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Joachim Zuther, Lymphedema Specialist. Read more
Lohmann Rauscher

Tactile Medical

Obesity and Lymphedema


Obesity contributes to the onset of lymphedema and often worsens the symptoms of already existing lymphedema. In a study conducted by researchers of the University of Missouri-Columbia (published in 2008 in the Journal of Lymphoedema Vol.3, No.2), it was suggested that the risk of developing upper extremity lymphedema following breast cancer surgery was 40-60 percent higher in women with a body mass index (BMI) classified as overweight or obese, compared to women with normal weight. In their study, which included 193 breast cancer survivors, researchers also report that the risk of lymphedema is especially high in overweight or obese women who experience cancer treatment involving the dominant side, or experience post-operative swelling.

Excessive weight, especially morbid obesity, may also contribute to the onset of primary and secondary lymphedema involving the lower extremities. Being overweight can have a negative impact on the return of lymphatic fluid from the lower extremities; additional fluid volumes associated with obesity may overwhelm an already impaired lymphatic system. Direct pressure on lymphatic vessels by excess fatty tissue, impaired diaphragmatic breathing and decreased muscular function can also be factors contributing to the manifestation of lymphedema.
Chronic venous insufficiency (CVI) is often associated with obesity; the increased burden on the lymphatic system in CVI can play a significant role in the manifestation of lower extremity lymphedema.

Treatment progress in existing lymphedema may be seriously hampered in patients with a high BMI. With obese patients it is often difficult to apply bandages, especially in cases of lymphedema affecting the lower extremities. Furthermore, the compressive materials (bandages, garments) applied to the affected extremities have a tendency to slide in obese patients. Compression garments may have to be custom ordered, creating an additional financial burden to the patient.
Exercise, a very important aspect in the management of lymphedema may be negatively affected as well. Mobility problems associated with a high body mass index can affect the patients’ participation in treatment, and exercise protocols used in lymphedema therapy for the upper and lower extremities may have to be modified accordingly.

Weight management and proper nutrition are essential for successful long-term lymphedema management. Please also see Nutritional Aspects in Lymphedema in the next blog entry.


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32 comments to Obesity and Lymphedema

  • Stephane

    I have primary lymphedema of the right leg, diagnosed over 37 years ago. I am 5’6″ tall and weigh in at 175. Maintaining my weight is a nightmare. I pump 3 times a week with a double boot that comes to my waist. I wear leotard compression stocking with 30-40 psi. I bandage every night. My weight never wavers. Once in a while I can lose 5 lbs., but it always comes back.

    I eat healthy, desserts rarely, and once a week I enjoy a glass of red wine.

    I worry constantly about angiosarma – I get cellulitis infections 2-3 times a years.

    What else can I do? By the way, at the onset of this lymphedema, I weighted 130 lbs and I was 3 mos pregnant. I have been diagnosed with Milroy’s Disease, primary type.

    Thanks for your help.


    • Joachim Zuther

      Dear Steph:
      If you never had appropriate lymphedema treatment, I would suggest you consult with a certified lymphedema therapist. You may click on the “Find a Therapist” button on the menu bar above in order to locate a therapist in your area. Pneumatic compression pumps should only be used once the lymphedemateous extremity is decongested using traditional lymphedema management techniques, i.e. Complete Decongestive Therapy. Pneumatic devices can cause a number of complications if not applied correctly.
      Regarding your recurrent episodes of cellulitis, I would like to refer you to a previous posting on the subject:
      I will write more on the topic of nutrition and lymphedema in the upcoming posting on this website next week, so please stay tuned.

  • pam

    Is fast weight lost recommanded?I have lower extremity , above the right knee in the center .it is hard to walk when the mass is full of fluid hey the mass fills and gets close to empty some days.I’m looking for a therapist in the chicago area who can deal with a obeast women with

    • Joachim Zuther

      Dear Pam:
      Fast weight loss is not recommended. An accepted approach in lymphedema management is to follow a low-salt and low-fat diet, which also positively contributes to weight management. A balanced healthy diet including whole grains, fish, fruits and vegetables and avoiding fatty foods, or those with high cholesterol will greatly reduce risk factors associated with lymphedema. I will write more on the topic of nutrition in the next blog posting. To locate a therapist in the Chicago area, please go to the “Find a Therapist” button on the above menu bar.

