By Brandon Stapleton, DVM

A colleague of mine (let’s call her Dr. Simms to protect the well-intentioned) was in a tough spot. Simms’ practice was in an urban area seeing a rash of a particular disease in dogs (let’s call it Canis morbidus). C. morbidus shortened a dog’s life expectancy, led to co-morbidities in many patients, and meaningfully decreased quality of life.

However, the therapies used to treat C. morbidus are not immediately effective, and take some work to institute. Further, clients usually do not follow Simms’ guidance. So, when C. morbidus became one of the most prevalent issues her practice saw daily, she got frustrated. She started giving it only a passing mention during many exams. Sometimes, she would not bring it up at all. On the upside, the practice ran a little smoother. After all, Simms was not wasting time talking about C. morbidus when she knew owners would not take steps to manage it. Yet, the net effect was more dogs with C. morbidus suffered its dire consequences.

Some of you reading this will empathize with her and the choices she made. Some of you will be, deeply disappointed with our colleague. After all, how could Simms not confront a disease with such clear consequences solely because it became difficult?

Now that the jig is up, please reread the first three paragraphs. This time, when you see C. morbidus, insert the name you know it by: Obesity. Are you still judging Simms—or do you empathize?

We have to talk about it

The latest study from the Association of Pet Obesity Prevention (APOP) found in 2022, 59 per cent of dogs in the U.S. were overweight or obese.¹ This number has grown from 56 per cent since the last measurement a few years prior, and from 43 per cent in 2007,.²

Many dog owners are simply unaware their pet is overweight—APOP calls this misalignment between the perception of what a healthy dog looks like and the reality of ideal body composition the “fat pet gap.” Even when dog owners recognize the extra weight, some tend to downplay it as “vanity pounds,” “extra padding,” or “fluff.”

A number of studies show, compared to their normal-weight counterparts, overweight or obese dogs live shorter lives, get certain diseases earlier in life (which are likely or often comorbidities to obesity), and have a worse quality of life.^3-6 This translates to one simple reality: We have to act. Our patients require it of us. Doing this requires accepting what you cannot change, realizing the things you can, and being willing to take action to bring about this change.

For example, we should be aware of a breed’s predisposition to obesity.^7-9 While we cannot change genetics,  environment can impact gene expression (regardless of whether a pet is predisposed).³ This is where we can have a real impact. At its core, the solution boils down to what—on paper—looks like the world’s simplest math problem: Calories out > calories in = weight loss. Yet, we all know it is not so easy.

Why can’t we get this right?

Getting daily calories right is simple in concept but not so easy in practice, hurdles include:

1) Accurate calculation of a patient’s daily calories. While it might seem as though the formulas we use can be quickly and easily applied, this is not always the case. We may be assuming dogs of a similar body weight and frame size might have similar caloric requirements, which is untrue.¹⁰ There are many factors to consider, including body condition score, age, neuter status, and activity level.

2) Owner overestimation. Two studies demonstrate how owners not measuring their pet’s food properly is a very real issue, with another study showing up to 152 per cent overestimation of portions by owners.^11,12

Wide ranges in recommendations on food labels and variances in the types of “scoops” used are just two very common factors influencing inappropriate patient-specific measurement of portions. Further, feeding treats—whether they are extras from owners’ plates, rewards for good behaviour, or enticements to take medicine—can add to daily calories.

What can we do?

We have convinced ourselves our efforts may be all for naught because owners simply will not listen to obesity discussions.

However, this perceived resistance is mostly rooted in how veterinary professionals decide to approach the conversation. Fortunately, research tells us how we can increase the odds of client compliance:

1) Talk about obesity. We may have convinced ourselves owners do not want to have this conversation, but they do. Research shows the manner in which we approach it matters, but people are open to both discussing obesity (almost 70 per cent of owners, according to APOP, have never felt ashamed by this conversation) and changing food behaviour.^1,13

2) Talk about its consequences. Research suggests owners will pay attention to the fact obesity might lead to other health problems, even if they do not really pay much attention to obesity as its own disease. Make sure the context of this discussion is a team-oriented one: “Us” against the disease.”^13-15

3) Get more comfortable with calorie calculations, or hand this off to a trusted expert. For some, this may mean spending some time doing calculations to get used to the math and tracking the results. For others, this might mean assigning calculations to a dedicated expert in the practice. Easier still, there are online tools that can help you accurately calculate calories. Or, if you want to avoid the calculation work entirely and save time, dog nutrition companies offer this work for you via in-house experts.

4) Encourage accurate portioning at home. Instead of measuring by the scoop or can, encourage clients to use gram scale weights. It will take just a little extra math to turn “cups” into grams, and most companies provide detailed information in their nutrition guides to help do this math quickly. Naturally, if clients are already getting pre-portioned meals from companies that provide these, this part is much simpler.

