Obesity

• