Statement, sessions, and toolkit address the excess weight so common now in cats, dogs, and horses
September 12, 2018
The veterinary profession should formally recognize canine and feline obesity as a disease, according to a position statement from the Global Pet Obesity Initiative. The statement also calls for the profession to adopt a uniform definition of canine and feline obesity as 30 percent above ideal weight and a universal system for body condition scoring on a scale of 1 to 9.
The AVMA Board of Directors endorsed the position statement in June. At July's AVMA Convention 2018 in Denver, the AVMA Future Leaders Program introduced Promise: A Campaign for Healthy Weight Management, which revolves around a toolkit to help AVMA members address the excess weight so common now in cats, dogs, and even horses.
On July 16, a series of three sessions covered human and pet obesity, practical weight-loss strategies for pets, and the new toolkit. Key elements of the toolkit include client questionnaires, questionnaire interpretation sheets for veterinary staff, examples of 30-day pledges clients can make to help their pets, templates for follow-up communication by staff, and tips on communication techniques for staff.
Human and pet obesity
The session "Human and Pet Obesity: A One Health Perspective" featured a panel consisting of Dr. Julie Churchill, a veterinary nutritionist at the University of Minnesota; Dr. Ernie Ward, founder of the Association for Pet Obesity Prevention; and Matthew Haemer, MD, a pediatrician at Children's Hospital Colorado.
"The definition of obesity in children tracks backward from the definition of obesity in adulthood," Dr. Haemer said. A body mass index above the 95th percentile in children corresponds with an adult BMI of 30, and a BMI of 30 or higher is considered obese.
Dr. Ward said veterinary medicine lacks definitions of obesity. Drs. Ward and Churchill worked with Dr. Alexander J. German, a professor of small animal medicine at the University of Liverpool in England, on the position statement from the Global Pet Obesity Initiative. They settled on a definition of canine and feline obesity as 30 percent above ideal weight.
"We felt that if we went to a 20 percent number, which had been used sometime in humans, that we would then suddenly diagnose every dog and cat in America," Dr. Ward said.
Veterinarians in the United States tend to assign body condition scores on a scale of 1 to 5 or a scale of 1 to 9. The Global Pet Obesity Initiative recommends a whole-integer scale of 1 to 9 for better accuracy.
"The third thing that we were striking out to do was actually to say that pet obesity is a disease, following our human counterparts' move," Dr. Ward said. In 2013, the American Medical Association's House of Delegates adopted a resolution to recognize obesity as a disease.
Dr. Churchill said animals that are 30 percent or more above ideal weight have metabolic changes, abnormal functions in many organ systems, clinical signs, and a decrease in lifespan.
Dr. Haemer said part of the approach to obesity is sensitive communication. He said, "For many, the pushback related to medicalizing or diagnosing obesity as a disease is the fact that, among the U.S. population, the term 'obesity' is a stigmatizing term."
Among pediatricians, he said, "In our communication with families, we use terms such as 'an unhealthy weight' or 'an unhealthy BMI' to bring it back out of the stigmatizing conversation to the basic health communication that this is a health risk associated with a weight status, and it's also something that we can do something about."
Dr. Churchill said: "I learned what not to say mostly because I made all the mistakes, and so really my passion is that we all think of it as a disease from the profession, that we put it in our hearts and minds because it is the way we approach our patients to achieve greater health."
Practical weight loss
The session "Over the Hurdles and Through the Hoops: Practical Weight Loss Strategies for Obese Pets" featured Dr. Ward; Garnetta Santiago, a veterinary technician previously in practice and at Hill's Pet Nutrition and now with Zoetis; Dr. Daniel Brod of Companion Animal Hospitals North America; and Dr. Aimee Eggleston Ahearn of Eggleston Equine LLC.
Dr. Ahearn advised veterinarians to ask clients what everyone in the family is doing for nutrition and treats for the animal. Dr. Brod suggested simply saying, "Tell me what you feed your pet." Santiago recommended adjusting communications to the situation. Dr. Ward said not to chase a number on a scale, but seek to improve quality of life.
