We all know that being overweight can lead to various health problems. Some of these, such as diabetes and premature arthritis make the news every day. What is not highlighted in the press much is that obesity can also 'hide' certain common conditions, such as varicose veins.
About 30% of people develop varicose veins at some point in their lives and some of them will be overweight. For people of a normal body size, the vein problem is usually obvious, because bulging veins are visible on the skin of the calf. The leaking veins also cause discomfort and heaviness of the legs - these symptoms in overweight patients are often attributed to the weight problem itself rather than the possibility of a varicose vein.
As I have noticed over the years at my clinic, obese people sometimes don't realise that they have varicose veins, as the swollen veins are not visible on the surface of the skin, due to the excess fat - in other words, the problem is hidden from view. Over time, the pressure in the leaking veins can cause damage to the skin on the lower leg. Only then the patients will go and see a specialist. This is a major problem in the overweight population, who are at greater risk of leg ulceration.
For overweight people, varicose veins are also more difficult to assess and treat. Vein issues are usually diagnosed by a duplex ultrasound scan - this non-invasive investigation can 'see' under the skin and locate the faulty vein. The technician then produces a 'vein map' of where the problems are in the vein system, which the surgeon can then use to direct the treatment to the right place. These veins in a standard size leg are usually 1 or 2 cm under the skin. In very large legs, the scanning is much more difficult to do as the veins are often 4 or 5 cm inside the leg, so much harder to detect accurately.
In addition, the depth of the veins in the leg makes it more difficult for the surgeon to treat the problem. The minimally invasive options of laser treatment are much more challenging in larger legs and much more uncomfortable for the patient if they are choosing the local anaesthetic option. On the other hand, giving overweight patients a general anaesthetic carries more risk than for someone of a normal body size. Finally, the option of the somewhat out of favour 'high tie and strip' operation is also unpalatable as an incision in the groin crease in overweight patients carries a high risk of wound infection.
For patients not fit enough or unsuitable for varicose vein surgery the alternative non-surgical solution of compression stockings is also more difficult. Compression stockings are notoriously prone to slipping down the leg. This is more frequent in certain leg shapes, especially where the thigh is very large. Stockings that slip down and bunch up tightly behind the knee can make veins worse rather than better.
Being overweight can therefore cause issues in diagnosing and treating certain conditions, as well as living with them. This should definitely be one more good reason to maintain or aim for a healthy weight and tackle the obesity epidemic.