Latest news with #TheRoxburyInstitute
Medscape
3 days ago
- Health
- Medscape
The Weight of Two Worlds: Lipo-Lymphedema and Obesity
When Shannon Ashley, now 43 years old, was in her tweens and teens, her legs were noticeably large. Shannon Ashley 'Once I hit 12, my calves were unusually large, like tree trunks,' Ashley said. She tried to hide her outsized lower extremities, a contrast to her slender upper body, beneath wide-leg pants, and the size of her legs made clothes shopping difficult. 'Doctors insisted that I was just fat,' Ashley said. 'I took a free consultation with a plastic surgeon when I was 14 who said he could perform liposuction on my calves if I lost at least 20 pounds, but since I was already struggling with weight loss and dieting, that felt impossible, and my family wasn't in a position to pay for such a surgery anyway.' David Amron, MD David Amron, MD, is a leading lipedema specialist at The Roxbury Institute, with locations in Beverly Hills, California; Tucson, Arizona; and Salt Lake City, and a well-known national and international speaker and surgical advisor on the subject of lipedema and liposculpture. He has treated Ashley off and on since July 2021. He said that sort of reaction isn't all that unusual, although lipedema is actually very easy to spot once you know what you're looking for. 'It's a characteristic column-like presentation that wraps around the legs, typically from the groin area down, and their upper arms tend to become involved years or decades later, and sometimes in other areas, the upper buttock areas — it's a characteristic look; these patients are disproportionate, that's one thing,' said Amron, whose team, through the Advanced Lipedema Treatment Program at The Roxbury Institute, has performed more than 8000 successful lipedema-reduction surgeries. 'These patients also have tenderness to pressure, and finally, they have a family history — there are as many men with the lipedema gene as women, but they rarely show signs of it, so you have to look at both sides of the family.' Research documented that two American physicians first chronicled lipedema at the Mayo Clinic in Minnesota in the 1940s. While they are credited with the initial identification and description, consistent with Amron's outline of a highly distinguishable presentation, lipedema remained relatively unknown and often misdiagnosed for decades after their initial findings. Amron said that today, awareness and understanding of the condition remain hit or miss, even among the clinical community. 'Why is it not being diagnosed is a really important thing — it's just ignored,' Amron said. 'I've been involved in this for over 25 years, and awareness has increased a little bit.' In fact, he said, it has increased more among patients and social media and less among providers. He estimates that only 5%-10% of physicians know about lipedema. 'It's lack of awareness that's our biggest problem,' Amron said. 'That goes back to the fact that we still don't teach it in medical schools, and that's a problem.' Holly Lofton, MD Holly Lofton, MD, clinical associate professor of surgery and medicine and director of the Medical Weight Management Program at NYU Langone Health, New York City, agreed with Amron's assessment that the disease must be addressed in medical school curricula and said that providers can get up to speed with additional coursework. 'It is crucial that US medical schools allocate time to teach the lymphatic system as well as comprehensive education on lipedema education and treatment for future providers,' Lofton, who is not connected to Ashley's case, said. Continuing medical education courses on lipedema can update current professionals on diagnostic criteria and treatment options. Increasing awareness by having patients share their stories in media can reduce the stigma related to lipedema and can overall help with patients feeling more comfortable with them talking to their providers about the condition, she said. That's what Ashley, who began researching her symptoms after her body 'exploded' following the birth of her daughter in 2014, did. That research led her to the condition lipedema, which seemed to match what she was experiencing, but none of the doctors she consulted near her home outside of Chattanooga, Tennessee, knew what lipedema was. Ashley said they fell back on the assumption that her diet and eating habits must be the cause of her woes. 'My whole life, doctors told me what to eat or what not to eat and often recommended gastric bypass surgery, but they never actually asked me how I ate,' Ashley said. 'They just assumed I was doing this to myself.' Lofton said that, unfortunately, this is not an unusual response from practitioners who are not accustomed to treating lipedema. 'Many patients with lipedema are advised that they need to treat obesity as a condition, when in fact weight loss does not treat lipedema, as it is an abnormal fat accumulation,' Lofton said. 'It doesn't respond to diet and exercise but instead to other treatments which focus on activating the lymphatic system.' Ashley's health began to decline, and she said that, especially as a single mother, she felt a great deal of responsibility to both herself and her daughter to correct that progression. She knew she had to get an official diagnosis in order to start treatment, and after a great deal of continued research, she met with Amron in 2021. Naming the Enemy Unfortunately, by the time Ashley was able to get treatment with Amron, her lipedema had progressed to the point that her diagnosis was lipo-lymphedema. This condition arises when lipedema progresses to a point where it starts to impair the lymphatic system, leading to secondary lymphedema. Tissue can progress to the point that it becomes hard and inflamed, and Amron says that at worst, it becomes inoperable. 