Chewing the fat about fat with clients

Chewing the fat about fat with clients

With exam room conversations about pet obesity, you’re playing the long game. It might take a few chats to get a veterinary client on board that there’s a problem and then more talking to agree to a plan. Don’t get frustrated. Try this.

This cat is open to, but not necessarily enthused about, an extended discussion and action plan to reduce his weight. (Shutterstock.com)It’s no secret that obesity is on the rise among companion animal patients in the United States and abroad.1-7 Up to 50 percent of U.S. pets8-11 are obese. This health status is shared by 22 to 40 percent of pets worldwide.12

As veterinarians, we know that obesity is a common link to systemic disease. The following conditions have been associated with obesity in dogs:1,6,13-20

• Bacteriuria and ascending urinary tract infections or urolithiasis

• Cardiovascular disease

• Diabetes mellitus and insulin resistance

• Lameness and osteoarthritis

In addition, overweight dogs have shorter lifespans, by two years, than their slim counterparts.18,21

As professionals, veterinarians recognize that obesity is a welfare issue, yet we are reluctant to address the figurative and literal elephant in the room.

Research also tells us that our clients are likely to underestimate the body weight of their furred companions.12,13,22-24 Therefore, clients are unlikely to initiate weight-reducing measures without our help.

To combat this growing epidemic, it’s critical that we as a profession improve efforts to discuss nutrition and weight status openly. Only then can we acknowledge, clarify and address weight concerns to effect change among the companion animal populations.  

How can you effectively introduce this topic to a consultation without damaging the tripartite veterinary-client-patient relationship? Walk your way through this sample script, with lessons along the way, to see if you can identify the places where you struggle and could change a little bit of your conversations to make a big difference ...

 

Let’s look at Levi …

Consider a clinical scenario in which you’ve just examined a 4-year-old Labrador, Levi, at his annual wellness visit. At his last visit one year ago, Levi was estimated to be five pounds greater than his ideal body weight. Today, Levi weighs 20 percent more. You’re anxious about bringing up his weight gain because you recall that the client wasn’t eager to discuss Levi’s weight at his last exam.

You: Levi appears to be in good spirits. As we move forward with his exam today, are there any concerns you have about his overall health or well-being?

Client: No, I don’t think so. He’s been fine.

You: That’s great! How is his activity and energy level these days? I remember that last year you said he was like the Energizer Bunny, he just had one speed and it was go, go, go!

Client: I think he’s finally starting to settle out of puppyhood. He’s not as bouncy as he used to be.

You: Yes, perhaps he’s learning what it’s like to be an adult. I also can’t help but notice that Levi has gained a significant amount of weight since last year. Have you?

Client: Oh, I don’t know, he’s not that bad.

You: (speaking to Levi) What do you think, Levi? I see that you’re getting quite the belly there. (speaking to the client) I am concerned that Levi has put on a significant amount of weight. Levi weighed 75 pounds at his last visit. He’s now 90 pounds.

Client: He had some filling out to do since last year.

You: (speaking to Levi) I think you overshot your goal, Levi. (speaking to the client) What are your thoughts about his current weight?

Client: Well, now that you mention it …

You: Do you think there’s room for some improvement?

Client: I suppose … it’s just that he really likes to eat, and it’s hard not to give in.

You: Absolutely it is hard! I know! I struggle with the same issue with my own dog. They’ve all got “The Look.” Do you know what I mean?

Client: Yes! Levi has mastered it. It’s so much easier to just give in.

You: For sure! But what Levi doesn’t know is that if he continues to gain at this same rate, his body can’t keep up. May I share with you some of the other problems that obesity may cause as he ages?

Client: OK.

You: Obesity is very hard on Levi’s joints. In fact, it may be one of the reasons he’s less active than normal. But joints aren’t the only body part that we worry about …

[Start a conversation about obesity and its link to systemic illness]

Client: So you’re saying Levi won’t live as long if he’s overweight?

You: Yes. On average, obese dogs have shorter lives than dogs that are healthy body weights.

Client: But he seems so happy.

You: Yes, he is. For now. But he won’t be happy if his joints start to hurt. And it won’t be easy on you if he becomes diabetic and we need to manage that. Investing in the hard work now may save us from problems later.

Client: I tried to cut back on food, but it didn’t work.

