October 17, 2017

CVC 2017: Tackling the Obesity Issue

With pet obesity reaching epidemic proportions, how can veterinarians guide owners toward making healthier decisions for their pets?
By Maureen McKinney
It's official: The obesity epidemic in the United States now includes pets. Banfield Pet Hospital's (Vancouver, WA) recently released "State of Pet Health 2017 Report"1 clearly shows that the number of overweight pets in the United States is skyrocketing.

According to Banfield’s survey of its practices, in which more than 2.5 million dogs and 505,000 cats are treated, the numbers of overweight cats and dogs have increased by 169% and 158%, respectively, over the past 10 years. “Right now,” says Kirk Breuninger, VMD, MPH, DACVPM, a research associate on the Banfield Applied Research and Knowledge team and lead researcher for the recent survey, “One in 3 dogs and cats is overweight.” Moreover, the Association for Pet Obesity Prevention noted in 2016 that 59% of cats and 54% of dogs are obese. In fact, overweight is the second most common diagnosis among pets today, preceded only by dental calculus.1

Obesity can be attributed to intrinsic and extrinsic factors. Breed, age, genetics, neuter status, gender, and the presence of certain diseases can play a role. The bigger problem seems to lie in pet owners’ knowledge (or lack thereof) and choices, including insufficient exercise and overfeeding, misperceptions about what qualifies a pet as overweight, and a changing attitude toward their pets.

Regardless of the cause, increased weight has insidious consequences for the health of the nation’s pets. Excess weight stresses every major system in the body, potentially leading to respiratory compromise, hypertension, diabetes, osteoarthritis, liver disease, and an increased risk for cancer, among many other expensive and potentially life-threatening conditions.

It may not be easy to broach the subject of excess weight in a patient—especially if the client is overweight as well. Nevertheless, to keep patients as healthy as possible, the conversation must be had.

Broaching the Subject
Many veterinary teams are reluctant to discuss weight issues with pet owners because they don’t want to offend, upset, or anger their clients. Thus, many teams simply ignore the problem. American Veterinarian® spoke with Deborah Linder, DVM, MS, DACVN, at the 2017 Central Veterinary Conference in Virginia Beach, Virginia, to get her take on how to broach the subject of weight loss with clients and how she helps her patients shed excess pounds. Her advice for pinpointing the best approach is to build trust and rapport with clients, and gain an understanding of their motivation (or lack thereof).

Dr. Linder, who heads the Tufts Obesity Clinic for Animals in North Grafton, Massachusetts, said she tries to build trust and rapport quickly by asking clients open-ended questions, such as “Describe your pet’s day” or “How have things changed?” If the pet has started to gain weight, she might ask, “What is your pet doing now that he or she might not have been doing before?” The answers to these questions give her a good idea about that owner’s readiness to change, which gives her a better sense of what approach to take.

Behavioral modification research in human medicine offers insight about when and how to intervene.2 Dr. Linder noted that a readiness-to-change scale2,3 can help. “This type of scale helps to identify clients who have no interest in changing their behavior, those who are thinking about it and maybe have started making changes, and people who are already making changes but need troubleshooting help,” she said. “Your approach with the client who isn’t interested is very different from your approach with the client who is already trying and just needs some help.”

For the people who aren’t interested, Dr. Linder is likely to provide them with some information and then revisit the subject at another time. “Sometimes, especially if a pet is really obese, it’s not the first time the client has been told that his or her pet is overweight,” she said. “And it almost works in reverse: Not starting an argument may actually pique their interest.” Instead, Dr. Linder may mention some interesting data about a relevant study. “I might say, ‘Oh, there is this really cool study where pets that were kept trim lived 2 years longer on average than pets that were overweight.’4 I just provide interesting information and move on.”

Some owners can be very emotional about the topic. “They’ll say, ‘I can understand that losing weight for my pet would be good, but I’ve gone through it, I know its miserable, and I don’t want that for my pet,’” Dr. Linder said. “Then we know where the con- cern is and why the client might be against it.”

What does Dr. Linder say to those clients? “I tell them about a study that showed that overweight pets are actually in pain and have loss of vitality, but when they lose the weight, it gets better,”5 she said. “That’s a really neat study because we can actually say that quality life is poor. So, if someone says that a fat pet is a happy pet, we have evidence to say otherwise.”

