Efficacy of a 5-Week Multilayer Bandaging Protocol on Clinical Outcomes in Women with Lipedema: A Retrospective Study

1. Introduction

Lipedema is a chronic condition with a significant impact on both physical health and psychosocial well-being. Despite the growing interest in the last years due to increased awareness among both patients and health care professionals, lipedema remains underdiagnosed and misunderstood. The disease almost exclusively affects females; female physiological hormonal changes (puberty, pregnancy, menopause), estrogen-progestin use, and weight gain are all factors related to the onset and worsening of the disease. [1]. As such, a multidisciplinary approach is essential for its proper management. Currently, international guidelines and literature describe two ways of treatment: conservative treatment and surgical treatment [2,3,4,5,6,7,8]. This work focuses on conservative treatment: the primary goals of conservative treatment are the reduction or elimination of symptoms (pain, reduced mobility, edema, fibrosis), the improvement of patients’ quality of life, and the prevention of disease progression and related complications [4]. Cardinal points of conservative management include compression therapy, nutrition, weight management, specific physical activity and physiotherapy, patient education and self-management strategies [2,3,4,5,6,7,8].

Complex decongestive therapy (CDT), commonly recommended in the treatment of lymphedema, consistes of manual lymphatic drainage (MLD), physical therapy, multilayer bandaging (MLB), compression garments, and skin care or each individually [9]. Compression therapy is generally considered useful in all consensus documents and guidelines for reducing discomfort, symptoms, and edema, if present. However, there is no unanimous agreement on how to use it, how often, the type of texture, or the indications, which may vary based on patient characteristics and the stage of the disease. Disagreement regarding the indication for using MLB is even more pronounced. If edema or lipolymphedema is present, especially in the initial stages of treatment, MLB is indicated [4,5,6,7,8], emphasizing that the treatment cannot reduce adipose tissue, but only the edematous component. More recent guidelines [7,8] recognize greater importance for this treatment, which recommend its use not only to reduce the edematous component, but also to treat pain and sensitivity in areas affected by lipedema [7,8]. Treatment is also suggested to reduce disease progression and even for early-stage lipedema [8].

Recent evidence from studies on lymphedema, chronic venous insufficiency, and obesity-related adipose disorders suggests that external compression is beneficial not only for its mechanical decongestant action and tissue fluid shift, but also for modulating the biochemical environment and exerting important biological actions on the subcutaneous tissue, including pain modulation, lymphatic stimulation, and inflammation control [7,10,11,12,13,14,15]. Studies have shown that compression reduces interstitial fluid accumulation, improves lymphatic clearance, and increases tissue oxygenation, thereby reducing the burden of pro-inflammatory cytokines such as interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), and monocyte chemoattractant protein 1 (MCP-1). These mechanisms may help interrupt the inflammatory cycle that drives pain, tissue remodeling, and fibrotic progression in lipedema [16,17,18]. Compression appears to influence macrophage behavior within the adipose matrix, promoting a shift from pro-inflammatory M1 macrophages to M2 anti-inflammatory phenotypes, potentially limiting chronic low-grade inflammation [14,18]. Compression may also exert effects on adipose tissue metabolism itself. Preclinical and translational studies have proposed that mechanical compression can inhibit adipogenesis and reduce adiponeogenesis—the formation of new adipocytes from mesenchymal precursors—by suppressing expression of peroxisome proliferator-activated receptor gamma (PPARγ) and CCAAT/enhancer-binding protein alpha (C/EBPα) [10,18]. This phenomenon could be particularly relevant in lipedema, where adipocyte proliferation contributes to the disease progression. Although these findings have been described primarily in animal models and in vitro systems in humans, these phenomena support a particularly important role for compression therapy on the tissues and limb volumes of patients with lipedema. Despite these indications, to date, efficacy studies remain scarce, they are applied differently in each study, on different patient populations, and use different methods to verify efficacy [8,11,20,21,22,23,24].

Among all the non-surgical treatments available, MLB is uniquely positioned for its ability to provide continuous, targeted compression in a customizable format, allowing it to adapt to different limb shapes and provide low pressure at rest: this feature allows the bandage to remain in place even during nights and periods of rest, allowing the patient to wear it for longer periods and therefore improving its effectiveness. Furthermore, the pressure can be modulated in real time, thus representing an optimal strategy in the intensive decongestant phase, during which the shape, tolerability and characteristics of the limbs can be modified [25]. Clinically, the efficacy of MLB in reducing pain and limb volume in lipedema has been supported by multiple observational studies. Szolnoky et al. demonstrated that a short course of complex decongestive therapy including bandaging led to significant improvements in pain scores and functional symptoms [21]. Additional pilot studies have reported decreases in limb circumference and subjective discomfort following compression protocols, even in the absence of dietary intervention or weight loss [24].

