Successful weight loss programs (Proceedings)

Obesity is the most common nutritional disorder affecting dogs and cats in the United States (and, now, other countries), and its treatment is extremely challenging.  Therefore, it is important to try to prevent obesity – this is much easier than treating obesity once present.  Feeding directions are required on pet food labels but the quality of the information varies greatly.  Feeding directions should be viewed only as a starting point for an individual animal. The veterinarian and the owner must monitor the individual animal's response.  Owners can be taught to accurately assess body condition at home to so that they can adjust the amount of food during growth spurts and plateaus to maintain a trim body condition (between 4 and 5 on a 1-9 scale).  

Adjusting the amount of food is particularly important after neutering the pet, at which time the energy requirements decrease 10-15% within a very short time of the surgery.  Be sure to talk to the owner about treats and table food as these can be a major contributor to obesity.  Puppies and kittens should eat a food that has gone through feeding trials for growth until they are 1 year old (18 mos for giant breed dogs).  If they are becoming overweight before 1 year of age, they should be switched to a puppy or kitten food that is lower in caloric density but still meets the requirements for growth.

If prevention does not work and the animal becomes overweight, a weight loss program must be designed to achieve the optimum body weight.  The key to successful weight reduction is a comprehensive program - this means controlling the calories (from all sources), increasing exercise (if possible), and changing behaviors that contribute to obesity.  The bottom line is that to achieve weight loss, a reduction in calories below baseline requirements is necessary.  All calories from pet food, treats, and table food must be addressed.  To do this, it is critical to get a thorough diet history.  Most owners will easily admit to the type of pet food and the amount, but it is often more difficult to get a complete story on treats, table food, and other sources of calories without asking very specific questions about these areas.  This history can be obtained by having the owner complete a diet history form while waiting or by having a trained veterinary technician administer it.

Once the diet history is reviewed (additional clarification may then be needed), a plan can be made that will avoid the problems encountered with the individual owner/pet.  This plan must control of the quantity and type of pet food, restrict treats and table food, limit access to all other sources of calories (children, other pets, neighbors, grandparents, etc), and provide exercise.  First, an initial goal weight should be selected.  This should be a reasonable goal for the owner (ie, if a 25 pound cat really should weigh 12 pounds, a reasonable initial goal might be to lose 6 pounds).  Owners can easily get discouraged if the initial goal is unreasonable.  Also, if they are successful in the initial goal, they are much more willing to continue.  Caloric requirements to reach the initial weight goal can be calculated as follows:

RER (in calories/day) = 70 (goal weight in kg).0.75

I use the RER for the goal weight as the daily calorie requirement (ie, I do not use an activity factor to calculate a MER).  Reducing the number of calories eaten requires controlling both the pet food and the treats and table food.  The total number of calories required per day is then divided by the pet food selected to determine the number of cups or cans required per day:

Calories/day ¸ calories per can or cup = cans or cups/day

The total amount of food/day should be divided into at least two meals per day.  The new food should be introduced gradually and the owner should monitor for changes in feeding behaviors.  If the pet appears hungry in between meals, dividing the food into additional meals (TID or QID) may be helpful.  The owner must be instructed to measure the foods exactly at each meal to prevent overfeeding.  It is recommended to select a diet that is reduced in calories compared to regular diets.

Generally, a diet that is reduced in calories will allow a larger volume of food to be fed which is helpful for most overweight dogs or cats.  A reduced calorie food also makes it less likely to have nutritional deficiencies from feeding extremely small amounts of a higher calorie food.  Be careful about just making a general recommendation to the owner to switch to a "low calorie” pet food because many of the diets that are marketed as low calorie diets may not be very low in calories.  Pet foods marketed as "weight reduction" diets can vary tremendously in terms of calorie density!   So, it is important to select a specific diet for overweight cats and to recommend a specific amount to feed (feeding directions often overestimate the amount of food required).