You: That’s a good start. It isn’t easy. I get that. Can you walk me through what specifically you’ve tried to do?

Client: I reduced how much I fed him from one scoop twice a day to three-quarters of a scoop, twice a day.  

You: I see. Is there a way for us to measure out how much food is in three-quarters of a scoop?

Client: I have a gram scale at home. I suppose I could weigh it out. Would that help?

You: Yes, it would. With your permission, I’d like to calculate how much he should be eating a day, compared to how much he’s eating now.

Client: OK.

You: To do that, I’m going to need a little bit more information. Can you tell me everything that you feed Levi from the time he gets up to the time he goes to bed?

[Start a conversation about food intake, including snacks, followed by recommendations for how to move forward]

You: I appreciate your willingness to work together to get Levi back on track. I know it won’t be easy, but we’re in this together.

[Result: The veterinarian contracts for the next steps, to which the client agrees. The client calls back in the next few days to share the exact quantity of food fed at each mealtime. The veterinarian uses this to develop a feeding schedule with restricted caloric intake and provides recommendations for increasing Levi’s activity level. The client commits to returning for bimonthly weigh-ins.]

‘Oh please. It’s NEVER that easy’

I get it. Although this conversation represents the best possible outcome for Levi, recognize that weight management plans may take time to obtain client buy-in. It could take several planned discussions before a pet owner is willing to consider weight loss as a feasible goal. It could take several more conversations before the client is spurred into action.

Don’t accept the pet’s weight loss as your only success. You need to consider that success takes many different forms. The first step towards success is simply getting the client to acknowledge that obesity is a problem. This requires patience and the ability to trade hats with clients to see their point of view. Clients need to feel safe to share their perspective, and they benefit from support throughout the weight-loss journey.

The fact that weight loss isn’t an instant outcome works against the process. Your own committed and motivating attitude is often the first step towards a mutually agreeable solution.

References

1. German AJ. The growing problem of obesity in dogs and cats. J Nutr. 2006;136(7 Suppl):1940S-6S.

2. Churchill J, Ward E. Communicating with Pet Owners About Obesity: Roles of the Veterinary Health Care Team. Vet Clin North Am Small Anim Pract. 2016.

3. Yam PS, Butowski CF, Chitty JL, Naughton G, Wiseman-Orr ML, Parkin T, et al. Impact of canine overweight and obesity on health-related quality of life. Prev Vet Med. 2016;127:64-9.

4. Sandoe P, Palmer C, Corr S, Astrup A, Bjornvad CR. Canine and feline obesity: a One Health perspective. Vet Rec. 2014;175(24):610-6.

5. Day MJ. One Health: the small animal dimension. Vet Rec. 2010;167(22):847-9.

6. Wynn SG, Witzel AL, Bartges JW, Moyers TS, Kirk CA. Prevalence of asymptomatic urinary tract infections in morbidly obese dogs. PeerJ. 2016;4:e1711.

7. Nijland ML, Stam F, Seidell JC. Overweight in dogs, but not in cats, is related to overweight in their owners. Public Health Nutr. 2010;13(1):102-6.

8. Brooks D, Churchill J, Fein K, Linder D, Michel KE, Tudor K, et al. 2014 AAHA weight management guidelines for dogs and cats. J Am Anim Hosp Assoc. 2014;50(1):1-11.

9. Colliard L, Paragon BM, Lemuet B, Benet JJ, Blanchard G. Prevalence and risk factors of obesity in an urban population of healthy cats. J Feline Med Surg. 2009;11(2):135-40.

10. Pibot P, Biourge V, Elliot D. Encyclopedia of canine clinical nutrition. Almargues, France: Royal Canin; 2006.

11. Lund EM, Armstrong PJ, Kirk CA. Prevalence and risk factors for obesity in adult cats from private US veterinary practices. Intern J Appl Res Vet Med. 2005;3(2):88-96.

12. McGreevy PD, Thomson PC, Pride C, Fawcett A, Grassi I, Jones B. Prevalence of obesity in dogs examined by Australian veterinary practices and the risk factors involved. Vet Rec. 2005;156(22):695-+.

13. White GA, Hobson-West P, Cobb K, Craigon J, Hammond R, Millar KM. Canine obesity: is there a difference between veterinarian and owner perception? J Small Anim Pract. 2011;52(12):622-6.

