{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T18:14:07Z","timestamp":1783620847689,"version":"3.55.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Severe obesity (body mass index [BMI] \u2265 40 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings\/Subjects:<\/jats:title>\n                    <jats:p>\n                      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\u201329.9 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), Class I\/II obesity (BMI 30\u201339.9 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), and Class III (severe) obesity (BMI \u2265 40 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Data regarding clinical and palliative care were extracted through retrospective chart review.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Median age at death was 68.8 years; 54.5% were female, and 84.2% were white. Higher BMI correlated with younger age (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0001). Decedents with severe obesity (BMI \u2265 40 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) had 4.15 times higher odds of ICU utilization (95% CI: 1.55, 11.11),\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 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 \u2265 40 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) had over three times higher odds of spiritual care documentation compared with those with BMI 18\u201329.9 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (adjusted OR: 3.02, 95% CI: 1.19, 7.69,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.026). Documentation rates for psychosocial and cultural aspects of care, as well as structured process measures, showed no significant variation by BMI group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10966218251409804","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T15:51:37Z","timestamp":1767973897000},"page":"453-463","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["End-of-Life Care for Hospitalized Patients with Severe Obesity"],"prefix":"10.1177","volume":"29","author":[{"given":"Shenbagam","family":"Dewar","sequence":"first","affiliation":[{"name":"Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA."},{"name":"Geriatric Research Education and Clinical Center, (GRECC), Veterans Affairs Ann Arbor Healthcare system, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Denny","sequence":"additional","affiliation":[{"name":"Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navasuja","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Kabeto","sequence":"additional","affiliation":[{"name":"Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"Montagnini","sequence":"additional","affiliation":[{"name":"Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA."},{"name":"Geriatric Research Education and Clinical Center, (GRECC), Veterans Affairs Ann Arbor Healthcare system, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","unstructured":"Emmerich SD Fryar CD Stierman B et al. Obesity and Severe Obesity Prevalence in Adults: United States August 2021\u2013August 2023. NCHS Data Brief. 2024. Available from: https:\/\/www.cdc.gov\/nchs\/data\/databriefs\/db508.pdf [Last accessed: February10 2025].","DOI":"10.15620\/cdc\/159281"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1909301"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.16.1530"},{"key":"e_1_3_3_5_2","unstructured":"World Health Organization: A different scale: Global action to address obesity. 2022. 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