Other properties that may differ between different brands of reduced calorie diets include protein and fiber content.  There is speculation that a higher protein content in reduced calorie diets may be helpful in maintaining lean body mass.  Certainly, if protein is restricted (this can unintentionally be a problem in cats that require severe calorie restriction in order to lose weight).  There also are high protein/low carbohydrate diets marketed for weight loss – these have no magical properties and animals will not lose weight when eating them unless the total calories are sufficiently restricted (which can be difficult with these diets because of their high calorie density).  Some reduced calorie diets are low in fiber while others are high in fiber. 

The effect of fiber on satiety is controversial but high fiber diets may be useful, particularly in animals that appear especially hungry when on a weight reduction diet.  Fiber content does alter fecal characteristics and owner preferences may dictate the type of diet selected.  Diet changes should be made gradually, particularly when transitioning to a high fiber diet.

Some owners are able to completely discontinue treats and table food but others will need recommendations for acceptable treats.  If the owner would like to give treats, work with them to determine a reasonable number of treats/day and the calories provided by the treats should be subtracted from the amount of pet food recommended.

Monitoring

Dogs and cats are individuals and can vary tremendously in their calorie requirements.  Some may require more calories than you initially estimate in order to have safe, steady weight loss.  More commonly, however, they require a reduction in calories from your initial recommendation.  Therefore, monitoring is critical to a successful weight reduction program.  I recommend that the patient be weighed two weeks after beginning the new diet program.  If weight has not changed (or has increased), the owner should first be questioned about possible non-compliance (eg, treats, table food, other pets' food, etc). 

If compliance is not an issue, then the total amount of pet food should be decreased further.  This is often the failure point in a weight loss program.  Animals should be weighed every 2 weeks until weight loss (1-2%/week) is achieved.  Once the amount of food required for this loss is determined, additional "weigh-ins" should be done at monthly intervals to ensure slow, steady weight loss.  Owners with tractable cats generally bring their cats in for regular weigh-ins but for cats for which the car ride and veterinary office visit is stressful, owners may prefer to purchase a baby scale to weigh the cat at home and then call in with updates.

DIET HISTORY FORM FOR WEIGHT REDUCTION PROGRAMS

Date:                       

Body weight:           __________lb (current)        __________lb  (usual)      

Body condition score (1-9):_________________

The following should be completed by the owner:

1.        Is your pet housed:           indoors   outdoors   both   other

2.        Please describe your pet's activity level:  low  moderate  high

Do you specifically exercise your pet in any way? yes no

If yes, please describe    __________________________________________________

3.        Do you have other pets?    yes  no

If so, how many:     Dogs:      ______    Cats:        ______              Other:      ______

4.        How many other people live in your household: _____

5.        Who feeds your pet?________________________________________________

6.        How many times per day do you feed your pet?

 once   twice   three   more than 3   food is out all the time

7.        Do you measure your pet's food at each meal or estimate the amount?  measure estimate

8.        Do you give your pet any commercial treats or table food? yes no

If yes, are these given:   At regular times each day    In response to begging   Other______________________________________________________________

9.        Do you give any dietary supplements to your pet?   yes   no

If yes, please list which ones and the doses_______________________________________

___________________________________________________________________

10.     Have you observed any changes in:

Defecation                yes   no

Appetite              yes   no

Activity level            yes   no

11.     Have you made any recent changes in diet   yes   no

If so, please note what the change was and why you made it:

_________________________________________________________________________

_________________________________________________________________________

12.  Is your pet receiving any medications?   yes   no

If yes, please list drugs and doses:  _____________________________________________

13.  Do you use food (eg, Pill Pockets, cheese, peanut butter, chicken, etc) to administer pills?                yes no   

If yes, please list what kind(s) and amounts:_________________________________

_________________________________________________________________________

14.  Please list below the brands and product names (if applicable) and amounts of ALL foods, treats, snacks, and any other foods that your pet eats.  This description should provide enough detail that we could go to the store and purchase the exact same food.  It should include “people foods” given as treats or at the table. 

Food                                                                Form                       Amount                   Number                   Fed since

Examples:

Pro Plan feline adult chicken/rice    dry                                           ½ cup                      2x/day                     Feb, 2004

Salmon                                                            broiled                     2 oz                         1x/week                   Jan, 2005

Pounce tarter control chicken treats ---                            1                              4/day                       Nov, 2005

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________