MON-737 - Synergistic Effect of GLP-1RA with Sympathomimetics for Weight Loss, Limb Reduction, and Pain Improvement in Lipedema

Lipedema is often misdiagnosed and managed as metabolic obesity. Since metabolic obesity is secondary to excess intake of calories leading to increased adipose tissue formation and metabolic dysfunction, decreased caloric intake in any form will lead to weight loss. However, this same intervention does not lead to weight loss in patients with Lipedema which tend to be metabolically healthy. Also, the distribution of fat differs in metabolic obesity, typically being central, compared to Lipedema which has a gynoid distribution in addition to being painful. Most recent guidelines have suggested that Lipedema tissue and subsequent weight loss does not reduce significantly after diet, exercise, or bariatric surgery and that Lipedema reduction surgery is currently the only available technique for removing abnormal lipedema tissue. Even though there are no known medications that specifically treat lipedema at this time, in our clinic we have seen significant weight loss, limb reduction, and pain improvement with the combination of a GLP-1 Receptor Agonist added to a Sympathomimetic.

We present 5 patients with Lipedema, Hispanic, ages 43 to 51, Types 3 & 4, stage 2-3 who at initial visit had tried multiple weight loss interventions including pharmacotherapy, strict diets, and weight reduction surgery but without success in weight loss as is characteristic of Lipedema with added to the painful fat and leg heaviness. At the time of initial visit they all were at a point of desperation since nothing they had tried previously had helped with weight loss. On initial visit they were all recommended conservative treatment with manual lymphatic drainage and deep tissue massage in addition to compression stockings. All of them met diagnostic criteria for adult Attention Deficit Disorder and for weight loss medications. Once a GLP-1 receptor agonist was added, improvement in pain and congestion was noted in all of them even within the first month of starting this and at low dose, however, weight loss and limb reduction was not non significant and on average < 5%, likely from decongestion. Once a sympathomimetic was added to their regimen along with continued conservative measures, weight loss was achieved along with a reduction in limb size judged on self-report and a decrease in clothing size and looser compression stockings. Average percentage weight loss from initiation of treatment up to the point of weight plateau was 19%, with one losing up to 71 pounds in the course of 4 years. None of them saw a need to proceed for surgery yet, all of them were satisfied, pain free, and motivated.

There is a synergistic effect with the combination of GLP-1 receptor agonist with a sympathomimetic amine. Pain reduction and decongestion is noted with a GLP-1 receptor agonist or a sympathomimetic itself, but significant weight loss and limb size reduction was only noted when combination therapy was added to their conservative therapy.

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