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Definitive Link Between Morbid Obesity and Severe Lymphedema

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Posted: 6/7/2011

COLUMBUS, Ohio – Researchers with Ohio State University Medical Center have shown an association between morbid obesity and a severe form of lower extremity lymphedema known as elephantiasis.
“Previous data limited to 3 or fewer patients showed that soft tissue infection in the legs or feet caused the majority of cases of elephantiasis,” says Dr. Steven M. Dean, a vascular medicine specialist at Ohio State.  “Our paper is the first to definitively show that morbid obesity underlies the majority of cases of elephantiasis.  I consider morbid obesity as the predominant cause of lower extremity lymphedema.”
Lymphedema is swelling caused by a blockage in the lymphatic system that allows lymphatic fluid to build up in the arms or legs.
In the largest report to date regarding elephantiasis, the team reviewed 21 cases that presented at Ohio State’s Vascular Medicine clinic between 2006 and 2008.  The findings were recently published in the Journal of the American Academy of Dermatology.
Among the 21 patients reviewed in the report, 91 percent (19) were morbidly obese.  The mean body mass index (BMI) was 56 and it ranged from 35 to 79.  Obesity is defined as a BMI of 30 or greater.  Morbid obesity is a BMI of 40 or greater.  On average, the patients had been battling lymphedema for 11 years.
Another finding that arose from this case review is that 71 percent of the patients also had reduced venous function in the legs.  Dean says it is unclear whether that contributed to the lymphedema or was a coincidental finding, due to the fact that the lymphatic and venous systems are closely related.
Elephantiasis represents the third and most severe stage of lymphedema.  Patients experience incapacitating swelling and skin changes that include marked thickening, ulcerations and wart-like nodules.
Treatment typically involves compression garments, pumps and lymphatic massage.  It can become costly as patients deal with recurrent infections and other complications that can lead to repeat hospitalizations and skilled nursing visits.  Additionally, Dean says these treatments often don’t work well for morbidly obese patients.
“In many cases, dramatic weight loss through bariatric surgery provides the most significant relief for these elephantiasis patients,” Dean said. 
The Centers for Disease Control and Prevention reports 34 percent of American adults are obese and the number is expected to rise. Obesity contributes to many conditions like high blood pressure, diabetes, heart disease, cancer and sleep apnea. Now, Dean says this report shows elephantiasis can be added to the list.
“It underscores the importance of working to maintain an ideal body weight,” says Dean.
Other Ohio State researchers involved in the review include Matthew J. Zirwas and Anthony Vander Horst.
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A video of Dr. Dean discussing the elephantiasis paper is available at: http://go.osu.edu/DZg
A high-resolution JPEG of Dr. Dean is available at: http://go.osu.edu/DZV
Contact:  Marti Leitch, Medical Center Public Affairs and Media Relations, 614-293-3737, or Marti.Leitch@osumc.edu
Skin Conditions; Surgical Weight Management; Stoneridge Medical; OSU Medical Center; Research Findings