Lightening up the conversation on obesity

A colleague of mine (let’s call her Dr. Simms to protect the well-intentioned) was in a tough spot. Simms’ practice was in an urban area seeing a rash of a particular disease in dogs (let’s call it Canis morbidus). On one hand, C. morbidus had all the hallmarks of the very thing we got into medicine to treat: It shortened the life of most dogs that had it, it led to co-morbidities in many patients, and it meaningfully decreased the quality of life of those suffering from it.

On the other hand, the therapies used to treat C. morbidus were not immediately effective. Further, it took some work to even get the therapies into place. Finally, very often, clients would not follow the guidance Simms offered, which led to worse outcomes for those with C. morbidus.

So, when C. morbidus became one of the most prevalent issues Simms’ practice saw every day, she got frustrated. She started giving it only a passing mention during many exams. Sometimes, if she was being honest, she would not bring it up at all. On the upside, the practice ran a little smoother. After all, Simms was not wasting time on talking about C. morbidus when she knew owners were not likely to take the steps necessary to manage it. This saved Simms and her coworkers time to talk about other things, but the net effect was more dogs with C. morbidus suffered its dire consequences.

Some of you reading empathize with her and the choices she made. Some of you are, for lack of a better term, deeply disappointed with our colleague. After all, how could Simms not confront a disease with such clear consequences solely because it got difficult or frustrating?

Now that the jig is up, please read the first three paragraphs again. This time, when you see C. morbidus, insert the name you know it by: obesity.

Are you still judging Simms’ handling of the disease—or do you empathize?

We have to talk about it

The latest study from the Association of Pet Obesity Prevention (APOP) found in 2022, 59 percent of dogs in the U.S. were overweight or obese.¹ This number has grown from 56 percent since the last measurement a few years prior, and from 43 percent in 2007, when the organization started keeping track.²

We know many dog owners are simply unaware their pet is overweight—APOP calls this misalignment between the perception of what a healthy dog looks like and the reality of an ideal body composition the “fat pet gap.” We also know, even when dog owners recognize their pets’ extra weight, some tend to downplay it as “vanity pounds,” “extra padding,” or “fluff.” (If you spend any time at all on social media, you have probably gnashed your teeth as owners celebrate how cute their “chunky” pets are). However, science disagrees with this sentiment.

A number of studies show, compared to their normal-weight counterparts, overweight or obese dogs live shorter lives, get certain diseases earlier in life (which are likely or often comorbidities to obesity), and have a worse quality of life.^3-6

This translates to one simple reality; however hard it might be to face: We have to act. Our patients require it of us. Doing this requires accepting what you cannot change, but realizing the things we can, and be willing to take action to bring about this change (in both old and new ways).

For example, we should be aware of the breeds predisposed to obesity.^7-9 While we know we cannot change genetics, we also know environment can impact gene expression (regardless of whether a pet is predisposed).³ This is where we can have real impact. At its core, the solution boils down to what—on paper—looks like the world’s simplest math problem: calories out > calories in = weight loss. However, we all know it is not so easy.

Why can’t we get this right?

Getting daily calories right is simple in concept, but not so easy in practice. We tend to tell ourselves the ultimate barrier to translating our advice to positive outcomes is compliance, or lack thereof. We cannot discount this, but I think there are additional hurdles:

1. Accurate calculation of a patient’s daily calories. While the formulas we use might seem they can be quickly and easily applied, this is not always the case. We may be making assumptions dogs of a similar body weight and frame size might end up with similar caloric requirements, which is not true.¹⁰ There are many factors to consider, including body condition score, age, neuter status, and activity level.
2. Owner overestimation. Two studies demonstrate how owners not measuring their pet’s food properly is a very real issue, with another study showing up to 152 percent overestimation of portions by owners).^11,12Wide ranges in recommendations on food labels and variances in the types of “scoops” used are just two very common factors influencing inappropriate patient-specific measurement of portions. Further, feeding treats can add up to the daily calories, whether they are extras from owners’ plates, rewards for good behavior, or enticements to take medicine.

   In reality, we may chalk this up to “human error,” but there are accessible steps we can take to help reduce it.

What can we do?

This is perhaps the most difficult issue in confronting and effectively treating this disease: we have convinced ourselves our efforts may be all for naught because owners simply will not listen to obesity discussions.

However, this perceived resistance is mostly rooted in how veterinary professionals decide to approach the conversation. Fortunately, research tells us how we can increase the odds of client compliance.

1. Talk about obesity. We may have convinced ourselves owners do not want to have this conversation, but they do. Research shows the manner in which we approach it matters, but people are open to both discussions on obesity (almost 70 percent of owners, according to APOP, have never felt ashamed by this conversation) and in changing food behavior.^1,13
2. Talk about its consequences. Research suggests owners will pay attention to the fact obesity might lead to other health problems (reduced life expectancy, arthritis, etc.) even if they do not really pay much attention to obesity as its own disease. Make sure the context of this discussion is a team-oriented one: It is “us against the disease.”^13-15
3. Get more comfortable with calorie calculations, or hand this off to a trusted expert. For some, this may mean spending some time doing calculations with a number of patients to get used to the math and the process and tracking the results to fine-tune them. For others, this might mean assigning a dedicated expert in the practice to mastering these. Easier still, there are online tools that can help you accurately calculate calories. Or, if you want to avoid the calculation work entirely and save the time, there are dog nutrition companies offering this work for you via their in-house experts of board-certified nutritionists.
4. Encourage accurate portioning at home. If clients are used to measuring by the scoop or the can, this is best done by converting them to gram-scale weights. It will take just a little extra math on your side to turn “cups” into grams, but most companies provide detailed information in their nutrition guides to help do this math quickly. Naturally, if clients are getting already pre-portioned meals from companies that provide these, then this part is much simpler.

