How does one tell if the “edema” in their lower legs is strictly from obesity vs. congestive heart failure?

Though an obese person may also have heart failure, there are obese people who do not have this condition, yet have plenty of swelling in their lower legs.

An obese person may be worried sick that the edema in their lower legs is from congestive heart failure, when in fact, it’s a condition called lipedema which is caused by obesity.

• Obesity is a risk factor for heart failure, but this doesn’t mean that all obese people have heart failure.

• Not all obese people have edema and seem to have normal legs other than just their supersize from excess fat.

• An obese person can have heart failure but not necessarily edema from heart failure or any edema for that matter.

Edema and Lipedema from Obesity

• In lipedema, the fat is distributed in an abnormal way, causing a cosmetic concern, but it can also cause pain and impair mobility.

• Additional fluid in fatty tissue can build up.

• Excess fat creates pressure on lymphatic vessels, impairing their function. This can lead to lymphedema.

• Obesity impairs proper breathing; improper breathing disrupts efficient lymphatic function. This as well can lead to lymphedema.

• Plus immobility from obesity causes fluid to pool in the lower legs.

If you’ve ever watched the TV show, “My 600 Pound Life,” you will have surely seen many cases of edema caused by obesity.

However, these are extreme examples. One need not be 600 pounds to develop chronic edema.

Edema from Congestive Heart Failure

• The inefficient pumping of the heart causes blood or fluid to back up, congesting the body’s tissues, resulting in edema (which can occur in the upper body, but more often in the legs including the ankle area).

Edema. Shutterstock/AppleDK

• Blood gets backed up in the leg veins, swelling up the leg (and ankles).

• The swelling often worsens after prolonged sitting or by bedtime.

Appearance of Obesity Edema vs. Heart Failure Edema

“Swelling in the legs can look very similar no matter what is the cause,” says Susan L. Besser, MD, with Mercy Medical Center, Baltimore, and Diplomate American Board of Obesity Medicine and board certified by the American Board of Family Medicine.

“However, there may be more swelling in heart failure than in someone whose swelling is due to obesity,” continues Dr. Besser.

• Lymphedema from being super morbidly obese can be grotesque and one-sided.

“Swelling that is chronic (for years), which is more likely to be obesity related, can cause changes in the skin-thickening and darkening of the skin,” says Dr. Besser.

“The texture of the skin can change over time with chronic obesity.”

• The swelling that occurs from obesity is non-pitting, meaning, if you press a fingertip to it, the resulting indentation disappears fairly quickly.

• Non-pitting edema is in general not caused by heart failure.

• The swelling from heart failure, on the other hand, is pitting, meaning that the indentation from a pressed finger remains for a few minutes after the pressure is removed.

Pitting edema on the front of the leg. Source: James Heilman, MD, CreativeCommons

“Acute edema (due to heart failure) may cause more pitting (dimpling of the skin when it’s pressed, as shown in the foot on the right) than chronic obesity, but this is not a hard and fast rule,” explains Dr. Besser.

• Though pitting edema has causes other than heart failure, this is a hallmark feature of heart failure.

• Heart failure swelling is often more pronounced towards the ankles, but can migrate into the hip area and abdomen.

Dr. Besser provides comprehensive family care, treating common and acute primary conditions like diabetes and hypertension. Her ongoing approach allows her the opportunity to provide accurate and critical diagnoses of more complex conditions and disorders.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


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