Ramin Shayan Reviews - Lipedema World Congress 2025

PhysioPod® UK asked Associate Professor Ramin Shayan for his valuable feedback on the Lipedema World Congress held in November.

Rome World Congress — Context & Significance

The 2025 Congress convened in Rome (5–8 Nov), organized by the Lipedema World Alliance. It brought together a wide multidisciplinary audience — lymphologists, surgeons, metabolic specialists, clinicians, researchers, patient-advocacy groups — to advance dialogue on lipedema from pathophysiology to treatments. (2025 Lipedema World Congress).

The agenda spanned basic science, diagnostics, metabolic aspects, conservative and surgical treatments, lymphatic and vascular involvement, and emerging therapies. On the last day I was honoured to be elected to the LWA board (GC Congressi).

Tara and I were privileged to present sessions on:

Our surgical approach (in the pre congress)
Three talks on our research in immune cells & fat-stem cells and emerging epigenetic mechanisms in lipedema
We chaired sessions on surgery for lipedema and the closing session of the future of lipedema research which ended the congress on a high note of hope and reflection on how far we have come.

In our own sessions we recast the role of the lymphatic-system which was once thought to be a cause for lipedema. “Not the root cause, but not to be forgotten: A pilot gene study, functional analysis and surgical proof-of-principle study of the lymphatic system in lipedema.” (2025 Lipedema World Congress).

We discussed our recent paper concluding that lipedema appears genetically heterogeneous. Our 31-individual, 9-family sequencing study found no single gene common across all families — suggesting many possible genetic routes to lipedema, complicating efforts to find a “one-size-fits-all” genetic target. (PubMed)

Our more recent lab data also explored epigenetic regulation linked to that abnormal fat-stem cell behavior, and in vitro experiments reportedly managed to “turn off” the excess adipose growth by targeting that gene pathway — opening the door to potentially disease-modifying drug treatments rather than solely symptomatic surgical or conservative care. (SVI)

Elsewhere in the congress, the field discussed development of diagnostic biomarkers and non-surgical therapies. This quest remains a priority as a biomarker could improve diagnosis, help differentiate lipedema from obesity or lymphedema, and allow early intervention before severe progression.

One of the other notable themes at the Congress was rising interest in metabolic/pharmacological approaches — in particular, using GLP-1 receptor agonists (or dual GLP-1/GIP agonists) as potential treatments for lipedema. There was a full session (Session 2 in the programme) dedicated to “GLP-1 and other medical therapies,” highlighting several oral communications and early clinical reports: including effects of tirzepatide (a dual GLP-1/GIP agonist), low-dose GLP-1 analogues, and preliminary data on tissue-level effects of GLP-1 on lipedema fat. (2025 Lipedema World Congress).

The rationale for GLP-1 use in lipedema is rooted in newer mechanistic hypotheses: rather than only targeting appetite or general obesity, these drugs may directly influence adipose tissue biology, inflammation, fibrosis, extracellular matrix remodelling, even thermogenesis — all factors implicated in lipedema pathology. (PubMed)

As highlighted, the dual agonist Tirzepatide (GLP-1 + GIP), for example, may modify the disease course by shifting macrophage populations toward anti-inflammatory phenotypes, reducing pro-inflammatory cytokines, suppressing fibrosis and extracellular matrix over-accumulation, and promoting adipose tissue remodelling. (PubMed)

The prominence of these sessions suggests that the lipedema field is increasingly shifting from a purely surgical/conservative model (compression, liposuction, rehab) toward a more integrative, metabolic-inflammation-based model — where drugs like GLP-1 or GLP-1/GIP agonists could become part of standard-of-care if ongoing research confirms safety and effectiveness.

Strengths / Why it feels like a turning point

The inclusion of immunology, stem-cell biology and metabolic therapy in a mainstream lipedema congress reflects maturation of the field: from “cosmetic / fat loss” framing to “disease with a cellular and molecular basis.” As I said in the summation of the surgical panel, if we are still talking about surgery as the prominent focus of lipoedema treatment in a decade, we have failed.
The willingness of the Congress to allocate a full medical-therapy session (GLP-1 etc.) — alongside traditional topics like liposuction, lymphatics, diagnostics — indicates openness to non-surgical interventions. That could be a game-changer for many living with lipedema, especially those unwilling or unable to undergo surgery.
The therapeutic hypothesis around GLP-1 and GLP-1/GIP is scientifically plausible and addresses several known pathophysiological mechanisms (inflammation, fibrosis, adipose hypertrophy, metabolic dysfunction) rather than only cosmetic fat reduction.

Challenges / What’s still uncertain

Even if metabolic drugs help, they may not address every aspect of disease — e.g., lymphatic dysfunction, structural changes, advanced fibrosis — which may still require surgery or other interventions.

Conclusion: A Promising, Evolving Landscape

The 2025 Lipedema World Congress in Rome marked a turning point. With basic-science evidence for lipedema as a distinct disease (stem-cell and immune-cell involvement), and with GLP-1 / GLP-1-GIP therapies gaining visibility as potential disease-modifying treatments, the field is shifting toward a more nuanced, biological, multipronged model of understanding and care.

There remains a long way to go — especially in validating drug therapies clinically, in defining diagnostic biomarkers, and in personalizing treatment according to disease stage, tissue pathology, genetics, and patient needs. But the direction is encouraging: lipedema is being reframed as a legitimate, complex, treatable disease — not simply excess fat — and that changes both scientific hope and patient outlook.

Lastly, I was delighted to catch up with Lipoedema UK representatives and we are arranging a webinar to UK members in the coming new year.

Have a wonderful Festive season and keep up the fight.

Kind regards

Ramin

A/Prof Ramin Shayan, MBBS, PhD, FRACS (Plas) Consultant Plastic Surgeon | Alfred Health, Brighton Plastic Surgery, Melbourne Health,

St Vincent’s Hospital Melbourne, VPSU.

Director | O’Brien Institute Department, St Vincent’s Institute for Medical Research.

Director | Gertrude BioMedical.