Fall 2020, Nutrition

Elements of a Successful Weight Management Clinic

Weight management clinics led by veterinary nurses allow for creation of more involved and closely followed individual weight management programs.

Nicola AckermanPGCert, RVN, CertSAN, CertVNECC, VTS (Nutrition)

Nicola has worked in the veterinary profession since 1994 and is currently the Head Medical Nurse at Plymouth Veterinary Group. She has written for many veterinary publications and textbooks and is the editor of Aspinall’s Complete Textbook of Veterinary Nursing. Nicola won the British Veterinary Nursing Association (BVNA)/Blue Cross award for animal welfare in 2010, and she was designated the SQP Veterinary Nurse of the Year in 2011 and the SQP Nutritional Advisor of the Year (2013). In 2012, Nicola was given the CAW Professional Development Award for outstanding service to the veterinary nursing profession. She is studying for a master’s degree in Advanced Veterinary Nursing from Glasgow University.

Elements of a Successful Weight Management Clinic
Usoltsev Kirill/Shutterstock.com
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Obesity in cats and dogs has reached epidemic proportions in the United States and around the world. Numerous health risks are associated with pets being overweight or obese; therefore, it is imperative that owners are educated regarding these risks and encouraged to promote weight loss in overweight pets. Weight management clinics led by veterinary nurses allow for creation of more involved and closely followed individual weight management programs. Such clinics benefit veterinary nurses, pet owners, veterinary clinics, and, most importantly, pets.

Many elements make up a weight management clinic, and setting up these clinics in practice can be very rewarding for all involved. Veterinary nurse–led clinics allow veterinary nurses to use their clinical judgment and obesity knowledge to take responsibility for weight loss programs.

STAFF RESOURCES

Before implementing an obesity clinic, veterinary nurses need to review what training requirements are needed by the whole team and ensure that all aspects are covered: communication skills, nutritional knowledge, and behavior. Some recommended resources are listed in Box 1.

BOX 1 Recommended Resources

  • Ackerman N. The Consulting Veterinary Nurse. Chichester, UK: Wiley Blackwell; 2012.
  • Pet Nutrition Alliance petnutritionalliance.org
  • World Small Animal Veterinary Association (guidance on nutritional assessments, diet history sheets, and how to implement nutritional assessments in clinics; available at wsava.org)
  • Wortinger A, Burns K. Nutrition and Disease Management for Veterinary Technicians and Nurses. Ames, IA: Wiley Blackwell; 2015.

Checklists can help in obtaining all the information required from the pet owner during clinic visits (Box 2). They can remind veterinary nurses of what questions to ask, ensure continuity between staff members, and be used as records in the clinical history.

BOX 2 Sample Checklist for Weight Loss Clinic Visits
Weight
Current body weight:________________________________________________
Ideal body weight:__________________________________________________
Body condition score:________________________________________________

Diet Information
Current diet:______________________________________________________
Treats:__________________________________________________________
Dental chews:______________________________________________________
Human foods:______________________________________________________
Number of meals per day:______________________________________________

Environment
Other animals in household:_____________________________________________
Access to other foods:________________________________________________
Exercise and play level:_______________________________________________

Other Information
Current health status:_________________________________________________
Current medication(s):________________________________________________
Suitable food weighing scales at home?_____________________________________
Any hindrances to completing the program?_________________________________
Any questions regarding the program?______________________________________

Recommendations
Diet and feeding plan:__________________________________________________
Exercise and play:___________________________________________________
Actions Weight loss graph? Yes/No
Neck, chest, hips, tail base measurements? Yes/No
Photos taken? Yes/No
Food diary:_______________________________________________________
Next appointment:__________________________________________________

OWNER BEHAVIOR AND PET OBESITY

Theoretically, weight loss can be achieved when the amount of calories consumed is less than an animal’s overall energy expenditure. Achieving the necessary reduction in calories and increase in energy expenditure in pets can be difficult, owing to owner education, owner compliance, lifestyle, and behavioral traits. The complex relationship between owner and pet therefore needs to be discussed as part of the weight loss program. Often, when obesity is addressed, the behavioral traits in the owner-pet relationship are compared with those between a parent and child,1 as pet owners have roles similar to parents (caregivers) in supplying food and using it as a reward.

Obesity treatment programs for humans that include behavioral interventions in conjunction with dietary changes and increased physical activity achieve higher success rates than those that do not include behavioral modifications.2 Pediatric obesity treatment programs that involve the whole family in intense behavioral interventions are more successful than those that do not, with the success of the programs related to the intensity of the behavior treatment.1 Such findings have implications for weight reduction in companion animals, with a positive correlation identified between the success of obesity treatment in dogs and behavioral changes of the owner.3 A standard obesity treatment program that included appropriate energy intake, monthly weight checks, and a structured maintenance period was sufficient to achieve these objectives.4

Owners of overweight cats indicate that they have a closer relationship with their cats than do owners of normal-weight cats, possibly with the cats serving as a substitute for human companionship.5 The “over-humanization” of the cats in these relationships may be related to weight gain. 

