Losing Pandemic Pounds

Tip the Scales with Changes in Communication

by Maureen Blaney Flietner

SINCE THE ARRIVAL OF COVID-19, AMERICA’S PROBLEM with pet obesity has only compounded.

“The obesity problem has been an epidemic within the pandemic,” said Ron Biese, DVM, co-owner of the AAHA-accredited Kaukauna Veterinary Clinic, who noted an increase in weight gain among patients at his Wisconsin practice.

 

“Many of my clients who learn their dog gained weight since their last visit are not surprised,” said Biese. “We will discuss why that may have happened and then what we can do to remedy the situation. The reason given most often is that they are giving more treats since they are home more often. It is difficult to stop despite knowing that overfeeding can have serious medical consequences.”

Biese, who estimated that at least 75% of his clients don’t take it to heart that their pet needs to lose weight, noted that “it can be a frustrating and difficult conversation to have.”

His findings are not an anomaly, according to a June 2021 press release on data pulled from Banfield Pet Hospital’s electronic veterinary health records system. It confirmed that the pet weight problem has grown over the past year, just as it has grown long before quarantine.

Banfield’s analysis of the health records of pets seen at the practice each year over the past decade saw a 108% increase in dogs diagnosed as overweight or obese, jumping from 16% in 2011 to 34% in 2020. The increase seen in cats was even greater: 114%, jumping from 18% in 2011 to 38% in 2020. Data from March 2020 to December 2020 revealed that dogs diagnosed as overweight or obese rose 2.3%, the largest increase in the past 10 years.

A Complex, Multi-Factored Problem

It’s not that pet owners have not been aware of the problem. Obesity has long been the subject of weight loss initiatives by veterinary organizations, pet food companies, and others. The below examples illustrate some of the efforts that have been initiated over the years.

• In 2005, Ernie Ward, DVM, founded the Association for Pet Obesity Prevention (APOP) to develop and promote parallel weight loss programs designed to help pet owners safely and effectively lose weight alongside their pets. APOP produced the first annual US pet obesity prevalence survey in 2007 and now has moved to a biennial survey with the most recent conducted October 13, 2021, on National Pet Obesity Awareness Day.
• In 2012, Hill’s Pet Nutrition and NBC’s The Biggest Loser host Alison Sweeney offered the online Million Pound Pledge, a program for pet owners to help their cats and dogs lose weight. Participants received access to a support system with live video chats, weight loss tips, interactive body condition scoring, and pet food rebates. • In 2013, Nestle Purina and weight-loss company Jenny Craig teamed up for the Power of Two program. It joined pets and their owners with weight loss experts who developed customized eating and activity recommendations, supervised regular weigh-ins, and provided ongoing counsel and support.
• Ideally, a client with an overweight pet should just be made aware of the need to bring the pet back to its appropriate weight. Too many calories + too little exercise = excess weight. That may be the simple math for obesity, but other aspects influence why the problem is hard to solve. Among those factors:
  • Social and psychological behaviors that link food and weight with love, control, and prejudices
  • Pet owners’ emotional responses to signs of hunger and begging from pets
  • Pet owners’ misunderstandings about what overweight or obesity in pets looks like
  • Neuter status, metabolic rate changes with age, weight set point persistence, and genetic predispositions of pets

In addition, the gut microbiome increasingly appears to be a player. In 2018, Purina collaborated with the European Molecular Biology Laboratory, a renowned research group in Heidelberg, Germany. Their study showed that human and dog gut microbiomes are similar, suggesting the link between obesity and gut microbiota in humans could be similar to that in dogs.

“Our research has shown that gut microbes respond differentially to diet intervention in obese versus lean dogs or cats. The hypothesis is that certain gut microbe– produced metabolites activate the molecular pathways that lead to lipogenesis and triglyceride accumulation in adipocytes as well as increase energy absorption in the gut. This is a rapidly growing area of research, and we still have a lot of work to do in pets,” said Johnny Li, PhD, molecular biology and genetics, senior research scientist at Nestle Purina Petcare.

Even when and how often a pet is fed—specifically cats— may play a role.

Adronie Verbrugghe, DVM, PhD, Diplomate European College of Veterinary and Comparative Nutrition, associate professor, and Kate Shoveller, PhD, associate professor, both at the University of Guelph, reported in 2020 on a small, controlled crossover study of eight lean cats to determine physiological responses to when and how often cats were fed.

“We saw that the cats fed once a day had an increase in the satiety hormones and a decrease in the hormones associated with feeling hungry,” said Shoveller. That could mean less begging for food and fewer chances for owners to give in to their demands. A 2022 study will look at physiological responses to lean and obese cats but over a longer period of time.

Just feeding less and restricting calories to achieve weight loss in cats without also changing the diet to a veterinary weight loss food is not good. Verbrugghe noted that certain essential micronutrients such as choline may be restricted too much and have a detrimental effect, predisposing the cats to fatty liver disease, for example. A 10% restriction of an over-the-counter maintenance food is likely still safe, she said, but a specially designed weight loss plan with a veterinary weight loss food has less risk of nutrient deficiency and targets satiety.

Get Client Buy-in

While veterinary teams keep up to date with the latest in research, their concern day-in and day-out is working with the main weight control factor: owners. So what is not getting through to them?

Studies are finding that changes in communication may make a difference.

Jason B. Coe, DVM, PhD, professor in the Department of Population Medicine at Guelph, and Kat Sutherland, PhD candidate there, noted that much of the discussion around pet obesity to date appears to focus on the content of the message: that pet obesity is a problem and a health concern for our pets, and that clients need to be educated.

