LymphLink Question Corner - Archived from July-Sept 2007
Kathryn McKillip Thrift, BS, CLT-LANA
Q: I have gained some weight since my chemotherapy and my doctor said it's not unusual. She said her biggest concern was the weight gain also increases the possibility of developing lymphedema (LE). I don't understand why weight gain can do this. Can you explain?
Q: I am post-menopausal, due to gynecological cancer. I have gained about 35 lbs. in the last couple of years since my surgery. My doctor wants me to shed those 35 lbs. to lower my risk of developing lymphedema. Is there any evidence excess weight can cause lymphedema?
A: The above questions are similar in nature so I am going to address them together. Several articles in peer reviewed journals seem to indicate there may be a correlation between increased body weight and its relationship to one's increased likelihood of developing LE.
In the Textbook of Lymphology, it states that, "Lymphedema combined with obesity is more than the sum of the two diseases. Obesity causes the diaphragm to be above its normal position, impairing its movement. As a result, a mechanism that supports lymph flow is impaired. In addition, all the other well-known complications of obesity must be taken into consideration."
Other factors to consider are, as we age, we tend to gain weight in each additional decade of life and our bodies are not as able to respond to being overworked as they were when we were younger. What this means in terms of the lymphatic system is that while it may be able to carry away enough fluid from the tissues to keep from developing visible LE, we can have an increase in stagnant tissue fluid which can make us more susceptible to infections, as well as make any additional load of fluid in the tissues too much. Another factor in aging is the ability of the skin to provide external support or resistance is reduced thus making LE more likely. So, the best defense is a good offense as they say in football. If your weight is normal, do your best to keep it there. If you are above your best weight as determined by you and your doctor, then do your best to shed the excess pounds.
In an article, "Obesity and cancer: the risks, science, and potential management strategies," Anne McTiernan, MD, PhD, from the Prevention Center, Fred Hutchinson Cancer Research Center in Seattle, WA, wrote: "The data from our survey suggests that lymphedema is more severe among those with higher body weight and that infections of the skin were much more common among patients with LE who were overweight. In addition, those who were overweight were more likely to have physical limitations that impaired their ability to conduct daily activities."
Q: I feel uncomfortable going to a gym with all those young, buff bodies, but my doctor has told me I need to reduce my weight by 20%. Any advice?
A: As someone who also carries extra weight, I can relate to this uncomfortable feeling. It is important for you to feel safe in the environment where you are exercising so maybe you need to look into another type of exercise arena. If you don't have a buddy to work out with, you might try the local YMCA/YWCA. It has programs for all types of folks from the very young to the senior citizen. You will be more likely to find a class with "big boys or big girls" in this environment instead of a fitness club where the young, buff bodies go to maintain their bodies.
We know it's important to be close to our ideal weight. For some of us, that's a long-term goal, but if we look at it in increments instead of thinking about trying to drop the whole amount, we usually can do better. My advice would be to first set a goal to drop 5% of the excess weight within a reasonable amount of time - 2 to 4 pounds a month is usually considered reasonable. When you have reached that goal, set another 5% reduction goal based on your new weight. If you can do more, then great but don't stress yourself out because stress helps weight to stay on based on the studies with cortisol, a stress hormone.
Q: Why does increased muscle mass help in weight management?
A: This is a key factor in weight reduction and maintaining an "ideal" weight, because muscle burns more calories than fat. So with more muscle mass, while just sitting around doing nothing, your body is a calorieburning machine. According to Drs. Michael Roizen and Mehmet Oz in their "Real Age Tip of the Day for December 15, 2006," muscles burn between 75 and 150 calories per day, while fat burns only 3 calories per day. Also, since we tend to lose 5% of muscle for each decade of life, it is important to continue building muscle mass (or at least maintain) as we age.
Q: If I maintain my "ideal" body weight, what is the chance I'll develop LE?
A: The best answer to this is that, right now, no one knows for certain. Dr. Tony Reid, Peninsula Medical, Inc., has written "our experiences in treating LE shows that obesity is not only a contributing factor to breast cancer risk, but also contributes to the risk of developing LE. In addition, the severity of LE is correlated with obesity.While obesity is not the only factor contributing to the risk of lymphedema, it is an important and potentially controllable factor."
In a study reported in Cancer; 2001:92(6) 1368-1377 by Dr. Jeanne Petrek, et al., researchers found "while obesity at the time of diagnosis also increased patients' LE risk, it was not nearly as influential as weight gain subsequent to breast cancer treatment." Their study went on to report "weight gain following cancer therapy should be avoided as much as possible, as it has been shown to increase susceptibility to LE. Although patients who were overweight at the time of their diagnosis had a higher incidence of LE than women of optimal weight, weight gain in post-treatment years were shown to be a stronger predictor of LE development."
Most recently at the 2006 meeting of the American Society of Breast Disease (ASBD), Lucy K. Helyer, MD, surgical oncology fellow, Princess Margaret Hospital University Health Network, Toronto, presented her group's findings that, "obesity appears to increase the risk of developing lymphedema after axillary lymph nodes are removed for breast cancer." They noted that there was an increasing rate of LE seen with increasing body mass index (BMI). About 36% of obese patients had the condition compared to about 16% of overweight patients, about 7% of normal weight patients and no underweight patients.
While most of this information pertains to post-axillary node dissection arm LE, it would be fair to extrapolate similar risks to leg LE and excess weight too.
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