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Conservative treatment approaches Physical activity and rehabilitation: Regular physical activity reduces proinflammatory adipokines and macrophages and improves blood flow, thereby counteracting hypoxia in adipose tissues.24 Exercise routines should be tailored to individual needs and ideally supervised by qualified health professionals.12 Beneficial exercises which should start slowly and progress as tolerated include swimming, aquatic therapy, elliptical machines, yoga, stationary biking, whole-body vibration, and walking.15 The goals of physical activity are weight control, improved muscle strength and mobility, and enhanced self-esteem.20 Special diets: Since lipedema is considered a polygenic disorder associated with chronic low-grade inflammation, some authors recommend anti-inflammatory diets such as the Mediterranean or ketogenic diet to reduce symptoms.37 Dietary management should prioritize reducing hyperinsulinemia and insulin resistance

For prediabetes patients, GLP-1 frequently normalizes fasting glucose entirely, potentially preventing progression to type 2 diabetes

BPC-157 may offer comparable or superior results at lower cost, though direct comparison studies do not exist

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Direct inhibition of the mitochondrial permeability transition pore: a possible mechanism responsible for anti-apoptotic effects of melatonin