A Weighty Matter: Effectively Communicating with Clients about Pet Obesity

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.

ENCOURAGING ACCEPTANCE

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

Understand Misconceptions

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.

Avoid Assumptions

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.

Be Encouraging

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.

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.

IN SUMMARY

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.

Cailin Heinze, VMD, MS, Diplomate ACVN, is a faculty member with the Clinical Nutrition Service at Tufts Cummings School of Veterinary Medicine. Her professional and research interests include canine and feline obesity, nutritional management of renal disease, long-chain fatty acids, and cancer nutrition. Dr. Heinze received her veterinary degree from University of Pennsylvania School of Veterinary Medicine; then completed a nutrition residency and MS in nutritional biology at University of California–Davis.

Deborah Linder, DVM, Diplomate ACVN, is the head of the Obesity Clinic for Animals at Tufts Cummings School of Veterinary Medicine. Her interests include obesity management, effective client education, and human–animal interaction. Dr. Linder has focused her research on safe and effective weight loss strategies for pets and the effect of obesity on pet and human well-being. She received her veterinary degree from Tufts Cummings School of Veterinary Medicine.