Weight Clinics: Educating and Helping Pet Owners

As a veterinary nurse, we see a lot of patients come into clinic that are overweight or even obese. It is important for the client to understand the risks associated with an overweight pet and how they can improve and correct the issue. Today, I will talk about how you, as a veterinary nurse, can educate and support pet owners through weight management consultations.

What are the risks associated with obesity?

Unfortunately, there are many risks associated with an overweight or obese pet and can lead to serious health complications, including (but not limited to):

• Diabetes

• Cancer

• Hypertension (high blood pressure)

• Cardiovascular disease

• Arthritis

• Kidney disease

• Respiratory disease

• Skin problems

How did we get here?

It is important to educate (not scare!) the client about the risks associated, as a lot of pet owners unfortunately just do not know or understand. I usually like to start by speaking to the client about the reasons a pet might have become overweight.

• Neutering: Neutering usually happens at a young age for most pets (but not always)- right around the time that there is a natural decrease in growth and energy needs. A lot of changes happen to the body post neutering - which can lead to weight gain if not managed properly. Neutering alters the pets hormones, which in turn, causes the metabolism to slow down. Pet owners who are unaware of this, often continue to feed their pets the same amount of food/not alter the pets diet, which will often lead to weight gain.

• Overfeeding: Most pet food brands have a guide on how much is recommended to feed their pet per day according to their weight/breed/etc. I have found that a lot of pet owners pay no heed to this guide and feed their pets whatever they think they should eat. This, paired with treats, scraps from the table and feeding ad lib all contribute to overfeeding, therefore, leading to weight gain.

• Age: Much like us, older pets become less active as they age. When this happens, pets require much less energy. If food is not altered to match their daily energy needs, this can also lead to eight gain.

• Medical Reason: A pet could have a medical condition (e.g. Cushing's disease - a condition which causes the over production of cortisol being released - causing increased appetite) which could be causing the weight gain. It is important for the pet to have regular vet visits to ensure they are treated for any underlying conditions.

Always ensure to remind the client that we are here to help and motivate them, not judge them. We both want the same thing - the healthiest, longest live possible for their pet. So, where do we go from here?

Weight Management Clinic

Step One: History

Have a questionnaire sheet ready to write answers down - or have the owner fill out themselves.

Feeding:

What does their pet eat over a 24 hour period?

Try to get an accurate history of what and how much their pet eats over a 24 hour period (including regular food and how much, treats, if any food scraps are given, if anyone else feeds their pet). Make sure the client understands that you are not here to judge them - but to help them, so the history needs to be as honest and accurate as possible in order to get the best results. Ask questions such as "what treats do you give your pet?" rather than "do you give your pet treats" - I find this makes for more honest answers.

What food is the pet on?

Try to find out the brand of food the pet is currently being fed. Is it wet food? Dry food? Raw food? A mix?

Who is the main feeder?

Try to find out who the main feeder is, and if they are not present for the first weight management clinic, strongly encourage their attendance for the next one! It's important that everyone in the household who may be involved in feeding the pet understands what we are trying to achieve. It also ensures communication within the household (so the pet doesn't accidentally get fed more than needed).

Is there any outside feeding?

Ask about outside feeding, (e.g. from a well meaning neighbour or visitors to the household.) Other outside feeding could include rummaging through bins or stables if the pet has access to such. Does the pet have access to any food outside of what he is directly given by the owners?

Is the pet on any medications?

If so - ask the owner how they give their pet their medication. Do they use food to encourage their pet to take tablets? Do they give their pet treats after taking the medication? I have found pet owners forget about this - a lot of pet owners use ham, cheese, butter, etc to hide the tablet from their pet. Take into account also that some medications can cause weight gain - e.g. steroids - so this question is important. Also consider parasite treatments, not just medication.

What des the pet get to drink?

The answer you get to this may surprise you - I have genuinely heard tea, coffee, Ribena and hot chocolate!

Exercise:

How much exercise does the pet do over a 24 hour period?

The answers to this question may differ depending on the animal - e.g. an indoor cat will be harder to determine than a dog who is walked twice a day. Rephrase this question to apply to the pet:

Dog

Is it a farm dog? Are they a working dog? Do they freely roam all day? OR How many walks do they go for a day? Who takes them for walks? How long are the walks?

Cats

Do they go outside? How long are they out for? Do they hunt? Do they visit neighbours? OR

Are they an indoor cat? Do they play a lot? Are they active? What kind of indoor set up does the owner have?

