{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:26:09Z","timestamp":1792034769392,"version":"4.4.0"},"reference-count":53,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Lipedema is a chronic, progressive adipose connective tissue disorder characterized by symmetrical, disproportionate fat accumulation, typically affecting the lower extremities and arms, accompanied by pain, swelling, and a sensation of heaviness. This study introduces intermediate Stages 1.5 and 2.5 to the established lipedema classification (Stages 1, 2 and 3), and other affected areas, based on physical examination, a questionnaire, and photographic documentation. Bioelectrical Impedance Spectroscopy (BIS) was employed to quantify total body water (TBW) across stages. A significant and linear increase in BMI was observed from Stage 1 to 3, correlating with increased reported pain and heaviness in the thighs, calves, and upper arms. Systemic symptoms of brain fog, debilitating fatigue, and hypothermia were significantly prevalent. TBW demonstrated a significant, stage-dependent increase in the lower extremities. Adipose tissue accumulation over the knees and feet significantly increased with lipedema stage. In contrast, shin involvement was evident in early stages and remained consistently elevated throughout later stages. Skeletal Muscle Mass (SMM) exhibited a significant increase across lipedema stages, positively correlating with fat mass (FM) in Stage 3. This study elucidates previously underrecognized clinical features and distribution patterns of lipedema, offering a refined staging system to improve understanding of its progression and burden.<\/jats:p>","DOI":"10.3390\/life15091397","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:07:32Z","timestamp":1756901252000},"page":"1397","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["New Characterization of Lipedema Stages: Focus on Pain, Water, Fat and Skeletal Muscle"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8544-5751","authenticated-orcid":false,"given":"Sara","family":"Al-Ghadban","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, Maxillofacial & Oral Health, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane V.","family":"Evancio","sequence":"additional","affiliation":[{"name":"The Roxbury Institute, Tucson, AZ 85715, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula E. F.","family":"Alfiscar","sequence":"additional","affiliation":[{"name":"The Roxbury Institute, Tucson, AZ 85715, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9079-9754","authenticated-orcid":false,"given":"Karen L.","family":"Herbst","sequence":"additional","affiliation":[{"name":"The Roxbury Institute, Tucson, AZ 85715, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1177\/02683555211015887","article-title":"Standard of Care for lipedema in the United States","volume":"36","author":"Herbst","year":"2021","journal-title":"Phlebology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s13679-024-00579-8","article-title":"The Role of Physical Exercise as a Therapeutic Tool to Improve Lipedema: A Consensus Statement from the Italian Society of Motor and Sports Sciences (Societ\u00e0 Italiana di Scienze Motorie e Sportive, SISMeS) and the Italian Society of Phlebology (Societ\u00e0 Italiana di Flebologia, SIF)","volume":"13","author":"Annunziata","year":"2024","journal-title":"Curr. 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