Introduction
In December 2025, Dr Samaro Blasco and colleagues published one of the largest cohort studies of lipoedema to date. Drawing on data from approximately 1,800 women in a Spanish clinical setting, the study explores lipoedema comorbidities at diagnosis, alongside the symptoms reported when the women first presented for care. The full paper is available here.
The paper has attracted attention because of the wide range of additional health conditions reported alongside lipoedema. As a clinician working with women with lipoedema every day, I am not surprised at all. In fact, the findings mirror my own clinical practice.This blog summarises what the study found and, just as importantly, explains how these findings should be understood.
What Kind of Study was this?
This was a descriptive study of people diagnosed with lipoedema, recording the symptoms and other health conditions present at the time of diagnosis in routine clinical practice.
Lipoedema rarely appeared in isolation
One of the central findings of the study was that most individuals did not present with lipoedema alone. Many reported symptoms affecting multiple body systems, alongside other diagnosed health conditions.
Pain and Musculoskeletal Symptoms
Pain was extremely common in the study population, particularly affecting the hips, thighs and lower limbs. Widespread musculoskeletal discomfort was also frequently reported.
The study could not determine whether this pain was caused directly by lipoedema, changes in movement and biomechanics, or by other musculoskeletal problems that were already present. What it did show was that pain was a central part of how many people experienced lipoedema at the time of diagnosis.
Digestive Symptoms and Gut Permeability
One of the more striking findings was the high frequency of digestive symptoms. These were described by the authors under the concept of ‘increased intestinal permeability’.
It is important to be clear about what this means. The study did not directly measure gut permeability using laboratory testing. Instead, this label was applied based on reported symptoms such as bloating, abdominal discomfort, food sensitivities and altered bowel habits.
The findings showed that digestive symptoms were very common in this group. They did not confirm that participants had measurable changes in gut barrier function.
Nickel Allergy and Sensitivity
In the cohort, around 40% of women were reported to have a nickel allergy or sensitivity. That proportion is higher than estimates for the general female population, which are usually cited at around 10–15%. Caution is required when interpreting the difference. The population was drawn from a specialist clinical setting, where people with more complex symptom profiles and multiple sensitivities are more likely to be referred and diagnosed.
Nickel allergy was identified through reported or recorded clinical history, rather than through systematic screening. The finding may therefore be clinically relevant for some individuals, but it does not establish nickel sensitivity as a cause of lipoedema or as a defining or diagnostic feature of the disease.
Hormonal and Endocrine Associations
The study reported a high prevalence of endocrine and reproductive system conditions. Thyroid disorders were commonly identified, and the authors also described what they termed inflammatory ovarian dysfunction, a broad category used to capture ovarian and reproductive abnormalities without specifying individual diagnoses.
These findings align with long-standing observations that lipoedema often becomes noticeable or worsens around hormonal transitions such as puberty, childbearing and menopause. However, the study did not establish directionality. These conditions may coexist, interact or simply cluster within the same population.
Psychological and Quality-of-Life Impact
The authors interpreted these findings as a response to living with chronic pain, delayed diagnosis and repeated experiences of weight-related stigma, rather than as evidence of a primary psychological disorder or a cause of lipoedema. This interpretation differs from the emphasis placed in the 2020 International Consensus Document, which highlighted the presence of psychological and behavioural factors, and was widely debated within the lipoedema community. In this study, psychological distress is understood as a consequence of living with lipoedema and its management, not as an underlying cause of the condition.
How these Findings Should be Interpreted
This paper provides a rich, descriptive snapshot of the complexity seen in people diagnosed with lipoedema in clinical settings worldwide. For clinicians, this level of complexity will not be surprising, as it reflects a pattern commonly encountered in daily practice. What is different here is that this complexity has been formally documented.
At the same time, it reminds us to be cautious. Many of the reported comorbidities are also common in the general population and may be over-represented in specialist cohorts.
What This Study Adds
This study supports an understanding of lipoedema as a condition that commonly presents with co-committant pain, hormonal changes, digestive symptoms, and associated inflammatory or autoimmune conditions, rather than as an isolated disease.
It shows why simplified explanations do not reflect how people with lipoedema live their lives and present in real clinical settings.
About the Lead Author of the Study
José Luis Simarro Blasco is a Spanish physician with over 40 years’ clinical experience, specialising in adipose tissue disorders and the non-surgical management of lipoedema. His work focuses on nutritional intervention, metabolic and inflammatory health and conservative medical strategies, with the aim of reducing pain, symptom burden and disease progression. He is the founder and medical director of the Instituto del Lipedema, a specialist medical centre in Spain dedicated to conservative lipoedema care. He is a founding member of the Lipoedema World Alliance, an international collaboration advancing research, education and clinical understanding of lipoedema.
Dr. Simarro is based at the Instituto de Lipedema in Spain.
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