U.S. Insurance Companies Use Aesthetics Stigma To Deny Lipedema Care

Board-certified dermatologic surgeon and lipedema specialist David Amron comforts a patient before surgery.

David Amron MD

A quick google search of the name “Luigi Mangione” reveals how contentious the debate over United States healthcare has become. The U.S. is known globally for its high costs of medical care, which make health insurance so important many consider it a right. An insurance policy’s coverage shapes virtually every step of the patient’s medical trajectory, from the doctor’s office visited, to the brand of medication received. Yet beyond the barriers preventing universal healthcare access, obtaining coverage is merely the first hurdle: collecting benefits from health insurers is often a Sisyphean task.

Most, if not all, covered Americans have experienced delays or denials related to their health insurance policy. Maybe it meant waiting for the pharmacy to order a specific brand of medication, or spending weeks to months on a specialist’s waitlist to fulfill additional diagnostic appointments. Yet I can think of multiple cases among friends of long-term debt and financial ruin stemming from medical expenses. One friend’s family declared bankruptcy following her mother’s lost battle to bone cancer, compounding her grief with the burden of financial stress from her teenage years onward.

Luigi Mangione, suspect in the killing of UnitedHealthcare CEO Brian Thompson in New York City, arrives at a heliport with members of the NYPD on December 19, 2024 in New York City. (Photo by Spencer Platt/Getty Images)

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Instances like these don’t just feel unjust; multiple doctors, patient advocates and policy experts believe that systemic dysfunction in healthcare demands reform. Miranda Yaver, PhD and Assistant Professor in Public Health at the University of Pittsburgh, presents data and case studies in Coverage Denied: How Health Insurers Drive Inequality in the United States (2026), that delineates how health insurance companies’ denials lead to quantifiable social inequalities. Social scientists use the term “medical intersectionality” to describe the phenomenon of systemic discrimination in healthcare that marginalizes patient subgroups.

In a surprising twist, the beauty and aesthetics industry has become an unexpected arena to highlight an instance of health insurance-perpetuated discrimination against patients suffering from a genetic fat disorder called lipedema. The disease progresses to the point of physical disability in later phases, yet patients are routinely denied coverage for lipedema by insurance companies that mislabel its medically-necessary treatment as “cosmetic” or “elective,” resulting in serious psychological, financial and physical harm.

The cover Coverage Denied by Miranda Yaver, PhD, of Pitt University, whose research reveals a systemically inequitable U.S. healthcare system fueled by health insurance denials.

Cambridge University Press

It might appear to be a simple case of insurance companies appropriating aesthetic stigma to medically gaslight patients—after all, treatment often entails liposuction, a procedure that is more commonly known for its applications in plastic surgery. But upon closer inspection of who profits from the erroneous dismissal of the disease as obesity, more insidious dysfunction at work within the American healthcare system is revealed.

Bear in mind that in 2024, the health insurance company Blue Cross Blue Shield (BCBS) reported historic losses in the hundreds of millions—some $400 million in BCBS Massachusetts alone. Meanwhile, CSNBC recently reported how the surging weight loss industry’s boom for prescription GLP-1 agonist drugs like Ozempic has “reshaped the economy.” This is not a coincidence: it represents the mezzo-level signs of the for-profit medical model that public health experts have long warned of.

The irony is that while the medical aesthetics industry is typically scapegoated as the source of social ills like fatphobia, in the instance of the rare disease known as lipedema, and its rampant misdiagnosis as obesity, beauty has become instrumental in exposing systemic dysfunction at-work in the American healthcare system. Find out more below.

A lipedema patient in later phases of the disease’s progression. (Photo by David Inderlied/picture alliance via Getty Images)

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The Lipedema Treatment Gap

First, it takes a better understanding of the disease itself. Board-certified dermatologic surgeon David Amron has spent the last three decades specializing in the treatment and research of lipedema and fat disorders at centers like The Roxbury Institute in Los Angeles, CA, and Salt Lake City, UT.

