One of the most common clinical findings in patients with obesity is swelling of the lower extremities due to accumulation of fluid.
This is not only cosmetically bothersome to patients but also carries the risk of infection and skin changes.
In the vast majority of cases, this accumulation is benign and can be dealt with by simple physical measures – however, in rare cases it may be the expression of true lymphedema – a more persistent and far more difficult to treat condition.
True lymphedema can be diagnosed by lymphoscinitgraphy, which must show imparied lymphatic function.
In a letter published in the New England Journal of Medicine, Arin Greene and colleagues from Children’s Boston Hospital, describe a series of 15 obese patients presenting with bilateral lower-extremity enlargement (12 women).
All underwent lymphoscintigraphy, which revealed pathological findings consistent with lymphedema in 5 patients – the other 10 had normal results.
Interestingly, the average BMI of those with true lymphedema was around 70 compared to the average BMI of those with normal findings. All patients with lymphedema had a BMI greater than 59 whereas all patients with a BMI less than 54 had normal findings.
This strongly suggests that severe obesity is likely to be an important risk factor for lymphedema and that, as the authors discuss, there may be a threshold of BMI above which lymphatic flow becomes impaired. This could be either due to a change in lymph production (load) or lymphatic function (clearance) – the latter may result from dysfunctional lymphatics due to either local compression through fat mass or inflammation. On the other hand, increased lymph production from an expanding limb may overwhelm lymphatic capacity.
Whatever the cause, the question is whether or not this process can be reversed by weight loss – surprisingly enough the medical literature appears to be rather sparse on this issue.
I wonder if any of my readers have noted reversal of true lymphedema following significant weight loss – surgically or otherwise.
AMS
Edmonton, Alberta
Greene AK, Grant FD, & Slavin SA (2012). Lower-extremity lymphedema and elevated body-mass index. The New England journal of medicine, 366 (22), 2136-7 PMID: 22646649
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Obesity and Lymphedema,
In The News
July 5th, 2012 at 7:23 am
Very interesting as always, thanks Dr. Sharma
I was obese as a teenager and but have mainly been in the 23 – 27 BMI range most of my adult life (am now 40). However I experience lymphedema sporadically and have wondered why – doctor’s checks did not identify a cause – although I didn’t get as far as being tested for this (I’m in the UK so it would need to be more severe than it is to warrant investigation on the NHS!). I’ll be interested to hear other readers experiences of this too.
July 5th, 2012 at 7:37 am
Yes, Arya, I had Lymphedema. My feet, ankles and lower extremities swelled up so much that I couldn’t even get my socks and shoes on anymore when I was at my heaviest body weight.
With my weight loss of 216 lbs. over the past two years, the Lymphedema has completely gone away and my feet, ankles and lower extremities are completely “normal” again now.
July 6th, 2012 at 1:02 am
I was obese as a teenager and have never lost weight; I’m still around the same size at 42, with a BMI in the mid-thirties. I’ve never had swelling of the ankles, let alone Lymphedema.
(this is just to provide another fat-teenager-as-an-adult example.)
April 10th, 2013 at 11:36 pm
I don’t have an answer yet, but I plan on finding out. I’m about 6 feet tall and at my peak weight a few months ago I’m sure I a little over 500 lbs. I now have Lymphedema in a leg and my abdomen. I quit smoking almost a year ago now and in recent months have made numerous positive changes in the areas of diet and exercise. I will know the answer to this question one day.