Obesity: A big problem

Our patients are facing an epidemic. Left untreated, it can lead to severely debilitating conditions resulting in pain, suffering, and expensive medical care. Fortunately, the problem is preventable and can usually be reversed with simple treatment. The problem is obesity.

Ernest E. Ward Jr., DVM

Here's the real question: Why aren't we talking about it? Every veterinarian and healthcare professional knows the story by heart. We eat too much. We feed our pets too much food. We all get fat. We become sick and arthritic and develop other weight-associated conditions and then undergo expensive medical treatments.

Obesity in people is a huge problem, of course. The American Medical Association estimates that 300,000 people die each year in the United States because of poor diet and physical inactivity, both of which contribute to obesity. The Centers for Disease Control and Prevention calculates that obesity-related problems cost our economy more than $75 billion each year. And our pets are suffering a similar fate. Roughly 40 percent to 55 percent are classified as overweight, and one-third to one-half of those are obese.

This is largely a modern problem. Obesity rates in the United States rose about 112 percent from 1970 to 2000. When I graduated from veterinary school in 1992, pet obesity wasn't even discussed in the classroom. And with such a seemingly simple solution for most pets and people—eat less and exercise more—you'd think we could reverse the trend. But the World Health Organization estimates that the number of overweight adults will grow by 40 percent over the next 10 years. And we're likely to see the same trend in the number of the plump pets visiting us.

Help study obesity in pets

It's time to speak out

The first step in improving pets' health and ending this epidemic is to talk about it. Why don't we?

Let's consider human medicine. In a 2004 study, more than 50 percent of obese people who did not undergo bariatric surgery reported that their primary care physician "never" or only "once in a while" discussed their morbid obesity with them. One reason physicians fail to counsel patients on obesity may be doctors' distrust of the available treatments. They see lots of weight loss options and lots of overweight patients; one doesn't seem to make an impact on the other. Physicians are unlikely to discuss weight loss plans that don't appear to work.

It's no different for veterinarians. We see lots of overweight pets and lots of diet foods and treatments, yet the number of fat pets keeps growing. So we don't talk about it.

For some of us, our busy schedules and lack of training in weight-related disorders and nutrition hold us back. But no matter the reason for our reticence, now is the time for us to learn about these issues and make time to talk to clients about them.

It starts with you

If we truly believe that maintaining an ideal weight will improve patients' quality of life and life expectancy, we'll naturally be more enthusiastic about the topic. So each of us needs to understand the link between obesity and conditions such as type 2 diabetes, osteoarthritis, hypertension, heart disease, and cancer. We must understand how weight-associated morbidity in pets affects the pet-family bond and how this can decrease the level of care pets receive as they age. We need to look for simple lifestyle changes that can improve pets' health. We must feel comfortable looking clients in the eye and confidently discussing weight-loss strategies in a nonthreatening manner. If we believe, clients will see our passion and be more inclined to listen and believe in us when we tell them obesity is a serious issue.

Because of the social stigma attached to being overweight, many doctors avoid the topic altogether. Further, a few high-profile cases involving people suing physicians for offending them while discussing their weight has heightened doctors' worries about addressing weight issues proactively. But as veterinarians, our responsibility is to the pet—regardless of the client's weight. With this in mind, we can learn to separate a client's obesity from discussions of his or her pet's health.

Communication tip: Talking as a team

How to begin

The client usually knows the pet is overweight or obese yet may not fully understand how much that can hurt the pet. Instead of stating the obvious ("Did you know Fluffy is obese?"), try saying, "I'm concerned about Fluffy's weight because it may be causing health problems for her. Do you think her weight is causing health problems?"

If you get a noncommittal or uninterested response, don't start detailing how diet and exercise can help Fluffy achieve an ideal weight. Instead, focus on the long-term health risks associated with Fluffy's excess weight. "I know how much you care about Fluffy, and that's why I want to help you avoid some serious diseases such as diabetes, heart disease, and arthritis." Center the conversation on disease prevention instead of the latest diet tool.

Show your support

Admit that weight loss is a challenge for everyone, including doctors. If you understand the difficulties firsthand, share your own struggles and you'll gain your clients' trust.

Clients also respond more favorably to your recommendations if they feel understood. These strategies can help you communicate your empathy:

• Use nonverbal cues. Make eye contact, nod in agreement, and lean toward the client to convey interest in what he or she is saying.

• Frame the client's statements to demonstrate that you understand: "Let me see if I have this right. Fluffy began gaining weight after a new neighbor moved in next door."

• Reflect the emotional tone of client statements to show that you empathize: "Yes, I know how frustrating this can be."

• Involve the client as a partner in the care of the pet: "Is there anything I left out?" or "Does that sound right to you?"

Get clients on board

The key here is to match the treatment plan to the particular client's preferences, abilities, and readiness for change. In contrast, the traditional approach is often too directive. We tell clients what they need to do, and they should do it because we say so.

Communication tip: If youre overweight

Today's clients no longer accept everything a veterinarian says as valid without a challenge. It's not that they're looking for an adversarial relationship; it's that they want to be involved. We should encourage clients to discuss their lifestyle patterns (what, how much, when, and where they feed and exercise their pets), why they think it's important for their pet to lose weight, what signs of improvement they expect and in what time frame, and what challenges they foresee. By actively partnering with clients, we're letting them help us tailor a treatment plan that's more likely to succeed.

