title: Obesity-related chronic lymphoedema-like swelling and physical function.
abstract: 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.
  
  
  OBJECTIVE
  We sought to determine the relationship between the presence of lymphoedema-like swelling and physical function in the severely obese.
  
  
  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.
authors.affiliation: From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: O'Malley
authors.affiliation: From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland tomasbahern@physicians.ie.
authors.forename: T
authors.initials: T
authors.lastname: Ahern
authors.affiliation: From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Dunlevy
authors.affiliation: From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Lehane
authors.affiliation: From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Kirby
authors.affiliation: From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland From the Weight Management Service, St Columcille's Hospital, Loughlinstown, County Dublin, Obesity Research Group and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: O'Shea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D007866:Leg; D008209:Lymphedema / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008487:Medical History Taking / Q000379:methods; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000503:physiopathology; D010808:Physical Examination / Q000379:methods; D016138:Walking / Q000502:physiology*; D055815:Young Adult