July 21, 2025, 5:25 pm | Read time: 4 minutes
Pain and Prejudices Shape Daily Life
In lipedema, abnormally enlarged fat cells typically accumulate in the legs, and less frequently in the arms. The condition almost exclusively affects women and has far-reaching consequences for daily life. The affected body parts are extremely sensitive to pressure and touch–even harmless situations can lead to severe pain. “It causes immense pain when children sit on your lap,” explained Peggy Bergert, second chairwoman of Lipödem-Hilfe Deutschland, to the “dpa.”
But lipedema is not only physically burdensome. “For example, if the thighs or buttocks are very pronounced due to lipedema, you have trouble sitting in public. Chairs with armrests are particularly problematic,” said Bergert. Added to this are feelings of tension and heaviness, which further complicate life.
Many affected individuals also suffer from stigmatization. The disease is not well known, and outsiders often suspect an unhealthy lifestyle behind the altered body shape. Time and again, those affected report suffering from pain and movement restrictions for years without receiving a correct diagnosis. This was also the case for Tanja Degner: She struggled with swollen ankles, heavy, aching legs, and significant weight gain. Nevertheless, her family doctor merely advised her to eat less.1 However, conventional measures like exercise or diets do not help against the pathological fat. “Sometimes people are approached when they eat ice cream,” reported Bergert. For many, the disease also represents a significant psychological burden.
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What Treatment Options Are Available?
Conservative Therapy Approaches
The focus of treatment initially lies in so-called conservative therapy, which primarily aims to alleviate symptoms. Key measures include manual lymphatic drainage, which according to Peggy Bergert, “should be done one to three times a week.” Additionally, it is recommended to wear compression stockings or tights as often as possible. These help regulate pressure on the tissue and reduce swelling.
Furthermore, movement therapy, nutritional counseling, and targeted skincare are part of the overall therapeutic concept. All these measures aim to improve the quality of life for those affected, even if they do not eliminate the cause of lipedema.
Surgical Treatment as a Last Resort
If conservative methods do not provide sufficient improvement, the next step is the surgical removal of the pathological fat tissue–a procedure known as liposuction.
However, until now, only patients with pronounced lipedema in stage III were eligible for insurance coverage. This led many affected individuals to finance their surgeries themselves. “As an average, you can estimate about 6,000 euros as a complete package for an operation,” explained Peggy Bergert. “Many have taken out loans for this and then pay them off for years.” Additionally, more than one procedure is often necessary to achieve the desired result.
Under What Conditions Does Insurance Cover Liposuction Costs?
The Joint Federal Committee (G-BA) has now decided that statutory health insurance can cover the costs of liposuction in the future, regardless of the stage of the disease, but not for all affected individuals and only under certain conditions.
Requirements
- A conservative therapy must have been conducted for six months without alleviating symptoms.
- For a BMI over 35: An obesity treatment must first be carried out.
- For a BMI between 32 and 35: It is assumed that restrictions will apply in this range as well, although these have not yet been specifically defined.
Peggy Bergert cautioned: “Those severely affected will unfortunately not be able to take advantage of it because they cannot meet or achieve the requirements, even with the best weight loss efforts.”
Patients who have already undergone liposuction will not receive reimbursement for further procedures. Often, there is a need for additional treatment even years after the first operation. “Pathological fat cells always remain, and they will enlarge again–with visual and pain-related consequences,” explained Bergert.
What Happens Next?
The G-BA’s decision will first be reviewed by the Ministry of Health. It will only come into effect after publication in the Federal Gazette. For doctors to bill the procedures as insurance services, billing codes must also be established. According to the G-BA’s estimate, this will be possible by January 1, 2026, at the latest.
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A Long Overdue Decision
The current decision stems from a 2019 initiative by the federal government. At that time, former Federal Health Minister Jens Spahn urged the Joint Federal Committee (G-BA) to allow liposuction for lipedema as an insurance service under certain conditions, even before the completion of conclusive studies. Originally, the G-BA had suspended its evaluation in 2017 due to a lack of scientific evidence and initiated a trial study.2
*With material from dpa