No doing without understanding

Now, this is probably obvious. But even if the client agrees that the pet needs to lose weight, he or she needs to understand how to achieve that goal or it won't happen. And you can't just ask, "Do you understand?" Everyone nods blankly in agreement when they hear that question, because the last thing they want is to hear your lecture again.

Instead, try using the "teach back" method. After you explain how much and how frequently you want the client to feed the pet, ask, "Would you mind explaining that feeding plan to me so I can make sure I didn't leave anything out?" This technique also works well when you give pet owners directions for medications and follow-up care that clients handle at home on their own.

With all of your conversations, it's important not to end the discussion at the food bowl. Diet is one of the most important factors, and arguably the easiest to talk about, but it's not the cure. High-calorie treats and inactivity contribute greatly to obesity. Our pets are becoming a nation of lap potatoes.

We need to expand our arsenal of tools to reverse this trend. And clients will respond better if they can see just how much they're overfeeding and under-exercising their pets. I've had good luck asking pet owners to keep a food and activity diary.

Ask the client to record every feeding (including food type and amount), treat (including the occasional table goodie), and activity (such as walking or playing fetch) for one week. Make it easy by offering them an online form or a prepared written log. (See "Related Links" below.)

Once you have this data, you can customize a weight loss plan that fits the client's lifestyle. For example, if a client works until 8 in the evening and has two kids, it may be unrealistic to advise him or her to take an overweight dog for a 30-minute brisk walk daily. This client needs to be reassured that it's OK to exercise as time permits and substitute carrots or celery as doggie treats.

When you establish rapport and a shared sense of responsibility, a client may open up and offer possible solutions, too. Maybe she'll say she can take Gracie to her son's soccer practice and throw a ball for her. Once clients understand how an extra 50-calorie treat given at bedtime is adding up to five or six pounds of weight gain per year—and that simple physical activities really make a difference—they'll often change their habits.

"But he looks so hungry!"

Of course, it's tough to resist the pleading eyes of a dog or persistent cries of a "hungry" cat. Our desire to please our pets is at the core of overfeeding. We need to counsel our clients that it's OK to give in to these requests—as long as they offer a healthy reward.

The first step is to praise demanding dogs or persuasive cats. Owners can pet them, kiss them, hold them, and say how beautiful the pets are and how much longer they're going to live because the owners aren't giving in to temptation. They can take the pets to the food bowl and hand them some kibble of low-calorie diet. Or, some dogs will completely forget about that piece of pie if you take them on a walk instead. Cats may be satisfied with a sample of the food already in the bowl or even an extra 10 or 20 kibble.

Many times it's not about the food for pets but about friendship. Their social exchanges in the wild include eating as a group or sharing prey, and they just want to be a part of the experience. When a client simply must give a food treat, he or she can try vegetables such as broccoli, asparagus, carrots, or celery. For cats that wake the family at 2 a.m. to tell them the food bowl is empty, owners can try offering more frequent but smaller meals, including a meal at bedtime to satisfy a restless stomach. Share your own stories about trying these tactics, and clients will see you as a collaborator rather than feeling lectured.

Don't expound on pounds

When it comes to setting weight loss goals for pets, don't make it about the pounds at first. Too often we limit the discussion to losing weight when it really should be centered on improving overall health. Focus on increasing activity and decreasing calories:

"Mrs. Floyd, our long-term goal is for Scruffy to lose 20 pounds. For the next month, however, let's forget about losing weight and concentrate on you two taking that 20-minute walk you mentioned every morning. Also, it'll help if every time you or Scruffy wants to reach for a doggie treat, you give her a big hug instead. If she still insists, give her a baby carrot and take her outside for a few minutes." If we initially focus on big, challenging goals, clients may become overwhelmed and abandon the plan.

Next, make sure clients understand that it's OK to forgive themselves when they slip up and give that piece of pie to Scruffy. We want clients to stick with the plan, not dump it because they relapsed. Instead of saying, "I can't believe I just did that. I'll never stick to this diet plan," we want them to say, "I goofed. I'll have to be extra diligent to make sure I don't do that again."

One step back, two steps forward

The ultimate solution is to make healthy eating and physical activity a part of the normal routine. Encourage clients to take small steps and win seemingly insignificant battles until they've reached a long-term goal.

And remember, even our best clients may fail when it comes to helping their pets shed pounds. Setbacks are a part of a lifelong commitment and must be handled in a positive manner. Don't blame clients or label them as "noncompliant" for failing to adhere to your recommendations. Getting upset will increase everyone's frustration and damage the partnership between you and them. Instead, work with these clients to discover the reasons for their missteps and seek solutions together.

Maybe a client didn't understand your directions the first time. Or maybe he or she encountered unforeseen obstacles or thought your plan was unrealistic. Regardless of the cause, collaborate with the client, listen to the issues, and work together to solve problems and develop new strategies.

The war against pet obesity will not be easily won. There's no magic cure. Even with today's amazing pharmacologic advances, long-term success lies in changing pet owners' attitudes toward weight issues and helping them adopt a healthier lifestyle for their pets. By extension, we may positively impact our clients' health as well. It's time to take a stand and stop ignoring one of the leading causes of death in our patients.

Dr. Ernest E. Ward Jr., a Veterinary Economics Editorial Advisory Board member, owns Seaside Animal Clinic in Calabash, N.C. He finished the Ironman competition in Hawaii last month. Send questions or comments to ve@advanstar.com