14. German AJ. Obesity in companion animals. Companion Anim Pract. 2010;32:42-50.

15. Lund EM, Armstrong PJ, Kirk CA, Klausner JS. Prevalence and risk factors for obesity in adult dogs from private U.S. veterinary practices. Intern J Appl Res Vet Med. 2006;4:177-86.

16. Markwell PJ, Vanerk W, Parkin GD, Sloth CJ, Shantzchristienson T. Obesity in the Dog. J Small Anim Pract. 1990;31(10):533-7.

17. Weeth LP, Fascetti AJ, Kass PH, Suter SE, Santos AM, Delaney SJ. Prevalence of obese dogs in a population of dogs with cancer. Am J Vet Res. 2007;68(4):389-98.

18. Kealy RD, Lawler DF, Ballam JM, Mantz SL, Biery DN, Greeley EH, et al. Effects of diet restriction on life span and age-related changes in dogs. J Am Vet Med Assoc. 2002;220:1315-20.

19. Mattheeuws D, Rottiers R, Kaneko JJ, Vermeulen A. Diabetes mellitus in dogs: relationship of obesity to glucose tolerance and insulin response. Am J Vet Res. 1984;45(1):98-103.

20. Thengchaisri N, Theerapun W, Kaewmokul S, Sastravaha A. Abdominal obesity is associated with heart disease in dogs. BMC Vet Res. 2014;10:131.

21. Lawler DF, Larson BT, Ballam JM, Smith GK, Biery DN, Evans RH, et al. Diet restriction and ageing in the dog: major observations over two decades. Brit J Nutr. 2008;99(4):793-805.

22. Robertson ID. The association of exercise, diet and other factors with owner-perceived obesity in privately owned dogs from metropolitan Perth, WA. Prev Vet Med. 2003;58(1-2):75-83.

23. Scarlett JM, Donoghue S, Saidla J, Wills J. Overweight cats: prevalence and risk factors. Int J Obes Rel Metab Disord. 1994;18 Suppl 1:S22-8.

24. Courcier EA, Mellor DJ, Thomson RM, Yam PS. A cross sectional study of the prevalence and risk factors for owner misperception of canine body shape in first opinion practice in Glasgow. Prev Vet Med. 2011;102(1):66-74.

25. Freeman LM. Cachexia and sarcopenia: emerging syndromes of importance in dogs and cats. J Vet Intern Med. 2012;26(1):3-17.

26. Freeman LM. Cachexia and Sarcopenia: Emerging Syndromes of Importance in Dogs and Cats. J Vet Intern Med. 2012;26(1):3-17.

27. Mallery KF, Freeman LM, Harpster NK, Rush JE. Factors contributing to the decision for euthanasia of dogs with congestive heart failure. J Am Vet Med Assoc. 1999;214(8):1201-+.

28. Baldwin K, Bartges J, Buffington T, Freeman LM, Grabow M, Legred J, et al. AAHA nutritional assessment guidelines for dogs and cats. J Am Anim Hosp Assoc. 2010;46(4):285-96.

29. Freeman L, Becvarova I, Cave N, MacKay C, Nguyen P, Rama B, et al. WSAVA Nutritional Assessment Guidelines. J Small Anim Pract. 2011;33(8):E1-9.

Ryane E. Englar, DVM, DABVP (canine and feline practice), is an assistant professor and clinical education coordinator for Kansas State University College of Veterinary Medicine in Manhattan, Kansas. Her teaching responsibilities include designing and debuting a new Clinical Skills curriculum for veterinary students to improve their confidence and competence with professional and technical skills. Her research emphasizes veterinary client communication preferences. You can reach her at [email protected].

 

Social Innovation Enhancing Success in Pet Weight-Loss

Beyond the insightful perspectives shared by Dr. Englar, there is a new social solution* families are using to enhance pet weight-loss. According to Sarah Wooten DVM, CareCorrals remove many of the feelings of guilt and restraint in the weight-loss process - making the journey more entertaining and interactive for the family and, as a result, more likely to succeed." Ernie Ward DVM, founder of the Association for Pet Obesity Prevention added, "The social influence fostered by a CareCorral helps mitigate the risk of a "weak link in the chain" among the family - that one loving family member who is either content with the pet's obese weight, or who cannot or will not sidestep the recurring urge to show their love thru a fatty treat."

*Social Networking Proving Successful in Reversing Pet Obesity