What you need to know about obesity and lymphedema
What is lymphedema?
Lymphedema is a chronic, but treatable condition marked by an accumulation of lymph fluid (i.e. swelling) in parts of the body where lymph nodes or lymphatic vessels are damaged or inadequate.
An estimated 3-5 million Americans are affected, most commonly from cancer, with 1.5 -3 million being Medicare beneficiaries. As cancer survivorship increases, a growing number of men, women and children are becoming affected by lymphedema.
There are two types of lymphedema – primary & secondary. Primary, or congenital lymphedema, makes up about 10% of those with lymphedema. The other 90% are secondary (or acquired lymphedema). Within the secondary category, there are two additional categories – non-cancer-related, equaling about 22%, and cancer-related, making up 68%.
With the right treatment, it is possible to lead a normal and enjoyable life with lymphedema.
What is obesity?
Obesity is an excessive accumulation of fat that presents a health risk, not to be confused with overweight. According to the CDC, a person is classified as overweight if they have a body mass index (BMI) of at least 25, while a person is obese if they have a BMI of at least 30. Common causes of obesity can include a poor diet, a lack of exercise, genetics, or a combination of these factors.
The biggest concern with obesity is that it can put you at risk for several medical conditions and complications. For example, people who are obese are more likely to experience high blood pressure and heart disease, which can lead to heart attacks and strokes. Excess fat may also result in your circulatory system working harder to circulate blood, while your lymphatic system has to work harder to move and drain lymphatic fluid.
Worldwide obesity has nearly tripled since 1975.
Are obesity and lymphedema linked?
People with lymphedema are sometimes initially misdiagnosed as obese or their doctor determines that they have both conditions simultaneously. As the rate of clinical obesity rises worldwide, it is becoming more common for people to have clinical obesity while also managing other chronic health conditions like lymphedema.
An obese person is also at a higher risk of developing lymphedema due to the increased pressure that obesity exerts on the lymphatic system. With compromised baseline lymphatic function, they are more likely to have abnormal inflammatory responses and an impaired ability to maintain normal lymphatic movement.
New research is finding a strong connection between being severely obese and developing secondary lymphedema. A study published in the European Journal of Vascular and Endovascular Surgery found the diagnosis of simultaneous severe obesity and lymphedema doubled over a seven-year period.
What are the signs and symptoms of lymphedema that obese people should be aware of?
- Pain: Pain is more likely when severe swelling is present, so proper lymphedema management can help prevent this pain. If you’re experiencing lymphedema pain, complete decongestive therapy can help you get relief from the pain and swelling.
- Swelling: Swelling in lymphedema patients occurs from the buildup of lymph fluid in the fatty tissues underneath the skin. This swelling may result in pain, or it may be purely cosmetic.
- Decreased range of motion: Depending on the severity of your lymphedema, the swelling may eventually get to a point where it affects your range of motion. This decreased range of motion usually goes away when the swelling goes down.
- Hardened skin/fibrosis: In very severe cases of lymphedema, the skin may begin to harden and take on the look and feel of a tough animal hide, such as an elephant. Hardening of the skin is also called fibrosis. You may also notice your skin changing from its regular color to a brownish color.
- Limb heaviness: Like other types of edema, lymphedema can make your limbs feel heavy. This is largely a result of the swelling in the limbs, but it’s compounded for obese patients who may already have a tough time moving around comfortably.
- Numbness: Numbness and tingling are common sensations for lymphedema patients, although these symptoms may not last for extended periods of time.
- Pitting: Pitting is when you can leave a mark on the affected limb by gently pressing a finger into the swollen area.
What are the treatment options?
Weight loss through approved program: Weight management is considered an important element of treatment. This is largely because obesity is a major risk factor for lymphedema. If a patient has confirmed lymphedema, they should aim to maintain body weight or strive for losing weight if the patient’s weight is above standard guidelines. Working with a professional who knows how to use weight management in lymphedema treatment will help patients. Doctors often recommend people with obesity-related lymphedema visit a bariatric weight loss center for surgical weight loss. This is because many people with obesity may find it difficult to lose weight through diet and exercise alone.
Manual lymph drainage: Lymphatic drainage massage is a form of gentle massage that encourages the drainage of lymph nodes and the movement of lymph fluids around the body. It can help relieve symptoms of lymphedema. These massages can be performed at home, and you can have a lymphedema specialist show you how to do it.
Compression therapy: Doctors recommend compression garments to help the fluid move out of the affected area and prevent its accumulation. Compression garments for lymphedema can help promote the flow of lymph fluid, which helps reduce swelling in the affected part of the body.
If flat-knit garments become too difficult to apply, there are also inelastic garments, like circaid® (link to revised circaid landing page). The inelastic nature of the wraps provides better resistance for greater containment of edema or swelling. Additionally, many patients and clinicians find that the application of adjustable compression wraps can be easier to apply.
Additionally, pneumatic compression devices gently encourage the flow of lymph fluid with chambers that inflate and deflate offering a range of pressure options, which helps reduce swelling and the symptoms that come with it.
What can you do?
If you need help losing weight to lower your risk of developing lymphedema, consult with a doctor. Losing weight is easier when you have professional help, whether that’s a special diet, an exercise plan, or a doctor who can help you figure out what lifestyle and genetic factors may be playing a role in your inability to manage your weight.
Research has found there is a link between lymphedema and obesity, whether you’ve recently had surgery or not. However, more research needs to be done to determine the exact link between the two conditions. Managing your weight is an important part of lowering your risk of developing lymphedema, plus it can help you manage symptoms if you already have lymphedema.