Unlock the Truth: How Weight Loss Impacts Lymphedema and What You Need to Know

Lymphedema, a condition characterized by the buildup of lymph fluid in the body's tissues, affects approximately one in every 1,000 Americans. Obesity is an excessive accumulation of fat that presents a health risk. Obesity is a significant risk factor for many conditions, including lymphedema. It can be caused by a blockage or damage to the lymphatic system. While solutions for improving its symptoms are not commonly discussed, a healthy diet can help maintain a healthy body weight and body mass index (BMI), potentially alleviating lymphedema symptoms. This article delves into the intricate relationship between lymphedema and weight, exploring how obesity can contribute to lymphatic dysfunction and whether weight loss can reverse or mitigate these effects.

Understanding Lymphedema

Lymphedema occurs when a blockage forms in the lymphatic system, preventing the lymph fluid from properly draining. The lymphatic system is responsible for maintaining fluid levels in our body tissues by removing all fluids that leak out of our blood vessels. The lymphatics also function to transport fat, protein, and other nutrients, as well as prevent infections. With nowhere else to go, the lymph fluid begins to build up and cause swelling. This swelling can occur in any part of the body, but it often occurs in extremities (your hands, feet, arms, and legs). The swelling can be asymmetrical - for example, it may affect only one arm or leg. Swelling may also occur in the genitals, groin, face, neck, mouth, breast, chest, shoulder, and pelvis.

Lymphedema affects the body’s ability to drain extracellular fluid from the tissues, causing buildup in the affected limbs. Lymphedema is typically caused by lymph nodes being damaged or removed as a result of cancer treatment, such as surgery or radiation therapy. Surgery, trauma and radiation treatments are secondary causes of lymphedema.

Symptoms of Lymphedema

Swelling in a part of the body, primarily arms or legs
Tightening and hardening of the skin
Tingling, numbness, or discomfort in the area
Reduced flexibility in the nearby joints
Itching in the affected area
Feeling heavy in the affected area, along with aching
Recurrent skin infections
Development of wart-like growths on the skin
Difficulty fitting into clothing and jewelry

The Link Between Obesity and Lymphedema

Obesity can increase stress on the various systems in your body and has been linked to an increased risk of many health conditions. Researchers have recently indicated that obesity is a significant risk factor for developing lymphedema. Obesity-induced lymphedema can occur in people with a BMI of 30 or greater and tends to be associated with swelling of the legs.

According to an article published on PubMed Central by Drs. Babak J. Mehrara and Arin K. Drs. Mehrara and Green found that patients with breast cancer who had a body mass index of at least 30 were three times more likely to develop lymphedema in the upper body when compared to patients with a body mass index of 25 or less.

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While the exact mechanism is still being researched, experts generally agree that obesity can strain your lymphatic system. This can reduce its function and, in some cases, damage it to the point that lymphedema sets in. A 2020 study indicates that obesity can cause inflammation in the lymphatic system. This reduces the flow of lymph through the vessels and can cause the lymphatic vessels to leak. This can lead to lymphatic dysfunction and, ultimately, lymphedema. Another 2016 study reports that obesity-induced lymphedema can develop in the lower part of the body if an individual has a BMI that exceeds 50 and in the upper parts of the body if the BMI exceeds 80.

Obesity-Induced Lymphedema

When lymphedema is associated with obesity, it’s called obesity-induced lymphedema. In obesity-induced lymphedema, swelling most often affects your legs and feet. Parts of your body with swelling might feel full or heavy, and you may experience discomfort, such as aching or tingling sensations, in those areas. Also, your skin may feel tighter in those areas, and this might affect your range of motion.

Complications of Obesity-Induced Lymphedema

Obesity-induced lymphedema can lead to a variety of complications. Because your lymphatic system is involved in protecting your body from infections, a damaged lymphatic system can lead to an increased risk of bacterial and fungal infections, including cellulitis. Lymphedema is also associated with more severe complications such as blood clots and lymphangiosarcoma, a rare form of cancer. Obesity-induced lymphedema - especially when it affects your legs - can make it more difficult for you to walk or move around, significantly limiting your mobility.

Research on Obesity and Lymphatic Function

Clinical and experimental studies have shown that obesity results in lymphatic dysfunction. Obesity is negatively correlated with cutaneous lymphatic collecting vessel pumping rate (r = -0.9812, P < 0.0005) and initial lymphatic vessel density (r = -0.9449, P < 0.005). Weight gain has a linear effect on accumulation of perilymphatic inflammatory cells and expression of inducible nitric oxide synthase (iNOS).

A mouse model of diet‐induced obesity was used to identify putative cellular mechanisms of obesity‐induced lymphatic dysfunction, determine whether there is a correlation between these deleterious effects and increasing weight gain, and finally examine whether lymphatic dysfunction is reversible with diet‐induced weight loss.

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Can Weight Loss Reverse Lymphedema?

The primary treatment for obesity-induced lymphedema is weight loss. Losing weight is an effective treatment option for lymphedema. Doctors may recommend surgical weight loss procedures for people with obesity who find it difficult to lose weight through diet and exercise alone. This can help slow or stop the progression of the swelling.

