Obesity still a top health threat to pets, nutritionist says

C.A. Tony Buffington, DVM, MS, PhD, Dipl ACVN, is a professor in the department of veterinary sciences at The Ohio State University, Columbus. He has conducted extensive research on the clinical nutrition of small-animal patients and the lower urinary tract disorders of cats. Here Dr. Buffington shares his thoughts on the indoor-cat initiative, nutrition issues facing pets, the difference between compliance and adherence, and future research endeavors.

DVM: What would you say are some of greatest nutrition issues facing pets today?

Buffington: Obesity – it ranks as issues 1 through 10. What's being done to prevent obesity? First, we have to get beyond equating diet and obesity. It's far more complex. For example, it's really about diet, exercise and the brain. And the brain is a big place. That factor is almost always left out – across species. Interestingly, we're seeing an epidemic of obesity and obesity-associated diseases in dogs, cats, horses and humans. When I talk to my physician colleagues, they're just as interested in what's going on in veterinary medicine, because it looks so similar. That's got to be telling us something. We just need to figure out what it's telling us and how to act on it.

Everybody plays a part: pet-food companies, owners and veterinarians. Veterinarians need to be teaching body- condition scoring, resulting in an appropriate body condition. Many of the pet-food companies have helped by having body-condition scoring schemes that they share with veterinarians and owners. Some companies have described this scoring on their packaging. Feeding directions on foods give you a ZIP code, but not the address of the animal. We need to be more focused on body-condition scoring. Again, animal husbandry is a very important approach to therapy. The American College of Veterinary Nutrition, American Academy of Veterinary Nutrition and the Pet Food Manufacturers Association, as well as pet food manufacturers in general – all those groups are doing what they can. Could we be doing more? We probably should.

We should attempt to prevent obesity, because it's not so easy to treat. Our approach to therapy for obesity includes variable combinations of diet, activity, stress reduction and rehabilitation therapy.

DVM: How do you think we got to this place of rampant obesity among pets?

Buffington: It's probably not one factor. It's partly the result of the increasing complexity of life, which can be stressful to people and animals. When it's stressful for humans, it's stressful for animals. As kids, we all knew when our parents were having a fight; our animals know that, too. Additionally, there's an enormous amount of readily available, calorically dense food, and it's really hard keep these pets active. Many neighborhoods do not have good places to walk. It is difficult to find the time in many people's lives for activity. So I think every case is going to be a little different. Those are the general features contributing to this situation.

DVM: What's the indoor-cat initiative, and how does it impact the practice of veterinary medicine?

Buffington: Since the late 1970s or so, as people have moved into more urban environments and taken their cats and other animals with them, our animals are being exposed to different environments just like we are. That may call for different approaches to animal husbandry.

In the university practice here, for example, a number of owners didn't grow up around animals. They didn't have lots of animals as pets, so maybe they don't know as much about how animals behave as people who have had those experiences.

The cat initiative effort was designed to try to educate people on how to be a good animal owner. What do cats really need, and how can owners help meet those needs?

We honestly just adapted our initiative from the zoo veterinarians, who have done many good things with environmental enrichment. In developing the initiative, we also looked at the intensive agricultural production, particularly in Europe, where they're very concerned about animal welfare from a production standpoint.

What we're doing right now is really an outreach to try to get the word out to more animal owners and veterinarians about how animals should be housed and the health issues associated with it. From a clinical point of view, we're very interested in investigating how problems of housing and environment play into the progression or natural history of disease. I don't think stressful circumstances necessarily cause any diseases, but it has certainly been well shown in a variety of species that it can unmask susceptibilities and also complicate therapy.

DVM: Is there a similar initiative for dog owners?

Buffington: I'm not aware of any. Honestly, for me, working with the cats is a full-time job. One of the reasons I got interested in cats is because they're really the outlier species. This means they're not a pack species, whereas humans, dogs, cattle, sheep, ducks, horses, pigs and geese are all pack species. Most people have never thought about the fact that cats aren't a pack species. That has led to a lot of confusion about how a cat's environment ought to be structured, and how they like to interact with other animals, including humans. A practical example that I tell my students is that you can slap your dog or slap your horse and they understand what you mean. You slap a cat, and they think you're trying to kill them. They don't have the pack communication skills. They don't have a dominance hierarchy that is as rigid as it is in the pack species. Most of their interactions are either avoidance or aggression. The expression, 'fight or flight' came from studies of cats. Those are their choices.

DVM: Compliance versus adherence: What's the difference?

Buffington: I've been thinking about this a lot. Technically the difference is this: compliance is something you do because someone told you to do it. Adherence is something you do because you think it is good to do on your own. I don't think it's too helpful to sit down and argue terminology. What we could do is put those two words together. You might get something like coherence, which means having a consistent, sensible message that's attractive and doable to help our clients.

It is the veterinarian, client and pet all working together in coherence.

There's a whole healthcare institute that is dedicated to veterinary communications. It's being taught in the schools now. Hill's has a big effort under way about increasing compliance. What we ultimately mean by compliance is doing the right things for animals and owners, which is really what adherence means as well.

I'm sure there are many efforts to enhance communication skills of veterinarians. Just as our animals are living in different circumstances than they were a generation ago, our clients are different than they were a generation ago. Animals are much more important to clients, for whatever reason. I imagine as we become more isolated from each other by our work and complexity of our lives, as those animals take on increased meaning to people, it's going to be helpful to us to understand that meaning and act within those constraints.

DVM: What are the age-related diseases that are having the greatest damaging effects on pets today?

Buffington: I'm not sure that age-related diseases have changed so much. I'd be thinking of chronic organ systems diseases and cancer. Part of that is because animals are living longer. Just as in human medicine, we're seeing some of these diseases because people are old enough to be getting them.

DVM: You've been involved in research on the human side. Are you continuing to work in this field?

Buffington: Yes, every day. I'm currently adviser to the local interstitial cystitis support group. I've talked to two urologists, and an autonomic neurologist over the last three days about grants we're going to submit to study humans. Some of the study is based on what we have learned in cats. And we're taking some of what we've learned in people back to cats. The opportunity to have naturally-occurring disease in two species is telling us things that there is no other way we could have learned. I find that intensely exciting.

DVM: What projects do you have on the horizon?

Buffington: From a research point of view, we're looking into how changes in gene expression are affecting certain diseases. We are looking at how changes in brain function are influencing diseases – all from the point of view of what can we do therapeutically.

These studies are being conducted both in humans and cats. We just got funded for some of it. Something we discovered in cats two or three years ago was that their adrenal cortex does not always function normally. And we've now looked at that in both men and women with related disorders and found the same thing. How that is going to play out, we're not sure. There is a lot more coming out of the adrenal cortex than just cortisol, which is what most people think. Some people have tried and failed to use some of these hormones.

Hormones are like internal nutrients. You can have imbalances between one and another. To me, it has been very interesting to take a nutritional approach to therapy.