'Lipo-lymphedema occurs because of the chronic inflammation leading to the fibrosis and scar tissue that can begin to scar down the lymphatics and permanently damage the lymphatic capillaries and lymphatic circulation,' Amron explained. 'I find a pattern of a dense fibrosis is more prone to lipo-lymphedema. Generally, patterns of a loose fibrosis don't progress to lipo-lymphedema. So, it's something that we don't completely understand, but certain patients are more prone to this type of development.' Over the course of 2022, Amron performed three lipedema removal surgeries on Ashley, all successful. Ashley, a writer who has been very open on Medium and elsewhere about her battle with lipo-lymphedema, encountered considerable swelling after her surgeries, which Amron said is due to the specific type of scarring that she had developed. 'I define four patterns of fibrosis that I see: Nodular, dense, granular, and more of a spider-like network. Shannon had primarily more of a spider-like, loose network,' Amron said. 'Those patients are more prone to swelling and moving a lot of fluid across membranes because they have a lot of loose connective tissues. In a patient like Shannon, I'll go in and remove 40 liters and make great improvements, and they'll still have consistent swelling.' Amron's practice includes a diagnostic and preventive center where his associate Karen Herbst, MD, provides treatments for patients who experience these symptoms, including dealing with mast cell activation syndrome, evaluation of inflammatory markers, genetic testing, and other modalities. Ashley had an additional battle to face: In July of 2022, decades of carrying the weight of what was now lipo-lymphedema caused her knees to erupt with severe pain. After battling for months just to get an MRI because of her still-high weight, she learned that a torn medial meniscus and several related knee injuries and conditions were causing her pain. This was a real setback for Ashley in terms of her ability to get around and care for herself and her daughter, particularly depressing after all she had been through to get the severely needed surgeries. Lofton said that it's important that patients in situations such as Ashley's are treated with a holistic approach in order to achieve the best results. 'It's important to recognize that lipedema can lead to joint issues due to altered biomechanics and increased weight bearing. It is important that we as providers avoid biases based simply on BMI, or body mass index because this can be falsely elevated in patients with lipedema,' she said. 'Once a patient is diagnosed with lipedema, they can work with vascular surgeons, physical therapists, and other specialists to develop comprehensive treatment plans.' Treatments and Outcomes Ashley's knees have continued to be a battle, as no orthopedists have been willing to take her on due to her BMI, even at Amron's urging. However, in the spring of 2024, she signed on with a new nurse practitioner who 'actually had a basic understanding of lipedema.' Then, after several months of physical therapy and trying a few rounds of medication for her knee pain, Ashley was able to get access to compounded tirzepatide injections, though still at a very high out-of-pocket cost. The results weren't instantaneous, but Ashley noticed rapid progress. 'After several weeks on the shots, but before I lost any real weight, my knees began to feel much less painful, and I quit getting such bad joint flares. I also quit swelling up so much in my calves,' she said. 'As of now, I've lost nearly 80 pounds, and my knee pain rarely bothers me. My range of motion in my knees is still poor, and I am still regaining my strength with physical therapy, but I am finally seeing some real progress.' The dramatic effects of tirzepatide on patients with lipedema came as a surprise to Amron, who originally thought it would just be a complementary tool in the arsenal available to his patients. 'Initially, I assumed that it would be another weight loss strategy — it's almost like simply dieting, so you're taking in less food, so of course you're going to lose weight, but you're going to lose weight in the areas you don't have lipedema, and the areas you have lipedema aren't going to respond,' Amron said. 'We subsequently see that these medications can help with inflammation quite a bit.' Ashley is still fighting her battle against lipo-lymphedema, including against the limitations placed on coverage of the disease by the insurance industry. 'I'm stuck with limits like only 20 total covered therapy sessions per year — that includes lymphedema therapy and physical therapy together, not each. They won't cover my tirzepatide injections despite my positive results,' Ashley said. The issues at the heart of getting insurance companies to cover lipedema and expanding provider understanding of the disease are the same: Awareness and understanding. That's why Ashley has made her case public, and that's why she continues the fight.
