Feline Obesity: The Elephant in the Exam Room

Are your feline patients becoming increasingly rotund? If so, they are part of the nearly 60% of cats in the United States that are overweight or obese, according to the 2016 US Pet Obesity survey.¹ Although we may occasionally chuckle at memes and videos of roly-poly cats, feline obesity is no laughing matter. Obese cats face serious health challenges and consequences, such as osteoarthritis, diabetes, and reduced life spans.²

The typical approach to feline and canine weight control is dietary management. The American Animal Hospital Association recommends that nutritional assessments occur during each veterinary visit to provide a window into a pet’s nutritional status and help veterinarians establish a partnership with the pet’s owner to help maintain or improve a pet’s health.

Despite cats’ increasing pudginess and the importance of nutritional history taking, feline obesity remains an elephant in the examination room. Veterinarians tend to struggle with addressing this complex and sensitive topic effectively with clients, and many avoid the topic altogether. Previous studies have proposed why feline obesity discussions at veterinary practices can be so challenging, such as:

• Veterinarians and clients sometimes see a pet’s weight differently. In dogs, for example, what a veterinarian perceives as obese may be considered normal by a client.³
• Feline office visits are less frequent than canine visits,⁴ resulting in missed opportunities to address and manage obesity.

To date, very little is known about how veterinarians and cat owners really interact during clinical appointments when feline obesity is discussed. A team of Canadian investigators recently sought to understand this by analyzing video recordings of feline veterinary visits.⁵ Their findings shed light on communication strategies used by both veterinarians and clients when discussing feline obesity and can serve “as an important starting point for veterinarians to consider in their own practices regarding sensitive topic discussions,” they wrote.

RELATED:

• CVC 2017: Tackling the Obesity Issue
• Combatting Obesity in Pets and People: A One Health Approach

Video Analysis and Appointment Details

The investigators screened 284 video-recorded appointments from several small animal veterinary practices in Ontario, Canada. Of these, 123 were feline appointments. From these 123 appointments, 25 met the study’s inclusion criteria—at least 2 back-and-forth exchanges between the veterinarian and the client regarding a cat’s obesity.

The videos were analyzed qualitatively for verbal and nonverbal communication. Verbal discussions were transcribed. A thematic analysis of the videos was also performed to identify themes and subthemes in communication between the veterinarian, the client, and the patient.

The 25 appointments were conducted by 12 veterinarians, 75% of whom were female; most clients (72%) were also female. Nearly all clients had worked in the past with the veterinarian conducting the appointment.

Nineteen of the 25 appointments included obesity and diet discussions, and 6 included obesity prevention discussions. Veterinarians initiated most of these conversations. In addition, most discussions occurred during wellness visits, rather than during visits for specific health problems. The depth, duration, and complexity of obesity dialogue varied widely.

A handful of the veterinarians contributed to over half of the obesity discussions. Interestingly, in all but 1 case, obesity was not the reason for the appointment.

Emerging Themes

The researchers identified 3 main themes: communication alignment/misalignment between veterinarian and client, patient-directed speak, and oblique or absent messaging.

Communication Alignment/Misalignment

Misaligned communication about diet and weight management was common. Veterinarians focused on a diet’s brand and perceived quality. Clients, on the other hand, discussed a diet’s shape, flavor, or ingredients. When asked about diet during a visit, for example, one client couldn’t recall the brand but described the food as “organic” and “from the pet store.”

Regarding weight management, a client suggested a dietary change during an appointment; the veterinarian, however, recommended reducing ration size. Also, this client repeatedly asked for the veterinarian’s assessment on food choice appropriateness, but the veterinarian provided only vague answers and dropped the topic.

Dropping the topic may ease tension, the investigators noted, but it also creates ambiguity for clients and signals a missed opportunity for a conversation about effective weight management. Rather than dropping the topic, the authors recommended a helical approach, in which a topic is repeatedly circled back to during a discussion.

Resistance

Clients became resistant during appointments if they did not agree with the veterinarian or if the veterinarian singularly pursued an obesity discussion. Some veterinarians, when met with resistance, altered their communication strategy. This often meant at least partially abandoning their recommendations and attempting to circle back to the resisted topic.

