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Food for thought

Therapeutic diets are a great way to treat pet obesity. Veterinary teams need to remember the three keys: patience, flexibility and creativity.

Food for thought
Treating a disease as complex as obesity is never easy, and that’s part of the challenge and appeal.

Pet obesity is a huge problem, with nearly 60% of all U.S. dogs and cats classified as overweight or obese in 2018. The Association for Pet Obesity Prevention, which I founded, conducts yearly prevalence surveys each October to measure not only the number of affected pets but also the attitudes and opinions of pet owners and veterinary professionals when it comes to salient nutritional topics. Want to know the most contentious topic everyone is talking about? Pet food.

Pet owners seem genuinely confused about a few things:

  • Is corn healthy for pets?
  • Are wet or dry diets more nutritious?
  • How safe are raw meat diets, and what are the benefits?
  • How can food help pets with diseases such as obesity?

Complicating matters for veterinary professionals is that many clients are increasingly skeptical about traditional pet food brands and actively follow the latest food fads and social media movements. That’s not to say veterinarians should dismiss media-hyped nutritional advances and meaningful messages. Instead, we need to be more active in discussing pet nutrition, the essential role of therapeutic diets and the treatment of obesity. Perhaps more importantly, we need to adjust our thinking about dog and cat weight-loss strategies.

The evidence is clear: The only current proven treatment for pet obesity is a therapeutic diet plan combined with lifestyle changes. To disregard the amazing research, weight-loss formulations and nutritional technology available in a convenient bag or can of therapeutic pet food is, in my opinion, doing our patients an incredible disservice. As trained scientists and medical professionals, we need to follow scientific truths. But first, we need to become creative artists.

As Much Art as Science

When we offer evidence-based nutritional advice, we need to accept that nutrition is as much art as science. Even though our understanding of canine and feline physiology is exponentially greater today than it was 50 years ago, we’re still unable to precisely tailor nutrition to an individual pet (or person). We apply general digestibility, metabolic and biological tenets in a variety of combinations until we find the perfect food fit. Sometimes we get lucky and our first diet and activity plan strikes weight-loss gold, and other times we’re still accumulating adiposity six months later. This leads me to my first bit of pet weight-loss advice: Be patient, flexible and creative.

If you adjust a pet’s diet, activity or lifestyle, I tell my team to “check for change in 90 days.” That simple clinical mantra has successfully guided me on countless cases over the past 25 years. The first element of my treatment ethos is to give change some time. Too often, veterinarians and pet owners are looking for instantaneous results. If a 22-pound cat doesn’t lose two pounds in two weeks, we declare failure and switch approaches, or the client gives up in frustration. That’s a mistake in most cases.

Begin by providing realistic weight-loss expectations. The mammalian body is a master of physiological adaptation. Cut calories or increase activity and the body resists with systemic shifts, metabolic plateaus and behavioral outcries. This is why research-backed therapeutic diets are an indispensable part of obesity treatment. Safe and successful weight loss is much more than eating less and exercising more. If it were that simple, we wouldn’t continue to diagnose obesity in so many pets and people. Modern weight-loss diets manipulate macronutrients — Fewer calories per cup! Higher protein, lower carbs! More soluble fibers! —and add nutrients such as L-carnitine that are proven to facilitate fat loss and preserve lean muscle mass. But you have to give change time to work.

Patience

Ninety days is a realistic and reliable indicator of whether a weight-loss strategy is working for most pets. Unless a patient has a serious comorbidity or complication, I recommend the first veterinarian recheck at 90 days. We chose 90 days because I was frustrated with too many missed or cancelled appointments and not having much to say after just four weeks besides “Hooray! Sandy lost 0.3 pounds!” We stuck with it because we saw higher compliance and better rationale for continuing or changing the clinical course.

We conduct monthly weight checks with a team member, but the non-negotiable “doctor’s exam” can wait until 90 days. In the interim, we rely on weekly emails, text messages or phone calls to help guide the pet owner and address any problems. We ask about eating habits, activity levels and behavior changes. (Did someone say “begging”?) If you’re into emerging technologies, I think this is an area in which chatbots can be put to work. (Are you listening, major pet food companies?) The 90-day recheck is one for celebration (“She lost a pound!”) or change (“She gained a pound!”). So how do you change?

Flexibility

Flexibility in treatment is critical to a veterinarian’s success and even more in weight loss. I can’t tell you the number of patients seen on referral that had been fed the same weight-loss diet for a year or more despite not losing weight. If it’s broke, fix it!

We treat individuals, not averages. This is why being dogmatic in a weight-loss approach is problematic. I’ve seen many dogs and cats respond to low-calorie, higher protein and fiber formulations that failed on a lower-protein, higher-fiber therapeutic diets. In other words, I have a typical approach for initiating treatment, and then I try whatever is necessary to find the right solution for the individual pet.

I think this outcome uncertainty is the most frustrating factor of treating obesity for many veterinarians. We prefer absolutes, direct actions and predictable effects. Rarely do these apply to pet nutrition and obesity. Biology is a b!+ch.

