Previous studies have estimated that merely 16% of veterinary appointments include nutrition discussions and 25% of owners have not discussed nutrition with veterinary staff. A recent study published in JAVMA features an anonymous survey of 561 small animal veterinarians in private practice regarding the barriers and solutions to pet nutrition conversations with clients. The study aimed to determine the frequency of conversations about pet nutrition during small animal veterinary appointments, proportion of small animal veterinarians that feel confident communicating about pet nutrition, and nuances of pet nutrition communication including barriers and solutions. We spoke with Megan Shepherd, DVM, PhD, DACVIM (Nutrition), who conducted this study when she served as a faculty member at the Virginia-Maryland College of Veterinary Medicine.
Editor’s Note: This is an excerpt from Research Wrapped, a free monthly newsletter that collects the latest scientific research relevant to small animal veterinarians and pulls out practical takeaways. To be the first to receive this newsletter each month, subscribe here.
Q: This study highlights the importance of trust within the veterinarian-client relationship and the fact that “there is no one-size-fits-all approach to nutrition discussions.” Would you consider those to be the primary takeaways?
Absolutely, a good takeaway is that there is no one-size-fits all approach; conversations should be tailored to the situation. I would also like the takeaway to be a reflection of:
- What barrier(s) the veterinary professional encounters (naming them may help eventually dispel or deal with them).
- What the veterinary professional and/or their veterinary team can do to engage more in nutrition conversations with clients.
Q: According to the survey’s respondents, the most common barriers to pet nutrition communication are a client’s preconceived notions (86%), insufficient time (63%), and client resistance to discussing nutrition (41%). The fourth most common barrier was identified as inadequate nutrition resources to share with clients (35%). Do you have any resources you would recommend?
- The World Small Animal Veterinary Association (WSAVA) Nutrition Guidelines is a great resource. On the Global Nutrition Guidelines webpage, veterinary professionals can scroll down to “Resources for the Healthcare Team.” From there, they can click on:
- “Charts, Checklists and Guidelines,” where they can find body condition score charts, muscle condition score charts, and
diet history form. - “Tools for Pet Owners,” where they can find “Selecting a Pet Food” that outlines how to navigate pet food—from reviewing information on the label to considering important information not captured on the label.
- “Charts, Checklists and Guidelines,” where they can find body condition score charts, muscle condition score charts, and
- The Pet Nutrition Alliance (PNA) is another handy resource. From the homepage, veterinary professionals can navigate to “Calorie Calculators,” where they can input a pet’s body weight and body condition score, then a daily calorie allotment will be recommended. Veterinary professionals can also navigate to the “2023 Pet Food Manufacturing Evaluation Report.” This report is a helpful resource when a veterinary professional is asked about a pet food brand that they are not familiar with. (Investigators contacted manufacturers and asked questions motivated by the WSAVA “Selecting a Pet Food” guidelines.)
- Tufts Petfoodology Blog is a great resource for veterinary professionals and clients. They have posts on all things related to pet food, including treats and supplements.
- In addition to finding a veterinary nutritionist (and other specialties within the ACVIM), VetSpecialists also offers nutrition articles for veterinary professionals.
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Q: The top 3 solutions to overcoming these barriers were for veterinarians to show clients what they feed their pets (i.e., personal experience and diet information), be specific with nutrition recommendations (i.e., explain why a recommendation is being made), and have honest conversations (i.e., display compassion and nonjudgment, do not avoid difficult topics like obesity). Are there additional solutions you would suggest?
I appreciate all solutions proposed by veterinarians that participated in this study as these are SUCH valuable insights! Being specific with nutrition recommendations is important because there are lots of different diets available. Even diets within the same category (e.g., hydrolyzed protein diets) vary in amount and source of protein, fat (e.g., marine-based omega-3 fatty acids), and fiber (e.g., prebiotic, viscous, insoluble).
Regarding honest conversations, 3 considerations I find helpful are:
- The conversation should be tailored to the client’s goals and pet’s needs.
- Be the guide.
- Admit bias.
Understanding a client’s goals for their pet, in the context of the client’s capacity (e.g., time, financial), provides such helpful information. For example, if a client says their goals for their pet are to minimize the risk for joint disease and optimize longevity, then when assessing the pet’s body condition score and talking about the importance of maintaining healthy weight, you can communicate: “Maintaining a healthy weight for your pet is really important for achieving your goals of supporting joint health and optimizing longevity. Body condition scoring is an important indicator of your pet’s healthy weight.”
