DVM as nutritional consultant

Often practitioners comment that owners eventually resemble their pets. But perhaps it is the other way around!

This obese cat has been gaining weight for three consecutive years. Now weighing 18 pounds he is a medical dilemma. This cat's health is in jeopardy if allowed to continue gaining weight or if started on a strict dieting program without discussing the dangers of lipidosis. As pet health care providers, it is our professional obligation to spend the necessary time educating the client and providing him or her with proper health care recommendations.

How many times do we go into the exam room and observe a cat that is so obese that its width nearly equals it length! There can be no collar because there is no neck.

As a veterinarian, we are poised to exclaim some profound bit of wisdom about over-feeding and the associated health risks, but we make a quick turnabout as we raise our head and see the obese owner who came along with this obese pet. A new challenge has arisen. How do we speak to this owner without insulting them?

• An epidemic

Studies on the human side are claiming that approximately 1/3 of all Americans are obese and another 1/3 considered overweight! That comes to an astounding two out of every three clients. Is it any wonder our pets are overweight?

And it is not simply for appearance sake, either.

Table 1. Wellness Guidelines for Puppies

A study recently released by the American Medical Association shows that poor diet and lack of physical activity account for the cause of 6.6 percent of deaths in America. That is second only to tobacco use (18.1 percent) and more than the combined deaths caused by alcohol, microbial agents, toxic agents, car accidents, gun-related deaths, drug usage and sexually transmitted diseases combined!

• Impacts body systems

While obesity is not the only problem, it is simply the biggest problem and impacts all major body systems.

Pets generally don't feed themselves. It's the owner who feeds the pet, and feeds, and feeds and feeds. Furthermore, pets tend to adopt the lifestyle of the owner. So now we are faced with the challenge of providing counseling for the pet and knowing that it relates to the owner as well!

For a long time I was not comfortable making strong recommendations to these owners, unless, of course, the pet's health was seriously at risk. However, the problem of pet obesity is now so large that we cannot sit idly by; we have to take a stand.

Table 2. Wellness Guidelines for Adult Dogs

• Counseling needed

We don't have to be nutritional specialists. We already have more knowledge of pet nutrition than 99.9 percent of the pet-owning public, including breeders and pet shop sales clerks. Plus, consider the resources that we practitioners have.

What's needed is counseling. Counseling is the missing ingredient. Pet owners may know that their pet is overweight but are either ignorant of the risks or simply unable to do anything about it.

Look again at the human side. Sixty-seven percent of Americans are either overweight or obese, yet the knowledge is out there. Witness all the books and magazines teeming with weight loss programs, and consider the massive amount of dietary foods that are available. With all that information, still more people are overweight now then ever before.

We have to educate the public by first demonstrating to them that their pet is in need of dietary change, whatever the problem may be. After that, we need to counsel them to help them achieve the goal.

Table 3. Common Dietary Concerns

For example, in the case of obesity, the client must first be made aware of the problem and the health risks that accompany it. While they may already know that their pet is overweight, they must actually hear the words for impact. This is where the practicing veterinarian comes into the picture.

Thinking less about our role as vaccinators and more about our role as health care advisors will add extraordinary value to our wellness care programs.

• Wellness care includes counseling

In my practice a portion of each wellness visit is devoted to counseling on nutrition.

Some time is spent inquiring about type of food, amount of food and feeding schedules. Questions must be specific and ardent in order to acquire accurate information.

Owners may even say one thing to the technician doing the pre-exam portion of the visit and reveal a different story to the doctor who is following up.

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Worse yet, owners may not be truthful, choosing instead to recite a diet that they know is appropriate, but in reality, are not using.

A variety of reasons may exist, but exploring the lack of compliance is essential. Once the true diet is known it can be interrelated during the doctor exam.

Perhaps a case can be built for a meaningful recommendation as the doctor performs the physical exam, pointing out deficits or problems such as abnormalities to haircoat, body weight, teeth and nature of stool. Then a truly significant recommendation can be made.

• A yearly affair

Furthermore, clients must be re-educated about proper nutrition each year. Poor habits develop and clients are vulnerable to media advertisements, Internet, breeders, pet shop personnel, and other less-than-scientific sources. An annual review is essential.

• Life stage significance

Puppy, kitten, adult and senior ages all have different nutritional considerations. As a matter of fact, each of the three or four visits within the puppy or kitten series may require different recommendations as the young animal progresses through teething, bone growth and development.

Feeding schedules should be changing throughout the series. There can be some serious problems developing if attention to feeding recommendations is overlooked. In fact, the owner of the newly acquired pet is often indoctrinated with poor advice from the breeder or pet shop salesperson.

Moreover, these contacts seem to carry phenomenal credibility and may present a challenge to create changes. For example, I recently saw a new owner who was advised by the breeder, to feed her 10-week-old Lab puppy only 11/42 cup of food twice per day. Additionally, no regard was given to increasing the amount fed as time passed. The owner unquestioningly complied with the breeder! Now we have a nearly emaciated puppy being presented for vaccination.

Upon questioning the owner about the diet and the feeding schedules my support staff made appropriate recommendations. The owner however, challenged these recommendations, stating that she would have to check first with the breeder before changing the diet and feeding schedules! All the while she was clutching her emaciated puppy!

• Treats, toys

Besides the diet and feeding schedules, the introduction to proper treats and chew toys imparts some veterinary expertise as well.

Bad habits are often hard to break and it is important to make in-depth recommendations to the client. In fact, counseling clients to provide a solid base of nutrition in the young, growing animal may be as important as stimulating a solid immunity to infectious diseases through series vaccinations.

Adult stages of life bring more nutritional considerations. As mentioned, obesity is a major concern, but poor nutritional habits commonly develop throughout adult life.

