Obesity and Cellulitis

Cellulitis is a common infection that affects more than 14 million people in the United States each year. It occurs when bacteria enter the body through a crack in the skin, and is most often seen in the lower leg. Although it can be treated with antibiotics, it can become severe, and even life-threatening if left untreated.

Some groups are at higher risk for developing cellulitis, including people susceptible to skin conditions such as eczema or athlete’s foot, and those with weakened immune systems, diabetes or lymphedema. People with diabetes also can be at higher risk of becoming infected by other bacteria.

People with obesity are at particular risk, both because of their Body Mass Index (BMI) and also because of the strong association with diabetes. A recent large-scale study of healthy adults found that obesity increased the risk of cellulitis independent of coexisting metabolic conditions, and also increased the likelihood of hospitalization for infection.¹

Treatment, Reoccurrence & Self-Diagnosis

Prompt treatment is critical to minimize the infection and keep it from entering the bloodstream. Still, eight to 20 percent of patients have annual reoccurrences, and these rates increase to 49 percent for overall reoccurrences. This may be attributed, in part, to cases among people in the highest BMI groups, that is, >50 kg/m², for whom it may be challenging to achieve necessary antimicrobial concentrations to treat the infection. People in this weight group also are more likely to have lymphedema.

People with obesity also may miss signs of cellulitis due to an inability to closely self-monitor for potential areas of bacterial entry. Whereas patients with recurring cellulitis often are confident in being able to self-diagnose a case of cellulitis, people with excess adiposity may be unable to inspect their lower extremities, particularly lower legs, the soles of feet and between toes.

Reduced Risk through Weight Management

Because of the direct link between obesity and cellulitis, as well as the connections between obesity, diabetes and lymphedema, weight loss should be considered as part of a long-term approach to health management. Weight loss can reduce the risks associated with obesity and other comorbidities, and it is particularly critical to reduce the risk of lymphedema. Research finds that unlike other comorbidities, lymphedema may not reverse upon weight loss for people with severe obesity.²

A Very Low Calorie Diet (VLCD) yields excellent outcomes for people with obesity and diabetes.³ Further, because the risks associated with lymphedema are exacerbated at higher weights, losing and maintaining weight to a healthier range can help patients avoid serious infections like cellulitis and lymphangitis. More specifically, patients at risk for obesity-induced lymphedema should be counseled to join a weight loss program before their BMI reaches 50 to minimize the risk of reaching a weight level where the lymphedema may not resolve.

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Sources:

1. Metabolic Obesity Phenotypes and Risk of Cellulitis: A Cohort Study
2. Obesity-induced Lymphedema Nonreversible Following Massive Weight Loss
3. Assessing the Evidence for Weight Loss Strategies in People With and Without Type 2 Diabetes

About the Author: Dr. Andrea Pampaloni has over 20 years of communication experience across corporate, academic, nonprofit and government sectors. She provides research and writing services on a range of business issues and industry-specific topics to prepare white papers, articles, proposals, presentations, technical content, and speaking points, as well as marketing-communications content such as blogs, website content, newsletters, news releases and award submissions. Dr. Pampaloni’s research findings have been presented at national and international conferences and published in peer-reviewed journals, and she is a ghostwriter for three books, a Forbes article, and several corporate blogs.