The role of patient behavior—both dogs and cats—in weight loss also needs to be discussed during the veterinary nurse consultation; therefore, understanding feline and canine behavior (especially feeding behaviors) is also important.

The extent of behavioral advice and its role in treating obesity (especially in cats and multicat households) is vast. Consultation of resources such as those listed in Box 1 is highly recommended.

FEEDING QUANTITIES

Success in obesity clinics also relies on gaining a full understanding of how much food the owner is providing the pet. A 4 kg (8.8 lb) cat consuming just 10 kcal/day (the equivalent of approximately 10 kibbles or 10 g of tuna) in excess of its daily energy requirements will gain 12% of its body weight in one year.6 Accurate measurement of quantities fed is therefore required. As feeding scoops have proved to be very inaccurate,7 weighing out the daily portions should be the only method recommended for determining the amount being fed.

Diet history forms can be used to gain insight into an animal’s current energy intake and to record the initial nutritional history at the first clinic visit. A sample form created by the World Small Animal Veterinary Association can be seen below and downloaded here. However, obtaining a full nutritional history might need to be completed over a couple of visits, as the owner might not know how much they feed or even what brands.

Owners should be encouraged to keep a food diary for their pet. A study of weight loss in humans showed that people who kept a record of what they ate were more successful.8 However, a surprising aspect of this study was the reluctance of people to participate in recording what they had consumed, perhaps because they were worried about being judged for it. For owners who are willing to undertake a food diary for their pet, long-term use of the diary may become a motivator to stay with the program.

Graphs that show weight loss can also be a motivating visual prompt (Figure 1). Graphs can be based on biometric measurements, such as weight, or morphometric (body shape) measurements, such as the diameter of the chest, neck, waist, and tail base. It is common for animals to not lose weight according to the scale but to lose centimeters around the waist. Seeing a record of these measurements can act as a real incentive for the owner to continue the weight loss plan.

EXERCISE AND OBESITY

If weight loss can be achieved by expending more calories than consumed, increasing calorie expenditure through increased exercise can aid in weight loss. More importantly, exercise helps to preserve lean tissue during a weight loss program and to maintain metabolism at a higher level.

Along with a food diary, owners can be encouraged to keep an exercise diary. For dogs, exercise can be monitored accurately with movement devices, GPS collar monitors, and apps that map walks with the owner. In the author’s experience, some dog owners have difficulty judging walking distances, and most overestimate the exercise their dog gets. As part of increasing exercise, however, owners need guidance on the difference between quantity and quality. A 1-hour walk with the dog “plodding” along beside the owner burns fewer calories than a half-hour walk during which the dog is engaged in intense physical activity.

Cat owners can benefit from a discussion of natural play activity in cats. Anecdotally, many owners expect cats to play for periods longer than a natural feline pattern. Cats prefer to play for a few minutes several times each day than to play for one half-hour session. Play activity in cats needs to replicate hunting behavior, which involves many short, high-intensity bursts.9 These types of activity can be replicated through the use of toys that move on their own or have elements that move (e.g., feathers), toys that are meant to be moved by the owner, and toys that swing. The size of the toy needs to be appropriate to the size of the cat.

Environmental enrichment for cats (especially indoor cats) is very important. Cats explore their environment in 3 dimensions, and their home environment should take this into account. Cats should have the ability to climb and sit up high on safe platforms if they wish.

DIET

Once food and exercise amounts have been recorded, a feeding plan and an exercise plan can be created. In some cases, decreasing the pet’s daily energy intake to the correct level and instituting an appropriate exercise plan can be enough for the animal to attain and maintain a healthy weight. However, some pets require weight loss diets. The Pet Nutrition Alliance website (petnutritionalliance.org) is a good resource for details on how to create nutrition plans and it even provides species-specific calorie calculators.

The specific diet recommended needs to be the one most appropriate for the animal—its life stage, age, and any specific nutrient requirements (e.g., for animals with chronic health conditions)—and the owner. Owner considerations may include financial constraints, personal mobility, and ethical requirements, such as the desire to feed “organic” or “natural” diets. Veterinary nurses need to listen to these needs with regard to what the owner can realistically achieve for their pet. For example, if the owner has reduced mobility, they may not be able to exercise an obese dog to attain its ideal target body weight, but some weight loss will still be beneficial for the dog.

Treats should not constitute more than 5% of the pet’s overall daily energy intake, and all family members need guidance on this restriction. If an owner is unwilling to stop giving treats, these extra calories need to be calculated and added to the daily intake. Recommendations could include using lower-calorie treats or using the weight loss diet as “treats.” Owners should be reminded that a “reward” does not have to be food. Play, social interaction, grooming, exercise, and toys can all be used as rewards.

All topics discussed should be written down for the owner so that they have the details to take home with them. A copy of the completed checklist in Box 2 may be useful in this regard, as well as placed in the patient’s medical record.

