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Phlebologie 2018; 47(02): 75-83
DOI: 10.12687/phleb2410-2-2018
Originalarbeit – Original articles
Schattauer GmbH

Obesity related Lymphoedema – underestimated and undertreated

Article in several languages: deutsch | English
T. Bertsch
1   Földiklinik Hinterzarten – Europäisches Zentrum für Lymphologie
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Publication History

Eingereicht: 08 January 2018

Angenommen: 28 January 2018

Publication Date:
02 April 2018 (online)

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Summary

A dramatic change within the field of Lymphology has been caused by the worldwide increase in the prevalence of obesity, which the WHO has already termed an obesity epidemic. While “classic secondary” lymphoedema after oncological surgery is decreasing due to improved surgical techniques, the number of patients with obesity-associated lymphoedema is increasing at an exponential rate. That change in the lymphological patient population is still being vastly underestimated and frequently ignored. This topic is, if at all, only marginally represented at scientific congresses and in the literature. Helplessness dominates when dealing with these patients in clinical practice, even though the pathophysiological associations between obesity and lymphoedema have been well established. Obesity can cause lymphoedema, and worsen pre-existing lymphoedema. Therapy concepts which focus solely on the lymphoedema and ignore obesity as a significant cause are therefore not efficient. Therapeutic approaches which attempt to treat obesity with diets or commercial weight-loss programmes are also counterproductive. Long term studies have proven only one thing with regards to these diets and weightloss programmes so far – that they fail. At the Foeldi Clinic obese patients with lymphoedema (and lipoedema) are treated with a multimodal obesity programme. In this programme we apply therapeutic options from various fields: internal medicine, psychology, and where required bariatric and plastic surgery. The long-term care of patients is planned and laid out. Unexpectedly, the treatment of patients with obesity-associated lymphoedema is often very rewarding, because patients experience not only an essential improvement of their lymphoedema but are also able to return to a normal, much healthier lifestyle due to the weight loss, through the use of bariatric surgery for example.