One aspect on which all guidelines agree is that the treatment of lipedema must be based on a multidisciplinary approach, whether conservative or surgical. A multidisciplinary approach is essential to address different aspects of the disease, and it is recognized that different approaches enhance the benefits of others. In this regard, nutritional therapy plays a key role: nutritional measures should be an integral part of lipedema treatment. First, all consensus documents agree that weight gain should be prevented and contained as it can contribute to a worsening of general clinical conditions: although nutritional measures are considered mandatory in cases of associated obesity, they must also be considered in the early stages of the disease, even in the absence of obesity [2,3,4,5,6,7,8]. Furthermore, evidence suggests that a nutritional approach is not only important for weight control, but can also modulate inflammation, edema, and improve body composition [26,27,28,29,30,31,32]. There is still no unanimous consensus on the best diet to treat the disease, but there are some key characteristics that diets should adhere to, including: personalized plans for the patient [3,8], plans that reduce glycemic and insulin spikes [2,6,7], and low intake of inflammatory foods or foods that negatively alter the intestinal flora [2,6,7,8]. It is also recommended to avoid short-term diets [4,7], by preferring long-term modifications.

Although scientific evidence is still limited, efficacy data is growing. In recent years, positive effects of the ketogenic diet (standard or mediterranean type) have been demonstrated not only on body weight reduction but also on pain [31,32,33,34,35] and quality of life [34,35], on the improvement of body composition [33,34,35,36,37], and on the reduction of limb circumferences affected by lipedema [33,36,37]. Only two studies are available on the effects of the low-carbohydrate diet, which demonstrated positive effect on pain reduction, quality of life, body composition, and adipose tissue reduction measured by magnetic resonance imaging (MRI) [38,39]. Only one study is available on the modified Mediterranean diet, which was also found to be effective on body composition and quality of life [40,41], but not directly on pain and limb circumference.

Data on the effectiveness of different types of diets on lipedema are scarce. However, the effects of some specific diets, such as the Mediterranean diet and the ketogenic diet, on inflammatory status, pain modulation, glucose and lipid metabolism, and modulation of the gastrointestinal microbiota have been demonstrated in patients with obesity, metabolic syndrome, and other chronic inflammatory diseases [42,43,44,45].

The aim of this study is to support the positive effect of a multilayer bandaging protocol applied to patients with lipedema, alone or in combination with diet, on anthropometric parameters, lower limb volume, pain, and lipedema symptoms.

2. Materials and Methods

2.1. Study Design

This is a retrospective observational study. All patients were recruited from a large population of woman with lipedema, diagnosed between 2023 and 2025. Inclusion criteria were clinical diagnosis of lipedema (stage 1, 2 and 3), age ≥ 18 years, no previous treatments for lipedema (including bandages and compression stockings) or previous surgical treatment. The exclusion criteria included: pregnancy, breastfeeding, major chronic diseases (such as diabetes mellitus, cardiovascular disease, or renal disease), hormonally unbalanced thyroid disease and lymphedema.

The diagnosis, staging and phenotyping of lipedema was based on clinical findings of characteristic symptoms and signs of the disease, as described in our previous studies [1,23,46]. The population was divided into three groups based on the treatment received:

• patients treated with a 5-week multilayer bandage protocol (BEND)
• patients treated with a 5-week multilayer bandage protocol combined with diet (BEND+DIET)
• patients reevaluated after 5 weeks without receiving any treatment and without dietary modification (CONTR)

All participants completed a 5-week treatment or observation period and provided written informed consent. Patients in the treatment groups (BEND, BEND+DIET) were evaluated at baseline (T0) and after 5 weeks of treatment (T1) with an assessment of anthropometric parameters, limb volume, clinical assessment of pain with the Progressive Pain Check (PPC) method, and subjective symptoms with a dedicated questionnaire, as described below. The control group (CONTR) was evaluated at T0 and after 5 weeks with clinical assessment using the PPC method and a repeat of the symptom questionnaire; data on limb volume, weight changes, and waist and hip circumferences for the control group are not available.