   It is especially important to get the client’s whole family involved in this process. In some cases, this can be done through take-home educational materials that everyone in the house can read. In other cases, you can give clients simple systems to keep the family on the same page. Here is one example: Families can have a container in the fridge or on the counter where the dog’s total daily caloric allotment goes. Only one person can fill the container each morning, but that is the only place that people can feed the dog from—so an empty container means no more food that day.

   Or, again, you can turn to dog food companies that provide services like pre-portioned food delivered on a set schedule. This eliminates portion inaccuracy and seamlessly reinforces the “no extra measurement” philosophy for owners.
   

5. Set up rechecks. You can decide on the type of appointment (doctor, nurse, etc.), and the cadence, but at least once monthly is a good start. No matter what, the whole team should be involved, and these should be scheduled, like any appointment. Use this time to make any caloric adjustments that you need, and to celebrate the success that the patient is having. Any progress is worthy of celebration.This not only likely keeps the client motivated, but also stands a good chance of engendering goodwill toward your practice and maintaining an “us against the disease” approach.

Where do we begin?

Not to oversimplify, but you start by starting; and give yourself grace.

Think back to the first time you had to give a cancer diagnosis, explain Cushing’s to an owner, or have a post-op conversation. Think of how long it took then versus how long it takes now. Expect the same with this process. Every time you do it, it will get easier, shorter, and less awkward. In no time, what feels like eternity now will be down to a 20-second, highly impactful “elevator pitch.”

On days when you feel like every pet you see is overweight/obese, and you start to lose heart, do the same thing you will be doing with owners. Focus on the good you will do by changing the lives of these dogs, the good and healthy years with that pet you may well give to those families who trust you, and the satisfaction of making a real difference. It is why we do what we do.

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Brandon Stapleton, DVM, was in private practice for nearly 10 years, where he was passionate about treating obesity, before moving into the animal health and nutrition industry. Dr. Stapleton currently serves as the head veterinarian for The Farmer’s Dog, the pet-food company making fresh, complete, and balanced, pre-portioned food for dogs. The Farmer’s Dog is a charter sponsor of APOP.

References

1. 2022 State of U.S. Pet Obesity Report. 2023. Association for Pet Obesity Prevention. [accessed 2023 Dec 17]; https://www.petobesityprevention.org/state-of-pet-obesity-report
2. 2018 & 2007 State of U.S. Pet Obesity Reports. 2019. Association for Pet Obesity Prevention. [accessed 2024 Mar 20]; https://www.petobesityprevention.org/2018
3. Kealy, RD, Lawler, DF, Ballam, et al. Effects of diet restriction on life span and age-related changes in dogs. J Am Vet Med Assoc. 2002;220:1315–1320.
4. Lawler DF, Larson BT, Ballam JM, et al. Diet restriction and ageing in the dog: major observations over two decades [published correction appears in Br J Nutr. 2009 Apr;101(7):1112]. Br J Nutr. 2008;99(4):793-805.
5. Salt C, Morris PJ, Wilson D, Lund EM, German AJ. Association between life span and body condition in neutered client-owned dogs. J Vet Intern Med. 2019;33(1):89-99.
6. 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(3):428-434.
7. Toll PW, Yamka RM, Schoenherr WD, Hand MS, Chapter 27: Obesity. In: Hand MS, Thatcher CD, Remillard RL, Roudebush P, Novotny BJ,eds., Small Animal Clinical Nutrition, 5th Ed. Mark Morris Institute; 2010: 509-510
8. Lund EM, Armstrong PJ, Kirk CA, Klausner JS. Prevalence and risk factors for obesity in adult dogs from private US veterinary practices. Intern J Appl Res Vet Med. 2006; 4: 177-186.
9. Corbee RJ. Obesity in show dogs. J Anim Physiol Anim Nutr (Berl). 2013;97(5):904-910.
10. Gross KL, Yamka RM, Khoo C, Friesen KG, Jewell DE, Schoenherr WD, Debraekeleer J, Zicker SC Chapter 5: Macronutrients. In: Hand MS, Thatcher CD, Remillard RL, Roudebush P, Novotny BJ,eds., Small Animal Clinical Nutrition, 5th Ed. Mark Morris Institute; 2010: 73-81.
11. German AJ, Holden SL, Mason SL, et al. Imprecision when using measuring cups to weigh out extruded dry kibbled food. J Anim Physiol Anim Nutr (Berl). 2011;95(3):368-373.
12. Coe JB, Rankovic A, Edwards TR, Parr JM. Dog owner’s accuracy measuring different volumes of dry dog food using three different measuring devices. Vet Rec. 2019;185(19):599.
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14. Churchill J and E Ward. Communicating with pet owners about obesity: roles of the veterinary health care team. Vet Clin North Am Small Anim Pract. 2016;46(5):899-911.
15. Sutherland KA, Coe JB, Janke N, O’Sullivan TL, Parr JM. Veterinary professionals’ weight-related communication when discussing an overweight or obese pet with a client. J Am Vet Med Assoc. 2022;260(9):1076-1085. Published 2022 Apr 15.