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July 01, 2021

Nutritional conversations, front and center

Veterinary experts suggest steps to navigate nutrition and diet
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Dr. Julie Churchill knows food is intertwined with how people show care and love to each other and their animals.

Dr. Churchill, a professor in clinical veterinary nutrition at the University of Minnesota College of Veterinary Medicine and a board-certified nutritionist, said, “Nutrition and nurturing are linked.” Which may be why over half of the dogs and cats in the U.S. are overweight, according to data from the Association for Pet Obesity Prevention. Nearly 70% of pet owners said they would like veterinarians to recommend a diet for their pet, according to survey results from APOP from 2018.

Dr. Churchill with a client
Dr. Julie Churchill reviews nutritional recommendations with a client whose cat has hypertrophic cardiomyopathy and was formerly overweight. (Photos courtesy of Dr. Churchill)

Pet food and treats totaled $42 billion in sales in the U.S. in 2020, according to data from the American Pet Products Association.

Nutrition is an integral part of proactive veterinary care. Sometimes it can be a simple topic to discuss with clients, and other times conversations about nutrition and diet can be fraught with challenges. Veterinarians can navigate them by leveraging tools such as sending a nutritional assessment before examinations, teaching pet owners about body condition scores, and implementing empathic communication techniques.

Dr. Churchill said pet owners want these conversations, and veterinary teams must have them.

“We (societally) lose sight of what healthy looks like. We are not used to what a healthy pet looks like or feels like,” said Dr. Churchill, a board member of the Association for Pet Obesity Prevention and the Pet Nutrition Alliance. “We (as veterinary teams) have to be the antidote to that.”

Overhead view of overweight Sasha
Sasha, a 2-year-old Chihuahua, was brought to the University of Minnesota for nutritional services and assistance with weight management. Her initial weight was 25 pounds.
Overhead view of slim Sasha
Sasha, after about two years of weight management and nutritional services, lost about half her body weight and is at a healthy weight of 12.5 pounds.

Starting the conversation

Kara Burns, a licensed veterinary technician with a specialty in nutrition, said veterinary teams should start a discussion with open-ended questions.

Slim Sasha looking at the camera

“I ask what is being fed and why,” Burns said. “Pet owners typically have a reason for their choice of food. To fully understand the pet owner and their decision, we have to ask, ‘Why?’”

For example, pet owners may be vegetarian and feed their pets a vegetarian diet as well, which is important information for a veterinary team to have when discussing nutrition. The team should educate pet owners on the nutrients animals may need in their diet.

Burns is president of the Pet Nutrition Alliance, an organization dedicated to raising awareness around integrating nutritional assessment into veterinary care and promoting veterinary teams as sources for pet nutrition information. The PNA has calorie calculators, tools for creating nutrition plans, and resources for understanding pet food. The PNA offers a client communication resource (PDF).

Dr. Sarah Abood, founder of consulting firm Sit, Stay, Speak Nutrition, speaks with veterinary team members who don’t feel comfortable discussing nutrition and diet because they are such multifaceted topics.

Dr. Abood suggests figuring out what the root of that anxiety is. It could be a fear of not having enough time during an examination, a concern about owner compliance with diet suggestions, or a feeling of not wanting to fight with a client who may already have researched diets and doesn’t want advice from the veterinary team.

A lack of belief in science and evidence is also a concerning extra layer to a nutrition conversation, Dr. Abood said. However, in her experience, many pet owners do want to talk about nutrition with their veterinary team.

Dr. Churchill said nutrition will typically come up during an examination because clients want advice. She prepares clients for the conversation before an appointment by sending a note before the visit.

“It sets the mindset that we are a nutritional-focused practice,” she said. “If you ask them ahead of time, they’re able to take pictures beforehand, and it is easier so they don’t have to remember the name,” of pet foods and treats.

Dr. Jackie Parr, a clinical assistant professor of nutrition at the University of Georgia College of Veterinary Medicine, says her service won’t see clients for nutritional services until they’ve submitted a diet history form.

Dr. Parr, a board-certified veterinary nutritionist, said veterinary teams have been talking about nutrition for decades. Questions about vomiting, skin or coat issues, and bowel habits are all related to nutrition.

She also suggests telemedicine appointments can make nutrition conversations even easier.

“There is a lot of important information that can be captured,” she said. “Two partners can join a video call over their lunch break. More family members can be on together. With telemedicine, we can reiterate a plan to the whole family.”

WSAVA score chart
The World Small Animal Veterinary Association body condition score chart for cats (Enlarge)

On board

Dr. Churchill said training pet owners how to assign a body condition score can also be beneficial. It can keep them involved and aware of their pet’s health. A body condition score is an estimate of body fat percentage and is used in conjunction with body weight and a muscle condition score. The most common body condition scoring systems use a nine-point scale.

Dr. Churchill tells clients to do an assessment once a month.

Dr. Joseph Bartges, a professor of medicine and nutrition at Georgia’s veterinary college and a board-certified veterinary nutritionist, said the body condition score is critical.

“It is easy to say that a cat looks thin, but the body condition score provides an actual number,” Dr. Bartges said. “If you quantify the information, you can notice trends and head them off.”

There is also variation in weight within breeds. For example, a male Labrador may weigh between 80 and 100 pounds, he said. What is its healthy weight? A body condition score can help determine that.

University of Minnesota screening card
A University of Minnesota screening card for nutritional risk factors adapted from the American Animal Hospital Association’s Nutritional Assessment Guidelines for Dogs and Cats

Talking through challenges

Dr. Churchill said there are always challenging conversations.

“Sometimes it is not the right time in a family’s life,” she said. “They have other things, especially during the pandemic. There are a lot of other problems. Plant seeds of concern, and give them permission not to act now, but let them know when they’re ready, you’ll be there.”

Dr. Abood agrees. She said veterinary teams will have less anxiety and frustration around conversations related to nutrition if they assume not every client is ready to make a change.

“Think about it as an ongoing conversation,” Dr. Abood said. “ They’re not always ready to make a commitment. They need motivation and support. If you have a philosophy where you think about it as ongoing support, it will be easier to keep engagement.”

Dr. Bartges added that despite the potential challenges, there is no excuse not to talk about nutrition.

“As a priority, it should be high,” he said. “All dogs and cats have to eat. It’s 100%.”

The veterinary nutritional experts suggest the following tips for talking about nutrition:

  • Don’t enter a conversation with preconceived notions.
  • Use the whole veterinary team to promote nutrition and share information.
  • Consider adding a nutrition section on the clinic’s website.
  • Include communication around nutrition in every examination.
  • Ask open-ended questions.
  • Don’t suggest only one diet or one brand.
  • Educate yourself on different foods and diets. 
  • Be open to hearing about a diet you may not know about, and be willing to learn.
  • Send a note before an appointment to ask about nutrition and diet. 
  • Use tools and resources on nutritional assessments and body condition score charts.

Dr. Churchill said being nonjudgmental and empathetic are also key.

“Take the judgment out of the conversation,” she said. “Most obese pets I meet, they’re all loved.”

Partnering with pet owners on nutrition

Slides 1 and 2: Dr. Julie Churchill discusses how she involves pet owners in nutritional conversations, including teaching them about body condition scores. Slide 3: Hannah Rasmussen, a veterinary technician, helps Dr. Julie Churchill perform a nutritional and body condition score assessment on a patient.

The AVMA offers nutrition resources.

For members, the AVMA also offers communication tools (PDF) for nutrition conversations.