2.2. Clinical Assessment

The clinical examination focused on the evaluation of anthropometric parameters (height, weight, and waist circumference) and the presence and extent of pain provoked by pinching subcutaneous tissue. To assess pain provoked we used the PPC method, as described in our previous work [23,46]: gentle but firm pressure was applied to 11 predefined anatomical sites, and pain at each site was rated on a verbal scale from 0 (no pain) to 4 (severe pain). From these data, three indices were calculated: a total score or Ricolfi-Patton Score (RPS) (sum of all 11 sites evaluated, range 0–44), a score for the lower body or the Lower Body Pain Score (LBPS) (sum of scores from 8 lower body sites, range 0–36) and a score for the upper body or the Upper Body Pain Score (UBPS) (sum of scores from 3 upper body sites, range 0–12).

The volume of the lower limbs was calculated using the trunk formula derived from circumferential measurements taken every 4 cm from the ankle to the groin. The volume calculation used the Kuhnke disk method [47].

2.3. Symptom Assessment

Each item quantifies the severity of the symptom using a 6-point Likert-type scale with the following verbal descriptors for each individual question (0 = none, 1 = very mild, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe). The total score ranges from 0 to 85 points. Symptoms can be assessed individually, and a final score can be calculated from the sum of the individual scores, ranging from 0 to 85 [23,46].

2.4. Treatments

2.4.1. Multilayer Bandage Treatment Protocol

Both the BEND and BEND+DIET groups underwent an intensive cycle of multilayer bandaging according to a protocol that our group has standardized and used for several years for the treatment of lipedema. The protocol involves 10 sessions of multilayer, multicomponent bandaging applied twice a week for 5 consecutive weeks. The bandages are applied by experienced physiotherapists, following the recommendation and supervision of a lymphologist (Figure 1).

The bandage consists of three layers (Figure 2). The first layer (sub-bandage layer) includes a dressing and a padding layer, a non-compressive material (foam, 0.4 mm thick) used to protect the vulnerable area and increase pressure at specific points. The second layer is a medium-stretch bandages (70–140 per cent) performed using the herringbone wrapping technique from the ankle to the groin and, if necessary, extended to the abdomen for anchoring. A third layer (over-bandaging) consists of non-woven adhesive tape and tubular material used to stabilize the bandage. These bandages have low resting pressures and working pressures as they work with muscle contraction, this characteristic allows the bandage to be maintained even during night-time and periods of rest, enabling the patient to wear it for longer periods and thereby enhancing its effectiveness. Proper application requires advanced manual skills to ensure effective tissue containment without restricting functional movement, allowing immediate ambulation and active exercise as part of the integrated conservative management (Figure 3). Patients were instructed to wear the bandages for as many hours per day as tolerable, aiming for continuous daytime use. Each patient kept a clinical diary to record the daily duration of bandage wear and any symptoms or adverse events. At the treatment’s conclusion, diaries were collected and the mean wear time per day was computed.

2.4.2. Dietary Intervention

Patients followed a diet based on our protocol, which we have standardized over time based on scientific evidence and on our specific experience with patients with lipedema. For this study, we excluded patients who had been treated with a ketogenic diet, an approach we also use but reserve just for selected cases.

The nutritional plan applied is primarily based on the Mediterranean diet, but modified in some aspects, relating to macronutrient composition and food selection. The macronutrient composition is 40-50% carbohydrates, 20-30% protein, and 30% fat. It is not a carbohydrate-restricted diet; however, the carbohydrate composition generally varies on alternate days, from days with 40% carbohydrates to days with up to 50%. Furthermore, it is recommended to favor medium- and low-glycemic load carbohydrates and to reduce gluten consumption, preferring the use of naturally gluten-free carbohydrates (such as potatoes, corn, peas, rice, etc.). It is also recommended to choose proteins with lower acidifying properties (preferring fish, legumes, and eggs over meat and dairy products) and to consume at least one serving of raw vegetables per day. Generally, no food is eliminated, but it is essential to pay attention to portions, cooking methods, and combinations, as well as choosing foods that are easily digestible, that activate lipid metabolism, improve carbohydrate metabolism, and reduce inflammation. All subjects followed a calorie-restricted diet of approximately 20% of their daily energy needs and their personal nutritional habits. No specific questionnaires were used to evaluate diet and physical activity, which were assessed by nutritionists and doctors during the visits.