Step Two: Body Condition Score (BCS) and Body Fat Index (BFI)

Body Condition Score is a method to assess how underweight or overweight an animal is one a scale from 1 to 5 (with 1 being very underweight and 5 being obese).

Body Fat Index is a rough percentage of the pets body fat. Ideal weight is considered to be a BFI in the 20% range (from 16-25%) in both cats and dogs.

The target weight may vary depending on each pet, but the priority is to achieve a healthy BCS and BFI.

(I use the Hills BCS and BFI charts - but many companies have similar charts).

Hills Veterinary, Body Condition Score Chart

• 1 – Very Thin: There is no fat around the pet’s ribs, and they are visible to the eye. Bony prominences are also visible with no sign of fat.

• 2 – Underweight: Little fat is covering the ribs, and they are visible without having to touch the pet.

• 3 – Ideal: You can easily feel the pet’s ribs, but there is a slight layer of fat covering them. Bony prominences also have just a slight layer of fat.

• 4 – Overweight: The ribs and bonier areas are difficult to feel with a thick layer of fat.

• 5 – Obese: A thick layer of fat makes the pet’s ribs very difficult to find. Bonier areas like the knees are covered by a moderate to think layer of fat.

Hills Veterinary, Body Fat Index Chart

Dogs	Ribs	Shape from Above	Shape from the Side
20	Slightly prominent, easily felt, thin fat cover	Well proportioned lumbar waist	Abdominal tuck present
30	Slightly to not prominent, can be felt, moderate fat cover	Detectable lumbar waist	Slight abdominal tuck
40	Not prominent, very difficult to feel, thick fat cover.	Loss of lumbar waist, broadened back	Flat to bulging abdomen
50	Not prominent, extremely difficult to feel, very thick fat cover.	Markedly broadened back	Marked abdominal bulge
60	Not prominent, impossible to feel, extremely thick fat cover.	Extremely broadened back	Severe abdominal bulge
70	Unidentifiable, impossible to feel, extremely thick fat cover	Extremely broadened back, bulging mid-section	Very severe abdominal bulge

Cats	Ribs	Abdomen	Shape from Above	Shape from the Side
20	Prominent, very easy to feel	Loose abdominal skin, easy to feel abdominal contents	Marked hourglass	Moderate to slight abdominal tuck
30	Not prominent, easy to feel	Loose abdominal skin with minimum fat, easy to feel abdominal contents	Slight hourglass/lumbar waist	No abdominal tuck
40	Not prominent, can feel	Obvious skin fold with moderate fat, easy to feel abdominal contents	Lumbar waist	Slight abdominal bulge
50	Not prominent, difficult to feel	Heavy fat pad, difficult to feel abdominal contents	Broadened back	Moderate abdominal bulge
60	Not prominent, extremely difficult to impossible to feel	Very heavy fat pad; indistinct from abdominal fat, impossible to feel abdominal contents	Severely broadened back	Severe abdominal bulge
70	Unidentifiable, impossible to feel	Extremely heavy fat pad; indistinct from abdominal fat, impossible to feel abdominal contents	Extremely broadened back	Very severe abdominal bulge

Ask the owner to identify their pet on both charts - this can help you to understand how the owner sees their pet. If the owner choses inaccurately, I then will show them where I think their pet actually is, and where these weight clinics will aim for them to be.

The aim here is not to embarrass or correct the client - but to kindly educate them about their pets condition!

A reduction in BFI of even 10% can slow down the onset of obesity related diseases by up to 2 years in some cases!

Step Three: Making a Plan

After gathering all of your information, the next step is to help the owner to make a plan going forward. This usually involves changing their diet, exercise and sometimes, overall routine where you can. It is important to work with the client to make a plan that is achievable and maintainable for them. Making a maintainable plan is very important for ensuring client compliance - if the owner feels as if it's impossible, it will be. In the first few months of weight loss, exercise to diet ratio is 20:80, meaning 80% of weight loss will be from a change in diet. Exercise still helps, by increasing the pets metabolic rate and help to burn some extra calories.

Hill's Metabolic Dog Food

Food and Daily Allowance:

Depending on the pets BCS and BFI, I usually recommend clients switch to a metabolic diet. The one we use in my practise is Hill's Metabolic (for dogs or cats). This sometimes is not an option for clients, as the bag of food can be quite expensive compared to what they usually would pay for food. If this is the case - I would then usually break down the cost of food per day and how long the bag of food will last.