  • Nancy Fortin

    Great job Joe, this is Nancy in Maine. Hope you are well.

  • スピリチュアル

    Great Post!! Thank you very much!

  • Lee Blank

    Thanks so much for sharing this info. I’ve been curious about this ever since I had a case where a client was fasting quarterly during her treatment for breast cancer. She was not obese and had mild bilateral lymphedema in hands and wrists. We began to notice that every time she did a week long fast her symptoms resolved completely and did not return for a week or so. Not recommending fasting – just interested in the association that you’ve noted here.

  • Abby

    You have officially made me realize I have to get this weight off. Not only does it put me at risk for my cancer but now LE. I want to see my child grow up. It is very hard being a picky eater and loosing weight. Then there are the issues with foods thanks to chemo. I am struggling now to eat chicken the healthy way. I keep trying hoping it will go away. Any suggestion would be great on your next blog. My Oncologist has agreed with me that right now is not a good time to start dieting. However come Jan. we are going to get strict. Thanks for giving me that kick I needed.

  • Franco Lima

    Well written article. I plan to share it on my Facebook fan page. I think my blog readers will enjoy it.

  • Vickie

    Thanks for posting this. We see many pts in our clinic with lymphedema of both legs, sometimes there is no history to explain other than morbid obesity. We are no always able to treat as there are weight restrictions on our clinic equipment. By the way, we have found that abdominal binders sometimes work well to compress large upper thighs. Weight loss is key for long-term success but pts face many challenges as you mentioned in your article. Looking forward to your suggestions on nutrition!

  • […] The Role of Cholesterol in the Management of Lymphedema Cholesterol is a fatty substance which is produced by the liver and found in food with a high content of saturated fat, such as meat, eggs and dairy products. Cholesterol has gotten somewhat of a bad name. However, the amount of fat eaten is not really linked with disease; it is the kind of fat which is consumed. Low-density lipoprotein (LDL) consists of saturated and trans fats. LDL, also known as “bad” cholesterol may stick to the inside wall of arteries and increase the risk of coronary diseases. The “good” fats, monounsaturated and polyunsaturated fats, or high-density lipoprotein (HDL) lower the risk of disease. Eating too many saturated fats can raise the level of “bad” cholesterol and contribute to obesity. […]

  • pam

    Thanks for your speedy reply!It is great to know that Ido not suffer alone with this problem.

  • What remedies are best prescribed for a person who has no health insurance and can’t get theraphy or customized support stockings? I am overweight have venous insufficiency in both legs. Left leg very swollen from lymph edema. When I fast from meat and cut down on salt, my stomach doesn’t bloat and swelling is less in my feet and legs.

    • Joachim Zuther

      Dear Georginna:
      The best approch to treat lymphedema is complete decongestive therapy. If, such as in your case, therapy is not an option, I would suggest to elevate the affected extremity as often as possible during the day, and to wear over-the-counter compression stockings.

  • charity

    i am 650 pounds. i am only able to be mobile in my tiny apartment. im a single mother of a 16 yr old and i need help or im going to die. i have severe lymphadema in my left side and my left leg is 4 times the size of my right. in 2005 i got necrotizing facitis and had to have 40 pounds of muscle and tissue cut out of my left side. my leg is so big im not able to leave the house or fit into a car of any kind. please help me so i can live. i dont want to die and i cant find anyone here to do anything. this is my last hope to save my life. i need some kind of inpatient rehab cuz im going to need a catheter to relieve all the fluid off my body every night. i wet the bed every night now due to the severe lymphedema in my whole left leg and side. im going to die if someone doesnt help me. i can feel my leg getting bigger every day.

    • Joachim Zuther

      I would strongly recommend you contact the National Lymphedema Network and the Lymphatic Research Foundation as soon as possible. These organizations have resources that I am sure will be a great assistance to you.

  • charity

    ive tried everywhere and no one responds back to me..its hopeless

  • Karla Andrade

    Dr. Zuther,
    What anresting article.
    Im a nursing student and as a part time job I do home healthcare. One of my clients 47 y/o obese350-400lbs.
    I assist him with wound care for a DVT wound on the anterior part of his right leg. He had strugled with lymphedema for the last 25 years, and at this point he had stopped using the complession stockings since they were too tight for him, and also with the compression, and the fluids pull, most of the fluids drawn from his legs go to the scrotum area. This has made ambulation extremely difficult.
    I hear my client ready to make the needed life changes and I feel bad that it seen like there is a lack of resources and support from his physician.
    Is there a specialist in the Phoenix area that you can recommend?
    Sincerely, Karla.

