Skin Problems in the Lower Legs of Morbidly Obese Patients and the Possible Role of Bariatric Surgery

Objective: Anecdotally, lower leg skin changes in morbidly obese people appear much improved with weight loss following bariatric surgery. The objective of this study was to compare prevalence of lower leg symptoms in obese patients awaiting, and those who have had, bariatric surgery. Methods: An audit was undertaken, utilising questionnaires, to identify obesity-associated lower leg symptoms: swelling, itchiness, colour changes, hot/burning feeling, eczema and ulcers. There were three groups: those awaiting surgery (‘Obesity Clinic’), those who had surgery (‘Post-Surgery’), and those in ‘Post-Surgery’ recalling pre-operative symptoms (‘Pre-Surgery Recall’). Results: Participants totalled 117; 62 in ‘Obesity Clinic’ and 55 in ‘Post-Surgery’ (81.8% response rate). Overall prevalence of symptoms was significantly lower in ‘Post-Surgery’ (36.4%) compared to ‘Obesity Clinic’ (80.6%) and ‘Pre-Surgery Recall’ (74.5%) (p<0.0001). Individual symptoms were also similarly less prevalent. Conclusion: These results establish the high prevalence of lower leg skin changes in morbidly obese patients, which is significantly lower in those who have undergone bariatric surgery, possibly due to improved underlying venous stasis from decreased intra-abdominal pressure and weight. Decreased popliteal vein compression from weight loss, and weight reduction itself may also be contributing factors. This suggests a role for bariatric surgery in the potentially cost-effective treatment of lower leg symptoms in the morbidly obese.