Obesity and Lymphedema

Introduction
Obesity is a national epidemic of grave concern in the US. Obesity can complicate the treatment of lymphedema due to other causes. In addition, lymphedema can develop as a complication of extreme obesity.
An Online Survey
Peninsula Medical, the manufacturer of the Reid Sleeve and similar garments, is conducting an online survey on this topic. (If you would like to take part in this survey, go to the Obesity and Lymphedema Link.) The results of approximately 100 responses were studied by Dr. Reid and, not surprisingly, he found a correlation between being overweight and having problems with lymphedema. See Dr. Reid Reports.
These results are interesting and well presented; however, as Dr. Reid pointed out: “In any survey of this type it is important to remember (1) how the questions were worded, (2) who responded, and (3) how the responses were interpreted.”
The Normal and Impaired Flow of Lymph
In normal tissue lymph flows between the cells, collects waste, returns to the lymph capillaries, and is eventually returned to the venous circulation (for details, see Understanding the Lymphatic System).
This normal flow can be disrupted by any of the factors that make an individual “at risk” for lymphedema. When this disruption occurs, the lymphatic system continues working until it is so overwhelmed that it can no longer remove all of the lymph. It is at this tipping point that the swelling of lymphedema occurs. See Delayed Onset of Lymphedema.
Excess Weight Adds Another Risk Factor
Gaining excess weight places yet another stress factor on the lymphatic system.
As weight is added, the fat cells that were already present enlarge. In addition, new fat cells form.
This creates more cells to be serviced by the circulatory system and more waste products to be removed by the lymphatic system.
Despite increased weight and body size the number of lymph capillaries and vessels do not increase. Therefore more lymph must be collected and transported by a system that is not large enough to effectively serve the body mass.
Excess weigh also increases the risk of developing other conditions, such as diabetes.
Morbid Obesity
Morbid obesity is the condition of weighing two or three times, or more, than the ideal weight. Alternatively, a body mass index greater than 39 may be used to diagnose morbid obesity.
As the weight increases, the individual becomes less mobile and able to exercise. Yet, the motion of the muscles is an important factor in maintaining the normal flow of lymph. Exercise also helps to burn calories, improves cardiovascular health, and increase general well-being.
Conclusion
Obesity creates stress on all of the body systems including the lymphatic system and lymphedema can be a comorbidity caused by it.



Delayed Onset of Lymphedema
Introduction
The lymphatic system works in a delicate balance. As long as amounts of fluids-in and fluids-out are equal, lymphedema does not develop. Despite injuries or other risk factors, the lymphatic system continues to cope as long, and as well, as it can. When the strain becomes too great, the visible signs of lymphedema develop.
The Tipping Point

The tipping point comes when more fluid is coming into the system than the lymphatics can remove. When the lymphatic system is no longer able to manage this load effectively, the swelling of lymphedema develops.
Some therapists describe the situation as a bath tub with clogged drain and a dripping faucet.[1] All is well until the tub is full. Then the next drop of water causes the tub to begin overflowing.
In lymphedema the tipping point occurs when the lymphatic system can no longer manage the amount of incoming fluid and the overflow produces the swelling of lymphedema.
Lymphedema can develop immediately or as long as 30 or more years later. The time between becoming at risk, and the time of onset, is known as the latency phase.
For example, a case was reported of a woman who, 30 years after a mastectomy, was diagnosed with diabetes. Within days of beginning to perform finger stick tests on the fingers of her “at risk” arm, she developed lymphedema in that arm.
Reaching the Tipping Point
There are many reasons why the lymphatic system reaches this tipping point and lymphedema develops. Anything that stresses the lymphatic system increases this risk and the more common risk factors include:
Pressure changes, as when flying or traveling at high altitudes, often triggers the swelling of lymphedema. For this reason, those at risk for lymphedema (and those with it) are urged to wear compression garments when flying. See Travel Tips.
Obesity by itself does not cause lymphedema; however, excess fat slows the flow of lymph and creates added strain on the lymphatic system. Maintaining your ideal weight helps to reduce this risk. See Obesity and Lymphedema.
Decreased mobility due to any cause can increase the risk of developing lymphedema because muscle movements and exercise are so important in helping lymph to flow normally.
An infection in the “at risk area” puts an added strain on the lymphatic system. The infection can be the first sign of lymphedema or the added strain can push the lymphatics in this area beyond the tipping point.
Other illnesses or medications can stress the body and negatively affect the lymphatic system.
Pay Attention to Your Body!
Know, and watch for, the early warnings of lymphedema.  If you develop any of these signs, don’t wait for an overwhelming swelling as your wake-up call. Heed these signs and seek treatment promptly.