English version available at: www.phlebologieonline.de

Keywords

Obesity - Lymphoedema - multimodal obesity concept - bariatric surgery
 

  • Literatur

  • 1 WHO. Controlling the global obesity epidemic, 2017, verfügbar unter. http://www.who.int/nutrition/topics/obesity/en/
  • 2 Robert Koch-Institut 2016, Studie DEGS1, Erhebung 2008-2011.
  • 3 Sifferlin A. 40% of Americans Are Obese – And the Trend Isn’t Slowing in TIME HEALTH, Oktober 2017 verfügbar unter. http://time.com/4980225/obesity-rates-adults-children
    Google Scholar
  • 4 Gregg EW. et al. Global Health Effects of Overweight and Obesity. N Engl J Med 2017; 377: 80-81.
    CrossrefPubMedGoogle Scholar
  • 5 Farshid G, Weiss SW. Massive localized lymphedema in the morbidly obese. Am J Surg Pathol 1998; 22: 1277-1283.
    CrossrefPubMedGoogle Scholar
  • 6 Wu D. et al. Massive localized lymphedema. Hum Pathol 2000; 31: 1162-1168.
    CrossrefPubMedGoogle Scholar
  • 7 Vana J. et al. Massive localized lymphedema in an extremely obese patient. Chirurg 2002; 73: 383-386.
    CrossrefPubMedGoogle Scholar
  • 8 Zoeltzer H, Linker I. Präkollektor und Randsinus des Lymphknotens. LymphForsch 11 (02) 2007; 76.
    Google Scholar
  • 9 Bergman RN. et al. Why visceral fat is bad: mechanisms of the metabolic syndrome. Obesity (Silver Spring) 2006; Feb; 14 (Suppl. 01) 16-19.
    CrossrefPubMedGoogle Scholar
  • 10 Georgescu A. et al. Initiale Lymphsinus und Präkollektoren innerhalb der Fettläppchen der Subcutis des Menschen. LymphForsch 2008; 12 (02) 61-70.
    Google Scholar
  • 11 Ponds CM. PLEFA. Adipose tissue and the immune system 2005; 73 (01) 17-30.
    Google Scholar
  • 12 Rutkowski J. et al. Mechanisms of Obesity and Related Pathologies: The Macro- and Microcirculation of Adipose Tissue. FEBS Journal 2009; 276 (20) 5738-5746.
    CrossrefPubMedGoogle Scholar
  • 13 Savetsky I. et al. Obesity increases inflammation and impairs lymphatic function in a mouse model of lymphedema. Am J Physiol Heart Circ Physiol 2014; 307: H165-H172.
    CrossrefPubMedGoogle Scholar
  • 14 Mehrara BJ, Greene AK. Lymphedema and Obesity: Is there a Link?. Plastic Reconst Surgery 2014; 134 (01) 154e-160e.
    Google Scholar
  • 15 Weitmann ES. et al. Obesity impairs lymphatic fluid transport and dendritic cell migration to lymph nodes. PLoS One. 2013: 12 08. 08
    Google Scholar
  • 16 Blum KS. et al. Chronic high-fat diet impairs collecting lymphatic vessel function in mice. PLoS One. 2014 09. 04
    Google Scholar
  • 17 Földi E. et al. Adipositas, Lipödem und Lymphostase. Medwelt. 1983: 25.
    PubMedGoogle Scholar
  • 18 Zampell JC. et al. Regulation of Adipogenesis by Lymphatic Fluid Stasis Part 1. Plastic Reconstruct. Surgery 2012; 129 (04) 825-834.
    Google Scholar
  • 19 Földiklinik Hinterzarten. Eigene Untersuchungen. Unveröffentlicht.
    Google Scholar
  • 20 S2K Leitlinie. Diagnostik und Therapie der Lymphödeme, verfügbar unter. http://www.awmf.org/uploads/tx_szleitlinien/058–001l_S2k_Diagnos-tik_und_Therapie_der_Lymphoedeme_2017–05.pdf
    Google Scholar
  • 21 Wiedner M. et al. Entstehung des Lipödems. Lymphselbsthilfe. 2017: 15-16.
    PubMedGoogle Scholar
  • 22 Rüger K. Das Adipositas-Lymphödem. Lymph- Forsch 2008; 12 (01) 31-35.
    Google Scholar
  • 23 Das LipoLymphödem. Verfügbar unter. http://www.lymphverein.de/lipoedem.html
    Google Scholar
  • 24 Buck DW, Herbst KL. Lipedema: A Relatively Common Disease with Extremely Common Misconceptions. Plast Reconstr Surg Glob Open. 2016 04. 09
    Google Scholar
  • 25 S3 Leitlinie zur Prävention und Therapie der Adipositas. 2014. Verfügbar unter http://www.awmf.org/uploads/tx_szleitlinien/050–001l_S3_Adipositas_Pr%C3%A4vention_Therapie_2014–11.pdf
    Google Scholar
  • 26 Wing RR, Jeffery RW. Outpatient treatment of obesity: A comparison of methodology and clinical results. International J of Obesity 1979; 03: 261-279.
    Google Scholar
  • 27 Wing RR, Phelan S. Long-Term Weight Loss Maintenance. American Journal of Clinical Nutrition 2005; 82 (Suppl. 01) 222S-225S.
    CrossrefPubMedGoogle Scholar
  • 28 Institute of Medicine. The Nature and Problem of Obesity in Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington DC: NA Press; 1995: 55-58.
