At the 2020 Veterinary Meeting & Expo (VMX) in Orlando, Fla., Banfield Pet Hospital unveiled its fourth annual Veterinary Emerging Topics (VET)® Report, developed in conjunction with the North American Veterinary Community (NAVC). The 2020 VET Report reveals obesity in dogs and cats continues to rise. Of the 1.9 million adult dogs seen at Banfield hospitals in 2018, a whopping 51% were overweight, and less than 10% of those diagnosed as overweight or obese successfully lost weight. What’s more, of overweight dogs that do achieve a healthy weight, about 40% resume their overweight status within a year.1 Clearly, this is an issue that needs further attention.
In a session presented by Banfield, Alex German, PhD, DECVIM-CA, SHFEA, FRCVS, professor of small animal medicine at the University of Liverpool, spoke to conference attendees about the challenges today’s veterinary practices face with regard to pet obesity and his proposed solutions for overcoming these challenges to help improve health and quality of life in dogs and cats.
Challenge #1: The changing demographic of pet obesity
Shifts in the popularity of certain breeds may play a role in the increasing problem of pet obesity. The top five overweight breeds today, according to the VET Report, are pugs, English bulldogs, beagles, corgis and American cocker spaniels. “Aside from the obvious impact on quality of life, the medical impact of obesity in brachycephalic breeds will be far greater, especially the severity of respiratory disease,” Prof. German said.
The other issue facing the profession is that many pets today are extremely obese. On a nine-point body condition scale, he noted, each point above five represents about 10% extra weight for the pet. Therefore, a pet with a score of 9/9 is 40% above its ideal weight. But many pets go “beyond the scale,” he said. “If we set a weight management plan for a pet that is 9++++ on the body condition scale, our estimate of ideal body weight will be way off reality,” he said, “and the weight management plan is less likely to succeed.”
Challenge #2: Imperfect weight management strategies
“Current strategies are less than perfect,” Prof. German acknowledged. In weight reduction research, where every variable is accounted for, pets are able to lose 1% to 2% of body weight per week. But laboratories aren’t reality, he cautioned, because research colonies don’t factor in compliance.
In pet dogs, studies have found weight loss rates averaging about 0.8% per week. “Weight loss is not a linear process, and the slower it goes the harder it is to achieve success, Prof. German said. “As in people, weight loss in pets will be quicker at first, then it will get harder and take longer to shed pounds. It’s kind of like there is a physiological brick wall.”
In addition, he noted, simply getting started on the weight loss journey is difficult, and veterinary professionals can do more to initiate these challenging conversations with clients. In one study of more than 21,000 veterinary medical records, researchers identified how many times veterinarians wrote the term “obese” or “overweight” the clinical record. “If half of all dogs are overweight, then you’d expect about half of the records to include one of those terms,” he said. But what the investigators found was that only 1.4% of the medical record notes included those words. “These findings indicate that, setting aside tackling the weight problem itself, it’s a major problem even getting started,” he said.
Challenge #3: Societal and professional attitudes about obesity
Society’s impression of obesity, if YouTube popularity is used as an indicator, is that obesity is both sad and funny. Surveys show that people view overweight individuals as lazy and lacking in motivation with little self-control. People tend to blame the individual for their own excess weight, and pet obesity is often considered the fault of the owner, Prof German said.
This attitude persists even though science has shown obesity is a complex, multifactorial disease, Prof. German said, with genetic, medical, behavioral and other components at play.2,3 “Knowing this, you would think that medical professionals would view obesity differently from the way the rest of society views it, but even health care professionals carry a weight stigma that makes its way into the exam room,” he said.
Do you have a weight stigma?
Veterinary professionals who have a weight stigma are less likely to engage clients in conversations about their obese pets. Some people have implicit biases they don’t even realize they have.
If you think you might have a weight stigma, or if you’re not quite sure, Harvard’s Project Implicit can help. Visit implicit.harvard.edu, which offers a number of tests that gauge biases of all kinds. If you find that you do have an implicit weight bias, adjust your actions accordingly.
Solution #1: Rethink weight management strategies. Instead of focusing on target weights, percent weight loss, ideal body weight and other numbers-driven data, Prof. German recommended what he calls an “oven-ready” 12-week plan, especially for middle-aged or older pets and those with comorbidities.
In both people and pets, the “golden period” for weight loss—when compliance is highest and the most weight is lost—is the first three months. The idea behind the 12-week plan is to help patients have better quality of life, Prof. German said. “Don’t fret about getting them to perfect weight,” he advised. “Prioritize completing the 12-week plan, with the primary outcomes being better function and improved quality of life.” After that period, review the results and consider continuing the plan after consulting with the client.
But will 12 weeks be enough time to make a difference? In two of largest studies of pet weight loss to date (one in dogs and one in cats), pets lost an average of about 11% of their body weight in 12 weeks’ time.4,5 Further, another study showed pet mobility improves after as little as 6% to 9% weight loss.6
Solution #2: Focus more on overweight prevention. Identify at-risk pets before obesity develops, then monitor those pets proactively for life. “Risk factors for obesity in pets include breed, neuter status and owner demographics,” Prof. German said, adding that “obesity in dogs can also be predicted in some cases by growth patterns. Pets that grow more quickly than average are more likely to become overweight later in life.” Prof. German recommended using growth charts to gauge trends (canine growth charts are available here). "Optimal growth should follow a single line on the chart, with less than 5% movement up or down," he said.
Solution #3: Have better weight conversations. “Don’t ignore the elephant in the exam room,” Prof. German advised. “And the conversation doesn’t need to be an uncomfortable one.” In general, he advised:
- Avoid blame. Park your prejudices and opinions about obesity at the door.
- Avoid toxic words. “Fat” and “obese”—even though the latter is a medical term—typically don’t go over too well with clients. Instead, Prof. German suggested talking about body condition and sharing relevant charts.
- Treat overweight owners the same as non-overweight owners. “It’s the same conversation regardless of who the client is,” Prof. German said. “Focus on the pet and show your clients empathy. You’re not going to mention the owner’s weight because our obligation is to the pet.”
- Ask permission. After explaining a patient’s body condition score visually to the client, ask simply, “Would you be open to having a discussion about it?”
References
1. German AJ, Holden DL, Moprria PJ, et al. Long-term follow-up after weight management in obese dogs: the role of diet in preventing regain. Vet J 2012;192(1):65-70.
2. Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health 2010;100(6):1019-1028.
3. Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring) 2009;17(5):941-964.
4. Flanagan J, Bissot T, Hours MA, et al. Success of a weight loss plan for overweight dogs: The results of an international weight loss study. PLoS One. 2017;12(9):e0184199.
5. Flanagan J, Bissot T, Hours MA, et al. An international multi-centre cohort study of weight loss in overweight cats: Differences in outcome in different geographical locations. PLoS One. 2018;13(7):e0200414.
6. Marshall WG, Hazewinkel HA, Mullen D, et al. The effect of weight loss on lameness in obese dogs with osteoarthritis. Vet Res Commun 2010;34(3):241-253.
