A Weighty Matter: Effectively Communicating with Clients about Pet Obesity
This article presents the key concepts to a successful conversation with clients about their overweight pets, and how to implement a weight loss plan.
The blood and urine analyses recently ordered on a patient show azotemia in the face of low urine specific gravity. Most veterinarians feel quite at ease discussing renal disease with an owner and outlining a plan for follow-up care.
When it comes to overweight pets, however, many veterinarians do not feel as comfortable discussing the condition and associated therapeutic strategies. This may be complicated by the veterinarian or client’s weight status, or the fear that the discussion may be perceived as hypocritical or judgmental.
These concerns can prevent veterinarians from having very important discussions about pet obesity with clients.
THE RIGHT APPROACH
As more overweight and obese pets are seen in daily practice and more data about negative health consequences of obesity are collected each year, conversations about obesity in pets are becoming more frequent and increasing in importance.
The approach one uses when presenting therapeutic options for obese patients makes a critical difference in how the information is received and perceived by the owner.
Present recommendations for weight loss with the same importance as recommendations for other preventive services or treatment plans. In today’s busy practices, it is not uncommon for a heartworm test to be presented to the client as critical to a pet’s health, while weight loss is presented as an optional therapy.
Consider the potential differences in client buy-in if a weight loss program is included in an estimate for a workup/treatment plan for a concurrent condition associated with obesity, such as orthopedic disease, compared to offering weight loss services alone.
Choose an approach that caters to the client—pet owners who are more scientifically focused may benefit from a research-based approach (“studies have shown that…”) whereas others may benefit from a more emotional approach (“Mrs. Jones, Fluffy is clearly a very important member of your family. We can help Fluffy feel even better and potentially live longer by…”). Remember, though, that this type of approach can only be chosen once you are familiar with the client’s understanding of obesity (see Open-Ended Questions for Better Communication).
Involve the entire family, if possible, as weight loss plans cannot be successful unless all family members are adherent. We have frequently had patients that were not losing weight, despite what seemed to be appropriate caloric restriction, only to find that a spouse, child, or parent of the owner present for the appointment was sneaking the pet treats or additional food on the side.
Open-Ended Questions for Better Communication
In one study on pet obesity prevalence,1 owners often used narratives or personal stories to explain their pets’ weight status. When asked open-ended questions, these owners:
- Responded with historical information, such as the pet was previously much more overweight and seems thin in comparison now
- Described personal or emotional components; for example, acknowledging that he or she felt guilty denying food to the overweight pet when it acted hungry.
Encouraging an owner to describe his or her pet’s weight and the perceived consequences of excess weight helps ascertain the owner’s knowledge and perceptions and identify potential challenges to weight loss. Open-ended questions the clinician can ask include:
- What are your thoughts on your pet’s current weight?
- At this weight, how would you describe your pet’s quality of life?
- If your pet’s weight has increased/decreased, how does your pet act now as compared to before?
- Have you had discussions with other veterinarians or veterinary technicians regarding your pet’s weight?
- If your pet has been on a weight loss plan before, what strategies were successful versus unsuccessful?
The first challenge for many owners is accepting that their pets are overweight. It is often reported, both anecdotally and in the literature,1 that many pet owners underestimate their pets’ body condition score (BCS), assuming the pet is a healthy weight when, in fact, it is overweight to obese. One study among pet owners showed that half of the owners who correctly identified their pets’ BCS above ideal still did not consider their pets to be overweight.2
These incorrect perceptions may be rooted in denial or guilt, or may be due to the high prevalence of obesity in the general pet population.
- A recent European study3 reported that many show dogs of certain breeds were overweight or obese, and the authors have had clients tell them that their breeders indicated that their overweight dogs were perfect or even underweight.
- A simple Internet image search for certain breeds, such as Labrador retrievers and beagles, quickly demonstrates that images of healthy weight dogs are few and far between, which can certainly alter public perception of what constitutes “normal” weights for these breeds.
- Cats do not fare any better, which is evident by the popularity of internet memes of overweight cats and the extensive use of the term fat cat in the pop-culture lexicon.
