loss; Lipedema
• Other Study ID Numbers: 201702107

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Adipose tissue RNA sequencing will be uploaded to Gene Expression Omnibus (GEO).
• IPD Sharing Time Frame: Before publication of manuscript containing RNA sequencing results
• IPD Sharing Access Criteria: RNA sequencing results will be publicly available.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No