Obesity is a disease and should be referred to and treated as such⁶.

Weight management is now recognized as a priority in both human and veterinary medicine. The American Medical Association voted in 2013 to class obesity as a disease¹. The prevalence of obesity is increasing in both humans and companion animals, with studies reporting between 22-44% of the animal population being affected⁷.

The One Health initiative⁸ was developed in 2008 to combine and compare clinical research and focus on health conditions that affect humans, animals and the environment. This includes medical conditions found in all species as well as a particular focus on zoonotic disease⁷. ‘One Health’ is an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes (World Health Organisation).

Research into effective communication to maximise success in weight management is relevant to both^1,7. The focus on increasing activity in addition to dietary modification presents an opportunity to utilize the human-animal bond to benefit both¹.

Vets have a responsibility to discuss weight management and nutrition as they would with any other serious health condition. ‘Obesity is the most common nutritional disorder of dogs and cats’¹. Veterinary healthcare professionals should always be the primary source of support and information for owners. Without understanding the factors that predispose to obesity, and the link between the human-animal bond, the veterinary team may struggle to communicate their concerns effectively and see the desired results.

Welfare implications and ethics

For veterinarians, the oath taken upon graduation is to preserve the health and welfare of those pets entrusted into our care. Obesity can be considered as affecting both- chronic obesity will give rise to/or exacerbate comorbidities and negatively affect health.  This will, in turn, lower quality of life and welfare.

In dogs, obesity decreases life span by approximately two years⁶.

Recognition of obesity

There is a hurdle for vets to overcome in the representation of certain breeds and sizes in media and advertising. It can be difficult for owners to acknowledge that their pets are obese as we have become conditioned to see overweight animals as ‘the norm’ or even the ideal.

Use of weight charts for gender and breed are known to be inaccurate due to individual variation. Body Condition Scoring (BCS) is more reliable⁶ and efforts are being made to standardize into the /9 scale recommended by the World Small Animal Veterinary Association (WSAVA)⁹.Both weight and BCS should be measured at every routine visit to monitor for trends and provide an opportunity to discuss with the client. Conversations should include any changes in diet, exercise and ‘treat’ habits.

Human-animal bond

The link between overweight or obese owners and increasing BCS in their companion animals has long been observed⁶. It is very important that veterinary staff focus on showing concern for the pet and remaining non-judgemental¹. Often owners feel they are acting in the best interest of their pet by meeting all their nutritional demands⁴. The discussion must be handled with care to be motivational and supportive, rather than negative.

Owners can settle into a pattern of showing affection via food and treats. Often pets may be looking for attention rather than food⁶. Cats in particular don’t require social interaction during mealtimes, and so vocalizing and interacting with owners is often misinterpreted as a request for food, when in fact it is simply initiating play!⁴ It is also conceivable that pets can condition their owners by begging during food preparation and mealtimes to get the desired response⁶.

It can be a challenge to convince owners to change their habits. Clients need to understand that their behaviour with feeding will need to adjust along with the diet and activity, and this will take commitment and patience.

Comorbidities

Obesity in dogs is associated with hyperadrenocorticism, osteoarthritis, pancreatitis, respiratory problems (particularly in brachycephalic breeds) and neoplasia^3,6. In cats, more specifically, obesity is associated with diabetes mellitus, urinary tract disease and hypertension.^3,6 Failure to address the role that obesity plays in these conditions will make them much harder to manage/treat and will impact negatively on quality of life.

Tips for weight management within the clinic

Studies have shown that overweight and obese dogs are more likely to have overweight or obese owners⁷. This observation has not been noted with cats, although an indoor lifestyle is a known predisposing factor³. Here in the Gulf region, certain lifestyle factors will be more relevant to the individualized weight management plan. Lack of activity in the summer months and a more sedentary and indoor lifestyle affects us all.

Recommendations for weight management;

• Routine recording of BCS and weight at every visit to the vets- so early increases or trends in variation can be noted and discussed. Using a standardized BCS will improve the monitoring between individual vets and veterinary nurses.

