Managing chronic oedema in the morbidly obese patient

The obesity epidemic has become one of the major challenges for health and social policy makers around the world. The increase in obesity is commensurate with the rise in associated complications, including type 2 diabetes, cardiovascular disease and some types of cancer (breast, colon, endometrium, prostrate, kidney and gallbladder). There are also increased cost implications for health services, welfare services and employers. A crude estimate of approximately 15000 patients attending a US clinic showed almost 75% of morbidly obese patients have chronic oedema of the legs. An audit of body mass index of patients attending a specialist lymphoedema clinic showed 36% were clinically obese and 23% were morbidly obese. This has major implications for lymphoedema practitioners in terms of allocating time and resources, and health and safety issues relating to providing a safe environment for both patients and practitioners. This article investigates the financial and health consequences of the rising obesity problem and outlines some of the strategies implemented to halt this trend. The effects and management of chronic oedema in the morbidly obese patient are also presented.