Cath Lab Digest

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Index: Ostomy Wound Manage. 2008;54(1):44-56.

  In the majority of US states, 20% to 24% of the population – approximately 40 million individuals – is considered obese (20% over the ideal body weight).¹ Morbid obesity is defined as weighing >100 lb more than ideal body weight or having a body mass index (BMI) of >40; its prevalence increased from 2.9% in 1988 to 1994 to 4.7% in 1999 to 2000.² The healthcare costs for morbidly obese patients are nearly double those of normal weight patients due to the additional costs of obesity-linked chronic health conditions, such as diabetes, hypertension, and cardiovascular disease.³ Moreover, results from Fontaine et al’s⁴ epidemiological research study using National Health and Nutrition Examination Survey I and II cohort data (N = 14,407 and 9,282, respectively) show that morbidly obese Caucasian men and women ages 20 to 30 years are estimated to lose 13 and 8 years, respectively, from their life expectancies. For young African American men, this figure is even higher at 20 years. Conservative estimates based on two prospective studies^5,6 of morbidly obese bariatric surgery candidates and a comparative retrospective study⁷ approximate that 75% of morbidly obese people have at least one comorbid condition that may explain the observed risk of premature death.

  Lymphedema is one comorbid condition that has not been studied extensively in morbidly obese patients. In general populations, lymphedema is a relatively rare and serious disorder of the lymphatic system with a reported crude prevalence rate of 0.13%⁸ that tends to be associated with older female patients. However, information from wound clinic data submitted through the Intellicure (The Woodlands, TX) Research Consortium (IRC), a repository of de-identified electronic medical records (EMR) of approximately 15,000 patients from 17 wound centers in both urban and rural areas of 18 US states, show a 74% crude prevalence of lymphedema in morbidly obese patients. This is a very high prevalence rate compared to the reported rate in the general population. The prevalence of lymphedema among morbidly obese people has been referred to by some lymphologists as an “epidemic hidden in plain sight.” The purpose of this article is to educate clinicians regarding the features and treatment of lymphedema in the context of the morbidly obese.

Obesity Data

  To determine the accuracy of the authors’ clinical perception that the actual weight of lymphedema patients had increased over the years, a total of 1,463 electronic patient records from 2000 to 2005 were analyzed. Data were available for 575 men (39.2%) and 889 women (60.8%) with lymphedema. Without corresponding height data, BMI cannot be determined; however, by evaluating only patients (all races) weighing more than 350 lb, a trend toward increasing weight among patients presenting for treatment was noted during the 5-year period surveyed (see Figure 1).

Edema and Obesity

  Because the body’s rich capillary network is designed to be “leaky,” filtered capillary fluid can remove the waste products of the extracellular space due to the slight pressure imbalance resulting from Starling forces, as long as the lymphatic system functions normally.