Weight Loss Strategies
Beyond the physical strategies for helping a pet lose weight, Dr. Linder also recommends psychological strategies. “This is where I get creative,” she said, “although the psychology is more with the owner than the pet." Studies have shown that many of the same tactics people use to lose weight will work for helping pets lose weight.6 One simple strategy that Dr. Linder recommends is to have the owner use a smaller scoop and a smaller bowl. “Owners will actually feed their pets less food if the materials they use are smaller,” she said.

Dr. Linder finds that most clients whose pets have weight issues use food to create an emotional bond with their pet. “The obesity is just something that happens because the food is how they show their love to their pet,” she noted. So, she talks with owners about other ways to show love that don’t add calories, such as belly rubs and toys. “We do a lot of substitution, a lot of compromise,” Dr. Linder said. “I think that preserves the bond they have and keeps the pet healthier.”

Just as for people, real and sustained weight loss in pets will not occur based simply on changes in eating habits.7 Consistent weight loss requires increased energy expenditure, in the form of exercise, and decreased caloric intake. For clients who are motivated to help their pet lose weight, a customized weight loss plan, which should be reassessed over time and modified as needed, is ideal (Box).

With regard to how quickly a pet should lose weight, Dr. Linder defers to the 2014 American Animal Hospital Association (AAHA) Weight Management Guidelines for Dogs and Cats,8 which she helped create. “Based on the different studies we compiled and analyzed, AAHA recommends about 1% to 2% weight loss per week,” she said. For cats, that can be anywhere from 0.5% to 2% of their body weight.

Most studies indicate that pets that lose 3% or more of their body weight per week are much more likely to have rebound weight gain and to lose muscle rather than fat.9,10 “If the pet is just losing weight consistently, I am over the moon,” said Dr. Linder. “My clients tend to prefer the gradual approach, and I say that is fine with me as long as we aren’t going back up.”

 
References:
  1. Banfield Pet Hospital. State of pet health: United States. Banfield Pet Hospital website: https://www.banfield.com/state-of-pet-health/us. Accessed August 28, 2017.
  2. Churchill J. Increase the success of weight loss programs by creating an environment for change. Compend Contin Educ Pract Vet. 2010;32(12):E1-E4.
  3. Apodaca TR, Longabaugh R. Mechanism of change in motivational interviewing: a review and preliminary evaluation of the evidence. Addiction. 2009;104(5):705-715. doi: 10.1111/j.1360-0443.2009.02527.x.
  4. Kealy RD, Lawler DF, Ballam JM, et al. Effects of diet restriction on life span and age-related changes in dogs. JAVMA. 2002;220(9):1315-1320.
  5. German AJ, Holden SL, Wiseman-Orr ML, et al. Quality of life is reduced in obese dogs but improves after successful weight loss. Vet J. 2012;192(3):428-434. doi: 10.1016/j.tvjl.2011.09.015.
  6. Kushner RF, Blatner DJ, Jewell DE, Rudloff K. The PPET Study: people and pets exercising together. Obesity. 2006;14(10):1762-1770.
  7. Bartges J, Kushner RF, Michel KE, Sallis R, Day MJ. One Health solutions to obesity in people and their pets. J Comp Pathol. 2017;156(4):326-333. doi: 10.1016/j.jcpa.2017.03.008.
  8.  Brooks D, Churchill J, Fein K, et al; American Animal Hospital Association. 2014 AAHA weight management guidelines for dogs and cats. J Am Anim Hosp Assoc. 2014;50(1):1-11. https://www.aaha.org/public_documents/professional/guidelines/weight_management_guidelines.pdf
  9. Laflamme DP, Hannah SS. Increased dietary protein promotes fat loss and reduces loss of lean body mass during weight loss in cats. Intern J Appl Res Vet Med. 2005;3(2):62-68.
  10. Nagaoka D, Mitsuhashi Y, Angell R, Bigley KE, Bauer JE. Re-induction of obese body weight occurs more rapidly and at lower caloric intake in beagles. J Anim Physiol Anim Nutr. 2010;94(3):287-292. doi: 10.1111/j.1439-0396.2008.00908.x
  11. World Small Animal Veterinary Association Global Nutrition Committee. Nutrition toolkit. WSAVA website. www.wsava.org/nutrition-toolkit. Accessed August 28, 2017.


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