Understanding Lipedema from the Treatment Room

“He notices what others don’t.” Insights from Physiotherapist and Lymphedema Therapist Christen Chr. Sigridnes, Hana Fysioterapi, Sandnes (Norway).

When women describe physiotherapist Christen Chr. Sigridnes, the same sentence returns again and again:
“He notices what others don’t.”

At Hana Fysioterapi in Sandnes, he has become an important clinical voice for women with lipedema. Not because he claims to have all the answers, but because he refuses to accept explanations like “that’s just how it is.”

Christen did not start his career in healthcare. He was once a rock musician living a bohemian life, before later retraining as a physiotherapist as an adult. A chance “yes” to a lymphedema course became the beginning of what is now his primary clinical field.

Today he works almost exclusively with lipedema — and he has seen the patterns, the pain, and the misunderstandings up close. These are his observations.

It Started with One Patient — and a Pattern That Kept Repeating

Christen’s first lipedema patient was a woman who had spent years searching for answers. She had seen doctors, physiotherapists, and specialists — but no one understood what she was experiencing.

When he examined her, he recognised a constellation of signs:

• pain on pressure

• extremely tender connective tissue

• swelling that did not match other diagnoses

• symptoms repeatedly dismissed as “obesity” or “psychological”

More women came. They told similar stories. Eventually it became clear:
these were not isolated cases. This was a patient group overlooked for years.

When Christen Started Searching for Knowledge, He Found Almost Nothing

In 2018, when he wrote his master’s thesis on lipedema and nutrition, the research field was nearly empty.

At the time, there was hardly any published evidence — and what existed was superficial. Many clinicians simply stated:

“Diet does not work for lipedema.”

But they never explained which diet they had evaluated.
Or which mechanisms they believed were immune to nutritional influence.

Christen began exploring what is often called “grey literature” — clinical reports, conference contributions, practitioner experience and observations from abroad. There he found small threads pointing in the same direction:

This was not only about fat.
It was about hormones, inflammation, fluid regulation, and the body’s response to different types of food.

Today, the research landscape is growing — but the field is still in its early stages.

How Women with Lipedema Are Met in the Healthcare System

Most of the patients who come to him share one experience:
they have been dismissed.

Common things they have been told:
“You need to lose weight.”
“This is in your head.”
“You have a low pain threshold.”
“You just need to exercise more.”

Many have spent years dieting without effect. Many have exercised intensely, only to become worse.

What surprises him most is this:
many women genuinely believe the problem is themselves — not their physiology.

He also sees positive change. Younger clinicians are more open, curious and willing to learn. But the path from ignorance to good care remains long.

What an Initial Consultation Looks Like — and Why It Makes a Difference

When a new patient comes to Christen, he sets aside plenty of time.

He maps:

• symptoms

• eating patterns

• hormonal rhythms

• sleep

• stress

• physical activity

• pain

• swelling

• skin and connective tissue

He examines fat distribution, tissue quality, and signs of both lipedema and lymphatic dysfunction.

But the most important part is this:
he removes the sense of blame.

He explains the physiology in a way that makes sense:

• why the pain occurs

• why the legs feel heavy

• why the volume fluctuates

• why exercise may worsen symptoms

• why conventional dieting often fails

• which aspects of the body can be influenced

He then tests the pneumatic pump, and explains how compression maintains its effect:
“First we squeeze the lemon — then we keep it squeezed.”

What the Healthcare System Keeps Overlooking

After years of experience with lipedema patients, Christen sees that three things are repeatedly misunderstood:

1. The pain is real — and biological.
   It stems from connective tissue changes, fluid dynamics, inflammation, and microcirculation — not a “low pain threshold.”

2. Fluctuating swelling and volume are normal — but underestimated.
   Even small changes can trigger significant pain.

3. Small details matter.
   Insulin dynamics, stress, temperature, sleep, and food choices affect lipedema tissue more than many realise.

This is not about lifestyle failure.
This is physiology.

Nutrition and Inflammation: Why Food Actually Matters

Christen places strong emphasis on how the body responds to different foods, because lipedema tissue is often extremely sensitive to:

• fast carbohydrates

• high blood sugar

• stress-related hormones

He frequently sees marked improvements when patients:

• reduce sugar

• increase protein

• choose foods that lower inflammation

• stabilise circadian rhythm

• sleep better

• exercise at low intensity (zone 2)

Many notice changes within weeks: less heaviness, less pain, improved energy.

Compression, Pneumatic Pump and Lymphatic Treatment — Never “One Size Fits All”

Treatment must be individually tailored.

Some need firm compression, others light.
Some tolerate deeper techniques, others worsen.
Some must start with pneumatic therapy, others with sleep and stabilisation first.

When tailored correctly, many experience:

• improved function

• less pain

• more energy

• reduced swelling

• an easier everyday life

A System Not Designed for Lipedema

In Norway, support schemes are designed for lymphedema, not lipedema. Many fall through the cracks.

The result:

• women do not receive the correct medical aids

• they must argue for every component of care

• clinicians lack competence

• patients are left on their own

For many, these aids are essential for staying in work and daily life — yet access varies enormously.

Surgery: A Meaningful Option — But Never the First Step

Christen observes that surgery can be life-changing, but only when the surrounding factors are in place:

• stable hormones

• good sleep

• proper compression

• supportive nutrition

• adequate lymphatic flow

• consistent postoperative follow-up

Done properly, up to 80% of pain can disappear for many women.

Without pre- and postoperative support, results are often poor.

What Needs to Change in the Coming Years?

Christen believes Norway urgently needs:

• a national lipedema treatment pathway

• education for healthcare professionals

• better diagnostic standards

• improved access to medical aids

• publicly funded surgery for those who require it

And, critically:
less dependence on isolated champions — more system, more structure, more fairness.

A Message to Health Authorities

Stop treating lipedema as a cosmetic issue.
It is a function-limiting disease that requires a real healthcare framework.

A Message to Women with Lipedema

You are not lazy.
You are not imagining anything.
You are not “difficult.”

Your body follows biological rules — and you can influence many of them.
With the right knowledge, support and treatment, it is possible to experience less pain, more energy and a higher quality of life.

What Can We Learn from Christen’s Experience?

1. Lipedema is physiology — not lifestyle.
   Women deserve to be met with understanding, not blame.

2. Small adjustments yield meaningful change.
   Sleep, hormones, nutrition, stress, compression and lymphatic support can transform daily life.

3. Individualised treatment works.
   When care is tailored to the body, women gain function, pain relief and greater control.