Lymphatic system function and obesity — are there links?

Piller, Neil; Damstra, Robert; Cordero, Isabel Forner; Harvey, NNatasha and Pond, Caroline (2008). Lymphatic system function and obesity — are there links? Journal of Lymphoedema, 3(1) pp. 81–85.

Abstract

The work of Natasha Harvey et al in 2005 showed a strong link between lymphatic vascular defects and adult onset obesity (in mice), and Schneider et al (2005) commented that this, and other research, raised the spectre of significant involvement of the lymphatic system and its functioning (or more properly its inability to function well) and obesity. When we follow the development of primary and secondary lymphoedemas of the limbs, we see a
gradual progressive development of epifascial adipose tissue. It is not totally clear if they are new adipocytes or in situ ones becoming larger. Most lymphoedemas have slower than normal lymph flow, but the lymphatic system is usually structurally sound. When we follow the development of lipoedemas, we find a similar epifascial fatty deposition, but it is limited to specific areas and there are underlying weaknesses (microaneurysms) of the lymphatic capillaries and the collectors leading to poor lymph flow. When a patient with lymphoedema loses weight, the lymphoedema seems to resolve, but often when a patient with lipoedema presents, the lipoedema area generally does not resolve.
So, what is going on? What is the level of involvement of the lymphatic system, is there some relationship between a ‘normally functioning’ and structurally sound lymphatic system and control of adipose tissue, and a poorly functioning and structurally weak lymphatic system and excess adiposity? Does fast lymph flow make you skinny, and can slow or poor lymph flow make you fat?