Dr. Amron writes via e-mail that lipedema impacts roughly 11% of women—an estimated 17 million in the United States and 370 million worldwide—and progresses to the point of physical disability when left untreated. In most cases cases, a one-time curative treatment called lymphatic sparing liposuction remove the diseased fat cells to halt the disease’s progression, along with a holistic treatment plan that incorporates other lifestyle factors and complementary treatment options. Throughout his medical career, he has performed close to ten thousand of these life-changing surgeries to halt the disease’s dismal prognosis, but they represent the minority of patients—the typical patient trajectory is much more difficult.

To begin with, it is already an uphill battle for patients to make their way to a specialist because so few physicians—perhaps 10%, in Dr. Amron’s estimation—are versed enough in lipedema’s presentation to make the referral. Instead, most patients are led to believe they are simply overweight or obese. Without a specialist’s understanding of the disease and its disproportionate allocation of diseased fat cells, typical weight loss efforts will not be sufficient to prevent its progression into dangerous phases.

But even under the specialist’s care, insurance companies routinely deny coverage for their treatment that makes specialized treatments inaccessible. Dr. Amron says that it often takes patients years to change insurance plans, take out loans, ask family members for help and save, before they can afford the out-of-pocket cost of treatment.

Lipedema patient Yola Robert wears compression boots at an appointment with her specialist.

Yola Robert

“It was hard to get my diagnosis and took me a while to find a doctor,” lipedema patient Yola Robert, FDN-P, CPT, tells me over the phone. In her case, lipedema was triggered as a comorbidity with an autoimmune condition she suffers from, and she first began to develop bruising, swelling, fat nodules and areas that felt like a “weighted sandbag” on the backs of her legs. She believes that her documented co-morbid diagnoses made it easier for her to obtain “partial” coverage from her health insurance provider, such as the co-pay for visits to her specialist.

However, Robert points out that the costs of these visits—sometimes multiple times per week—have added up. She has not undergone the surgery that would serve as a one-time, curative treatment for the disease, but in the meantime, she has embraced the non-surgical complementary treatment modalities to slow its progression: MLD therapy, lymphatic drainage, compression garments. Most of these are not covered.

“My experience with the healthcare system [taught me] that I have to take my health into my own hands, do my own research and become my own advocate,” Robert says. She even underwent training in nutrition to reduce symptoms and slow the progression of the disease with the support of diet. Robert’s proactiveness and resourcefulness have made her experience better than most, but far from ideal.

“The [patients’] resilience amazes me, but it shouldn’t have to be this hard. I see the emotional toll it takes on them, and one of the most emotionally taxing aspects of my work [personally] is facing the insurance challenge as a physician,” Dr. Amron says.

The treatment for lipedema requires surgery to remove diseased fat cells and halt the disease’s progression.

David Amron, MD
Misappropriated Aesthetics Industry Stigma

Health insurance negligence with lipedema patients is creating what is known as a treatment gap, a treatment disparity between what is required and received. It all stems from the systemic perpetuation of medical gaslighting that is rooted in aesthetics industry stigma, mischaracterizing the disease as obesity and mislabeling its treatment as “cosmetic.” Experts see firsthand that this insurance practice is causing unconscionable physical and psychological harm to patients.

“There is absolutely a gap in access to treatment for lipedema, and it is driven by financial limitations and insurance barriers. The reality is that treatment for lipedema [is] medically-necessary, but is often treated by insurance companies as elective—placing a disproportionate burden on patients with limited financial means,” Dr. Amron says.

Again, the treatment of lipedema is a time sensitive matter. In early phases of the disease, therapies like the ones Robert relies on—weight loss, compression, nutritional counseling—can slow progression. But what sets lipedema apart from normal fat, or a simple obesity diagnosis, is its genetic cause for abnormal and disproportionate fat accumulation on the body, accompanied by swelling and chronic inflammation that worsens over time.

