Compression stockings in Overweight and Obesity

Relationship between obesity, overweight and venous insufficiency

Obesity is the most frequent metabolic disorder in industrialized countries and is negatively associated with diseases such as diabetes, high blood pressure, cardiac disorders, etc.

Weight gain above normal values is a risk factor for suffering from venous insufficiency. Obesity and venous insufficiency are two highly prevalent entities, and there is a relationship that enhances the former over the latter.

Obesity increases the risk of developing varicose veins in the lower limbs 7 times as well as its complications

Obesity is an important conditioner of problems for the patient with venous insufficiency because:

• It has implications for its cause and limits its prevention.
• Difficulty of diagnostic examinations.
• Obese patients may manifest symptoms of later stages of venous disease earlier.
• Its presence potentially affects therapeutic decisions, complications and the prognosis of patients.
• Its presence is capable of potentiating other factors causing venous insufficiency, such as heredity or standing up for long hours.

How do overweight and obesity affect leg veins?

The problem of obesity seems to correspond to an increase in abdominal pressure due to the accumulated fat that exerts resistance to the rise of venous blood from the lower limbs, generating what is known as venous hypertension, which causes varicose vein problems.

Prolonged distension of the veins due to their elevated pressure can lead to inflammation of the veins and valve failure, particularly in the superficial veins.

People who are overweight and have limited physical activity and / or limitations in the range of motion of the ankles may have an additional commitment to the state of health of their veins. This compromise occurs due to a failure in the pumping of venous blood that normally should be sufficiently impelled by the contraction of the leg muscles when we are physically active to return it to the heart.

Proper venous pumping thus requires unrestricted movement of the joints.

Complications associated with obesity in the patient with venous insufficiency

Obesity is an independent factor that has been associated with pulmonary embolism, being more recurrently associated with venous thrombosis. In hospitalized or operated patients it can be prevented with adequate prophylaxis.

Obesity leads to a more unfavorable effect on varicose veins, with the obese developing more frequently late skin manifestations of venous insufficiency: dermatitis, lipodermatosclerosis, ulcers, etc. These can occur without showing varicose veins that can be hidden by fat.

Considerations on the use of compression stockings in the overweight patient

The obese patient with venous insufficiency should be managed by a specialist in vascular diseases.

Elastocompression with stockings in these cases is a possible alternative if we consider:

I. Use stockings appropriate to the size of the patient

You have to look for stockings that have sizes specially designed for people who are overweight, we should not buy small stockings because their effect will not be correctly proportionate, they could be harmful and may even break apart easily within the first few uses.

II. Take care to prevent stockings from rolling up

We must be very careful in case the stockings used reach the thigh level and roll up since, as we stated in the article on how to try to prevent the stockings from falling, a stocking rolling up generates increased pressure in the area where it turns back on itself, the rolled – or bent – part can act as a tourniquet and worsen the venous problem, obstructing blood flow. In that article you will find several possible solutions, such as the use of garters.

III. Replace stockings when seeing a change in weight

In case of variations in weight, the patient should acquire new stockings according to their new size, since otherwise the pressure exerted by the stockings they had been wearing will be less than the required.

Models

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Recommended reading: R. Gómez-Medialdea. Obesidad e implicaciones venosas (patología venosa).ANGIOLOGÍA 2003; 55 (2): 120-122.