Terminally ill people with higher body mass indices, or BMIs, are less likely to die at home than people with lower BMIs, according to a new study authored by University of Pittsburgh professor John Harris.
The data is based on records from a long-running National Institutes of Health survey called the Health and Retirement Study, which includes a broad array of information on 5,600 senior citizens from age 51 until death.
“We found that among elderly adults, people with increasing obesity were less likely to receive hospice care at the end of life, less likely to die at home and more likely to have higher Medicare expenditures in the last six months of life,” said Harris, who teaches obstetrics and gynecology at the Pitt School of Medicine.
The study did not look at why end-of-life experiences were different for people who are overweight and obese, but Harris hypothesized that it might have to do with whether or not people look like they are close to death. He explained that when people are dying, they typically become thin and frail, a condition known as kikexia.
“You can imagine two women with breast cancer, both of them who have advanced disease, both of them who are losing weight, but one person had started at a higher weight,” he said. “Even when they lose weight, they look a little less thin and frail than someone who started at a much lower weight would look.”
Thus, said Harris, a doctor might be more likely to recommend that the thinner woman receive hospice care at home sooner, but might delay such a recommendation for a woman with more body fat.
“You can imagine that someone that has less visible signs of kikexia, someone who is obese, might look healthier than someone that happens to be a few pounds lighter,” he said.
Harris said it might also be possible that people who are obese require more care than people who are not. Because home hospice does not offer round-the-clock care, family members might be more comfortable if the patient is in a nursing home or hospital setting.
Regardless of potential reasons for the disparity, Harris said it should be corrected, noting that people of all body types “deserve the best health care and better health outcomes.”
“One of the ideas would be to help physicians understand that there might be some implicit biases toward people that are thinner who are seen as closer to death than other people who are more obese,” he said. “Secondarily, thinking about how to design a health care system that provides adequate care for people that need more health care services, especially home health care, for instance, people with morbid obesity.”
Many researchers and physicians have noted the limitations of BMI, which is based on a person’s weight and height, but it does not take into account the amount of muscle mass versus fat mass or natural variations in body type.