“The way the message is delivered has been less of a focus until more recently. We are seeing in our research that how the message is communicated around pet obesity, including the way veterinary professionals navigate the topic with their clients, may have significant implications for the outcome of these conversations,” said Sutherland.

“When addressing pet obesity, our research supports that a comprehensive understanding of the pet’s diet history is likely to be critically important. The 2021 AAHA Nutrition and Weight Management Guidelines for Dogs and Cats emphasizes the importance of collecting information about the pet, the diet, the home environment, and the pet owner,” noted Coe, a member of the task force that crafted the AAHA guidelines.

“During our research we have observed limited information gathering by veterinary professionals from clients about their views and the pet’s diet and lifestyle,” said Coe. “Without that information, veterinary professionals run the risk of making recommendations without understanding the client’s individual circumstances or preferences. When that happens, client buy-in becomes less likely and adherence goes down.”

A 2020 Veterinary Emerging Topics Report from Banfield Pet Hospital and the North American Veterinary Community seems to support that lack of buy-in. The report noted, for example, that pet owners who did not follow diet recommendations reported that they did not because of:

• the cost of diet (31.6%),
• the pet’s food preference (26.3%),
• comorbidity (5.3%),
• multi-pet household (5.3%),
• ineffectiveness of the diet (5.3%), and
• owner habit (5.3%).

Owner reasons given for not following activity recommendations included:

• time or schedule (40.7%),
• owner health or other physical limitations (33.3%),
• change in weather or season (18.5%),
• change in living situation (3.7%), and
• “pet is lazy” (3.7%).

To get needed information for better client buy-in, Coe and Sutherland suggested that veterinary hospitals try the following tips.

Gather a comprehensive diet history using open-ended inquiry, rather than the common question “What kind of food are they eating?”

Previous research shows that closed-ended questions do not yield much information from clients, especially when it comes to treats and other aspects of the diet that are important in developing a tailored plan for managing pet obesity.

Gather information about the client’s preferences and perceptions of their pet’s nutrition and weight so communication and recommendations can be tailored to the individual client and their pet.

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Meet Communication Challenges

From her research, Jane R. Shaw, DVM, PhD, professor and director of veterinary communication for professional excellence at Colorado State University, found four specific challenges that are not often met in gathering information:

Seek Out the Client’s Perspective

“What is your perception of your pet’s weight? What’s important about your relationship with your pet? What do you consider when feeding your pet? What criteria do you use in choosing pet’s food?” are all questions that Shaw asks to seek out the client’s perspective. “Part of the complexity is the caregiver’s beliefs, thoughts, and values around feeding their pet, which probably relates to their own choices in nutrition and feeding themselves,” said Shaw, noting that it’s critical to find out where the client is coming from on this issue.

Use a Conversational Approach

“We tend to use more of a lecture/expert approach instead of being conversational,” said Shaw. “This can be a fragile or sensitive conversation. Clients can feel judged. We can overwhelm them, or they can be detached or not involved because we are doing all of the talking.”

Make It a Collaborative Effort

“[Veterinarians] tend to be—even after all of these years— paternalistic instead of a partner. Clients want partners today. They want a collaborative relationship. They’re engaged with their pets, empowered to make decisions, and want to be an advocate,” said Shaw. “So take a more collaborative approach: ‘We’re in this together. We’re going to work on this as a team. I’m going to support you and rely on you to implement the changes at home.’” Shaw’s suggestion is to “chunk and check, give small pieces of information and then check for the client’s response. For example: ‘I have other clients with similar problems with their pets. I am concerned about the long-term effect of this on Charlie’s life. How has this weight gain changed how Charlie acts?’ or ‘It is going to take commitment to reduce calories and increase his exercise. How would you see that fit in with your life right now?’”

Remember to Explain Why

“We often give recommendations without explaining the value, the benefit to the client and the pet—this is the why and what motivates the client to change, noted Shaw. “How will it benefit the pet? Why should the client put their pet on a weight-management diet?” “This is the hardest thing about obesity,” said Shaw. “We have diets and medications but none of these are very successful without a compliance program at home. The only way to get compliance is to get buy-in. And the only way to get buy-in is to have the client be invested in it.”

Take the Lead

“Prevention is easier than a cure,” said Coe, noting that the 2021 AAHA Nutrition and Weight Management Guidelines encourage veterinary practices to pursue their expertise in pet nutrition and take the lead in helping prevent and treat obesity.

“Normalize conversations about a pet’s weight by engaging with clients early and often about their pet’s nutrition and weight, especially when the pet is at a healthy weight. It is important to help clients maintain their pet at a healthy weight and prevent weight gain throughout their pet’s lifetime.” One way is to include all five vital physical assessments in every physical exam: temperature, pulse, respiration, pain, and the one there is a tendency to skip: a nutritional assessment.

“Veterinarians walk a tightrope,” explained Shaw. “You can’t make clients do something they don’t want to. If the client says ‘no, this is not possible right now,’ we can say ‘We’re glad you brought him in.’ Then, the next time you see them, mention the earlier conversation and ask for their thoughts again. It may take multiple attempts to engage a client and there will be a certain percentage of clients who don’t buy in and comply with your recommendations. The key is keeping that client coming back for regular visits and preventive care.

“Our profession is already stressed,” Shaw said. “But we need a call to action, and the entire veterinary team can take part in it. We choose the things to talk about and this is a courageous conversation. But if we are not talking about weight, how do we move the needle?”

Maureen Blaney Flietner is an award-winning freelance writer living in Wisconsin.

 

Photo credits: Slavica/E+ via Getty Images, simonkr/E+ via Getty Images, SeventyFour/iStock via Getty Images, Ridofranz/iStock via Getty Images, Andrey Zhuravlev/iStock via Getty Images