Take on obesity one bowl at a time

Dr. Randy Miller looked across the exam table. Sitting in the corner was a pair of pumpkins. At least they were shaped like pumpkins. These pumpkins had legs and were actually Mr. and Mrs. John DeArmo. The DeArmos had been sitting placidly albeit precariously for about 10 minutes on the two relatively smallish fiberglass seats in the exam room

The Anecdotal Epiphany

When Dr. Miller opened the exam room door, the couple started to move around anxiously within their sea of clothing and unidentifiable paraphernalia. Theoretically, somewhere underneath in the same corner were two cats — Killer and Frankenstein. In the far corner, two cat carriers lay askew — one contains a fresh and aromatic deposit from Killer.

"Good morning, Mr. and Mrs. DeArmo," Randy chimed.

Although they did not answer, they smiled and constantly shook their heads in deference to Dr. Miller. This was just one of their unusual ways. The DeArmo's were, if anything, wonderfully friendly people. A sudden turmoil ensued in the corner as the overtly plump couple grappled to find their cats. Several seconds passed until it was realized that both cats had unknowingly retreated to the backs of their carriers. Killer's paws were now undoubtedly painted with the fresh coat of feline "do-do".

In order to save at least 15 minutes, Dr. Miller took immediately to the task of extracting cats from their respective sanctuaries. Frankenstein came easily despite his enormous size and girth. Killer was a chore. Somehow she had been able to wedge her claws into the plastic in such a way that extraction was hopeless. Randy had to dissemble the carrier in order to expose Killer. Since the DeArmos had remained seated during all of this and did not try to help, Dr. Miller estimated that he had saved another 10 minutes of exam room time.

Janet Fritz had entered the room somewhere in the interim and was providing support for the multi-tasking event in progress. Janet was a longtime technician for Dr. Miller and was used to these scenarios.

Finally, at least 50 pounds of cat lard and savagery appeared before them on the exam table . They were here for "shots".

Randy hesitated. Did he dare bring up the weight of these felines as he had mistakenly done last year and the year before? He decided to wade into the issue at hand. After all, he considered himself a good vet.

After a lengthy presentation of the medical facts, the following conversation ensued:

"Dr. Miller, they hardly eat a thing," cried Mrs. DeArmo.

"They only are fed once per day in the morning, and I fill it up again each morning!"

"Do you feed them any treats?"

"We give them some cheese and crackers every night — but not very much?"

And then finally, the inevitable question arrives (this question if answered truthfully requires some careful history taking, some outside research and multiple calculations): "How much should we feed them?"

Dr. Miller realizes that he started it and now must finish it.

After a considerable amount of time is spent with the calculator and some cardboard feeding guides, Dr. Miller comes back in and makes his recommendations. These include exercise and a change to a prescription diet.

After a few moments, Mrs. DeArmo exclaims that they are already on a "light" diet from the store, and they cannot get the cats to move, much less exercise.

Dr. Miller continues to make his case and starts to become quite demonstrative in the exam room. While in full battle mode, he suddenly looks again at the pumpkins on the other side of the room and a small balloon deflates in his mind and realizes he had been defeated before he even began. He decides to finally finish his war dance and give the "shots".

Mr. DeArmo starts to nod his head and slightly bows as they leave the room. They are happy — their cats are not.

Janet opens the door and whispers that he is three appointments behind.

He mutters to himself that there is high price to pay for trying to be a good vet.

The feline dilemma

Cats are carnivores and are therefore meat eaters by definition. They were meant to hunt and eat unsuspecting varmints in the pastures and woods of this world. They originated in the Middle East, and the harsh environment of the desert and steppe limited their numbers. Enter mankind.

Because of our tendency to be blinded by anthropomorphism in the animals that we domesticate, human beings become dismayed when cats bring half-eaten birds and snakes to our doorsteps.

Therefore, we have mostly taken these hunting machines indoors and given them a high-carbohydrate diet and nothing to hunt but toys and their food bowls.

