The fat factor
There’s the case of the 67-pound Beagle who lost two-thirds of her weight. Then there’s the case of the 68-pound Dachshund that died. And then there are the millions on millions of other pets that are obese or at least overweight.
The situation parallels society’s struggles with weight. More than one-third of U.S. adults are obese. In June, the American Medical Association adopted a policy stating that obesity is a disease, requiring a range of medical interventions.
In veterinary practice, the problem of overweight pets has become a steady undercurrent. Awareness is increasing, though, alongside resources for treatment.
The challenge remains for veterinarians to prioritize the issue. Although prescribing a program of diet and exercise sounds simple in theory, weight management can be far from simple in practice.
A big battle
Estimates of the prevalence of overweight and obese cats and dogs in the United States range from less than 25 percent to more than 50 percent. A 2012 survey by the Association for Pet Obesity Prevention found that 58.3 percent of cats and 52.5 percent of dogs in the United States were overweight.
Dr. Ernie Ward, founder of Seaside Animal Care in Calabash, N.C., established the association in 2005 to shine a spotlight on the problem.
“I was seeing an increased number of overweight pets and, of course, correspondingly I was seeing an increase in the conditions and diseases that are exacerbated or brought about by excess weight, so this became a real personal thing for me,” Dr. Ward said.
He said awareness of the issue exploded between 2007 and 2010. Now the topic permeates veterinary conferences, and the public has come to understand that pet obesity is a problem.
Nevertheless, public awareness suffers from a “fat gap.“ According to the Association for Pet Obesity Prevention, 45.3 percent of cat owners and 45.8 percent of dog owners assessed their pet as being normal weight when their veterinarian assessed the pet as being overweight.
Dr. Ward said veterinarians need to initiate the conversation with clients about a pet being overweight—or someone with less expertise will do so. The discussion can be particularly difficult if the client or the veterinarian is overweight, too.
“Veterinarians need to understand our position and role in this fight against all of our expanding waistlines is bigger than just the dog or the cat that you’re seeing,” Dr. Ward said.
While veterinarians won’t win in every case, he said, the topic should remain at the forefront.
Complexity of the cure
Jasmine is among the weight-loss success stories. The 10-year-old Miniature Schnauzer was overweight and had a history of joint problems, hyperlipidemia, and cardiovascular disease. Losing weight has resolved the joint problems and hyperlipidemia.
The dog was one of the first patients at the new Tufts Obesity Clinic for Animals. The Cummings School of Veterinary Medicine at Tufts University opened the clinic in 2012 to provide weight management and conduct research.
“Weight management in cats and dogs can be very challenging and confusing for owners,” said Dr. Deborah E. Linder, the nutritionist who oversees the clinic. “I would hear frequently owners were told to just ‘feed less,’ but the weight wasn’t coming off, and they would get discouraged.”
The Tufts obesity clinic is investigating approaches to make weight loss safer for pets and easier for pet owners and veterinarians. Dr. Linder is examining the risk of nutrient deficiencies with calorie restriction.
Despite the complexity of weight loss, Dr. Linder sees obesity as a curable condition. Plus, she enjoys the close relationships she develops when working with pet owners to help pets lose weight.
“I recommend veterinarians become more of a coach and partner helping owners achieve weight-loss goals in their pets, instead of the typical doctor-patient relationship,” Dr. Linder said. “Owners are much more invested if it’s their plan you’re helping them with instead of your plan that they need to obey.”
Resources for treatment
Many veterinary associations and pet food companies have been focusing more on overweight pets in recent years.
In 2008, the AVMA and Hill’s Pet Nutrition formed the Alliance for Healthier Pets—Obesity Awareness and Prevention Program. The short-term initiative provided materials for veterinary clinics and incorporated a campaign to increase public awareness of the health consequences of pet obesity.
The American Animal Hospital Association has been advocating for nutritional assessments for every pet at every veterinary visit, including an assessment of weight. In 2010, with a grant from Hill’s, AAHA released nutritional assessment guidelines as a resource for veterinarians. The guidelines cover animal factors, diet, feeding management, and environment.
At the same time, AAHA established a consortium to promote the important role nutrition plays in pet health, now under the name of the Pet Nutrition Alliance. The members are AAHA, the AVMA, the American College of Veterinary Nutrition, and other veterinary organizations. The sponsors are pet food companies.
This year, AAHA plans to release guidelines specific to weight management. Obesity is actually a form of malnutrition, emphasized Dr. Kate Knutson, AAHA president and chair of the Pet Nutrition Alliance.
Echoing that sentiment is Dr. Daniel S. Aja, Hill’s director of U.S. professional and veterinary affairs. He said Hill’s recently worked with the University of Tennessee to develop the Healthy Weight Protocol, a tool to determine the ideal
body weight of overweight cats and dogs. Hill’s introduced the tool in January with a new weight-loss diet, Metabolic.
“It has given veterinarians a voice when they go into the exam room to talk to clients,” Dr. Aja said. “It’s objective. It isn’t me saying, ‘Boy, the dog looks a little heavy,’ or you saying, ‘Doc, I think he’s normal weight.’”
Other associations and companies also have turned their attention to overweight pets, offering a variety of resources and products.
Treating the disease
Dr. Joe Bartges, a nutritionist at the University of Tennessee College of Veterinary Medicine, agrees that people have become more aware of the problem of pet obesity.
“There is more of an awareness of it with dogs and less of an awareness and appreciation of it with cats,” he continued. “An 18- or 20-pound cat is just this nice big fat cat.”
Dr. Bartges believes the veterinary profession must push the message that obesity is a disease—and must treat obesity as a disease, like any other.
He suggests making a body condition score part of every physical examination. For an overweight pet, the next step is to take a team approach, enlisting the owner as well as practice personnel. The team starts with one diet and exercise plan, and, if necessary, moves on to others, monitoring the pet’s progress.
“Be creative with treatment, realizing there are options—that if one diet, one treatment plan doesn’t work, there are other options available,” he said.
The nutrition center at the Tennessee veterinary college sees many cases of pet obesity. The center offers a “fat camp” for some pets to stay on-site for a week or longer to begin losing weight.
Dr. Angela Witzel, one of the nutritionists, even adopted a 67-pound Beagle, Mabel. Mabel’s previous owners had surrendered her to a shelter because she was too large for them to care for. Dr. Witzel helped Mabel get down to 23 pounds between winter 2012 and spring 2013.
Doing better
Not every story has a happy ending. The account of a 68-pound Dachshund was one of the most striking points of a talk by Dr. Julie Churchill, a nutritionist at the University of Minnesota College of Veterinary Medicine.
Dr. Churchill was speaking at the AAHA conference in March about tips for weight management. The Dachshund, Chloe, served as an example of an extreme case.
“She died because of the sequelae secondary to many of the problems exacerbated by obesity,” Dr. Churchill said.
Despite the careful phrasing, Dr. Churchill considers obesity itself to be a disease. Just being overweight can have health consequences, she said.
“If we assess every pet, every time, and do a recommendation to ward off (weight gain) before they get to be Chloes, I think we can do better,” Dr. Churchill said.
Dr. Churchill’s approach to weight management revolves around owner commitment, individualized programs, and regular rechecks. Of these, owner commitment is the most important.
A client must be ready to make changes, but the veterinarian can set the stage. Dr. Churchill gets the client’s perspective, asks about challenges, and brainstorms solutions. She talks upfront about relapses.
Most of all, she strives to provide empathy rather than pass judgment.
“I have never seen an overweight patient that wasn’t loved,” she said.