Picture Proper BCS
Collecting a library of pictures of ideal weight (BCS, 4–5/9) dogs and cats can help teach owners what constitutes a healthy weight, as can helping them score their own pets. For puppy and kitten visits, it can be valuable to consistently reinforce to clients that the way their “trim” puppies or kittens look now is the way that they should always look and feel—emphasizing frequent palpation over the ribs and examination of the waist from above. Keeping good quality pictures of patients as they age—both side and top views—in your medical records can also help pet owners realize their pets have gained excessive weight.
Emphasize Health Concerns
Explain to pet owners that obesity is an important health concern—while it may not seem as urgent as other conditions, it can have long-lasting consequences, including:
- Shortened life span4
- Increased pain and mobility issues that affect quality of life5
- Higher veterinary costs.
If clients are overweight, do not assume that they are not interested in helping their pets lose weight. These clients may have had a similar discussion with their physicians, and may be more aware of the health concerns associated with obesity. In our experience, some overweight clients have been more adherent with weight loss plans for their pets than “normal weight” owners because they report that, even though they struggle with their own weight management, their pets’ weights are something they can more easily control.
Empathy is very important in these conversations—be clear with clients that overweight pets are common and having an overweight pet does not make them a bad pet owner.
- Stress that weight loss is not without challenges, but quality of life of pets has been shown to improve after weight loss.5
- For owners concerned that their pets have a lot of weight to lose, even weight loss as small as 6% to 8% of total body weight has been shown to produce significant decreases in subjective and objective lameness scores.5
- Having documented “success stories” with before and after pictures and testimonials from clients in a book or on a bulletin board can be helpful.
Wait, If Necessary
To prepare for pet owners’ responses to a weight loss discussion:
- Assess owners’ perceptions of their pets’ weights and knowledge of health concerns
- Determine owners readiness for change (described in detail elsewhere)6
- Recognize that some clients may not be ready to make immediate changes or accept that their pets are overweight.6
With hesitant clients, some may benefit from reading material, such as client handouts or a list of trusted websites, while others will need to discuss the issue multiple times yet will still hesitate to make changes. Eventually these clients may be willing to make some changes, especially if faced with a pet health issue, such as a cruciate tear requiring surgery or a diagnosis of diabetes.
Basic Tenets of Weight Loss
While the in-clinic form—Developing Protocols for Obese Animals (September/October 2013 issue; available at tvpjournal.com)—outlines the more detailed mechanics of a weight loss plan, here are some basic tenets to keep in mind:
- For systemically healthy, but overweight, pets that can be fed a diet with appropriate nutrient concentrations (such as a veterinary therapeutic weight loss diet), an ideal rate of weight loss is 1% to 2% of original body weight per week.
- For pets with systemic disease in which weight loss is still appropriate or those that cannot eat a diet formulated for weight loss (lower nutrient to calorie ratio), a more conservative rate of 0.25% to 0.5% of original body weight per week is recommended.
If a pet does not meet the above goals at the 2-week recheck, the caloric intake (including treats) should be adjusted by 5% to 20% based on whether the pet lost more than the goal rate, maintained weight, or gained weight.
- If healthy animals are losing 3% to 4% of body weight initially, we do not recommend increasing caloric intake unless this rate of loss is documented at more than 2 consecutive bi-weekly weigh-ins; rapid initial weight loss followed by a plateau is common.
PUTTING A PLAN INTO ACTION
1. Diet History
Once the client and veterinarian recognize that weight loss is needed, the first step toward developing a plan is obtaining a thorough diet history that includes all foods, treats, and supplements that the pet receives as well as who feeds the pet, access to other sources of food (eg, owner feeds stray cats), and the makeup of people in the family. An example of a diet history form is available at http://wsava.org/nutrition-toolkit.
2. Feeding Plan
Once this information is collected, a diet and feeding plan can be designed. To avoid client confusion, or undue focus on a goal weight rather than the process of weight loss, we recommend concentrating on BCS and a goal rate of loss rather than a final goal weight. Clients can be taught to score their own pets, calculate the rate of weekly weight loss, and compare it to the goal rate (typically 0.5% to 2% of original body weight per week).
3. Human–Animal Interaction
Beyond the standard weight loss plan of calorie restriction and physical activity, successful weight management requires an understanding of human–animal interaction, such as using strategies that allow pet owners to maintain their current relationships with their pets.