2.5. Statistical Analysis

Anthropometric and clinical data were summarized using descriptive statistics and appropriate measures of precision for each variable (continuous or categorical). Continuous variables were reported as mean and standard deviation (SD) when normally distributed, and as median and interquartile range (IQR) when non-normally distributed. The normality of continuous variables was assessed using the Shapiro–Wilk test. Comparisons among the three study groups were performed using one-way analysis of variance (ANOVA) when all groups showed a normal distribution. When at least one group violated the assumption of normality, the non-parametric Kruskal–Wallis test was applied.

Homogeneity of variances across groups was evaluated using Levene’s test. Paired Student’s t-tests or Wilcoxon signed-rank tests were used to compare values before (T0) and after treatment (T1) within each group. For independent samples, unpaired t-tests or Mann-Whitney U tests (Wilcoxon rank-sum) were applied. Differences in categorical variables were evaluated using the Chi-square test or Fisher’s exact test, as appropriate.

To investigate the associations between clinical outcomes and potential predictors, eight separate multivariate linear regression models were performed, stratified by treatment group: compression bandaging alone (BEND) and compression bandaging plus diet (BEND+DIET).

The dependent variables for these models included the average volume of the lower limbs at follow-up (T1), the volume change (percentage), the total symptom questionnaire score at T1, and the lower body pain score at T1. All models were adjusted for a set of predictors, which included age, BMI, average daily duration of bandaging (mean wear time), stage of disease (Stage 2 or Stage 3), the presence of fovea, and the respective dependent variable measured at baseline (T0). All candidate predictors were selected a priori based on clinical relevance. Multicollinearity was assessed using variance inflation factors, while model assumptions were verified through residual diagnostics, which showed no evidence of heteroscedasticity; residual normality was further evaluated using the Shapiro–Wilk test.

For all statistical tests, a p-value < 0.05 was considered statistically significant. All statistical analyses were performed using R software version 4.4.2 (R Foundation for Statistical Computing, Vienna, Austria).

3. Results

3.1. General Description, Phenotypic, and Staging

A total of 114 women with stage 1, 2, or 3 columnar lipedema (Stage 1 34.2%, Stage 2 42.1%, Stage 3 23.7%) were included. Their mean age was 43.2 years (range 19–79 years) and their Body Mass Index was 30.0 (range 19.7–48.9 kg/m2).

The population was divided into 3 groups as follows:

• Bandage-only treatment group (BEND): 35 patients
• Bandage-plus-diet treatment group (BEND+DIET): 48 patients
• Untreated control group (CONTR): 31 patients

Table 1 shows the characteristics of the entire population and of the population divided into 3 groups. Before starting therapy (T0), the groups did not differ in the main clinical characteristics, including body mass index (BMI), clinical stage distribution, lower limb volume, symptom assessment questionnaire score, and tissue fold pain score.

The mean bandage wear time was 24.7 hours (range 8–52 hours); there was no significant difference between the two treatment groups.

3.2. Anthropometric Measurements and Volumes

3.2.1. Anthropometric Measurements

In both treatment groups (BEND and BEND-DIET), we observed a significant reduction in body weight and waist and hip circumferences from T0 to T1. The BEND-DIET group showed a significantly greater reduction in body weight compared to the no-diet group (0.6% vs. 4.4%, respectively) and a greater reduction in waist and hip circumference (P < 0.001 for all) (Table 2). These parameters were not evaluated in the CONTR group.

3.2.2. Lower Limbs Volume

Lower limb volume (right, left, and mean lower limb volumes) was significantly reduced in both treatment groups (p<0.001). The BEND-DIET group showed significantly greater reductions in right, left, and mean lower limb volumes (p<0.001), demonstrating a percentage reduction in mean volume almost double that of the BEND group (from a 5% reduction to a 9% reduction) (Table 2). This parameter was not assessed in the CONTR group.

3.3. Pain

Pain evoked by the subcutaneous fat fold, assessed with the PPC method, was reduced in a statistically significant way in both treatment groups, BEND and BEND+DIET. The reduction was verified for all three indicators RPS, LBPS and the UBPS in both treatment groups (P< 0.001 for all). There were no significant differences in pain reduction between the BEND group and the BEND+DIET group (Table 2 and Table 3).