Fox News
03-03-2025
- Entertainment
- Fox News
Hollywood stars slim down as Ozempic, social media change beauty standards: expert
Many stars who stunned on the red carpet during the 2025 awards season displayed visibly slimmer figures – igniting conversation around a growing trend in Hollywood. Demi Moore, Nicole Kidman and Mindy Kaling are among the stars who showed off their slender physiques at some of the biggest events leading up to the 97th Academy Awards ceremony on Sunday. While some celebrities have credited popular weight-loss drugs for their physical transformations, Beverly Hills cosmetic dermatologist Dr. Jason Emer told Fox News Digital that a number of variables could be fueling the slender fad that has been sweeping the industry. "There has been a noticeable trend of slimmer appearances on the red carpet. This could be attributed to a combination of factors, including the influence of social media, changing beauty standards, and the accessibility of weight-loss medications," Emer said. "Additionally, a focus on health and fitness, along with advances in aesthetic procedures, may also contribute to these trends," he added. Many celebrities have spoken out about the pressure that they experienced while trying to conform to the thin body trends that dominated the 1990s and early 2000s. Moore, who became the highest paid actress in history in the mid-90s, revealed in her 2019 memoir "Inside Out" that she battled an eating disorder at the height of her fame. "I didn't feel like I could stop exercising," Moore wrote. "It was my job to fit into that unforgiving military uniform I'd be wearing in two months in [1992's] 'A Few Good Men.' Getting in shape for that movie launched the obsession with working out that would consume me over the next five years. I never dared let up." The slimmer trend continued into the next decade, which saw the rise of a new generation of stars, including Taylor Swift, Hilary Duff and Demi Lovato, who have also shared that they struggled with eating disorders. However, the mid-2010s ushered in a more inclusive era of body positivity. Some of the movement's most vocal celebrity champions include Kaling, Lovato, Selena Gomez, Ashley Graham and Lizzo. In 2020, Kaling shared a body-positive message on Instagram, "IDK who needs to hear this but WEAR A BIKINI IF YOU WANT TO WEAR A BIKINI. You don't have to be a size 0." Yet, Dr. David Amron, founder and medical director of The Roxbury Institute, expressed his concern that trends have shifted once again. "The pendulum is swinging back toward an era of dangerous thinness, fueled by social media's relentless spotlight on unrealistic beauty," he told Fox News Digital. "After more than a decade of progress in body positivity, we're witnessing the resurgence of an impossible standard – one that pressures people of all shapes and sizes to shrink themselves at any cost," Amron continued. "Even more troubling, many are turning to extreme, unproven methods without medical oversight, risking not just their health but their lives." As the slimmed-down trend has made its return over the past couple of years, the use of Ozempic and other injectable GLP-1 drugs for weight loss has soared. GLP-1 medications, which include Ozempic, WeGovy and Mounjaro, mainly help manage blood sugar (glucose) levels in people with Type 2 diabetes. While WeGovy is also approved by the FDA to treat obesity, other similar drugs are increasingly being prescribed off-label for weight loss. In 2022, Kaling sparked rumors that she was using Ozempic after she reportedly lost 40 pounds. However, "The Office" alum explained that her trim physique is due to lifestyle changes, including adopting a regular fitness routine and using portion control. However, many other stars, including Kathy Bates, Oprah Winfrey, Sharon Osbourne, Amy Schumer, Chelsea Handler, Rosie O'Donnell, Josh Gad and Tracy Morgan, have admitted to trying Ozempic or other weight-loss medications. During an October interview with People magazine, Bates revealed that she used Ozempic but clarified that the weight-loss drug was only one factor in her overall body transformation. "There has been a noticeable trend of slimmer appearances on the red carpet. This could be attributed