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End of Life Care Around San Francisco Examines What a Patient’s Weight Indicates About Their Health

Weight is a big issue for pretty much everybody. But when it comes to Alzheimer’s patients undergoing end of life care, weight takes on a whole new importance as they face increasing hunger and decreasing activity. Recent research shows that those suffering from frontotemporal dementia and even Alzheimer’s disease can experience brain shrinkage in the hypothalamus — a small area in the center of the brain that regulates hunger, according to Alzheimer’s Reading Room. What a patient weighs can say a lot about their health. Let’s explore this concept as we head into National Healthy Weight Week (January 20 to 26).

Staying in control of your weight now can contribute to good health as you age. We’ve all seen the fad diets out there that promise fast results. But all they really do is compromise your overall health because they tend to limit nutritional intake, resulting in an unhealthy lifestyle — not to mention those fad diets often fail quite quickly. Instead, the key to achieving and maintaining a healthy weight doesn’t have as much to do with short-term dietary changes but has more to do with adopting a healthy lifestyle that includes eating good foods, engaging in regular physical activity, and balancing the number of calories you consume with the number of calories your body uses, points out the CDC.

That’s all well and good for relatively healthy people, but what about those facing end of life care?

Weight and Health in Hospice

Hospice is an important component of end of life care. The goals during this time of transition go from curative management to symptom management. A study outlined on AAFP detected an association between obesity and decreased hospice enrollment, shorter duration of hospice services, reduced incidence of in-home death and increased Medicare costs in the last six months of life. Prolonged cachexia, also known as body wasting, that many patients experience toward the end of life can act as a signal to family members and physicians. Providers may not as readily refer obese patients to hospice services as they would for those with noticeable cachexia, due to the extra weight in obese persons as opposed to the obvious gaunt and frail appearance of someone who is not obese. As a result, fewer obese terminal patients are referred to hospice and are referred less quickly.

Some hospice patients are already obese as they face end of life care. Others become overweight as they become homebound and bed bound due to their terminal illness. It has been a question of why aging patients with dementia feel compelled to overeat. It has long been hypothesized that they overeat because they simply don’t remember when they last ate. While this could play into things a little bit, research is now showing that there’s a real physical reason behind this. In scanning the brains of people with frontotemporal dementia, researchers have found that those individuals have a deterioration in the region of the brain that controls hunger. The thinking is: the cells in this brain region often lose the ability to alert individuals that they have had enough to eat. They then can’t control that urge to consume food, often bingeing on sweets and carbohydrates. Sometimes this manifests in socially inappropriate ways, such as stealing food right off others’ plates. And the more pronounced the problem, the more shrinkage that is happening in the hypothalamus.


In many hospice patients, especially Alzheimer’s patients, the appetite is lessened due to the terminal illness itself as well as any medications given. This can result in anorexia or malnutrition. But others react differently, with their depression, anxiety, restlessness and forgetfulness leading to a tendency to compulsively overeat or binge eat. As previously stated, this may be out of their control due to the changes in the hypothalamus, which also makes it harder for them to recognize when their stomach is empty or full.

Being overweight can place undue stress on the heart and other vital organs. No, you don’t want to put your loved one on a diet, especially as they go through hospice, but there are steps you can take to control their hunger every day, such as:

  • Offer several small meals a day.
  • Provide low-calorie snacks.
  • Restrict certain fattening or sugary foods and save them only for special occasions.
  • Find a distraction such as going for a walk or reading a book.

Contact Pathways Home Health and Hospice

If your loved one is facing end of life care in or around San Francisco, turn to Pathways Home Health and Hospice for help. Our care team includes a dietitian who can monitor your loved one’s diet and food intake to maintain an overall healthy weight. For more information about our home health care or our hospice care, call us at 888-755-7855.