Evaluating the change in pain scores at individual PPC assessment points, a significant reduction was observed for all assessed points (p<0.001) except for the forearm in both groups. We found no difference in the results obtained in the BEND and BEND-DIET groups at any score point (Table 3).

The control group, which received no treatment and was reevaluated after 5 weeks, showed no significant differences in the 3 pain scores (RPS, LBPS, and UBPS), nor at any individual body site (Table 3). The change observed in the control group compared to the two treatment groups was significant for all 3 scores of the score and for all individual points except for the forearm (Table 3).

3.4. Symptoms

The subjective symptom assessment using the questionnaire showed a significant reduction in the total score and in each individual item for both the BEND and BEND-DIET groups; no difference in the reduction of the total score or in the scores for each item was detected between the two treatment groups (Table 2 and Table 4).

The control group, CONTR, showed no significant differences in the total symptom questionnaire score or on any of the individual items (Table 4). The comparison of the change observed in the control group with the two treatment groups was significant (Table 4).

3.5. Multivariate Analysis

Table 5 and Table 6 show the results of the multivariate regression analysis that was carried out to evaluate the impact of the treatment on pain (Lower Body Pain Score, Models 1 and 5), symptoms (Total Symptom Score, Models 2 and 6), mean lower limb volume (Models 3 and 7), and percentage change in lower limb volume (Models 4 and 8) adjusted for potential confounders (baseline variables, age, BMI, stage of the disease, bandage wearing time and pretibial fovea). The analysis was performed for both treatment groups, BEND (Table 5) and BEND+DIET (Table 6).

The final effect on pain, symptoms, and volume is independent of possible confounding factors such as age, BMI, clinical stage, the presence of a pretibial fovea, and length of time the bandage has been worn (model 1, 2, 3 e 5, 6 e 7).

We also performed the same analysis on the percentage variation of the volume of the lower limbs in both groups (Model 4 and 8): with respect to the factors considered, we did not find any interference except for the time of wearing the bandage in the BEND+DIET group (Model 8, p 0.036)

4. Discussion

Currently, there is no widely shared consensus on the optimal therapeutic strategies for the management of lipedema, resulting in a substantial heterogeneity in the clinical approaches adopted across different healthcare settings. This variability contributes to a high degree of decision-making uncertainty among healthcare professionals and to a significant psychological burden in patients, who frequently report previous therapeutic experiences characterized by limited or absent efficacy. The lack of standardized therapeutic guidelines can be attributed to multiple factors, including the scarcity of high-quality clinical evidence, the fragmentation of available data in the literature, the variability of protocols adopted across specialized centers, and the marked phenotypic and clinic-functional heterogeneity of the population affected by lipedema.

This study was designed to evaluate the clinical efficacy of multilayer bandaging applied according to our intensive protocol, with materials, application methods, bandaging wear times, frequency, and duration of treatment chosen based on our years of clinical experience. The methods we have described to evaluate clinical and subjective outcomes are applied daily to assess the efficacy of the protocols and the various treatments that can be prescribed and applied to individual patients. The protocol we used in this study allowed us to achieve maximum results in the shortest possible time. Our primary goal is to reduce subjective symptoms, which are typically achieved after just a few bandaging sessions, but also, and above all, to reduce the pain caused by the tissue fold. This second aspect is more difficult to achieve; it requires more time and multiple application sessions and represents an aspect we believe to be more significant to evaluate the effectiveness of a treatment or the progression of the disease over time. We recommend evaluating this pain provoked sign together with the others subjective symptoms. Finally, the frequency and duration of the protocol were also calibrated to stabilize results in the medium to long term, reducing the number of patients who need, or depend, on cyclical treatments, which are often required but impact the disease management and the patients’ daily lives.

To this date, no studies have investigated the effectiveness of multilayer bandaging as a standalone therapeutic intervention in the treatment of lipedema. The available evidence comprises only four studies that evaluated bandaging within multimodal protocols, in combination with manual lymphatic drainage, skin care, and therapeutic exercise, or in association with intermittent compression therapy [21,22,48,49]. Furthermore, no studies have explored the effectiveness of bandaging combined with structured dietary interventions. Considering the growing relevance of a multidisciplinary approach in the management of lipedema, a second aim of the present study was to demonstrate that the use of bandaging combined with an anti-inflammatory diet was effective in reducing lower limb volume, subjective symptoms, and pressure-evoked pain.