    Google Scholar
  • 29 S3 Leitlinie zur Prävention und Therapie der Adipositas. 2014. a.a.O. S. 61.
    Google Scholar
  • 30 Jeffery RW. et al. Are smaller weight losses or more achievable weight loss goals better in the long term for obese patients?. Journal of Consulting and Clinical Psychology 1998; 66 (04) 641-645.
    CrossrefPubMedGoogle Scholar
  • 31 Foster GD. et al. What is a reasonable weight loss? Patients expectations and evaluations of obesity treatment outcomes. Journal of Consulting and Clinical Psychology 1997; 65 (01) 79-85.
    CrossrefPubMedGoogle Scholar
  • 32 Saxenda Fachinformation. Adipositas. 2017 11. 145.
    PubMedGoogle Scholar
  • 33 Stunkard A. The Results of Treatment for Obesity. A Review of the Literature and Report of a Series. AMA Arch Intern Med 1959; 103 (01) 79-85.
    CrossrefPubMedGoogle Scholar
  • 34 Bennett W, Gurin J. The Dieter’s Dilemma: Why Diets Are Obsolete–the New Setpoint Theory of Weight Control. New York: Basic Books; 1982
    Google Scholar
  • 35 Cogan J, Rothblum E. Genetic, Social and General Psychology Monographs. 1993 118. 04
    PubMedGoogle Scholar
  • 36 Perri MG. et al. Sucess and failure in the treatment of obesity: Where do we go from here?. Medicine, Exercise, Nutrition and Health 1995; 04: 255-272.
    Google Scholar
  • 37 Hensrud DD, Weinsier RL. A prospective study of weight maintenance in obese subjects reduced to normal body weight without weight-loss training. American clinical Nutrtion 1994; 60 (05) 688-694.
    Google Scholar
  • 38 Mann T, Tomiyama AJ. et al. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol 2007; 62 (03) 220-233.
    CrossrefPubMedGoogle Scholar
  • 39 Nordmann A. et al. Effects of low carb vs low fat diets on weight loss and cardiovascular risk factors: a meta analysis of randomized controlled trials. Arch Internal Med. 2006 166. 08.
    PubMedGoogle Scholar
  • 40 Fildes A, Charlton J. Probability of an obese person attaining normal body weight. American Journal of Public Health. 2015
    PubMedGoogle Scholar
  • 41 Dulloo AG. et al. How dieting makes the lean fatter. Obesity reviews 2015; 16 (S1): 25-35.
    CrossrefPubMedGoogle Scholar
  • 42 Lowe MR. Dieting: Proxy or Cause of Furture weight gain?. Obesity Reviews 2015; 16 (Suppl. 01) 19-24.
    CrossrefPubMedGoogle Scholar
  • 43 Pietiläinen KH. et al. Does dieting make you fat? A Twin study. International Journal of Obesity 2012; 36 (03) 456-464.
    CrossrefPubMedGoogle Scholar
  • 44 Stice E. et al. Caloric deprivation increases responsivity of attention and reward brain regions to in take, anticipated intake and images of palatable foods. NeuroImage 2013; 67: 322-330.
    CrossrefPubMedGoogle Scholar
  • 45 Sumithran P. et al. Long-Term Persistence of Hormonal Adaptions to Weight Loss. N Engl J Med 2011; 365: 1597-1604.
    CrossrefPubMedGoogle Scholar
  • 46 Tataranni PA, Ravussin E. in Energy Metabolism and Obesity in Handbook of Obesity Treatment. New York Guilford Press 2004: 42-72.
    PubMedGoogle Scholar
  • 47 Leibel RI, Hirsch J. Changes in Energy Expenditure Resulting form Altered Body Weight. N Engl J Med 1995; 332: 10.
    Google Scholar
  • 48 Lipek T. et al. Obesongenic environment: environmental approaches to obesity prevention. J Pediatr Endocrinol Metab 2015; 28 (5–6): 485-495.
    PubMedGoogle Scholar
  • 49 WHO Obesity. Preventing and managing the global epidemic Report of a WHO Consultation on Obesity. 1997 Geneva.
    PubMedGoogle Scholar
  • 50 Pollack A. A.M.A. Recognizes Obesity as a Dis ease. New York: Times; June 18 2014
    Google Scholar
  • 51 Zheng H. et al. Obesity and mortality risk: new findings from body mass index trajectories. Am J Epidemiol 2013; Dec 1; 178 (11) 1591-9.
    CrossrefPubMedGoogle Scholar
  • 52 Pischon T. et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359 (20) 2105-2120.
    CrossrefPubMedGoogle Scholar
  • 53 Flegal KM. et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309 (01) 71-82.
    CrossrefPubMedGoogle Scholar
  • 54 Blair SN. Physical inactivity: The biggest public health problem oft he 21st century. British Journal of Sports Medicine 2009; 43 (01) 1-2.
