Obese people may get less 'comfort care' at the end of life

Obese people in the U.S. may not receive the same kind of care at the end of their lives as people who are thin or normal weight, suggests a new study.

Before they died, obese patients were less likely to enroll in hospice care, spent less time in hospice and were less likely to die at home than thinner people, researchers found.

End-of-life care was also more costly for obese people. "People with obesity deserve high-quality care, but may not be receiving it at the end of life," said lead author Dr. John Harris, of the University of Pittsburgh School of Medicine in Pennsylvania.

More than a third of U.S. adults are obese, according to the U.S. Centers for Disease Control and Prevention. Harris and his colleagues note in the Annals of Internal Medicine that aside from health risks, obesity may present technical and logistical challenges during physical examinations and certain medical procedures.

Previous research also shows that stigma about weight affects how doctors and patients behave, they write. To see how body weight is linked to healthcare at the end of life, the researchers used data collected between 1998 and 2012 from 5,677 people on Medicare, the U.S. government's health insurance program for the elderly and disabled.

None of the participants were living in nursing homes or other institutions. The data were drawn from the last six months of their lives.

Based on body mass index (BMI), a measure of weight in relation to height, 7 percent of participants were underweight with a BMI of 18.5 or below, 44 percent were normal weight with a BMI of 18.5 to 24.9, 31 percent were overweight with a BMI of 25 to 29.9 and the rest were obese or morbidly obese with a BMI of at least 30.

A 5-foot-5-inch person weighing 120 pounds would have a BMI of 20, in the normal range. A person of the same height who weighed 240 pounds would be morbidly obese, with a BMI of about 40. The National Heart, Lung and Blood Institute provides a BMI calculator online (bit.ly/2lHXqP2).

The researchers found a 38 percent probability that people with a BMI of 20 would enter hospice care toward the end of life, compared to about 23 percent among people with a BMI of 40.

Hospice care, which can be provided in home or at a facility, provides physical support, including pain control, and emotional support for patients and families dealing with terminal illnesses.

When people with a BMI of 40 did receive hospice care, it was typically for a shorter time than normal-weight people. "It’s looks like people weren’t getting enrolled, and they got there later if they were enrolled," Harris told Reuters Health.

The researchers also found that obese people had lower odds of dying at home, which is a typically a wish for people at the end of life. Their likelihood of dying at home was 55 percent, compared to 61 percent for normal-weight patients. Gaps in care generally rose as BMI increased, the researchers found.

"It seems like people with obesity are getting lower quality of care at the end of life," said Harris. The cost of care was also higher when BMI was higher, they found.

The study can't say why these gaps exist, but the researchers suggest it may have to do with obese people looking less gaunt toward the end of life and not being referred for hospice. Or, they may be unable to find a hospice program that can accommodate their healthcare and family's needs.

The healthcare systems needs to make sure it's offering everyone the same level of care, said Harris. His overarching goal, Harris said, is to improve the quality of care for people with obesity.