A lipedema patient applies compression garments to help manage the disease’s symptoms. (Photo by David Inderlied/picture alliance via Getty Images)

dpa/picture alliance via Getty Images

Patients experience easy bruising, changed texture on the skin and physical pain, while the disproportionate allocation of fat cells and fibrotic tissue begins to lead to physical disfigurement. Later phases of the disease pose serious health and mobility concerns, often co-occuring with diagnoses like lymphedema and depression.

As mentioned, a surgical cure can be performed via the one-time removal of diseased fat cells and fibrotic scar tissue by lymphatic-sparing liposuction. Yet because “lipo” is more commonly associated with plastic surgery and body contouring, it is almost too easy for health insurance companies to deny coverage as “elective” or “cosmetic.”

“To dismiss their experience as elective stigmatizes them twice over: first, by the disease itself, and then second, by the insurance gatekeepers who conflate their medical needs with cosmetic desire,” says Melinda Farina, a patient advocate and founder of the plastic surgery consultancy Beauty Brokers Inc. on a phone call. “[So] the insurance companies fall back on their outdated narratives that frame the surgeries [for lipedema] as cosmetic or elective. This is not only scientifically inaccurate, but it’s damaging.”

Photo by David Inderlied/picture alliance via Getty Images

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Health Insurance’s Complicity in For-Profit Medical Dysfunction

Dr. Amron has long asserted that a lack of lipedema awareness is a fundamental cause of this treatment gap, stating that the “vast majority” of physicians are unequipped to recognize the disease. “Many even believe it is a made-up condition, or confuse it with obesity, lymphedema, or other unrelated issues,” he says. It turns out that the corporate structure of health insurance companies supports his hypothesis.

An anonymous source from one of the largest health insurance groups in their state, that is familiar with the staffing practices and corporate structure of the organization, explains on a phone call that the staff position responsible for making claims determinations is known as a “Physician Reviewer.” The source admits that the doctors that fill these positions come from the broader medical community and are not required to be versed in specialities like lipedema. “You don’t necessarily have a specialist on the insurer-side making the decisions [regarding claims coverage],” the source confirms.

If the Physician Reviewer’s claims determination stems from ignorance, it already identifies a need to raise awareness of the diagnosis and modify the curriculum in medical school. But to stop there is to miss the bigger picture—the policy and mezzo-level interactions between the organizations that make up the healthcare system reveal that some are profiting off of this ignorance.

Activists protest the price of prescription drug costs in front of the U.S. Department of Health and Human Services (HHS) building in Washington DC. (Photo by Anna Moneymaker/Getty Images)

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Who Profits Off Of Lipedema Misdiagnosis?

Remember again that seven BCBS plans reported historic losses in 2024. From a business perspective, the motivation to deny coverage would already seem high. But macro-level changes to the medical sector’s economy reveal massive profits being made off of the surging weight loss sector. So as lipedema’s misdiagnosis skews obesity statistics, it has never been a more profitable time to be in the business of weight loss.

This can even be seen in the adjacent beauty industry practices that address lost of volume and excess skin that go along with weight loss. Think, for instance, of the popularity of injectable biostimulant fillers, skin tightening thermal devices or plastic surgeries’ “lifts” to remove excess skin. The popularity of facelifts has surged so significantly that it is arguable our time’s peak form of conspicuous consumption; a friend of a friend just got a facelift in her thirties.

It is no secret that the weight loss boom is due to the surge in prescription of GLP-1 agonist’s like Ozempic, Mounjaro and Wegovy—medications that were formerly reserved for diabetics, but are now widely available to drop pounds. Globe Newswire reported via Yahoo! Finance that in 2023, the weight loss industry reached a new milestone of $90 billion with the “explosive sales of GLP-1 prescription weight loss drugs” specifically cited as a cause.

The Washington Post reports that the United States spent roughly $40 billion on these drugs in 2024, a figure that is expected to triple by 2030. Not all health insurance companies cover these medications, but they are expected to restructure in order to begin to as most patients remain on them long-term. How they will do so to overcome this financial burden opens the door for some serious ethical questions when you consider the different players in healthcare, as well as who is profiting from this major pharmaceutical push.

