Obesity-related chronic lymphoedema-like swelling and physical function

• Published in: QJM : An International Journal of Medicine 2015-03, Vol.108 (3), p.183-187
• Main Authors: O'Malley, E, Ahern, T, Dunlevy, C, Lehane, C, Kirby, B, O'Shea, D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Body Mass Index; Chronic Disease; Cross-Sectional Studies; Exercise Tolerance - physiology; Female; Humans; Leg; Lymphedema - etiology; Lymphedema - physiopathology; Male; Medical History Taking - methods; Middle Aged; Obesity, Morbid - complications; Obesity, Morbid - physiopathology; Physical Examination - methods; Walking - physiology; Young Adult
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcu155

People with severe obesity (body mass index [BMI] > 40 kg/m(2)) have an 85% higher mortality than people with a healthy BMI. Poor physical function may contribute to this excess mortality. Lymphoedema-like swelling can affect the legs of severely obese people with normal lymphoscintigraphy. We sought to determine the relationship between the presence of lymphoedema-like swelling and physical function in the severely obese. In people with severe obesity, we ascertained whether lower leg lymphoedema-like swelling was present and determined the circumference of the lower leg, time taken to ascend and descend a 17-cm step 50 times and time taken to walk 500 m. The 330 participants, 33% of whom were male, were aged 43.4 ± 12.7 years (mean ± standard deviation) and had a BMI of 51.7 ± 8.4 kg/m(2). Lymphoedema-like swelling was present in approximately one-third (n = 108) in whom a prior history of cellulitis and venous thromboembolism was more common (relative risks 6.16 and 3.86, respectively) than in those without lymphoedema-like swelling. Participants with lymphoedema-like swelling, compared with non-affected counterparts, had a higher lower leg circumference (35.0 ± 7.1 vs. 32.4 ± 4.8 cm), a slower step speed (0.40 ± 0.12 vs. 0.43 ± 0.10 steps/s) and a slower walking speed (0.97 ± 0.37 vs. 1.08 ± 0.30 m/s, P < 0.05 for all comparisons). In this cross-sectional study, 33% of our severely obese participants had lymphoedema-like swelling. Participants with lymphoedema-like swelling had worse physical function than those without. This association was independent of BMI. The presence of obesity-related chronic lymphoedema-like swelling should lead to interventions that improve physical function.