Nearly 20 years ago a senior colleague of mine enlightened me that fibromyalgia was on the continuum with insulin resistance. He shared with me that over his many years in listening and caring for his patients with chronic pain from fibromyalgia that they were often later diagnosed with type 2 diabetes. At times it took 5-10 years before their lab values started showing readings consistent with pre-diabetes or insulin resistance and they were typically women. Curious in wanting to learn more on how to help these women, I looked through the literature and there was nothing linking these two conditions at that time. With great respect for my senior, I started to pay attention, not in waiting 5 years to do something about it, but treating these women with lifestyle changes, supplements and medications that I would recommend to patients that had risk factors for diabetes or already had pre-diabetes. Risk factors like excess body weight, high blood pressure, gestational diabetes and a family history of diabetes. Many thanks to my senior colleague as my patients over the last 20 years have benefited from his astute observances and wisdom many years ago. He was truly a patient centered doctor that embraced using a holistic and physiologic approach to medicine, even when an “evidence-based” study wasn’t available to give him direction.
Many, many years later I was delighted to see a study finally published in 2019 linking fibromyalgia with insulin resistance. Another one shortly thereafter was published in PLOS in May 2019 in which 50% of patients with fibromyalgia had complete resolution of their pain when they were treated with metformin, a first line oral medication for diabetes.[1] Something that I had been witnessing clinically for over a decade. In my clinical practice, I see the symptoms of fibromyalgia improve when a patient starts to focus on reducing inflammatory triggers, addressing obesogenic risk factors in their life and begins to lose excess body weight.
It is not surprising given the complexities and similarities of fibromyalgia, lipedema[2] and obesity that these three conditions are often mistaken for each other. Furthermore, they can co-exist, presenting an even greater diagnostic challenge to the healthcare practitioner with limited time. All 3 are worsened by inflammation and often eventually lead to insulin resistance if not treated early and appropriately.
50% of women with Fibromyalgia also have Lipedema[3]
Fibromyalgia is a chronic pain disorder typically affecting women. Pain is widespread, worsened with pressure over certain locations and often has accompanying symptoms of fatigue, headaches, brain fog and irritable bowel symptoms. Worsens with inflammation.
Lipedema is an inherited connective tissue disorder causing large fatty deposits on the hips and legs, primarily affecting women. It is also a chronic pain disorder, developing after hormonal changes with pain felt primarily over the fatty tissue affected on the legs, hips and arms, worse with pressure. Inflammation stimulates progression of lipedema tissue.
35% of women with Lipedema also have Fibromyalgia [4]
Obesity is not a chronic pain disorder however it is often present with other pain disorders, fibromyalgia, lipedema, arthritis, psoriasis, musculoskeletal injuries, etc. Obesity affects men and women at any age and progresses with poor lifestyle choices, metabolic dysregulation, inflammation, hormonal trigger, medications just to name a few.
Table comparing Lipedema, Fibromyalgia and Obesity
| Lipedema | Fibromyalgia | Obesity | |
| Gender | Women (typically) | Women (typically) | Men, Women |
| Age of onset | Puberty (<30 yo) | Middle Age | Any age, increasing with age |
| Pain | Yes | Yes | No (except from co-morbidities) |
| Location of pain | Fatty tissues | Everywhere, musculoskeletal | N/A |
| Pain with Pressure | Yes | Yes | No |
| Bruising | Yes | No | No |
| Family history | Yes | Yes | Yes |
| Obesity (BMI>30) | 30-40% | 80-90% | N/A |
| Edema | Yes | No | No (except in extreme obesity |
| Fatigue, headache, brain fog | ++ | +++ | No (unless sleep apnea is present) |
| Depression | + | ++ | No (unless co-morbidities present) |
| Irritable Bowel Syndrome | + | ++ | N/A |
| Associated with dysregulation of gut microbiota | Yes | Yes | Yes |
| Nutritional Deficiencies | Yes | Yes | Yes |
| Associated with Heavy Metals | Yes | Yes | Yes |
| Chronic Systemic Inflammation | Yes | Yes | Yes |
Often treating a specific symptom present in fibromyalgia, like pain or insomnia, instead of addressing the root causes can exacerbate inflammation, leading to an increase in excess body weight and perpetuating a vicious cycle.
If you are a curvy woman and have symptoms of fibromyalgia or have been told you have fibromyalgia, you may also have Lipedema. How do you know? Take our 90 second quiz to find out. (Click Here) If you score 2 or more on the quiz, there is a high likelihood you do.
[1] Pappolla, Miguel, et al., “Is insulin resistance the cause of fibromyalgia? A preliminary report”, PLOS, 6 May 2019.
[2] Angst, Feliz, et al., “Common and Contrasting Characteristics of the Chronic Soft-Tissue Pain Conditions Fibromyalgia and Lipedema”, Journal of Pain Research, 17 Sept 2021.
[3] Gunaydin, Elzem Bolkan, et al., “Lipedema awareness in fibromyalgia”, Phlebology: The Journal of Venous Disease, Feb 14, 2025.
[4] Bolkan Turk, Ayla Cagliyan, et al. "Prevalence of Fibromyalgia Syndrome in Women with Lipedema and Its Effect on Anxiety, Depression, and Quality of Life", Lymphatic Research and Biology, 21 Febuary 2024.
Gunaydin, Elzem Bolkan, et al., “Lipedema awareness in fibromyalgia”, Phlebology: The Journal of Venous Disease, Feb 14, 2025
Additional References:
Martins, Airton, et al., “Association between Heavy Metals, Metalloids and Metabolic Syndrome: New Insights and Approaches”, Toxics, Aug 2023.
Li, Tiezheng, et al., “Association of Diet Quality and Heavy Metals with Obesity in Adults: A Cross-Sectional Study from National Health and Nutrition Examination Survey (NHANES)”, Nutrients, Sep 2022.
Tinkov, Alexey, et al., ”Adipotropic effects of heavy metals and their potential role in obesity”, Faculty Reviews, March 2021.
Zangiabdian,Moein, eta l., “The Association between heavy metals exposure and obesity: A systematic review and meta-analysis“, Journal of Diabetes & Metabolic Disorders, October 2023.,
Attia, Sarra Mohammed, et al., “Cadmium: An Emerging Role in Adipose Tissue Dysfunction”, Exposure and Health, Sept 2021.
Skalnaya, Margarita, et a., “Hair trace element contents in women with obesity and type 2 diabetes”, Trace Elem Med Biol, Nov 2007.
Cannataro, Roberto, et al., “Nutritional Supplements and Lipedema: Scientific and Rational Use”, Nutraceuticals, Oct 2022.
Bjorklund, Geir, et al., “Fibromyalgia and nutrition: Therapeutic possibilities?” Biomedicine & Pharmacotherapy, July 2018.
Stejskal, Vera, et al., “Metal-induced inflammation triggers fibromyalgia in metal-allergic patients”, Neuro Endocrinol Lett, 2013.
Wepner, Florian, et al., “Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial”, PAIN, February 2014.
Shukla, Varsha, et al., “Metal-induced oxidative stress level in patients with fibromyalgia syndrome and its contribution to the severity of the disease: A correlational study”, J Back Musculoskelet Rehabil, 2021.
Zeng, Wenzing, et al., “Copper and iron as unique trace elements linked to fibromyalgia risk”, Scientific Reports, 01 February 2025.