PREVENTION

As with most things, prevention of obesity is better than treatment, but once a pet becomes a candidate for a weight loss clinic, only management is an option. Veterinary nurses should start the conversation about appropriate weight early and continue it often with pet owners. Teaching new puppy and kitten owners about monitoring body condition score (BCS) rather than ideal breed weights is recommended and can be facilitated through a hands-on approach. Every time an animal visits the practice, it should be weighed and have its BCS and muscle condition score (MCS) assessed and recorded on the clinical history. Weight changes should be highlighted to the owner and addressed. Long-term weight charts can also be used to visually show any increase (or decrease) in weight. During a weight loss program, MCS should be monitored to ensure that muscle mass is not also lost.

Discussions about obesity prevention at key times has been shown to decrease obesity prevalence later in life. Veterinary nurse–led post-neutering clinics that showed owners how to judge BCS, discussed obesity prevalence, and gave dietary recommendations halved pet obesity rates later in life in one study.10 Neutering has been highlighted as a major risk factor in development of obesity, so reiteration of key messages about preventing obesity when a pet is neutered is a vital role for veterinary nurses.

FOLLOW-UP AND MONITORING

With all nutritional consultations and veterinary nurse–led clinics, it is important to monitor and follow up on the progress of clients. Making clear recommendations to clients is key to success. The CRAFT model (Box 3), developed in 2009, shows that for compliance to be successful, the follow through aspect of the equation is required.11 Following through can take all different forms of communication with an owner, such as a phone conversation, email, text, or repeat consultation. Discussing with the owner at the initial consultation which form of communication works best for them can really aid in following through.

BOX 3 The CRAFT Compliance Equation11
C = R + A + FT

Compliance = Recommendation + Acceptance + Follow Through

Achieving compliance requires a good, clear recommendation, as well as client acceptance of that recommendation. However, even with client acceptance, compliance is often poor because the follow-through component is lacking. Reasons for failure of clients to follow through include forgetfulness, financial and time constraints, and unclear recommendations. Follow-through by the clinic is therefore essential.

MOTIVATION

The success of an obesity clinic lies in owner compliance and motivation to succeed. The role of the veterinary nurse in these cases is to help motivate the pet owner in continuing with the weight loss program. Motivation can be achieved by educating the owner on the effects of obesity on the animal and the long-term medical consequences. Some owners need more motivation than others, and even small reductions in weight or waistline, chest circumference, and neck width measurements will need to be highlighted and celebrated to keep them on track.

Primary reasons for dog and cat owners to enroll their pet in a weight loss program include personal recommendations from a veterinarian or member of the veterinary healthcare team.12 Identification of overweight patients, together with client education, is therefore essential. Obesity treatment programs that include dietary changes and monthly evaluations of body weight by members of the veterinary healthcare team are reported to be the most successful.12

KEY POINTS

  • Owner motivation needs to be maintained throughout the weight loss program, and the practice needs to provide support.
  • If weight loss is not being achieved, all factors need to be reviewed: diet, lifestyle, and quantity and quality of exercise.
  • All practice team members need to promote obesity clinics. A recommendation from a veterinarian always helps with compliance.

References

1. Epstein LH, Myers MD, Raynor HA. Treatment of pediatric obesity. Pediatrics 1998;101(3 Pt 2):579-584.

2. Cowburn G, Hillsdon M, Hankey CR. Obesity management by life-style strategies. Br Med Bull 1997;53(2):389-408.

3. Laflamme DP, Kuhlman G, Lawler DF. Obesity management in dogs.
Vet Clin Nutr 1994;1:59-65.

4. Yaissle JE, Holloway C, Buffington CAT. Evaluation of owner education as a component of obesity treatment programs for dogs. JAVMA 2004;224(12):1932-1935.

5. Kienzle E, Bergler R, Ziegler D. Human-animal relationship of owners of normal and overweight cats [abstract]. Proc Waltham Int Nutr Sci Symp 2005:22.

6. Michel KE, Scherk MA. From problem to success: feline weight loss programs that work. J Feline Med Surg 2012;14(5):327-336.

7. 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):368-374.

8. Gregory R, Walwyn L, Bloor S, et al. A feasibility study of the use of photographic food diaries in the management of obesity. Pract Diabetes Int 2006;23(2):66-68.

9. Yaguiyan-Colliard L, Diez M, German A, Lloret A. Tackling obesity in cats. ISSUU. issuu.com/corecph/docs/inside_pages_a5ff43014fa0a8. Accessed August 2020.

10. Ackerman N. The importance of veterinary nurse led nutritional consultations in obesity prevention. 18th Annu AAVN Clin Nutr Res Abstract Symp Proc 2018:10.

11. American Animal Hospital Association. American Animal Hospital Association Compliance Study Executive Summary. aahanet.org/PublicDocuments/ComplianceExecutiveSummary0309.pdf. Accessed March 2020.

12. Roudebush P, Schoenherr WD, Delaney SJ. An evidence-based review of the use of therapeutic foods, owner education, exercise and drugs for the management of obese and overweight pets. JAVMA 2008;233(5):717-725.

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