Do you have patients with varicose veins? Do you also have patients dealing with obesity? They might be one and the same, but those patients may not understand the connection.

As a primary care provider, you’re often one of the main sources of information regarding these types of health conditions. When explaining the cause and treatment of varicose veins, it could prove helpful to bring up the topic of obesity. Here’s how to approach the subject with an informative tone.

How to Explain What Varicose Veins Are

Varicose veins are enlarged veins close to the skin’s surface and are mostly found in the legs. For some, varicose veins are a cosmetic and not a health issue or sign of poor circulation; however, varicose veins can be uncomfortable and even painful and make the legs feel heavy, said William Shutze, MD, vascular surgeon with Texas Vascular Associates in Dallas.

Most varicose veins are caused by damaged valves inside the veins that reduce the ability of the blood to return back to the heart from the legs, he said. This leads to the blood pooling in the veins, stretching them outward and damaging the valves even more as the veins get larger and larger. Sometimes the blood pooling is so severe that damage occurs to the skin of the legs with dark spots appearing, dry itchy skin developing, and, in advanced cases, open painful and weeping sores erupt, Shutze said.

Varicose Veins Go Beyond Vanity Issues

This condition can be a serious medical issue and an early sign of poor circulation.

“If the varicose veins are associated with chronic venous insufficiency or from poor blood flow back to the heart from narrowing or blockage in the veins, the legs can suffer damage in the long term and there may be an increased risk of blood clots which can be fatal,” Shutze said.

Questions About Obesity

Developing obesity is multifactorial and complex, and this should be explained to your patients in easy-to-understand language.

“There is a genetic, or inherited, predisposition in some, while the increased accessibility and addictive nature of ultraprocessed foods that are rich in the Standard American Diet (SAD) is also to blame for the rise in the epidemic in the US,” said Lily Dastmalchi, DO, cardiologist at Preventive Cardiology and Women’s Cardiovascular Health, Inova Schar Heart and Vascular, Fairfax, Virginia. “As a culture, we have moved away from more active lifestyles and dependent on driving with sedentary jobs that contribute to an inactive lifestyle that also contributes to excess weight gain.”

It is also helpful to tell patients that the addition of poor sleep and chronic stress also contributes to obesity, she said.

How Obesity Can Cause Varicose Veins

A good starting point is to discuss how obesity, especially obesity in the abdomen and trunk, impairs the ability of the blood to return to the heart from the legs, said Shutze. “This leads to the blood pooling and increases the back pressure in the veins of the legs, which can damage the valves and cause varicose veins through a condition known as chronic venous insufficiency,” he said.

Certain Patient Populations More Vulnerable to the Condition

There are several groups that are susceptible to varicose veins, such as patients with obesity, adults older than 50 years, as well as those who have one or more relatives with varicose veins. Pregnant women also experience added pressure on the veins in their legs in the third trimester and are, therefore, more vulnerable to varicose veins, he said.

It may also be relatable to discuss with your patients that people who are constantly and consistently standing on their feet such as teachers and surgeons are at an increased risk for varicose veins too.

Lifestyle Tweaks to Help Short-Term

Lifestyle modifications can help your patients manage and even prevent the progression of varicose veins. Here are some suggestions:

• Regular exercise. To improve blood flow and reduce pressure on veins, encourage patients to get active, even just walking 30 minutes a day.
• Eat a healthy diet. A well-balanced diet is always a win for patients.
• Wear compression stockings. Suggesting these to patients are a “first-line treatment for varicose veins and an excellent resource to avoid or minimize their development in the first place,” said Shutze.
• Elevate feet at night. This suggestion can be easily adapted.
• Avoid sitting or standing for too long. Encourage patients to be mindful of long periods of being sedentary.

What Are Some Long-Term Options?

In some serious cases of varicose veins, which have not improved with the above recommendations, or in advanced cases, one or more procedures may be needed. Procedures could include sclerotherapy (an injection of medication to shrink the varicose veins) or an ablation procedure. The ablation procedure involves either a laser catheter, radiofrequency catheter, or an adhesive injecting catheter. It is done to eliminate the culprit vein(s) causing the blood to pool so that when the other varicose veins are eliminated, they are less likely to come back. Leg circulation is improved, and the symptoms are relieved, said Shutze. It’s important to consult a vascular surgeon to determine the right treatment option, he said.

How Obesity Affects the Cardiovascular System

Obesity affects the vascular system, just as it significantly affects overall health.

“Outside of the extra pressure that obesity puts on a person’s veins, it can lead to secondary risk factors such as high blood pressure, diabetes, and high cholesterol. These risk factors can contribute to very serious vascular conditions like peripheral artery disease (PAD), blood clots, and stroke,” Shutze explained.

Furthermore, obesity also increases the risk for obstructive sleep apnea, which can heighten the risk for atrial fibrillation, an arrythmia, and pulmonary hypertension, which in extreme cases could cause right side heart failure, said Dastmalchi.