Background: Despite its estimated high prevalence among women and increasing awareness, lipedema remains under-investigated. Ignoring its debilitating nature, surgical treatment for this condition is frequently covered by health insurance only in advanced stages and after the exhaustion of conservative therapies. Methods: A total of 1015 patients with lipedema were recruited via social media platforms. Of these, 860 patients provided answers to at least one complete section of the modified Body-Q questionnaire (response rate 85%). The Mann–Whitney U and Kruskal–Wallis tests were utilized to assess the impact of the surgical treatment by means of patient-reported outcomes on the self-perception of various body areas. Results: The satisfaction scores among conservatively treated patients for abdominal appearance, arms, back, body, buttocks, and inner thighs showed a statistically significant decline with increasing stages of lipedema. The comparison of patient evaluation scores in the appearance domain demonstrated better patient self-perception scores in patients who received at least one session of the surgical treatment for the hips and thighs (p < 0.01), inner thighs (p < 0.01), and excess skin (0.01) scales. On the body scale, the patients who underwent liposuction again reported better satisfaction scores; however, this did not reach statistical significance (p < 0.081). In the health-related quality of life domain, the patients who received liposuction treatment reported a better outcome in the body image (p < 0.01), physical function (p = 0.05), physical symptoms (p = 0.04), and psychological function (p < 0.01) scales. Conclusions: The current study underscores the burden of lipedema of affected patients and its negative impact on self-perception. As the disease progresses, conservatively treated patients experience a decline in satisfaction with various aspects of their appearance. However, surgical interventions, particularly liposuction, does not address esthetic concerns but significantly improve health-related quality of life across multiple domains, emphasizing the comprehensive benefits of surgical intervention in the management of lipedema.

Trotz fortschreitender Forschung wird die Prävalenz des Lipödems weiterhin nur geschätzt- mit variablen Schätzungen zwischen 1% und 10% in der Literatur. Es fehlen großangelegte epidemiologische Studien. Diese retrospektive Beobachtungsstudie analysierte Abrechnungsdaten der BARMER, der zweitgrößten Krankenkasse Deutschlands (8,7 Mio. Versicherte), mit Fokus auf Frauen mit Lipödem in den Stadien I–III. Die Komorbiditäten wurden mithilfe von Propensity Score Matching mit der Allgemeinbevölkerung und Patientinnen mit Adipositas Grad III verglichen. Zwischen 2017 und 2021 stieg die dokumentierte Prävalenz des Lipödems um 123,5% (von 3,89 auf 8,69 Fälle pro 1000 Versicherte). Stadium II war am häufigsten mit einer Prävalenz von 0,34% im Jahr 2021. Die Hochrechnung auf die Gesamtbevölkerung ergibt ca. 338 200 betroffene Frauen in Deutschland im Jahr 2021 – entsprechend einer Prävalenz von 0,95%. Diese Studie ist die erste, die eine belastbare Extrapolation der Lipödem-Prävalenz auf Bundesebene vornimmt. Die Ergebnisse verdeutlichen die Unterversorgung mit konservativen Therapien und die signifikanten Komorbiditäten in der betroffenen Population. Despite ongoing research, the prevalence of lipoedema still relies on estimates, with figures in the recent literature ranging from 1% to 10%. Large-scale epidemiological studies on lipoedema are lacking. This retrospective observational study analysed health insurance claims data from the second-largest health insurance fund in Germany (8.7 million insured individuals), focusing on women with lipoedema stages I-III. Propensity score matching was performed to compare co-morbidities in lipoedema patients with those in the general patient population and in patients with grade III obesity. Between 2017 and 2021, the documented prevalence of lipoedema increased by 123.5% (from 3.89 to 8.69 cases per 1,000 insured individuals). Stage II lipoedema was the most common, with a prevalence of 0.34% in 2021. Extrapolation of the data to the total population suggests approximately 338.200 affected women in Germany in 2021, corresponding to a prevalence of 0.95%. This study is the first to provide a robust nationwide extrapolation of lipoedema prevalence. The findings highlight the underutilisation of conservative treatment and the significant comorbidities present in the affected patient population. ^‡ Geteilte Erstautorenschaft ^* Geteilte Letztautorenschaft Received: 14 September 2025 Accepted: 27 November 2025 Article published online: 12 March 2026 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany