We see it every day: fat cats, fat dogs, fatter cats and fatter dogs.
Presenter's Note: Visit the Association for Pet Obesity Prevention's website (www.PetObesityPrevention.com) for more information and clinic tools.
We see it every day: fat cats, fat dogs, fatter cats and fatter dogs. The pet obesity epidemic is here and is evidenced by the growing number of portly pets seen in veterinary clinics nationwide. What started out as a trickle has swollen to a rushing river of weight-related disorders such as osteoarthritis, type 2 diabetes, heart disease, hypertension and more. It is vital that today's veterinarians learn to recognize weight related health issues and implement intervention strategies to help our clients better care for their pets and prevent obesity. Further, the discussion of pet obesity may help improve our client's health and well-being by getting them to think about their own weight in the non-threatening context of their pet's condition. By learning how to discuss obesity with our clients and understanding the ramifications even a few "extra" pounds have on a pet's wellness, we will help our pets live longer, more fulfilling lives and, in the process, we may help our clients do the same.
The first step toward improving the lives and well-being of the pets we're entrusted to care for and to end this epidemic is to start talking about it. We know that being overweight and obese is bad for pets; why aren't we talking about it?
In a 2004 study published in Obesity Research, 52.6% of obese patients that did not undergo bariatric surgery reported that their primary care physician "never" or only "once in a while" discussed their morbid obesity with them. In other words, unless the obese patient was going to have surgery, their doctor rarely mentioned their weight. One of the key reasons why physicians fail to counsel their patients about obesity may lie in their perceived distrust in the success of available treatments. They see lots of weight loss options and lots of overweight people; the math simply doesn't add up. When confronted with the decision to discuss something you don't really believe works, you're unlikely to discuss it.
It's no different in veterinary medicine. We see lots of overweight and obese pets and lots of diet foods and diet treatments and yet the number of fat pets keeps growing. Subsequently we stop talking about it. Nobody likes to bet on a losing horse – especially one that we believe loses with patient after patient, day after day.
Our clients depend on us for recommendations to improve the quality of life as well as life expectancy of their pets. However, due to busy schedules and lack of training in weight-related disorders, nutrition and weight loss, it is often difficult for veterinarians to communicate this information and promote change. For our profession to truly help our patients, we must take the time to learn about these issues and make the time to talk about them with our clients.
If we're going to talk about pet obesity, we must believe it's important – really important. Veterinarians who understand that achieving and maintaining ideal weight will improve their patient's quality of life and life expectancy are more enthusiastic about the topic. We must study the association between obesity and conditions such as type 2 diabetes, osteoarthritis, hypertension, heart disease, cancer and more. We must become familiar with the impact that a pet's weight-associated morbidity has on the pet-family bond and how this can negatively influence the level of care a pet receives as they age. We must search for simple lifestyle changes that can make huge improvements in a pet's well-being. We must feel comfortable looking a client in the eye and confidently discussing strategies for losing weight in a non-threatening manner. Once you believe in something, others sense that passion and are more inclined to listen and believe in you.
Another potential source of bias against counseling clients about their pet's weight issue is the doctor's perception that the client doesn't care or want to hear about it. If a doctor enters the room and thinks that the client isn't motivated to change their pet's weight, they're probably not going to start talking about obesity. Unfortunately, we're often wrong. In the same manner that we pre-judge clients and their willingness to pay for medical care, we often incorrectly assume that clients don't want to learn about pet weight loss. The issue becomes even more challenging if we don't truly believe in the benefits of weight loss and the value of spending our precious time discussing it. If we assume that everyone will be willing to pay for our services and is interested in improving their pet's quality of life, regardless of the challenges, we will better serve them.
Because of the social stigma associated with being overweight and obese, many doctors simply find it more comfortable to avoid the topic altogether. Further, a few high profile media cases involving patients suing physicians for offending them while discussing their weight has heightened fears and decreased the number of doctors being proactive about weight issues. The American Medical Association (AMA) commented on this dilemma in November 2003: "(I)f your patient's weight is a health issue, you should not hesitate to approach the topic."
Regardless of the client's weight, our responsibility is to the pet. With this in mind, we must feel comfortable separating our client's obesity from the discussion of their pet. Normally the client is already aware that their pet is overweight or obese yet may not fully understand its impact on their pet's health. Instead of stating the obvious, "Did you know Fluffy is obese?" try saying, "I'm concerned about Fluffy's weight because I'm worried it may be causing health problems for her. Do you think her weight is causing health problems?" This is especially important when the patient has weight-associated conditions such as osteoarthritis, type 2 diabetes, heart disease and hypertension.
If you get a noncommittal or disinterested response, don't start detailing how diet and exercise can help Fluffy achieve an ideal weight. Instead, focus on the long term health risks associated with Fluffy's excess weight. "I know how much you care about Fluffy and that's why I want to help you avoid some serious disease such as diabetes, heart disease and arthritis." Center the conversation on the prevention of debilitating and often costly diseases as opposed to the latest diet fad or tool.
It is vital you demonstrate unconditional support and acceptance when confronting obesity. Admit that weight loss is a challenge for everyone, including veterinarians, and that you understand the difficulties first hand. Share your own struggles and you'll gain the trust of your clients.
Clients will also respond more favorably to your recommendations if they feel understood. A 2001 Annals of Internal Medicine study demonstrated that by communicating empathically doctors had higher diagnostic accuracy, patients adhered to the recommended therapies more frequently and patient and physician satisfaction was higher in a shorter amount of time. The hallmarks of empathic communication include active listening skills such as using nonverbal cues such as maintain good eye contact, nodding in agreement and leaning toward the client to convey interest in what they are saying; framing the client's statements to demonstrate that you understand what they are saying ("Let me see if I have this right: Fluffy began gaining weight after a new neighbor moved in next door."); reflecting the emotional tone of the client's statements to show you understand how they feel ("Yes, I know how frustrating this can be."); involving the client as partners in the care of their pet ("Is there anything I left out?" or "Does that sound right to you?").
Partnership with our clients is a vital component of any successful medical recommendation. It is critical that we match our treatment plan with our client's preferences, abilities and readiness for change. This is contrast to the traditional directive approach in which we simply tell the client what they need to do because we say they need to do it. Today's client no longer accepts everything a veterinarian says as valid without challenge. This isn't a threat or creation of an adversarial relationship but rather a cry for involvement. We should encourage our clients to discuss their lifestyle patterns (what, how much, when and where do they feed their pet or exercise them?) , why they think it's important for their pet to lose weight, what signs of improvement in what time frame do they expect and what challenges do they foresee (multiple cats on various diets). By actively partnering with clients, we allow them to help us tailor a treatment plan that is more likely to succeed as opposed to dictating the terms for change.
In addition to accepting a weight loss or other health plan, we must also be certain our clients understand it. Don't rely on the old standard "Do you understand?" Everyone nods blankly in agreement because the last thing they want to do is to be lectured – again. Try using the "teach-back method." After you explain how much and how frequently you want the client to feed their pet, ask "Would you mind explaining to me that feeding plan so I can make sure I didn't leave out anything?" This technique works well for medications, follow-up care or any actions that your clients need to complete on their own.
When dealing with weight loss, it is important not to end the discussion at the food bowl. The diet they are feeding is one of the most important factors, and arguably the easiest to talk about, but it is not the cure. High-calorie treats and inactivity contribute greatly to the obesity epidemic. Our pets are quickly becoming a nation of lap potatoes. To reverse this trend and highlight just how much we're overfeeding and under-exercising out pets, we need to develop tools to assist us. One of the most effective tools for weight loss is a food and activity diary. Ask the client to record every feeding by food type and amount, treat (including the occasional table goodie) and activity such as walking or play for one week. Make it easy by providing them with an online form or a prepared written log. Once you have this data, you can customize a weight loss plan that fits into the client's lifestyle. If a client works until eight in the evening and has two kids, it may be unrealistic to advise them to take their overweight dog for a 30-minute brisk walk daily. This client needs to be reassured that it's ok to exercise when time permits and they can help by substituting doggie treats with healthy carrots or celery. By establishing rapport and a shared sense of responsibility, the client may open up to and offer that they can take Gracie to soccer practice and throw a ball while they watch their son practice. Once they understand how an extra 50 calorie treat given at bedtime is adding up to five or six pounds of weight gain per year and that simple physical activities can have positive impact on their pet's health, clients will often change.
Of course, who can resist the pleading eyes of a dog or persistent cries of a "hungry" cat? Our desire to please our pets is at the core of over-feeding. We need to counsel our clients that it's ok to give in to these requests – as long as it's a healthy reward. The first step is to praise a demanding dog or persuasive cat. Stroke them, kiss them, hold them, tell them how beautiful they are and how much longer they're going to live because you're not giving in to temptation. Take them to their food bowl and hand them a kibble of low-calorie diet. Some dogs would love to go for a walk and completely forget about that piece of pie (It'll do you good, too.). Cats may be satisfied just by you mixing the food already in the bowl or even adding ten to twenty kibbles. Many times it's not about the food for our pets but about the friendship. Their social order included eating as a group or sharing prey (how many times has your cat brought you a lizard for you to enjoy?) and they simply want to be a part of the experience. Include them, but not at the expense of their health. If you feel that you must give a food treat, try vegetables such as broccoli, asparagus, carrots or celery. For cats that wake you at two in the morning to tell you their food bowl is empty, try dividing their meals into multiple small meals including one at bedtime to satisfy a restless stomach. Share your own stories with your clients and they'll see you more as a collaborator rather than a superior.
When it comes to setting weight loss goals, don't make it about the pounds in the beginning. Too often we limit the discussion to losing weight when it really should be centered on improving overall health. Focus on increasing activity and decreasing calories. "Mrs. Floyd, our obvious long-term goal is for Paris to lose 20 pounds. For the next month, however, let's forget about losing weight and concentrate on you two taking that twenty-minute walk you mentioned every morning. Also, every time you or Paris wants to reach for those doggie treats, I want you give her a great big hug. If she still insists, give her a baby carrot and take her outside for a few minutes." If we initially focus on big, challenging goals, it may simply be too much for many clients and they quickly abandon our recommendations. Next, make sure clients understand that it's ok to forgive themselves when they slip up and give that piece of pie to Paris. We want our clients to stick with their plan, not dump it because they relapsed. Instead of saying, "I can't believe I just did that. I'll never stick to this diet plan." we want them to say, "I goofed. I'll just have to be extra diligent to make sure I don't do that again." The ultimate solution is to make healthy eating and physical activity a part of the normal routine. Encourage your clients to take small steps and win seemingly insignificant battles until they've reached a long-term goal.
Even our best clients may fail when it comes to helping their pet shed pounds. Although this may discouraging to both you and your clients, it is important to remember that this is part of a lifelong commitment and that temporary setbacks must be handled in a positive manner. It is critical not to blame the client or label them as "noncompliant" or difficult" for failing to adhere to your recommendations. This can lead to increased frustrations for everyone and damage the partnership between you and the client. Work with the client to discover the reasons for their missteps and seek solutions together. Many times the client will have misunderstood the feeding directions or did not understand how many calories were in that treat. Use the teach-back method to ensure that they clearly understand what they should do. Other times a client may encounter unforeseen obstacles to adhering to the plan or felt that it was unrealistic. Regardless of the cause, collaborate with the client, listen to their issues and work together toward solving them or developing new strategies.
Waging the war against pet obesity will not be easily won. There is no "magic cure" or "silver bullet". Even with today's amazing pharmacological advances, the foundation for long-term success lies with changing pet owner's attitude toward pet weight issues and adopting a healthier lifestyle for their pets. The fantastic opportunity that we have as veterinarians is that we may, by extension, positively impact the health and well-being of our human clients. It is time to make a stand and stop ignoring one of the leading causes of morbidity and mortality in our pet patients. Educate yourself, develop a communication strategy and uphold the oath we took when we entered our profession with each and every patient.