Summary
A dramatic change within the field of Lymphology has been caused by the worldwide increase in the prevalence of obesity, which the WHO has already termed an obesity epidemic. While “classic secondary” lymphoedema after oncological surgery is decreasing due to improved surgical techniques, the number of patients with obesity-associated lymphoedema is increasing at an exponential rate. That change in the lymphological patient population is still being vastly underestimated and frequently ignored. This topic is, if at all, only marginally represented at scientific congresses and in the literature. Helplessness dominates when dealing with these patients in clinical practice, even though the pathophysiological associations between obesity and lymphoedema have been well established. Obesity can cause lymphoedema, and worsen pre-existing lymphoedema. Therapy concepts which focus solely on the lymphoedema and ignore obesity as a significant cause are therefore not efficient. Therapeutic approaches which attempt to treat obesity with diets or commercial weight-loss programmes are also counterproductive. Long term studies have proven only one thing with regards to these diets and weightloss programmes so far – that they fail. At the Foeldi Clinic obese patients with lymphoedema (and lipoedema) are treated with a multimodal obesity programme. In this programme we apply therapeutic options from various fields: internal medicine, psychology, and where required bariatric and plastic surgery. The long-term care of patients is planned and laid out. Unexpectedly, the treatment of patients with obesity-associated lymphoedema is often very rewarding, because patients experience not only an essential improvement of their lymphoedema but are also able to return to a normal, much healthier lifestyle due to the weight loss, through the use of bariatric surgery for example.
English version available at: www.phlebologieonline.de
Keywords
Obesity - Lymphoedema - multimodal obesity concept - bariatric surgery