Weight loss resulting from conversion to a normal chow diet for 8 weeks resulted in more than a 25% decrease in body weight and normalized cutaneous lymphatic collecting vessel pumping rate, lymphatic vessel density, lymphatic leakiness, and lymphatic macromolecule clearance (all P < 0.05). In addition, weight loss markedly decreased perilymphatic inflammation and iNOS expression. Weight loss, induced by switching obese mice from a high‐fat to a normal chow diet (NCD), effectively reversed perilymphatic accumulation of inflammatory cells and iNOS expression. These changes correlated with improved collecting vessel pumping frequency, increased lymphatic vessel density and decreased lymphatic leakiness, resulting in significantly increased lymphatic clearance of macromolecules and improved migration of dendritic cells (DCs) to regional lymph nodes.

However, weight loss can be complicated by the fact that the swelling can make it difficult to move around. Surgical options may help reduce some symptoms of obesity-induced lymphedema, but obesity is also associated with an increased risk of surgical complications. Therefore, surgeons usually recommend losing weight to lower your BMI to a certain threshold before they attempt surgery.

Lymphedema does not have a cure. Its progression can be slowed or even stopped, but at this time it can’t be fully reversed. Once your lymphatic system is damaged, it might not be possible for it to fully recover. The long-term outlook for obesity-induced lymphedema is usually better if you’re able to quickly and consistently treat the condition.

A Contrasting Case Study

Despite the potential benefits of weight loss, some research suggests that the damage to lymphatic structures may be irreversible in certain cases. One case study followed a 46-year-old woman with a BMI of 80 who presented with bilateral lower extremity swelling and impaired lymphatic drainage. After undergoing a sleeve gastrectomy and reducing her BMI to 36, lymphoscintigraphy showed no improvement in lower extremity lymphatic function. This suggests that obesity-induced lymphedema may cause irreversible lymphatic dysfunction in some individuals.

Managing Lymphedema Symptoms

Regardless of whether you’re experiencing lymphedema, complete decongestive therapy is a popular treatment option. If you’re obese, you may experience more severe lymphedema or lymphedema that occurs without a secondary cause, such as an injury or surgery. For these patients, weight management is an important part of keeping lymphedema symptoms in check and preventing complications.

8 Dieting Tips for Improving Lymphedema Symptoms

Drink Plenty of Water: Drinking plenty of water can help manage lymphedema symptoms by promoting the body’s filtration and elimination functions.
Avoid Caffeine, Alcohol, and Diuretics: A key part of staying hydrated is limiting beverages that contribute to dehydration, including coffee and alcohol. Long-term use of diuretics can worsen lymphedema symptoms by causing dehydration by leaving a higher concentration of protein mass in the lymph fluid.
Keep Protein in Your Diet: It is important to consume enough protein daily to maintain your body’s fluid balance. The recommended amount of daily dietary protein is about 0.36 grams per pound of body weight.
Reduce Your Salt Intake: A large amount of salt can cause water retention in the body. Limit your daily intake of sodium by avoiding canned foods, fast food, frozen and boxed meals, cured meats, and salty condiments.
Incorporate More Whole Foods Into Your Diet: Whole foods are the best types of foods to eat for those with lymphedema because they are not processed. Diets high in processed foods leave less room for nutrient-dense foods that provide the vitamins, minerals, and antioxidants your body needs.
Limit Refined Sugars: You can start limiting added sugars by swapping out sodas for flavored water or eating fruit instead of candy for dessert.
Opt for Healthy Fats and Oils: Swap out processed butter and refined vegetable oils for healthier alternatives.
Incorporate Anti-Inflammatory Foods: Omega-3 fatty acids, for example, are known for their exceptional anti-inflammatory and immune-boosting properties.

Additional Strategies for Managing Lymphedema

Compression therapy: Compression therapy applies pressure from the outside, which can help filter fluid through the lymphatic system, helping to reduce lymphedema symptoms.
Proper skin care: Practice good skin hygiene and keep a close watch on your arm and leg skin so you can spot any changes or breaks in the skin early.
Avoid extreme heat or cold: Try not to expose the affected area or swollen arm or leg to extreme temperatures.
Elevate your limb: Try to elevate the affected arm or leg above the level of your heart whenever possible.
Daily exercise: Regular exercise also helps promote lymphatic drainage, which keeps lymph fluid from collecting in your tissues, which leads to swelling.
Get quality sleep: Make sure you get plenty of sleep to ensure your lymphatic system is functioning properly.
Consult a doctor: If you need help losing weight to lower your risk of developing lymphedema, consult with a doctor.

Stages of Lymphedema

Stage 1: Early onset, with accumulation of tissue oedema that reduces with leg elevation. The oedema may be pitting. This initial stage is a crucial window for intervention, as proper treatment can prevent progression to more severe stages.
Stage 2: Leg elevation alone rarely reduces the oedema, pitting is manifested. While this stage marks a point where the condition becomes irreversible, there are many ways to maintain your quality of life and prevent symptoms from progressing.
Stage 3: The most advanced stage of this chronic condition. Hard (fibrotic) tissue is present, while pitting is absent. Skin changes e.g. thickening, hyperpigmentation, increased skin folds, fat deposits, and warty skin is seen.

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