From 2022 to 2023 the average increase of drug prices in the U.S. was 15.2%, higher than the inflation rate, according to the U.S. Department of Health and Human Services. (Photo by Spencer Platt/Getty Images)

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First, Big Pharma is clearly one of the “big winners.” The surge in demand, coupled with the cost of GLP-1 drugs (a study by GoodRx reports that prescription drug costs have increased 37% in the last decade), initially put such an undue strain on health insurance companies that they risked going broke. Rebounding will mean renegotiation with Pharmacy Benefit Managers (PBM)’s, the “third-party” companies that manage prescription drug benefits for health insurance plans. They are highly controversial—having been sued and subjected to Congressional investigation for accusations of conflicts of interest. Not only are they accused with inflating drug prices, but watchdog organizations warn that oftentimes “your PBM and your insurer are the same big health care company.”

PBM’s are also the culprits that have effectively turned prescription medications into such a profitable business—the very crux of the for-profit medical model that policy experts warn is inherently at odds with the medical sector’s purpose, and the oath taken by physicians. It can be argued that PBM’s are responsible for incentivizing the long-term doling out of prescriptions rather than prioritizing curative and functional approaches to medicine—another one of the global critiques on American healthcare.

Dr. David Amron sits with his patient he is treating in an early phase of lipedema to halt its progression.

David Amron, MD
Aesthetics Industry: Scapegoat or Savior?

“I know a lot of people on social media are talking about lipedema and confusing it with cellulite, or wondering if it’s aesthetic. But truthfully, it is important to get that diagnosis and start treating it because it is a vascular and inflammatory condition that affects the whole body,” Robert says. “If you can get a diagnosis early, you are much more likely to slow down the progression of that disease into later stages where it becomes more life-threatening and harder to treat.”

Yet consider for a moment that while Robert speaks like a seasoned patient advocate, she was first a patient. Her medical journey required that she become confident enough to stand up to doctors until she could get her diagnosis, become educated on the disease and even receive training in nutrition that has shifted the focus of her career. These efforts are admirable—but should it take this much work to get care for your diagnosis when you pay high monthly premiums for health insurance?

To bring the entire discussion full circle, it is telling even that the aesthetics industry is the usual scapegoat—blamed for fueling social ills and stereotyped as offering prioritizing vanity over well-being. But as the story around lipedema reveals, this stigma is perhaps just a symptom of embedded corruption occurring in the broader healthcare industry around us, deflecting blame away from the true culprits of systemic-level injustices that are occurring.

Because of aesthetics stigma, doctors in the field have caught onto the way that it is weaponized by Big Beauty marketing and health insurance companies, making many of them fantastic and outspoken advocates—particularly when it comes to the erasure of patient experience. Board-certified plastic surgeon Amir Karam told me on a video call how aesthetics industry stigma has translated into lax ethics in beauty marketing often prioritizes profits over patient well-being—a micro-level acknowledgement of our healthcare system’s biggest problem: for-profit medicine.

There are also plastic surgeons, like board-certified plastic surgeon Ritu Chopra or the team of doctors as Cassileth Plastic Surgery, that speak out about breast implant illness (BII) and advocate for women suffering from the condition. This is the industry context that has primed Dr. Amron to risk backlash in order to tell the story of lipedema patients.

Hopefully, the efforts of physicians like Dr. Amron can begin to make a difference. His advocacy is rooted in his compassion and the oath he took as a doctor, but to fully understand the importance of his message requires a broader analysis of the healthcare system we are navigating. For the public, signs of medical injustice begins with an uncomfortable feeling that it is somehow not right for the pursuit of medical care to result in depression and financial debt. But understanding why this occurs requires opening your mind to the fact that the socially-conditioned aesthetic stigma we feel is perhaps one of the symptoms of healthcare corruption that has now infiltrated beauty.

U.S. Insurance Companies Use Aesthetics Stigma To Deny Lipedema Care

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