Comments on GeriPal - Geriatrics and Palliative Care Blog: “Moribund Obesity”: Palliative care diagnosis or...

Alex, your points are right on! This article make...

2009-09-18T05:41:06.659-07:00

Alex, your points are right on!

This article makes me think about a hospice case that still haunts me. The case was a 31 yo anorexic woman who had been fired from all the treatment programs in Denver ('manipulative' blah, blah, blah). When I saw her in hospice, she was begging for a bisacodyl PR. On one hand, I wanted to respect her wishes, on the other, I didn't want to support this dreadful disease. I remember thinking helplessly to myself 'all you have to do is eat.' but it is much more complicated than that. She died, peacefully, at the age or 31, from a completely reversible process. As society continues to expand at the waist, we will likely be faced with cases of obesity where similar feelings arise. 'All you have to do is lose weight.'

Moribund - from Marion Webster's Dictionary: ...

2009-09-17T10:46:30.411-07:00

Moribund - from Marion Webster's Dictionary:
1: being in the state of dying : approaching death
2: being in a state of inactivity or obsolescence
Ok, so perhaps both apply to some obese patients. The major issue I have with this term is the emphasis on lack of curative options as a criteria for palliative care. This is the model of palliative care, tied to hospice and it's requirements of a limited prognosis. The other issue I have is with the term "palliative care diagnosis." What is that? Is pancreatic cancer a palliative care diagnosis? Certainly, it is an illness where palliative concerns predominate, but I'm not sure what the author meant by palliative care diagnosis. I think he is trying to define "palliative diagnoses" as conditions for which curative treatment options are no longer available...again raising my concern addressed above. Palliative care can and in many cases should be delivered in conjunction with life-prolonging care, not defined in opposition to it.

I am confused as to Dr. Gupta's reasoning in c...

2009-09-17T09:35:32.162-07:00

I am confused as to Dr. Gupta's reasoning in coining this new term, "moribund obesity." Obesity is a risk factor for many other problems and conditions, and therefore cannot in itself be a palliative care diagnosis. Even the author's own example of pulmonary embolism being directly due to obesity is false. Obesity increases the *risk* of PE, just like it increases the risk of OSA, or diabetes. The author's own anecdote, of an obese man with chronic recurring cellulitis could just as easily be about an average-sized man with the same medical problems with chronic cellulitis.

I think the article misses the point. How can obesity be a palliative care diagnosis when it is not even a diagnosis that causes any problems in and of itself? It's like calling "old age" a palliative care diagnosis.