Explain the benefits of a metabolic diet:

• High in fibre, ensuring pet stays fuller for longer.

• Stimulates fat burning while maintaining muscle mass.

• Stimulates energetic use of body fat while maintaining lean body mass.

• Neutralizes free radicals that may increase while the pet is obese.

If the client cannot (or will not) switch to a metabolic diet, remind them that it is perfectly okay, but target weight may take slightly longer to reach. My next step would be to review the food they are currently on, and work out how much the pets daily allowance is, according to their weight/breed/etc (amount of food given to pet each day should be for their GOAL weight - not their current one!). Make sure the client understands that they must not exceed this amount. I usually advice my clients to divide the daily allowance into 2 separate meals (morning and evening). Ensure the client has a digital weighing scales at home, in order to weigh out their pets daily allowance. Demonstrate weighing in front of them in your weight clinic, ensuring they know how to weigh out the food correctly.

Treat replacements:

I try to avoid allowing any extras for the first 2 weeks of weight loss. The aim is to make it manageable from day 1, so that treats and extras can be added in later on if needed. If all options are given on day 1 and the pet doesn't lose much weight, the client may find it very difficult to cut out more food.

Dogs:

There are a couple of different options for treat replacements for dogs, including:

• Carrot - A chopped carrot is a great low calorie treat replacement for dogs. Carrots can be given cooked or raw, but always make sure it is chopped to avoid any choking hazards. Always supervise the dog while eating. Give half of a carrot to any dog that is under 10kg - (or should be!).

• Apple -  Apple is another great option for a low calorie treat replacement. Always make sure it is chopped to avoid any choking hazards. Always supervise the dog while eating.

• Metabolic treats - Much like metabolic food, metabolic treats are a great option while a pet is on their weight loss journey.
  

Hill's Veterinary Metabolic Cat Treats

Cats:

Cats are unfortunately harder than dogs in this regard - cats can also eat small chopped cooked carrots like dogs, but most of them have no interest.

• Metabolic treats are (in my opinion) the best way to ensure cats aren't being overfed.

• If outdoor cat, ask neighbours not to feed or get a "do not feed me" collar.

A tip for cats:

If the client finds that their cat seems hungry on just fry food, try switching the diet to 25% wet food and 75% dry food. This not only has a higher satiety and palatability, but also will help to keep their cat hydrated!

The only thing I ever recommend to give your pet to drink is water. Cats are sometimes picky about drinking from bowls, so a water fountain that makes the water move constantly can really help if the client feels their pet isn't drinking enough water.

Talking about exercise:

The most important part of discussing an exercising routine is to establish what both the client and their pet are capable of. For example, in some cases, both client and pet are elderly, or have a medical condition, making it difficult to exercise. Make sure the client knows that you understand their circumstances and do your best to make a plan that suits everyone.

Dogs:

The best way to increase pets exercise is to do so slowly. For example, start with short, sharp bursts of energy after slow, long walks. Ask the owner if they can jog or run for the last 5 minutes of their dogs walk. If this is not possible - ask the owner if they could bring a toy or ball and have a short play session at the end of their walks. The owner can slowly increase the length or walks and play sessions as they are able, which will eventually help with weight loss. Interactive toys (e.g. a ball launcher - supervised) can also be a good way to get some extra exercise in if the client is unable to walk their dog as often.

Cats:

Play is the best way for cats to get in some extra exercise is through play. Short play sessions at first, then slowly increasing. Interactive toys (supervised), are also a great way to get cats moving!

Step Four: Follow Up

I usually recommend to clients to return for a second visit in 2 weeks for dogs, and 3 weeks for cats. Always make sure to make the follow up appointment at the end of the first clinic, before the client leaves. Write their next appointment on an appointment card, and make sure to follow up with a phone call a few days later too see how everything is going.

optimal weight loss per week (optimal):

• dogs: 1-3% per week (average 0.9% per week)

• cats: 0.5-2% per week (average .08% per week)

Above or below this may require review.

Take pictures! This is an excellent motivator for clients and can be used to demonstrate weight loss on a similar breed during the first consult. I like to take pictures every 4 weeks and show the clients their progress.

Calculations:

START WEIGHT - CURRENT WEIGHT = TOTAL WEIGHT LOST

(TOTAL WEIGHT LOST ÷ START WEIGHT) x 100 = TOTAL % WEIGHT LOST

TOTAL % WEIGHT LOST ÷ NUMBER OF WEEKS SINCE LAST WEIGHED = % WEIGHT LOST PER WEEK.