From the Guidelines
Obese patients with generalized lymphedema should be managed with a multidisciplinary approach that includes weight loss and physical activity.
Key Components of Management
- Weight loss: Obesity is a risk factor for lymphedema, and weight loss is recommended for those who are overweight or obese 1.
- Physical activity: Supervised, slowly progressive resistance training is safe and effective for breast cancer survivors with regard to lymphedema development 1.
- Multidisciplinary team: A team that includes a dietician, exercise specialist, psychologist, and obesity nurse can provide comprehensive care for patients with obesity and lymphedema 1.
Approach to Care
- Assessment: Patients with lymphedema should be assessed for the extent of swelling and symptoms, and referred to a therapist knowledgeable about lymphedema diagnosis and treatment if necessary 1.
- Lifestyle modifications: Patients should be encouraged to make lifestyle modifications, including reduced calorie intake and increased physical activity, to support weight loss and improve lymphedema symptoms 1.
- Long-term management: Long-term measures for weight maintenance and lymphedema management are necessary to prevent exacerbation of symptoms 1.
From the Research
Approach to Managing an Obese Patient with Generalized Lymphedema
The management of an obese patient with generalized lymphedema requires a comprehensive approach that addresses both the lymphedema and the obesity.
- Weight loss is considered the fundamental treatment for obesity-induced lymphedema (OIL) 2.
- A multidisciplinary team, including nurses, dieticians, physical therapists, and psychologists, is essential in providing care to these patients 3.
- Treatment with semaglutide, a medication used for weight management, has been shown to be effective in patients with extreme obesity and massive localized lymphedema (MLL), with the support of a multidisciplinary team in a specialized obesity center 3.
- Compression bandaging, manual lymphatic drainage, and localized surgeries are also options for managing lymphedema in morbidly obese patients 4.
- It is crucial to address the primary issue of obesity to prevent the recurrence of massive localized lymphedema 4.
- The therapeutic strategy must address both lymphedema and obesity, as well as its comorbidities, to break the vicious circle of lymph stasis, local adipogenesis, and fibrosis 5.
Considerations for Treatment
- Patients with obesity-induced lymphedema are at risk of developing areas of massive localized lymphedema (MLL) 2.
- The risk of lymphatic dysfunction increases with elevated BMI, and is almost universal once BMI exceeds 60 2.
- Obesity is prevalent in patients with lymphedema, and is associated with delayed referral and increased cellulitis rates 6.
- Early detection and tailored management strategies are needed to address obesity in patients with lymphedema and the complexities associated with these two related conditions 6.