If you’re living with obesity, there’s a chance you may have also been diagnosed with lymphedema. Lymphedema — or swelling due to a buildup of lymph fluid — is very common. In fact, it’s estimated to affect 1 in every 1,000 Americans. If you or someone you love is a larger-bodied person who has lymphedema, you may wonder whether these two conditions are related.

Let’s look at how obesity and lymphedema are connected, including how weight management can help treat lymphedema.

What Is Lymphedema?

Lymphedema is a condition that causes swelling when too much lymphatic fluid builds up under the skin. Lymphatic or lymph fluid contains white blood cells, which help fight infections.

Normally, this fluid moves through tiny tubes called lymph vessels and reaches small filters called lymph nodes, which help clean out waste and germs. However, sometimes the lymphatic system doesn’t work properly, and the fluid gets trapped instead of draining like it should. When this happens, swelling occurs, most often in the arms or legs, though it can occur in other areas as well.

If you have lymphedema, you may experience:

• Swelling
• Infections that happen more often
• A feeling of tightness or heaviness
• Difficulty moving the way you used to
• Fibrosis (hard or thick skin)

Does Obesity Cause Lymphedema?

There are two types of lymphedema: primary and secondary. Primary is genetic (inherited), while secondary is caused by damage to the lymphatic system. Secondary lymphedema is much more common and is usually caused by surgical lymph node removal in cancer surgery.

Many conditions can harm the lymphatic system, including:

• Cancer treatments, such as radiation therapy and surgery (such as in breast cancer treatment, in which the removal of lymph nodes in the armpit leads to lymphedema in the upper limb)
• Health conditions, such as obesity, heart disease, liver disease, and vascular (blood vessel) disease
• Injuries
• Scarring caused by infections

In the U.S., the most common cause of secondary lymphedema is cancer surgery. When obesity causes lymphedema, it’s referred to as obesity-induced lymphedema.

Studies show that obesity is linked to both primary and secondary lymphedema. One study found that slightly less than 11 percent of people with lymphedema had a body mass index (BMI) greater than 40.

Many studies found obesity to be a risk factor for lymphedema. People with obesity are two to three times more likely to get the condition after surgery. An increased risk of lymphedema can also happen in people with weight gain after surgery.

How Does Obesity Affect the Lymphatic System?

Obesity impacts lymphatic function in many ways. Excess adipose tissue (fat) puts pressure on the lymph channels. This causes immune cells to build up around them. This swelling can make it harder for lymph fluid to flow.

Obesity can also change how the immune system and hormone system work. This can result in lymph vessels that are weak and leak fluid, and increase swelling. These changes also increase the risk of lymphedema.

Can Losing Weight Help Lymphedema?

There is no known treatment that can get rid of lymphedema. Instead, treatment options consist of symptom management and prevention of complications. The recommended therapy for lymphedema is called decongestive lymphatic therapy (DLT). DLT involves compression, exercise, skin care, and massage to help lymphatic drainage.

Extra weight impacts the lymphatic system. Because of this, losing weight is an important part of lymphedema treatment. Through weight loss, you can help to reduce the strain on your lymphatic system. Making healthy lifestyle changes through diet and exercise can help you achieve a healthy body weight and control your symptoms.

How A Healthy Diet Can Help Lymphedema

Following a healthy diet can help manage lymphedema. It’s important to choose foods that help rather than aggravate your symptoms.

If you have obesity-induced lymphedema, your doctor or dietitian may make some of the following suggestions:

• Eat anti-inflammatory foods, such as salmon, almonds, and garlic. These can help to reduce edema (swelling) and boost the immune system.
• Eat healthy proteins, including eggs, fish, and nuts. Lack of protein can cause fluid to leak into your tissues and worsen lymphedema.
• Choose healthy fats and oils, such as avocados and olive oil. Healthy fats can help reduce lymphedema symptoms.
• Choose unprocessed, whole foods. Foods in their natural states have more nutritional value.
• Limit salty foods. Eating too much salt causes your body to retain fluid, which can make lymphedema worse.
• Avoid items with added or refined sugar, such as white bread, soda, and candy. Extra sugar can worsen symptoms of lymphedema.

Drinking enough water is another important part of a healthy diet. It’s particularly helpful for people with lymphedema because fluid retention occurs when you’re dehydrated. Having enough water each day makes it easier for your lymphatic system to function properly. You can also keep your body hydrated by steering clear of drinks that are known to cause dehydration, such as alcohol and caffeine.

How Exercise Can Help Lymphedema

Physical activity can also help manage symptoms. In addition to promoting healthy weight loss, exercise can help to:

• Improve lymph fluid flow through muscle movement
• Decrease swelling
• Increase range of motion and flexibility

When starting a new exercise plan, it’s important to start slowly. Being active for too long or exercising too frequently may cause your swelling to worsen. Stop and rest if your skin turns red or discolored, or if it feels hot or sticky. If you have cellulitis — a painful skin infection — don’t exercise until it’s fully healed.

Some physical activities recommended for people with lymphedema include:

• Swimming or water aerobics
• Walking
• Exercises involving stretching, such as yoga

Surgery for Obesity-Induced Lymphedema

People with more severe lymphedema may need surgery. There are different types of surgery that may be recommended to help correct lymphatic dysfunction.

Surgical interventions for lymphedema include:

• Lymph node transfer — Healthy lymph nodes are moved to the affected part of the body, and the lymphatic system is “rewired.”
• Lymphovenous bypass — Lymphatic vessels are routed to small, nearby veins.
• Liposuction — Tissue affected by lymphedema is removed.
• Charles procedure — Affected tissue is removed and part of it is used to help repair the area as grafts.

Early Intervention Is Key

Lymphedema is a condition that gets worse over time. Keep in mind that lymphedema that’s left untreated leads to irreversible lymphatic edema (swelling). Because of this, it’s important for healthcare providers to be able to diagnose lymphedema early before symptoms worsen.

Early management, including healthy weight loss, can also help to prevent complications.

Possible complications of lymphedema, include:

• Skin infections, like cellulitis
• Lymph fluid that leaks through the skin
• Skin that hardens and thickens
• Sepsis (a life-threatening infection in the blood)
• Soft-tissue cancer (a rare cancer in muscles, fat, or other soft areas)

Early diagnosis and treatment require more awareness of obesity-induced lymphedema. Primary care providers may mistake lymphedema for lipedema, which can delay proper treatment. In addition, people with obesity-induced lymphedema tend to have higher healthcare costs than people with other types of lymphedema. Finding the condition earlier may help to reduce the financial burden as well as improve outcomes.

Talk to Your Doctor

If you’re living with obesity and have symptoms of lymphedema, it’s important to talk with your endocrinologist (hormone doctor) or healthcare provider. Your primary care provider can refer you to a lymphedema specialist who will work with you to find the best management plan.

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