The starting point: field observations

During a recent training session focused on perioperative care for lipedema, a trainer shared—during the discussion that followed her presentation—a pattern she regularly observes: years of diagnostic uncertainty, diets that never work, and then, once surgery has been performed, sometimes a shift toward a new quest for body transformation.

This observation was the inspiration for this article. Here is what the scientific literature says about it—and what it does not yet say.

Lipedema remains one of the most underrecognized conditions in primary care. A recent review highlights that diagnosis can be delayed by up to ten years, largely because the condition is mistaken for simple obesity. As long as lipedema remains undiagnosed, the only treatment offered is that for obesity: diet, calorie restriction, and increased physical activity—for a type of adipose tissue that, by its very nature, does not respond to these interventions. In fact, some patients report realizing in hindsight that the advice they received at the time could not have worked, simply because a diagnosis had not yet been made.

First Step: When Restriction Becomes a Disorder

A study published in early 2026 in Frontiers in Global Women’s Health assessed the eating attitudes of women with lipedema using the EAT-26 (Eating Attitudes Test, the gold standard for screening for eating disorders). The result: approximately two-thirds of the participants exceeded the screening threshold for ED risk. Another study, conducted among 150 diagnosed patients, showed that 80% of them exhibited a high level of psychological distress just before the onset of lipedema symptoms: depression, eating disorders, or post-traumatic stress disorder according to international diagnostic criteria.

A clinical case illustrates this mechanism well: a young woman, because lipedema had not been diagnosed, became convinced that she was overweight, began severely restricting her food intake, and was eventually diagnosed with both anorexia nervosa and lipedema.

Once a diagnosis has been made: conservative treatments first

Once the diagnosis has finally been established, treatment does not begin with surgery. Recommendations are based primarily on conservative approaches: compression (stockings or sleeves), manual lymphatic drainage performed by a physical therapist, adapted physical activity (particularly aquatic exercise, which is less traumatic to the tissues), and an anti-inflammatory diet. These approaches improve symptoms—such as pain, heaviness, and quality of life—without, however, reducing the volume of the lipedematous tissue itself, which does not shrink, no matter what efforts are made.

When these conservative treatments reach their limits, surgery—liposuction for lipedema—may be considered.

Step 2: What Happens After Surgery?

Surgery offers real benefits: several studies show a lasting improvement in quality of life, pain, and body image—improvements that sometimes persist for more than ten years after the procedure. Since lipedema is a chronic and progressive condition, some patients legitimately require multiple procedures spaced out over time. This is not, in itself, a cause for concern.

What perioperative professionals sometimes observe is something else entirely: a request for another procedure that is no longer based on a clear medical indication, but rather on dissatisfaction that shifts from one part of the body to another. This phenomenon is well documented in surgery and cosmetic medicine in general: body dysmorphic disorder (an excessive preoccupation with a minor or imagined physical flaw) is found to be 15 times more common in these fields than in the general population, with rates reaching as high as 25% in certain cosmetic medicine patient populations. The mechanism described is always the same: postoperative satisfaction is temporary, attention shifts to a new “imperfection,” and the cycle begins again.

To my knowledge, there are no studies that have specifically measured this risk in patients with lipedema following surgery. This is a clinical hypothesis rather than an established fact, but it is consistent with what the literature has already shown: a marked predisposition to psychological vulnerability (distress, eating disorders) even before diagnosis. It would make sense that this same predisposition would expose some patients to an increased risk of shifting toward a broader quest for transformation once surgery has begun. This warrants specific study.

Here's what it all adds up to

A diagnostic odyssey leading to unnecessary diets → a breeding ground for eating disorders → a lipedema diagnosis finally made → conservative treatments that provide relief without resolving the problem → beneficial surgery → and, for some patients, a possible shift toward a new quest for body transformation.

This is neither inevitable nor universal. But the central theme is plausible from beginning to end: a relationship with the body that has been weakened by years of unexplained “resistance” and has never truly been addressed as such.

What Already Exists—and What Is Still Missing

Multidisciplinary approaches to treating lipedema are being developed, involving vascular specialists, physical therapists, nutritionists, and psychologists, with the psychological aspect increasingly recognized as a necessary—rather than optional—component of care.

On the ground, another group plays a role that is often underestimated: practitioners specializing in perioperative lymphatic drainage, who care for patients before and after surgery. Their work is not a medical procedure and does not replace the care provided by a physical therapist or vascular specialist; rather, it complements it. But their close proximity to the patient, both before and after the procedure, makes them privileged observers of the patient’s psychological state and relationship with her body throughout the entire journey—moments that are often less medicalized and therefore sometimes more conducive to open conversation.

But these tools remain focused on lipedema itself: pain, body volume, and quality of life. To my knowledge, none of them is specifically designed to track this journey from start to finish. Screening tools exist separately—for eating disorders early on, and for body dysmorphic disorder prior to cosmetic surgery—but each remains confined to its own stage of the journey. What’s missing is a protocol that integrates them and supports the patient throughout the entire journey, from the first ineffective diet all the way through post-surgical follow-up.

A path to explore together

Early diagnosis remains the most powerful tool: it puts an end to years of ineffective diets, the state of vulnerability they create, and thus the risk that this state will persist after surgery. But this understanding is gaining ground only slowly in primary care, and for patients already caught in the cycle at the time of diagnosis, taking early action is no longer enough: the entire course of treatment, extending beyond the operation, must be closely monitored.

A question therefore warrants consideration by the community of professionals involved in these care pathways—whether they are surgeons, vascular physicians, physical therapists, nutritionists, psychologists, or practitioners of perioperative lymphatic drainage: Shouldn’t we formalize systematic psychological follow-up, both before and after surgery, rather than leaving it to the initiative of a few pioneering teams?

Identifying this pattern does not require a new examination or a new questionnaire. It requires linking observations already made by different professionals at different points in the care pathway. This is a matter of coordination, not research, and is well within the profession’s capabilities once it decides to tackle it.