These strategies may include:
- Discussing a compromise for non-negotiables—food items that owners are likely to give their pets regardless of instructions—that allows them to be included in the weight management plan.
- Asking the owner to describe the pet’s feeding arrangements and who in the family feeds the pet—information that helps develop a weight management plan that fits into the existing family structure and capitalizes on the owner–pet relationship that already exists.
4. Follow-Up & Monitoring
In our experience, the two factors that best predict weight loss success are:
- Frequent weight checks
- Appropriate adjustment of calories based on whether weight loss goals are met.
At each recheck, it is important to assess the owner’s thoughts on progress and adjust the plan if reasons other than calorie intake are affecting its success. Adherence is more likely if plans are tailored to owners’ relationships with their pets and/or family dynamics. As weight management progresses, relationships and dynamics may change; assessing owner input helps address or avoid barriers to success.
Weight Checks. For cat and small dog owners, especially when the owners work long hours or the pets are anxious about travel, having the client purchase a baby scale can be invaluable for increasing convenience and, thus, compliance. For larger dogs, placing a scale in the reception area where it is easily accessible for clients, and keeping a list of local pet supply stores that have scales and extended hours can be very helpful.
Calorie Adjustment. A detail-oriented owner can be provided with a graph that outlines what the pet’s ideal rate of weight loss should be at points throughout the weight loss plan, and the owner can make changes in the amount of food given based on the whether the pet’s weight fits within the goals set. These clients may only require monthly check-ins.
Other clients may do best with weekly check-ins, and may need extensive help adjusting intake as well as emotional support in order to meet their pets’ weight loss goals.
5. The Team Approach
Designating a specific technician as the contact point for clients can ensure consistent support and also help bond clients to a practice. Any client whose pet is on a weight loss plan should be contacted by a member of the practice team at least monthly.
Obesity Prevention & Treatment: Communication Tips
- Don’t be afraid to bring it up—obesity is a medical condition, just like kidney or heart disease. However, compared to other chronic conditions, it can often be successfully treated.
- Use open-ended questions to understand the client’s thoughts and beliefs about obesity as well as evaluate how the client believes a weight loss program is progressing.
- Be empathetic—assure clients that their experiences are common and that many pet owners, even veterinarians, don’t notice that their pets are gaining weight until they are already overweight.
- If weight loss is critical to the pet’s health, communicate this information to the client with the same gravity you would use for other significant health concerns.
- Start the conversation early and continue it often—teaching new puppy and kitten clients about BCS and weight control helps emphasize the importance of the condition and makes later discussions, if needed, easier.
- Make the client part of the weight loss plan by asking about perceived challenges, and adjust the plan to best reflect the client and pet’s individual needs.
- Adapt the plan to the client’s lifestyle—family dynamics, work schedules, and other factors can contribute to poor adherence if not taken into account.
- Use visual aids—easy computer graphs of weight loss and pictures before and during weight loss can help keep clients motivated.
- Start a support group—if practice facilities and format allow, setting aside a time for clients with pets on weight loss plans to meet and discuss successes and challenges can help clients realize that they are not alone and maintain motivation.
Implementing a successful weight loss plan for a pet not only requires understanding the medical components of weight loss, but also the key components of client communication, which include:
- Choosing a discussion approach based on your relationship with the client and knowledge of the client and pet.
- Helping the client accept that his or her pet is overweight or obese.
- Developing a weight loss plan that addresses goals for weight loss and effective follow-up and communication with the practice team.
- White GA, Hobson-West P, Cobb K, et al. Canine obesity: is there a difference between veterinarian and owner perception? J Small Anim Pract 2011; 52:622-626.
- Bland IM, Guthrie-Jones A, Taylor RD, et al. Dog obesity: owner attitudes and behaviour. Prev Vet Med 2009; 92:333-340.
- Corbee RJ. Obesity in show dogs. J Anim Physiol Anim Nutr (Berl) 2012.
- Kealy R, Lawler D, Ballam J, et al. Effects of diet restriction on life span and age-related changes in dogs. JAVMA 2002; 220:1315-1320.
- 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; 192:428-434.
- Churchill J. Increase the success of weight loss programs by creating an environment for change. Compend Contin Educ Pract Vet 2010; 32:E1.