Impact of Body Mass Index on the Outcomes of Intensive Complex Decongestive Therapy for Lower Limb Lymphedema

Complex decongestive therapy is recognized as the primary treatment of lymphedema. While the influence of weight on the lymphedema appearance and evolution is well known, the relationship between weight and complex decongestive therapy outcome remains underexplored.

The purpose of this research is to evaluate the impact of body mass index on the effectiveness of intensive complex decongestive therapy in patients with primary and secondary lower limb lymphedema.

We conducted a prospective study on 159 patients who underwent 551 complex decongestive therapy programs at the CHU UCL Lymphedema Reference Center from April 1, 2018, to March 19, 2021. Patients were categorized by body mass index ranges (18.5-24.9, 25-29.9, 30-34.9, 35-39.9, and 40-55 kg/m²). Before and after treatment, limb volumes were calculated using the truncated cone formula and functional impairments using the Lymph-ICF-Lower-Limb questionnaire. Linear regression models were used to evaluate the association between weight categories and treatment outcomes and were adjusted for relevant confounding factors.

Higher body mass index was associated with larger initial lymphedema volumes and lower functional status. Complex decongestive therapy reduced the relative lymphedema volume of 7% and improved functional status irrespective of body mass index groups.

Although weight is correlated with an initial greater lymphedema volume and a lower functional status, it does not influence the ability of complex decongestive therapy to reduce limb volume and improve function. Complex decongestive therapy is recommended regardless of a patient's body weight.