    • Joachim Zuther

      Dear Karla: In order to locate a trained lymphedema therapist in this area, please click on the “Find a Therapist” button on the menu bar on top of this page.

  • Jodi

    I just got back from the vascular doctor and he diagnosed me with lymphedema. I have swelling in both of my legs from the knees down. The tops of my feet and ankles seem to have more swelling than the other areas. They did a doppler, so we know the veins are ok. I am obese, and have recently put on extra weight (not that I needed that at all) due to now working from home and not going into the office (sitting with little walking). Is it possible that the swelling can be from the additional weight and that I don’t have lymphedema which I understand is a lifelong condition? If it is lymphedema, and I lose weight, will I always have the swelling?

  • Jojo

    While being about 50 lbs overweight at the onset of my Lymphedema, it is hard to understand how all of a sudden this happened. My LE cam on immediately following a pelvic surgery. My whole life has changed and I now work with a Lymphedema therapist for my care. I work very hard to lose weight and had lost weight prior to getting LE. It seems as my fluid volume changes, so does my weight. Any tips on getting weight off are appreciated as nothing seems to really work.

  • Noadiah Malott

    I have secondary lymphedema caused by radiation treatment for sarcoma in my right thigh. I have lost 40 pounds over the past year and with the addition of the Flexitouch pump I have seen a significant reduction in the edema and have been able to wear the Jobst compression stockings daily. One year ago, I couldn’t wear the stockings because the swelling was so out of control, I would swell through the compression and my circulation would be further compromised. I still have some weight to lose, but even with the amount I have lost my lymphedema is much better controlled and I am wearing shoes I thought I would never get my foot back into and they are comfortable!

    I have struggled with my weight to some extent my entire life. The key to losing weight has been to find what triggers my unnecessary hunger, not eating junk food, cutting back on sodium and drinking only water, unsweetened tea and coffee. I stay away from simple carbs and processed foods. It hasn’t been easy, but the reward of not having the excessive edema in my leg is the best payoff I could have asked for.

  • younes

    i got my lymphedema in my right leg when i was soooo fat , 116 kilograms , now i am 85 but not totally satisfied

  • Alycia

    I have PCOS and have Lymphedema in both my legs, since the swelling started I have gained over 100lbs, I was already overweight to begin with. I have finally got my insulin resistance under control and was starting to lose weight with a healthy diet, but now I can’t exercise until the swelling goes down enough to be fitted for compression garments. is there anything besides swimming that I can do that won’t cause the swelling to get worse while i’m waiting for that? i’m using a lymphatic pump once a day on each leg and that is doing wonders but I also want to lose the fat with the fluid.

  • tonya escoto

    I have lymphoma in both my legs. I’m fixing to get gastric bypass in a month and I was wondering if my legs will go down when my weight starts dropping. My biggest fear is that I will lose all my weight but still have huge legs. Plz reply I really worry about this. Thanks