Creativity

My basic four-step pet weight-loss strategy is this:

1. Begin the therapeutic diet that best supports your weight-loss philosophy. There’s no right or wrong answer; do your research and reach your own conclusions. The only wrong answer is “Feed less of whatever you’ve got.” That strategy often fails because, despite the pet’s initially losing a few pounds, you risk losing muscle over fat and creating macro- and micronutrient imbalances, leading to secondary complications. A “regular” grocery store or maintenance diet isn’t designed to facilitate safe and effective weight loss. For the vast majority of patients, the ease and evidence-based efficacy of a commercial therapeutic food is perfect. Do your research and start experimenting with different approaches. Over time, you’ll gain confidence in your pet food philosophy. Avoid orthodoxy and commit to remaining current as therapeutic diets become more precise and powerful.

For a few pet owners, veterinary-approved and monitored home-prepared meals might be an option. As a believer in whole foods for pets, I can tell you from exhaustive experience that balancing nutrients in home-cooked meals is challenging, as is controlling calories and portion sizes. Flexibility is key, and if I have a client adamant and able to cook for her pet, I’ll guide her as much as possible. And, truth be told, we often end up switching to a therapeutic diet.

I typically begin feeding a weight-loss diet at 80% RER (resting energy requirements) calculated by this exponential formula:

RER in kcal/day = 70 x [(ideal weight in kg)] ^ 3⁄4
or
RER in kcal/day = 70 x [(ideal weight in kg) to the 3⁄4 power] 
or
RER in kcal/day = 30(body weight in kilograms) + 70

I also recommend daily 30-minute walks for dogs or three daily 5-minute playtime periods for cats, but I firmly focus on feeding a therapeutic diet. During the early phase of weight loss, food far exceeds exercise in shedding excess fat. If you want an easy way to remember it, weight loss in dogs (and people) is about 60 to 70% diet and 30 to 40% exercise. For cats, it’s about 90% what and how much you feed, and only 10% activity. Pet weight loss is won or lost at the food bowl.

2. Exchange weekly phone, email or text messages with the client to discuss progress or problems. If needed, an appointment is scheduled. For more serious cases, a monthly recheck is often set.

The most common complaint is a pet’s begging. Habits are hard to change, so we need to offer solutions to this behavior. I like automated feeders, especially those that prevent food stealing, that are set to dispense four to six times a day.

Protein promotes satiety. Adding a high-protein “midnight snack” at bedtime can delay nighttime pounces, howling and whining in many pets. Thankfully, as a replacement for junk food treats, several therapeutic diet options are available to help clients easily limit and count treat calories. In addition, fresh, crunchy veggies such as baby carrots, cucumber and zucchini slices, and green beans for dogs, and salmon or tuna flakes for cats, work well as low-calorie snacks.

Weekly support chats between the staff and client are a critical component of successful weight loss. Creating a community of shared experiences and advice in a non-judgmental, non-threatening and compassionate setting improves outcomes. Most of these conversations are facilitated by email and utilize prewritten questions. Based on the responses, sharing digitized content can remedy the most common pitfalls or personal calls in more complex cases. Online support groups are emerging to fulfill the need as well.

Our most common tip? “Dogs don’t do division. Take whatever treat you’re feeding and break into halves or thirds.”

3. At the 90-day recheck, if we see positive results and the client is satisfied, no changes are necessary for another 90 days. If we feel we can do better, I usually reduce the existing diet to 70% RER. If a patient is being fed 70% RER and shows no improvement, I alter the food as radically as possible. Higher protein to higher fiber, dry to wet, beef to fish — that sort of change.

If we’re encountering a weight-loss plateau after six months or more, I emphasize activity, particularly in dogs. Slow, aerobic activity such as walking is changed to several brief, anaerobic efforts such playing fetch, running hills, fast-and-slow games or swimming. Agility training, treadmills and equipment that places a dog on uneven surfaces and encourages core strength are excellent choices for stubborn weight-loss cases or the “final 5%.”

4. Don’t chase a number on a weight scale. Focus on improving quality of life (“I think Chloe feels better!”), mobility and ability (“He can get in the car on his own!”), and the knowledge that you’re reducing the risk of disease and easing pain.

Start by developing a client questionnaire that targets benchmarks. Ask about the pet’s favorite foods and flavors, activities that might be less frequent because of weight gain, any signs of pain or discomfort, and what the client hopes to accomplish with weight loss. These are the most important metrics we use to initiate a plan and measure clinical success.

Last Words

Patience, flexibility and creativity are the cornerstones of a successful weight-loss program and elements of a meaningful veterinary career. Treating a disease as complex as obesity is never easy, and that’s part of the challenge and appeal.

My goal is to help veterinary professionals and pet owners shift their attitudes, opinions and actions. I want them to understand that obesity is a disease, that disease-prevention strategies exist, and that diet and lifestyle greatly affect quality of life and longevity.

Your job is to serve our beloved pet patients to the fullest of your ability, striving toward a state of optimal health. Together we can help clients navigate the bewildering world of pet nutrition and provide the best evidence-based advice possible, one pet at a time.

Dr. Ernie Ward is a speaker, entrepreneur and owner of the veterinary consulting firm E3 Management. He serves on the Today’s Veterinary Business editorial advisory board.

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