to a combination of factors, including the influence of social media, changing beauty standards, and the accessibility of weight-loss medications." The Academy Award winner, who was diagnosed with Type 2 diabetes in 2017, shed 100 pounds over seven years after changing her diet and committing to a regular fitness routine. While speaking with People, Bates noted that she lost 80 pounds before using Ozempic, which then helped her shed another 20 pounds. "There's been a lot of talk that I just was able to do this because of Ozempic," Bates said. "But I have to impress upon people out there that this was hard work for me, especially during the pandemic. It's very hard to say you've had enough." Some Ozempic users have claimed that the drug has resulted in facial changes that are making them appear older, a mostly anecdotal side effect that has become known as "Ozempic face." To combat the possibility of "Ozempic face," Emer recommended that patients take microdoses of the drug along with hormonal regulation and supplements. Emer recently debuted his own supplement, VitaSculpt, which aids with body recovery, reduces pain and inflammation, and helps with weight maintenance. Meanwhile, anti-aging expert Dr. Michael Aziz told Fox News Digital that Hollywood's slimmed-down trends come as the stigma around the popular weight-loss drugs has diminished. "Oprah Winfrey, Sharon Osbourne, Whoopi Goldberg and Elon Musk have all reportedly taken GLP-1 drugs," he said. "Secrecy, shame and stigma once surrounded GLP-1 medications, but that is starting to change as more people are getting on board." Some celebrities, including Osbourne have spoken out about experiencing severe side effects while taking weight-loss drugs. During a September 2023 appearance on Talk TV's "Piers Morgan Uncensored," Osboune described her experience taking Ozempic and cautioned others against using the drug. "At first, you feel nauseous," she told Morgan. "You don't throw up physically, but you've got that feeling and I was about two, three weeks where I felt nauseous the whole time. You get very thirsty and you don't want to eat. That's it." "That's why I keep saying, you've got to keep this stuff away from younger people because they will go berserk on it and it's not right," the U.K. native added. In November 2023, Osbourne told The Daily Mail that she had stopped taking Ozempic but was unable to gain weight. "You can lose so much weight and it's easy to become addicted to that, which is very dangerous. I couldn't stop losing weight and now I've lost 42 pounds and I can't afford to lose any more," she said. However, many celebrities have praised the drugs, including Winfrey, who left her longtime position on the board of WeightWatchers in March 2024 after revealing that she used a weight-loss medication. "I realized I'd been blaming myself all these years for being overweight, and I have a predisposition that no amount of willpower is going to control. Obesity is a disease. It's not about willpower – it's about the brain," Winfrey told People magazine in 2023. "The fact that there's a medically approved prescription for managing weight and staying healthier, in my lifetime, feels like relief, like redemption, like a gift, and not something to hide behind and once again be ridiculed for," Winfrey said. "I'm absolutely done with the shaming from other people and particularly myself." Emer told Fox News Digital that his patients have experienced significant health benefits from taking GLP-1s and he believes that their use will continue despite changing trends in Hollywood. "It is likely that some celebrities are using these medications to achieve a specific look for public events like award shows or premieres. The pressure to maintain a certain appearance in the entertainment industry can lead individuals to seek out quick and effective solutions for weight management, especially before red carpet appearances," he said. "However, my clients are using this to live longer, feel healthier, and look their best. They notice much better results in the gym, and with the right skincare and laser treatment plans, the medication helps them heal more quickly and look better due to the decreased rate of inflammation in the body."
