Clinical Impact of Severe Obesity in Patients with Lymphedema

Published:November 16, 2022DOI:
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      With the rate of obesity increasing worldwide we compared Lymphedema (LED) patients with and without concomitant diagnosis of severe obesity (SO), in regard to their baseline demographics, health-related characteristics, treatment plans and patient outcomes.


      Retrospective observational cohort


      The IBM MarketScan Database was examined (2013 - 2019) for patients with a new diagnosis of LED. Of 60 284 LED patients identified 6 588 had Severe Obesity defined by a BMI> 40 kg/m2. The demographics and other characteristics of SO were compared to patients with LED without SO.


      SO and LED diagnosis increased two-fold from 2013 to 2019. LED SO+ patients were younger (57.8 vs 60.8 years, p <.001), having more men (37.7% vs 24.9%, p <.001) than the LED SO- patients. More comorbidities were observed in LED SO+ compared to LED SO-, (diabetes 46.0% vs. 24.9 % (p <.001), heart failure 18.3% vs. 7.4% (p <.001), hypertension 75.0% vs. 47.6% (p <.001), renal disease 24.8% vs. 11.9% (p <.001). Use of diuretics in the LED SO+ group was greater 57.6% vs. 38.0% (p <.001). LED SO+ patients had higher risk of cellulitis 34.5% vs. 13.5% (p <.001). Specific LED treatment was given more often to LED SO- 66.3% vs. 64.3% (p=.003). This was significant for manual lymphatic drainage 46.6% vs. 40.0% (p <.001) and physical therapy 55.4% vs. 51.6% (p<.001), but not for compression garments 18.2% vs. 17.7% (p=.38). However, more LED SO+ patients received pneumatic compression device treatment 20.9% vs. 13.7% (p <.001).


      There was an increase in SO associated LED. LED SO+ patients have over a two and half-fold increase in cellulitis incidence, with significant increase in medical resource utilization and cost. Despite this, LED SO patients receive less specific therapy such as compression which has proven to reduce cellulitis incidence.


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