  • Tawnie

    I have a bunch of things going on that I don’t understand and it all happened exactly around this time, last year. One night my leg felt really stiff so I got up from my desk to stretch. It had felt kind of stiff and heavy and I noticed that my feet looked swollen. Prior to that, I had been having this weird tension like sensation from the area opposite my elbow where they usually stick IVs, and up towards my wrist. It was uncomfortable at times to where I either couldn’t work at my desk or I had to move my arms around a lot. Anyway, following the swelling, I went to the ER bcus I was concerned. I wasn’t sure what was going on. The whole situation triggered my anxiety. The doctor only gave me paperwork to read up on about edema, the different types but nothing more. I never had a true exam or physical. After that visit, I ended up going back due to having a kidney stone which they said could’ve contributed to my swelling but the swelling never ceased. My concerns over the past year have been overlooked and since then, my feet have swollen to where now there are creases in my toes and the side of my foot. Both of my legs and both thighs have swelling. My butt has swelling and has caused indentations or dimples, dents whatever you want to call it… in all those areas mentioned above. I feel disformed and embarrassed. The skin around my upper inner thigh is starting to slouch. Not only just that but my arms have swelled, one slightly more than the other, along with my stomach. Basically, I am swelling everywhere and now this issue is attacking my face. It’s been happening slowly kind of and I’m embarrassed to go out, wear sandals etc. I’m afraid of how I look in pants and if my indentations are noticeable. My anxiety has been at an all time high which it has never been before. I get random moments where I feel suffocated and can’t breathe to where I have to stand up or hunch over. I have a hard time sleeping bcus my heartbeat is weird at times and the shortness of breath type feeling is on and off. I’m at the point where idk if ther s an underlying issue or not but nothing is really being said. I’ve had plenty of tests last year which said I don’t have diabetes but mild anemia. I’ve had a CT scan, an ekg, an ultra sound where it was said that my leg veins are fine. My heart seems normal, despite my random palpitations. I’ve always been pretty heavy but I lost weight before and sadly gained it back. In 2009, I went from 257 to 179 and kept it off for about a little over a year close. I go comfortable in a new relationship back in 2010 and my weight slowly creeped back up to 240 as of middle 2011. My newest breakup in late 2013 didn’t help and I gained more weight. I was depressed for 2 years and carried around 280 for most of that. It was that 2nd year where the trouble started, where all of these issues surfaced and I’m getting no help and no answers. The only response is to lose weight. Now with the swelling, I fear having excess skin. I fear the inability to lose weight bcus I tried before and it just is a to to affect but then maybe I could lose it, I fear the swelling will still make me look fat. I fear that losing weight might not even get rid of the swelling. I have no idea what’s wrong with me or why this happened and if I’ll ever be able to get rid of it. I’ll be 29 next month. I went from 5’5 to 5’4. I’m m always sad and this condition is just making me sink more and more into an isolated place within myself bcus I am so clueless as to what is going on with me and my body and why no one is taking my concerns seriously and I don’t know how to fix it. No matter whether I sit or stand, elevate my feet or not, my feet, my legs, everything just swells and swells. I feel so ugly. I once use to like my feet and now I don’t. I just want to hide from everyone. I don’t know if you could help me understand what this is but if you could, I’d truly appreciate it.

    • Joachim Zuther

      Tawnie: Lymphedema generally affects one extremity/body part only; if both extremities are affected, the swelling appears asymmetrically. In your case with multiple body parts affected by the swelling, the cause may be different. I would suggest to 1. seek consultation with a trained lymphedema therapist to assess whether your swelling is lymphedematous (click the “Find a Therapist” button on top of this page in order to locate a therapist in your area), and 2. consult with a physician who is familiar and knowledgeable on swelling and lymphedema. I would suggest you contact the National Lymphedema Network (NLN) to assist you in locating a physician.

  • Tawnie

    I meant yo yo affect in my last response.

  • Tawnie

    Thank you for your response. I did see someone once before, a specialist, regarding my swelling and the only thing that was said is that they don’t have enough information and because my swelling is everywhere, he couldn’t really help my situation without a clear idea of what to access. I guess because they claim my condition is mild that there’s not much to do except for me to lose weight but even with my troubled breathing every now and again, it’s hard to do the workouts that I once did when I wasn’t going through this type of stuff. I have been eating organic food for about almost 2 years so I don’t think it’s food based. I have swelling on my face as I mentioned. It’s around my cheeks and forehead and it’s weird because no matter where I swell, I can feel it happening. Like I get this weird sensation in my arms like it feels tight. I feel the same sensation around the front of my neck and as for my feet, as I said, no matter what I do they swell little by little. I don’t really feel much of a sensation there but my feet can swell instantaneously if I sit or when I sit with my legs propped after maybe 10 minutes or so. Another thing that I noticed is that a lot of my body parts, feet, legs, side of thighs, butt and my hands tend to fall asleep a lot. My thighs and butt would fall asleep while I’m laying on my side. So with everything going on, I’m just so confused as to what really is happening to me. I have an appt with a neurologist in a few days and another with a gastro doctor. I will check the listings for another lymph edema specialist as well that you mentioned. I am told that this is all in my head, it’s my anxiety or to ignore it and to lose weight but this is not in my head and it’s not my anxiety. My body is changing shape like how smooth my buttocks use to be to how now it’s not so much. Same with my arms and thighs. Even my chest has gotten bigger and my thighs and it was noticeable to someone I knew. It’s just upsetting and I truly hope that a new specialist can help me find out what is going on.