It is also valuable to note the life stages when changes in weight are most likely- and aim to provide nutritional reassessment at this time. Reaching skeletal maturity (moving from junior to adult diet) and time of neutering are both opportunities to prioritize a nutrition discussion.

• Weighing of young dogs and cats every month until they reach skeletal maturity will provide an accurate reference of the ideal adult body weight. This method is preferable to the use of breed charts.

Animals that become obese this stage can be difficult to ever decrease to an optimum weight. Communication as to the reasons for close monitoring at this stage can highlight weight management to clients. Emphasis on their role in feeding should be discussed in a non-confrontational way.

• Remember that a tailored/individualized programme for each pet will be more effective⁴. One method does not suit all. In some cases, moderate weight loss is better than nothing- not all animals may be able to get down to their ideal weight, particularly older patients and those with comorbidities⁴. Owners should never be made to feel as though they have failed. Discouraged owners are more likely to give up completely.
• Aim wherever possible to increase activity as well as adjusting the diet¹. This may require use of dog parks or doggy day care to allow for swimming and increased play. For indoor cats- toys, shelves, laser pointers and introduction of play times may help to boost activity.
• Consider providing scales for owners to weight their cats from home and schedule phone calls for review rather than demand owners return to the clinic- for cats in particular, veterinary visits can be extremely stressful and this can make owners very reluctant to return.
• Bring awareness to clients that even when target weight is reached, it is still vital to monitor and consider diet. A return to previous habits and diets will result in re-gain of weight⁴.
• Provide relevant dietary advice. A prescription diet is more appropriate in the clinic setting than simply recommending a reduction of the current feeding regime. Begging and scavenging behaviour when on a weight loss diet can decrease owner compliance and put pressure on the human-animal bond.

Royal Canin Satiety diet for dogs and cats is clinically proven^2,5 to effectively reduce weight and begging behaviour. The high fibre and high protein diet provides ‘more kibble for your calories’, thus allowing the pet to feel satiated^2,5. The high protein content also maintains lean muscle mass during the period of weight loss. The diet also provides joint support for those individuals with associated osteoarthritis, with the inclusion of glucosamine and chondroitin.

Royal Canin Satiety has the correct nutrient balance to compensate for calorie restriction, whilst maintaining health.

Successful weight management relies on the involvement of the full veterinary team. Veterinary healthcare professionals must be confident to approach the subject and prioritize the health of the pet. Open discussions should be supportive and encouraging, with emphasis on the key role of the owner in the journey. Nutrition and feeding behaviours must be considered a vital part of a clinical history and require adequate time allotted within the consultation.

At Saint Vincent Group, we are able to provide materials to aid in the weight management conversation- including Body Condition Score charts and tools for weight clinics. We can also provide in-clinic training for all veterinary staff. For further information please contact vets@saintvincentgroup.com

References;

1. Bartges, J., Kushner, R.F., Michel, K.E., Sallis, R., and Day, M.J. (2017) One Health Solutions to Obesity in People and Their Pets Journal of Comparative Pathology Vol 156 326-333
2. Bissot T et al. Novel dietary strategies can improve the outcome of weight loss programmes in obese client-owned cats (2010) Journal of Feline Medicine and Surgery 12; 104-112
3. Chandler M., Cunningham S., Lund E.M., Khanna C., Naramore R., Patel A., Day M. J., Obesity and Associated Comorbidities in People and Companion Animals: A One Health Perspective Journal of Comparative Pathology Vol 156:4 296-309
4. German. A., et al. Symposium proceedings (2013) Obesity is a complex issue Veterinary Record September 2013 207-208
5. German AJ, Holden SL, Bissot T, Morris PJ, Biourge V. (2010) A high protein, high fibre diet improves weight loss in obese dogs. The Veterinary Journal 183 (2010) 294–297
6. Kipperman, B. S., and German, A. (2018) The Responsibilty of Veterinarians to Address Companion Animal Obesity Animals 2018 MDPI.
7. Sandoe P., Palmer C., Corr S., Astrup A., Bjornvad C., (2014) Canine and Feline Obesity, A One Health Perspective. The Veterinary Record
8. The One Health Initiative http://onehealthinitiative.com
9. WSAVA The World Small Animal Veterinary Association http://wsava.org