Getting the client’s whole family involved in this process is especially important. This can be done through take-home educational materials that everyone in the house can read. You can also  give clients simple systems to keep the family on the same page. Here is one example: Families can have a container in the fridge or on the counter for the dog’s total daily caloric allotment Only one person can fill the container each morning, and that is the only place people can feed the dog from—so an empty container means no more food that day. Or, again, you can turn to dog food companies that provide services like pre-portioned food delivered on a set schedule. This eliminates portion inaccuracy and seamlessly reinforces the “no extra measurement” philosophy for owners.

5) Set up rechecks. You can decide on the type of appointment (doctor, nurse, etc.) and the cadence, but at least once monthly is a good start. No matter what, the whole team should be involved, and these should be scheduled like appointments. Use this time to make any caloric adjustments that you need and to celebrate the patient’s success.

Where do we begin?

Think back to the first time you had to give a cancer diagnosis, explain Cushing’s to an owner, or have a post-op conversation. Think of how long it took then versus how long it takes now. Expect the same with this process. Every time you do it, it will get easier, shorter, and less awkward. In no time, what feels like eternity now will be  a 20-second, highly impactful “elevator pitch.”

On days when you feel like every pet you see is overweight/obese, and you start to lose heart, focus on the good you will do by changing the lives of these. It is why we do what we do.

Brandon Stapleton, DVM, was in private practice for nearly 10 years, before moving into the animal health and nutrition industry. Dr. Stapleton currently serves as the head veterinarian for The Farmer’s Dog, the pet-food company making fresh, complete, and balanced, pre-portioned food for dogs. 

References

1. 2022 State of U.S. Pet Obesity Report. 2023. Association for Pet Obesity Prevention. [accessed 2023 Dec 17]; https://www.petobesityprevention.org/state-of-pet-obesity-report
2. 2018 & 2007 State of U.S. Pet Obesity Reports. 2019. Association for Pet Obesity Prevention. [accessed 2024 Mar 20]; https://www.petobesityprevention.org/2018
3. Kealy, RD, Lawler, DF, Ballam, et al. Effects of diet restriction on life span and age-related changes in dogs. J Am Vet Med Assoc. 2002;220:1315–1320.
4. Lawler DF, Larson BT, Ballam JM, et al. Diet restriction and ageing in the dog: major observations over two decades [published correction appears in Br J Nutr. 2009 Apr;101(7):1112]. Br J Nutr. 2008;99(4):793-805.
5. Salt C, Morris PJ, Wilson D, Lund EM, German AJ. Association between life span and body condition in neutered client-owned dogs. J Vet Intern Med. 2019;33(1):89-99.
6. German AJ, Holden SL, Wiseman-Orr ML, et al. Quality of life is reduced in obese dogs but improves after successful weight loss. Vet J. 2012;192(3):428-434.
7. Toll PW, Yamka RM, Schoenherr WD, Hand MS, Chapter 27: Obesity. In: Hand MS, Thatcher CD, Remillard RL, Roudebush P, Novotny BJ,eds., Small Animal Clinical Nutrition, 5th Ed. Mark Morris Institute; 2010: 509-510
8. Lund EM, Armstrong PJ, Kirk CA, Klausner JS. Prevalence and risk factors for obesity in adult dogs from private US veterinary practices. Intern J Appl Res Vet Med. 2006; 4: 177-186.
9. Corbee RJ. Obesity in show dogs. J Anim Physiol Anim Nutr (Berl). 2013;97(5):904-910.
10. Gross KL, Yamka RM, Khoo C, Friesen KG, Jewell DE, Schoenherr WD, Debraekeleer J, Zicker SC Chapter 5: Macronutrients. In: Hand MS, Thatcher CD, Remillard RL, Roudebush P, Novotny BJ,eds., Small Animal Clinical Nutrition, 5th Ed. Mark Morris Institute; 2010: 73-81.
11. German AJ, Holden SL, Mason SL, et al. Imprecision when using measuring cups to weigh out extruded dry kibbled food. J Anim Physiol Anim Nutr (Berl). 2011;95(3):368-373.
12. Coe JB, Rankovic A, Edwards TR, Parr JM. Dog owner’s accuracy measuring different volumes of dry dog food using three different measuring devices. Vet Rec. 2019;185(19):599.
13. Alvarez EE, Schultz KK. Effect of personal, food manufacturer, and pet health statements made by a veterinarian during a pet wellness appointment on a dog or cat owner’s decision to consider changing their pet’s diet. J Am Vet Med Assoc. 2021;259(6):644-650.
14. Churchill J and E Ward. Communicating with pet owners about obesity: roles of the veterinary health care team. Vet Clin North Am Small Anim Pract. 2016;46(5):899-911.
15. Sutherland KA, Coe JB, Janke N, O’Sullivan TL, Parr JM. Veterinary professionals’ weight-related communication when discussing an overweight or obese pet with a client. J Am Vet Med Assoc. 2022;260(9):1076-1085. Published 2022 Apr 15.