Humor

Humor was used often by veterinarians and cli-ents during obesity discussions and served many purposes:

• Realign communication
• Acknowledge a cat’s obesity
• Defuse tension and soften resistance
• Strengthen the veterinarian—client relationship
• Make recommendations on weight management and diet

In one visit, though, the use of humor backfired. A veterinarian used humor to undermine his colleague’s assessment of a cat’s weight. The cat’s owner, who had made changes to her pet’s diet based on that colleague’s assessment, became tense and less engaged. Unfortunately, the veterinarian did not perceive this tension, continued to use humor ineffectively, and ultimately dropped the topic.

Given these findings, the researchers suggested that “sensitive and careful use of humor can be used as a relationship-building tool and can be helpful for discussing complicated topics such as obesity.” Patient-Directed Speak

Veterinarians and clients spoke through and to the patient. As with humor, patient-directed speak had several uses:

• Project humor
• Express empathy
• Realign communication
• Introduce, or reintroduce, a sensitive topic

As an example, a veterinarian used patient-directed speak to counter a client’s resistance about discussing her cat’s obesity. In another visit, a veterinarian spoke to the cat to comment on the cat’s weight gain.

This type of speaking, the investigators noted, allows the client to listen to sensitive information without having to respond. This in turn can encourage communication between the veterinarian and the client.

Oblique or Absent Messaging

Discussions on weight and dietary management were typically unclear or absent. For example, in multiple visits, veterinarians did not give a clear weight assessment unless a client persistently asked for one; after the assessment, though, the weight discussion was often dropped without recommendations on weight-loss strategies.

Exercise was recommended in only 2 of the 25 appointments, both of which involved outdoor cats. In one of these appointments, the veterinarian implied that weight loss would occur once the weather was warm enough for the cat to go back outside. However, the veterinarian did not develop a clear weight-loss plan.

In the 6 obesity prevention appointments, veterinarians were usually oblique. They warned against further weight gain, but did not provide clear obesity prevention or weight management strategies.

Bringing It Together

Given the qualitative nature of the study, the investigators acknowledged that the findings are not easily generalizable. In addition, the appointments were recorded in 2006 and thus may not reflect advancements and current trends in veterinary education and practice.

Nevertheless, because “many discussions fell short of clear assessment, strategies, or identification of the client’s perspective,” the authors emphasized that “there is a need for a dynamic and individualized response to obesity management in veterinary medicine.” They proposed several recommendations for veterinarians to better facilitate feline obesity discussions:

• Share thoughts out loud with the client to encourage discussion of perspectives.
• Consider the patient and the client when developing a weight-loss treatment plan.
• Be intentional when asking about a client’s home environment and perspective.
• Provide clear direction to clients regarding weight-loss treatment plans and assessments.

Through future research and updated veterinary curricula that can unravel the complexities of feline obesity communication, the investigators believe that veterinarians can better communicate with their clients regarding feline obesity, dietary management, and weight loss.

Dr. Pendergrass received her Doctor of Veterinary Medicine degree from the Virginia-Maryland College of Veterinary Medicine. Following veterinary school, she completed a postdoctoral fellowship at Emory University’s Yerkes National Primate Research Center. Dr. Pendergrass is the founder and owner of JPen Communications, a medical communications company.

References:

• 2016 pet obesity survey results. Association for Pet Obesity Prevention website. petobesityprevention.org/2016/. Published February 21, 2017. Accessed August 9, 2017.
• German AJ. The growing problem of obesity in dogs and cats. J Nutr. 2006;136(suppl 7):1940S-1946S.
• White GA, Hobson-West P, Cobb K, Craigon J, Hammond R, Millar KM. Canine obesity: is there a difference between veterinarian and owner perception? J Small Anim Pract. 2011;52(12):622-626. doi: 10.1111/j.1748-5827.2011.01138.x.
• Lue TW, Pantenburg DP, Crawford PM. Impact of the owner-pet and client-veterinarian bond on the care that pets receive. J Am Vet Med Assoc. 2008;232(4):531-540.
• Phillips AM, Coe JB, Rock MJ, Adams CL. Feline obesity in veterinary medicine: insights from a thematic analysis of communication in practice. Front Vet Sci. 2017;4:117. doi: 10.3389/fvets.2017.00117.