Outside influences such as new family members, new pet additions to the household, owners changing jobs or daily routines all require an annual update and re-evaluation.

• Fine-turning recommendations

Take into account breed, age, climate, lifestyle and activity levels. Is the pet a small or large breed? Does the pet live outdoors and contend with climate extremes? Is the pet a working breed or is it simply a couch potato?

Also take into account the age and physical condition of the pet. Fortunately, there are numerous quality diets to choose from. Making customized recommendations to the owner based on these considerations will not only help the owner manage the pet's health, but provide tangible value to the wellness care visit. Hopefully, over time, the emphasis can be shifted from annual vaccinations to annual counseling, examination and lab screening.

• Annual screening aids in discovery

By adding a simple blood panel to the annual wellness visit a practitioner can make profound recommendations beyond the usual scope of the history and physical exam.

Consider the impact of being able to make dietary recommendations backed by laboratory testing.

For example, take the case of a senior dog presented for its annual visit. Upon examination a slight, yet significant, weight loss was noted. Upon questioning, the owner has noted some recent urinary accidents at night and possibly increased thirst. These could all be coincidental findings, but with an annual lab screen demonstrating an increased BUN, increased creatinine, and decreased potassium, it now begins to look more like early renal failure. A more in-depth work-up or at least some regular monitoring is indicated.

More dietary recommendations will likely be necessary to prolong the life of the pet.

Other examples might include finding a low albumin value or a high sodium value. These situations will almost always lead to a dietary recommendation whether it be a young or old animal, healthy or non-healthy animal.

Also consider hypertension, which has recently become more of a concern in senior care.

Cats with undiagnosed renal disease can be at increased risk to develop hypertension and accelerate the renal disease when fed diets that are too high in sodium. Consider finding a low potassium value in a senior cat that is being fed a urinary control diet (low pH diet). While the urinary control diet may have been important at a younger age, senior cats may develop hypokalemia and resultant tubular changes that can contribute to advancing renal degeneration.

Laboratory monitoring of the pet at the time of the annual visit will add to the value of nutritional recommendations as well as to the value of the wellness visit. Clients may leave the clinic with a startling recommendation about their pet's nutrition and with a laboratory report that provides tangible evidence.

• Senior label

Owners are often reluctant to label their pet as a senior!

Senior diets can be of great benefit to pets, but all too often they are not initiated soon enough.

A common observation is the owner's failure to recognize that their pet is, in fact, a senior pet. My staff makes it a common practice to review the pet's aging relevant to size and breed and educate the owner. This is an ongoing task, as pets seem to age rapidly. An age chart that compares different sizes with their comparable age in human years can be used to make the point.

Aging and medical conditions require frequent changes to dietary recommendations.

As dogs and cats live longer they are naturally more likely to develop age-related diseases such as obesity, arthritis, heart disease, kidney disease, diabetes and food intolerances. Advancing age further impacts the need for dietary changes. Yearly wellness visits are actually every five or six pet years. Dietary recommendations given one year will likely need to be updated the next year.

• Epidemic urgency

Obesity is one of the biggest challenges pets face. Since obesity impacts the development of arthritis, heart disease, diabetes and so many other diseases, it remains our first focus. Constant vigilance is needed as clients are continually being bombarded with media marketing to entice them to buy more and more treats and food items. It almost becomes an expression of love to over feed their pet.

Not getting involved in nutritional counseling could be professional negligence.

All too often a veterinarian or staff member may recommend a particular therapeutic-type diet at one stage of the pet's life and completely lose track of its usage in later years. As the pet ages and a dedicated client continues to purchase the same diet year after year, the original recommendation may no longer be valid.

Consider the dog that had struvite stones at one stage of life then later develops oxalate stones while taking the struvite prevention diet.

Animals on urinary control diets should be periodically re-evaluated by urinalysis to make certain that the condition has not changed. Or consider a dog getting an oxalate control diet and the owner is, in fact, feeding the proper product but is using raw meat to entice the dog to eat it. While the meat addition may enhance the palatability, it also lowers the urinary pH defeating the function of the oxalate diet.

• Food allergies

Food allergies also require constant nutritional vigilance. Restricted diets can only work well if used properly (100 percent of diet). However, clients commonly lose track of the purpose of the restricted food and offer treats and other items that are totally contraindicated, again, defeating the purpose of the diet. These same satisfied clients might eventually become disenchanted and even angry if their "expensive diet" appeared to fail.

As food allergies seem to be increasing, whether related to a true increase in prevalence or simply an increased public awareness resulting from media propaganda, a practitioner must not only monitor the pet, but also keep an eye on the ever-changing marketplace as well. New products may be available and it behooves all of us to be aware of them.

Hairball control diets, tartar control diets, diets to control brain aging, antioxidant diets, diets with glucosamine for joint disease, holistic diets and many other diets are available and all of these require veterinary expertise. Certainly more diets are on the horizon and these will likely present an even greater counseling challenge.

Good nutrition plays a key role in maintaining good health and increasing longevity. The practitioner's role as a nutritional consultant has great importance to the well-being of the pet throughout all life stages. We must respond to our clients' nutritional concerns and provide our much-needed and knowledgeable perspective.

Dr. Irwin has been a small animal practitioner for 32 years. He has owned and managed three practices in suburban St. Louis for more than 20 years. He has spoken to numerous veterinary groups on topics including hematology, diagnostic testing, wellness screening, using high technology equipment such as CO2 laser and other in-house diagnostic equipment to enhance the quality of practice. He has lectured to veterinary groups throughout the U.S., Canada, Australia, New Zealand, South Korea, England, France and Germany. He has written and published frequent articles in veterinary books and journals. He received his veterinary degree from Purdue University in 1971.

Disclosure: Consultant for IDEXX, Lumenis-Accuvet Laser Company.