If a client asks what they should feed their pet, there is a lot to consider beyond species, age, life-stage, activity, and healthy status—such as the client’s goals. If you are not familiar with the client’s goals for their pet (i.e., a new client), then you can respond, “Great question, there is a lot to consider when navigating pet food. In addition to ensuring that the diet is appropriate for your pet’s size, age, activity, and health status, we also need to ensure it aligns with your goals and is accessible to you. So, let’s explore your goals. What are your goals for your pet?” If the client seems overwhelmed with such a lofty question, you can provide examples of how nutrition impacts health and say, “For example, you may wish to support joint, metabolic, or coat health; or you may wish to support healthy longevity.”
Although the barriers are real, if you are not communicating about nutrition with your clients, someone or something, such as AI, is. Dr. Jessica Vogelsang talks about the magic of storytelling and suggests the following consideration in a pet’s story:
- The pet is the main character.
- The client/pet owner is the hero of the story as they have autonomy and the final say on what their pet consumes.
- The veterinary professional is the GUIDE.
If your goals (i.e., feed a complete and balanced diet that is safe and appropriate for the pet, produced by a manufacturer that practices good quality control, and formulated according to evidence-based medicine) and the client’s goals align so that there are diet options that fit within those shared goals, great! But, if your goals and the client’s goals do not overlap, it may be helpful to remind yourself that you are the guide. Explain your “why” (i.e., why you are providing the guidance that you are). Yet the client has the ultimate say as the hero of the story. Keep in mind, especially when feeling frustrated by a client’s goals (e.g., goals rooted in belief rather than science/evidence), that the client typically has good intentions for their pet.
Veterinary professionals are humans; and as humans, we are biased by life experiences. In the context of nutrition, veterinary professionals are biased by their prior experience with nutrition. For example, when a client asks what to feed their pet, in addition to considering that pet’s needs, the client’s goals, and your role as the guide, share that you are most familiar with pet food brands that offer veterinary (i.e., therapeutic) diets because representatives of those brands regularly approach veterinary professionals as their target audience. However, depending on a veterinary professional’s experience with pets in their personal life, their knowledge of pet food may have broadened.
Q: The study makes a few suggestions on how the veterinary staff can facilitate positive nutrition communication, including collecting a thorough diet history and following up on nutrition concerns. Do you have any specific clinical strategies for veterinary care teams to improve nutrition communication?
Nutrition is a team sport. Nutrition is a great way to empower veterinary technicians and support staff in the clinic. Support staff can ensure that diet history forms are provided to clients ahead of their next appointment and ensure that the completed form is added to the medical record at or before check-in. Support staff can reiterate nutrition recommendations and ensure that the client is purchasing or ordering the correct food.
A veterinary technician can review the diet history form, clarify details with the client, and evaluate the appropriateness of the current foods. A veterinary technician can ask the client’s goals and start or lead the nutrition conversation. Nutrition rechecks can be technician-led (e.g., rechecks for prescribed weight loss plans).
If you have someone at your clinic that is enthusiastic about science/evidence-based nutrition, consider developing that passion into a role that allows your clinic to communicate nutrition more with clients, including specific science/evidence-based nutrition guidance.
Q: Many respondents suggested that a single database for all commercial diets would be a helpful resource, and it was mentioned that one is in beta testing. Do you have any insight about this database and when it might be available?
There are 2 free resources available; you just need to establish your free account as a veterinarian. The Mark Morris Institute (MMI) Nutrition Guide includes all Hill’s, Purina, and Royal Canin diets. The BalanceIT team created vetnutritionist.AI, which includes generally all pet food available on the market. These are generous resources as it takes a lot of effort to maintain these databases and keep up with product updates and new products.
Editor’s Note: This article is an excerpt from the Research Wrapped monthly newsletter. Subscribe here for free.
Q: Is there anything you would like our readers to know that has not been mentioned?
Veterinarians reported that repetition and multiple formats of receiving information are helpful, so consider backing up what you communicate verbally with a written resource. Veterinary professionals can either structure what they communicate based on resources that already exist (e.g., WSAVA Nutrition Guidelines) or create their own nutrition resources.
Also, don’t forget to document the nutrition conversation in the medical record, at least the key points from the conversation (e.g., client’s goals, diet recommendations). The nutrition conversation is an important aspect of nutrition assessment (assess the patient, diet, and feeding management), which should be conducted on every patient at every visit.
Read the full study
Small animal veterinarians identify proactive, specific, and multimodal communication as helpful in supporting nutrition conversations with clients.
O’Brien JS, Wenzel SG, Hungerford LL, Gravley D, Coe JB, Shepherd ML. JAVMA. doi:10.2460/javma.26.01.0077.