Our study demonstrates the effectiveness of multilayer medium-stretch bandaging in reducing subjective symptoms, pressure-evoked pain, and lower limb volume, even when used as monotherapy; the outcome was observed in all three stages of lipedema, independently of BMI, age and the presence of fovea sign. As mentioned, the timing and frequency of bandaging are crucial: our protocol requires that the bandage be kept in place as long as possible between sessions and must allow movement, which is encouraged because it improves the effectiveness of the treatment on the tissue and must allow normal daily activities, particularly work, to be performed. In our experience, the longer it is kept in place, the greater the positive effects. This study was not aimed at evaluating the time required to keep the bandage on and in fact no relationship emerged between the duration and the effect on the parameters evaluated in the monotherapy group, while there would appear to be a positive relationship between the time the bandage was kept on and the % reduction in volume in the group also treated with the diet. But it should be emphasized that in this study, the average bandaging time applied to both lower limbs was over 24 hours, with a range, depending on patient tolerance, between 8 and 52 hours, for 5 weeks. Bandage retention tolerance is closely linked to the therapist’s ability to make the bandage as light and functional as possible, without excessive discomfort during movement and, above all, without causing pain.

Although the technique derives from the treatment of lymphedema, there are methodological differences primarily related to the different treatment objectives. Goals also include reducing tissue congestion, improving microvascular and lymphatic perfusion, and edema (if present), as in lymphedema [2,50,51,52], and indeed, treatment is indicated in these cases by the guidelines [2,3,4,5,6,7,8]. In this study, we demonstrated that clinical and subjective improvement is also achieved, and that the results are independent of the presence of signs of edema (pitting): this is a crucial aspect that suggests modifying the treatment indications.

In the case of lipedema, the application must be calibrated and sufficiently long-lasting to have an effect on the inflammatory and fibrotic degenerative phenomena present in the tissue, which are not rapidly reversible, and to have an effect on adipogenesis. Fascinating preclinical and clinical studies supporting this effect on tissue with compression are available and are increasing knowledge in this field. These studies also show that the method of applying the compressive force, which includes mechanical force, direction of the force, duration, and cyclicity of application, has an impact on the effect and must therefore be calibrated [10,11,12,13,14,15,16,17,18,52,53,54]. With these assumptions, we aimed to evaluate the effect of adding an anti-inflammatory diet. This study shows that the addition of the diet did not enhance the reduction of pain and subjective symptoms achieved by bandaging alone, as was also achieved with monotherapy. However, the diet resulted in a greater reduction in lower limb volume (from a 5% to a 9% reduction), body weight (0.6% vs. 4.4%, respectively), and waist and hip circumference (P < 0.001 for all) compared to bandaging alone. From a pathophysiological perspective, an anti-inflammatory diet, in addition to promoting weight reduction, can modulate the chronic low-grade inflammation characteristic of lipedema by reducing the activation of proinflammatory cytokines and improving adipose tissue function, for example by improving insulin sensitivity [28,29,30,31,32,55,56]. Regarding this last concept, in a precedent study, we demonstrated that using insulin sensitizing drugs, as exenatide, represents an efficient way to treat lipedema [46]. It is hypothesized that, in part, the reduction in both systemic and local inflammation may have also facilitated the mobilization of interstitial fluid and pathological fat deposits, amplifying the bandaging effect on limb volume. Volume reduction, coupled with pain relief, may significantly impact not only functional outcomes but also psychological well-being and quality of life. Furthermore, nutritional therapy, which is typically continued long-term in these patients, even after intensive treatment, could promote the maintenance and consolidation of the results achieved over time, also improving adherence to therapy. In addition, improvements in carbohydrate metabolism and insulin sensitivity may contribute to better metabolic control. In this context, dietary management should not be considered merely supportive, but rather a structural component of conservative lipedema treatment.

The results of the present study further support evidence for a multidisciplinary approach in the conservative management of lipedema, confirming the complementary role of both physical and nutritional interventions. In line with major consensus documents and international literature, our data suggest that the combination of targeted therapeutic strategies may produce superior clinical benefits compared to isolated interventions. Overall, these results contribute to addressing a gap in literature by providing preliminary evidence on the interaction between nutritional intervention and our intensive bandaging protocol in lipedema. Nevertheless, several methodological limitations should be acknowledged, including the relatively small sample size, lack of randomization, and limited follow-up duration.