Obesity-related chronic lymphoedema-like swelling and physical function

Background: People with severe obesity (body mass index [BMI] > 40 kg/m(2)) have an 85% higher mortality than people with a healthy BMI. Poor physical function may contribute to this excess mortality. Lymphoedema-like swelling can affect the legs of severely obese people with normal lymphoscintigraphy. Aim: We sought to determine the relationship between the presence of lymphoedema-like swelling and physical function in the severely obese. Design and Methods: In people with severe obesity, we ascertained whether lower leg lymphoedema-like swelling was present and determined the circumference of the lower leg, time taken to ascend and descend a 17-cm step 50 times and time taken to walk 500 m. Results: The 330 participants, 33% of whom were male, were aged 43.4 +/- 12.7 years (mean +/- standard deviation) and had a BMI of 51.7 +/- 8.4 kg/m(2). Lymphoedema-like swelling was present in approximately one-third (n = 108) in whom a prior history of cellulitis and venous thromboembolism was more common (relative risks 6.16 and 3.86, respectively) than in those without lymphoedema-like swelling. Participants with lymphoedema-like swelling, compared with non-affected counterparts, had a higher lower leg circumference (35.0 +/- 7.1 vs. 32.4 +/- 4.8 cm), a slower step speed (0.40 +/- 0.12 vs. 0.43 +/- 0.10 steps/s) and a slower walking speed (0.97 +/- 0.37 vs. 1.08 +/- 0.30 m/s, P < 0.05 for all comparisons). Conclusions: In this cross-sectional study, 33% of our severely obese participants had lymphoedema-like swelling. Participants with lymphoedema-like swelling had worse physical function than those without. This association was independent of BMI. The presence of obesity-related chronic lymphoedema-like swelling should lead to interventions that improve physical function.