End-of-Life Care for Hospitalized Patients with Severe Obesity

Severe obesity (body mass index [BMI] ≥ 40 kg/m²) is linked to multimorbidity, high hospitalization rates, ICU care, and increased mortality. The end-of-life care trajectory and the role of palliation for these patients remain poorly understood.

This study aims to describe the provision of palliative and end-of-life care to decedents with severe obesity at a large tertiary care medical center.

Utilizing a cross-sectional design, this study conducted a chart review to compare decedents across three BMI categories. Demographic, clinical, and palliative care data were analyzed using descriptive statistics and logistic, negative binomial, and Poisson regression models.

The study comprised 202 adult inpatients who passed away in 2019 at a large tertiary care academic medical center in the United States. Decedents were categorized into BMI groups: nonobese/overweight (BMI 18-29.9 kg/m²), Class I/II obesity (BMI 30-39.9 kg/m²), and Class III (severe) obesity (BMI ≥ 40 kg/m²). Data regarding clinical and palliative care were extracted through retrospective chart review.

Median age at death was 68.8 years; 54.5% were female, and 84.2% were white. Higher BMI correlated with younger age (p < 0.0001). Decedents with severe obesity (BMI ≥ 40 kg/m²) had 4.15 times higher odds of ICU utilization (95% CI: 1.55, 11.11), p = 0.010. Across palliative care domains, no significant differences were observed in the documentation of goals of care discussions, prognosis, or symptom burden by BMI category. However, after adjustment for age, race, and gender, decedents with severe obesity (BMI ≥ 40 kg/m²) had over three times higher odds of spiritual care documentation compared with those with BMI 18-29.9 kg/m² (adjusted OR: 3.02, 95% CI: 1.19, 7.69, p = 0.026). Documentation rates for psychosocial and cultural aspects of care, as well as structured process measures, showed no significant variation by BMI group.

Decedents with severe obesity tended to be younger, more frequently received ICU care, and had increased documentation of spiritual support before death. In contrast, the provision of other core palliative care domains did not significantly differ across BMI categories. Further research is needed to explore care trajectories and palliative needs of severely obese patients.