The concerns with crash diets are loss of lean muscle mass and other metabolic dysregulation, Dr. Ward said. Santiago said the practice should celebrate a 20-pound cat losing half a pound in a month. Owners tend to want to see faster progress, particularly if they have switched to a more expensive food. She said, "What they're wanting is: 'If I'm going to pay $80 a bag, I want to see that cat at 15 pounds in six minutes.'"
Dr. Ahearn said horse owners want to focus on how much the horse needs to lose. She said, "It really depends on the breed and the type of horse and where their fat deposits may be, where they're overweight." She will tell clients to check in at a month and sometimes leave the goal ambiguous.
Dr. Ward asks what the clients want the dog or cat to be able to do, such as get out of the car or go up the stairs. He said, "It's those little victories that I think make the most difference." He talks less about obesity and more about chronic inflammation. While a cat might have lost only a pound, the risk factors for other co-morbidities went down dramatically.
Santiago said obesity requires a treatment plan with follow-up visits. Dr. Ward said technology will help enhance the ability to care for chronic conditions such as obesity. Santiago said the cases where she has had success have had a lot to do with the relationship between the client and the entire veterinary team.
Dr. Brod said the worst thing for a pet owner is to have a pet not eat. One trick is to provide a list of treats with calorie counts. What he would like to see is coaching and mentorship in the examination room for new veterinarians to be comfortable addressing clients about pet obesity.
The 2017-18 class of the Future Leaders Program reviewed current literature on obesity in pets and looked at the implications of obesity in humans. Then the group put together the toolkit involving client questionnaires and pledges.
Dr. Alina Vale, a member of the class, said in an interview with JAVMA News, "The veterinarian in practice asks questions using motivational interviewing to find out what the root cause is of the obesity in the pet and then help think through some pledges that the client could do at home."
Instead of telling the client what to do, she said, the veterinarian can use the questionnaire and pledges so that the pet's weight-loss program is more the owner's idea, meaning the owner is more likely to stick with the program.
Owners can choose among the following pledges:
To go for a walk or jog with the pet for a certain number of minutes and times per week.
To arrange for someone else to exercise the pet when the owner is unable to do so.
To play fetch or do another form of physical activity with the pet for a certain number of minutes per day.
To ensure others in the home understand the healthy weight goals for the pet.
To measure the correct amount of food.
To follow feeding guidelines of a specific diet, amount, and frequency.
To use praise, grooming, and attention instead of treats to reward good behavior.
To feed healthy treats approved by the veterinarian.
To separate pets for a certain number of minutes during meals or until the pets have finished eating.
Participants in the Future Leaders Program tested the toolkit in a pilot program with practitioners, gathering feedback to polish the final product.
Dr. Vale is an equine veterinarian in San Diego who does consulting work. She said obesity in horses actually is a big issue. She was in denial about her own horse being obese, even though she knew he was overweight. She has been working on weight loss with him, and he lost about 100 pounds in six months.
The obesity toolkit is available to AVMA members online. Along with the campaign materials, the website provides a listing of links to other resources to help veterinarians manage overweight and obese pets, from background information on the prevalence and health concerns of obesity to scoring sheets for body condition to calorie calculators.
3 success stories
The obesity toolkit from the AVMA has seen some success stories, including the following:
A Chihuahua, which had a body condition score of 5 on a 5-point scale, was getting five Milk-Bones a day. The dog lost weight after receiving one treat broken up through each day.
The owner of a Dachshund had taken her dog on daily walks until the dog took off after a squirrel and the owner broke her foot. The Dachshund reached a BCS of 5 on a 5-point scale but lost weight after resuming daily walks.
A horse used for pleasure riding had a BCS of 8 on a 9-point scale. The horse dropped to a BCS of 6 with a tailored nutrition and exercise routine.
Before and after
The obesity toolkit from the 2017-18 class of the AVMA Future Leaders Program is available to members online.