Additionally, during veterinary school we were told that spaying really doesn't make dogs and cats fat and that cats will eat only enough to satisfy their carbohydrate requirements and then ostensibly they are satiated. We bought into that line of reasoning because so many problems (both medical and societal) are encountered with intact animals that we have been able to live with the lie all these years.

Unfortunately, if you practice long enough, you realize that it really doesn't take a lot brains and research to conclude that in fact a correlation exists between obesity and altering pets.

It is a hard thing to admit because so many other factors are in play here. Yet, a thinking person finally has to face facts. The question then is how we approach the public and our clients with this issue.

The 'cat fat' incubator

Now if you place a cat indoors with a low-protein, high-carbohydrate diet and nothing to do, the inevitable will ensue. Some of this is physiology.

According to Dr. Deborah Greco, a veterinarian at the Animal Medical Center in New York City, cats apparently were not intended to eat a lot of carbohydrate in that they have very limited glucokinase activity in the liver and thus cannot process glucose very well. Alternatively, they can convert a lot of protein to glucose and then to glycogen. Since protein is the stimulus for insulin release in the cat and insulin resistance is common in cats (to help maintain glucose levels while fasting in the wild) a high carbohydrate diet leads to an overall increase in glucose in the blood. This eventually leads to Type 2 diabetes. (Adapted from: "Notes from the 2003 AVMA Convention" Denver Colorado, American Veterinary Medical Association, Tuesday, 22 July 2003.)

In addition it has been postulated that estrogen tends to curb the overactive appetite. If that is found to be true, it could be one of the reasons that cats tend to gain both weight and appetite after they have been spayed. Androgen may have the same effect. Certainly removing androgens and estrogens reduces the metabolic rate. Combining all of these factors, is it any wonder we have a 40 percent obesity rate in household felines?

Feline diets are the way they are for one reason: economics and convenience. To feed cats a diet that mimics the diet in the wild would be impossibly expensive for the average cat owner. Additionally the portability and stability of dry cat foods makes it a rational choice. There is a lot of protein in many dry cat foods, it just comes with a price.

They are here

"They are here for their shots."

This common client enjoinder is fortunately but albeit slowly losing its grip as a "gateway" statement. However, years of annual vaccination dependency is evaporating and veterinarians are slowly moving away from this slipping anchor.

In its place must be sensible and scientific care for our patients. One of the most important is nutrition appropriate for the species and its environment.

One of the best management moves you can make is to switch to a consultation orientation in your practice and move away from the 15-minute appointment with shots and multiple pets. I would bet that there is not a single veterinarian who upon seeing patients today saw even one appointment that lasted approximately 15 minutes. If you have more than one exam room, you are multi-tasking and clients are often in the rooms for at least 45 minutes.

Can we realistically expect clients to call ahead for nutritional counseling? Probably not, but using a vaccination visit for an opportunity to reschedule the patient for another more in-depth consultation is a wise use of your time. It also is better medicine and better financial management.

Being surprised late in my practice life

I went many years acting a lot like Dr. Miller. I was pontificating and spewing out research notes and "scientific" statements from nutrition texts and experts. I was diagnosing and recommending diets (and still do) containing the various letters of the alphabet.

Many of these diets are appropriate and lifesavers for thousand of patients worldwide. I also am grateful to all the great companies that have contributed to sound nutrition over the years. Yet, one mountain seems impregnable—obesity. Will all due respect, I have seen cats put on weight with every food manufactured within this galaxy.

After gently castigating and mostly being skeptical of my client's responses to the amounts of food that was being given to their pets, I was surprised to learn that in fact many of my patients were in fact not eating very much and still gaining weight. This was an eye opener for me. Maybe there is something we are missing on our end. Was there something in the behavior of clients and pets that amplifies the "cat fat' incubator" effect of our households? (See story)

Dr. Lane is a graduate of the University of Illinois. He owns and manages two practices in southern Illinois. Dr. Lane completed a master's degree in agricultural economics in 1996. He is a speaker and author of numerous practice management articles. Dr. Lane also offers a broad range of consulting services and can be reached at david.lane@mchsi.com.