December 12, 2017

Feline Obesity: The Elephant in the Exam Room

Video analysis reveals that veterinarians have much to learn about how best to communicate with clients when it comes to this sensitive topic.
By JoAnna Pendergrass, DVM
Are your feline patients becoming increasingly rotund? If so, they are part of the nearly 60% of cats in the United States that are overweight or obese, according to the 2016 US Pet Obesity survey.1 Although we may occasionally chuckle at memes and videos of roly-poly cats, feline obesity is no laughing matter. Obese cats face serious health challenges and consequences, such as osteoarthritis, diabetes, and reduced life spans.2

The typical approach to feline and canine weight control is dietary management. The American Animal Hospital Association recommends that nutritional assessments occur during each veterinary visit to provide a window into a pet’s nutritional status and help veterinarians establish a partnership with the pet’s owner to help maintain or improve a pet’s health.

Despite cats’ increasing pudginess and the importance of nutritional history taking, feline obesity remains an elephant in the examination room. Veterinarians tend to struggle with addressing this complex and sensitive topic effectively with clients, and many avoid the topic altogether. Previous studies have proposed why feline obesity discussions at veterinary practices can be so challenging, such as:
  • Veterinarians and clients sometimes see a pet’s weight differently. In dogs, for example, what a veterinarian perceives as obese may be considered normal by a client.3
  • Feline office visits are less frequent than canine visits,4 resulting in missed opportunities to address and manage obesity.

To date, very little is known about how veterinarians and cat owners really interact during clinical appointments when feline obesity is discussed. A team of Canadian investigators recently sought to understand this by analyzing video recordings of feline veterinary visits.5 Their findings shed light on communication strategies used by both veterinarians and clients when discussing feline obesity and can serve “as an important starting point for veterinarians to consider in their own practices regarding sensitive topic discussions,” they wrote.

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Video Analysis and Appointment Details
The investigators screened 284 video-recorded appointments from several small animal veterinary practices in Ontario, Canada. Of these, 123 were feline appointments. From these 123 appointments, 25 met the study’s inclusion criteria—at least 2 back-and-forth exchanges between the veterinarian and the client regarding a cat’s obesity.

The videos were analyzed qualitatively for verbal and nonverbal communication. Verbal discussions were transcribed. A thematic analysis of the videos was also performed to identify themes and subthemes in communication between the veterinarian, the client, and the patient.

The 25 appointments were conducted by 12 veterinarians, 75% of whom were female; most clients (72%) were also female. Nearly all clients had worked in the past with the veterinarian conducting the appointment.

Nineteen of the 25 appointments included obesity and diet discussions, and 6 included obesity prevention discussions. Veterinarians initiated most of these conversations. In addition, most discussions occurred during wellness visits, rather than during visits for specific health problems. The depth, duration, and complexity of obesity dialogue varied widely.

A handful of the veterinarians contributed to over half of the obesity discussions. Interestingly, in all but 1 case, obesity was not the reason for the appointment.

Emerging Themes
The researchers identified 3 main themes: communication alignment/misalignment between veterinarian and client, patient-directed speak, and oblique or absent messaging.

Communication Alignment/Misalignment
Misaligned communication about diet and weight management was common. Veterinarians focused on a diet’s brand and perceived quality. Clients, on the other hand, discussed a diet’s shape, flavor, or ingredients. When asked about diet during a visit, for example, one client couldn’t recall the brand but described the food as “organic” and “from the pet store.”

Regarding weight management, a client suggested a dietary change during an appointment; the veterinarian, however, recommended reducing ration size. Also, this client repeatedly asked for the veterinarian’s assessment on food choice appropriateness, but the veterinarian provided only vague answers and dropped the topic.

Dropping the topic may ease tension, the investigators noted, but it also creates ambiguity for clients and signals a missed opportunity for a conversation about effective weight management. Rather than dropping the topic, the authors recommended a helical approach, in which a topic is repeatedly circled back to during a discussion.

Resistance
Clients became resistant during appointments if they did not agree with the veterinarian or if the veterinarian singularly pursued an obesity discussion. Some veterinarians, when met with resistance, altered their communication strategy. This often meant at least partially abandoning their recommendations and attempting to circle back to the resisted topic.

Humor
Humor was used often by veterinarians and cli-ents during obesity discussions and served many purposes:
  • Realign communication
  • Acknowledge a cat’s obesity
  • Defuse tension and soften resistance
  • Strengthen the veterinarian–client relationship
  • Make recommendations on weight management and diet

In one visit, though, the use of humor backfired. A veterinarian used humor to undermine his colleague’s assessment of a cat’s weight. The cat’s owner, who had made changes to her pet’s diet based on that colleague’s assessment, became tense and less engaged. Unfortunately, the veterinarian did not perceive this tension, continued to use humor ineffectively, and ultimately dropped the topic.

Given these findings, the researchers suggested that “sensitive and careful use of humor can be used as a relationship-building tool and can be helpful for discussing complicated topics such as obesity.”

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