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The results demonstrated the complex interplay between obesity and lipedema: Successful Weight Loss: Lost over 156 pounds Body fat percentage decreased from 56.7% to 36.6% Persistent Lipedema Indicators: Total body extracellular water to total body water ratio (ECW/TBW) increased from 0.402 to 0.430 Segmental leg measurements showed significantly abnormal ratios: Right leg ECW/TBW: 0.442 Left leg ECW/TBW: 0.445 Leg swelling persisted despite weight loss and daily medical-grade compression Leg pain and tenderness continued unchanged Despite successful bariatric surgery and adherence to conservative treatments, T’s lipedema symptoms remained significant enough that she elected to pursue lipedema reduction surgery for further symptom management