    PubMedGoogle Scholar
  • 55 Lantz P. et al. Socioeconomic and behavioural risk factors for mortality in a national 19 year prospective study of U.S adults. Social Science & Medicine 2010; 70 (10) 1558-1566.
    CrossrefPubMedGoogle Scholar
  • 56 Holt-Lunstad J. et al. Social relationships and mortality risk: a metaanalyses review. Plos med. 2010: 7.
    PubMedGoogle Scholar
  • 57 Malik VS. et al. Sweeteners and Risk of Obesity and Type 2 Diabetes: The Role of Sugar-Sweetened Beverages. Curr Diab Rep 2012; 12: 195-203.
    CrossrefPubMedGoogle Scholar
  • 58 Johnson RK. et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation 2009; 120 (11) 1011-1020.
    CrossrefPubMedGoogle Scholar
  • 59 AHA. Dietary Sugars Intake and Cardiovascular Health A Scientific Statement from the American Heart Association Circulation. 2009; 120: 1011-1020.
    PubMed
  • 60 University of California San Francisco. Sugar science. Verfügbar unter http://sugarscience.ucsf.edu/
    Google Scholar
  • 61 Lustig R. Fat Chance: The Hidden Truth About Sugar, Obesity and Disease. 2013
    PubMedGoogle Scholar
  • 62 Inge TH. et al. Long-term outcomes of bariatric surgery in adolescents with severe obesity: a prospective follow-up analysis. Lancet Diabetes Endocrinol. 2017 Volume 5, Issue 3, March 2017, Pages 165-173.
    PubMedGoogle Scholar
  • 63 Obeid NR. et al. Long-term outcomes after Rouxen-Y gastric bypass: 10– to 13-year data. Surg Obes Relat Dis. 2016
    PubMedGoogle Scholar
  • 64 Sjöstrom L. et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357 (08) 741-752.
    CrossrefPubMedGoogle Scholar
  • 65 Adams T. et al. Health Benefits of Gastric Bypass Surgery after 6 Years. JAMA 2012; Sep 19 308 (11) 1122-1131.
    CrossrefPubMedGoogle Scholar
  • 66 Adams T. et al. Long-Term Mortality after Gastric Bypass Surgery. N Engl J Med 2007; 357: 753-761.
    CrossrefPubMedGoogle Scholar
  • 67 Arterburn DE. et al. Association between bariatric surgery and long-term survival. JAMA 2015; 313 (01) 62-70.
    CrossrefPubMedGoogle Scholar
  • 68 Stunkard AJ. et al. An Adoption Study of Human Obesity. N Engl J Med 1986; 314: 193-198.
    CrossrefPubMedGoogle Scholar
  • 69 Stunkard AJ. et al. The Body-Mass Index of Twins who have been reared apart. N Engl J Med 1990; 322: 1483-1487.
    CrossrefPubMedGoogle Scholar
  • 70 Plagemann A. (Ed.). Perinatal Programming The State of the Art. Berlin/Boston: Walter de Gruyter; 2012: 11-22.
    Google Scholar
  • 71 Herrera B. et al. Genetics and epigenetics of obesity. Maturitas 2011; 69 (01) 41-49.
    CrossrefPubMedGoogle Scholar
  • 72 Hewagalamulage SD. et al. Stress, Cortisol and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domest Anim Endocrinol 2016; 56 Suppl: 112-120.
    CrossrefPubMedGoogle Scholar
  • 73 Volkow ND. et al. Obesity and addiction: neurobiological overlaps. Obesity reviews 2013; (01) 2-18.
    PubMedGoogle Scholar
  • 74 Nemiary D. et al. The Relationship Between Obes ity and Depression Among Adolescents. Psychiatr Ann 2013; 42 (08) 305-308.
    Google Scholar
  • 75 Andersen RE. (Ed.). Obesity – Etiology, Assessment, Treatment and Prevention. Part 1 and 2. Human Kinetics. 2003
    PubMedGoogle Scholar
  • 76 Taubes G. The Case against Sugar. New York: Alfred A Knopf; 2016
    Google Scholar
  • 77 Földi M, Földi E. (Hrsg.) Lehrbuch Lymphologie. 7. überarbeitete Auflage, München: Urban & Fischer. 2010: 175-238.
    PubMedGoogle Scholar
  • 78 Hongyu W. et al. Independent and Opposite Associations of Trunk and Leg Fat Depots with Adipokines, Inflammatory Markers, and Metabolic Syndrome in Middle-Aged and Older Chinese Men and Women. J Clin Endocrinol Metab September 2010; 95 (09) 4389-4398.
    CrossrefPubMedGoogle Scholar
  • 79 S3-LEITLINIE Interdisziplinäre Leitlinie der Qualität S3 zur “Prävention und Therapie der Adipositas”. AWMF-Register Nr. 050/001 Version 2.0 (April 2014). 58-62.
  • 80 Gemeinschaftsproduktion ZDF und ARTE. Doku: planet e.: Schlank durch Schokolade – Der Trick mit den Diäten. 2015. Verfügbar unter: https://www.youtube.com/watch?v=-35dij13n-U Hier insbesondere Minute 8 bis Minute 14.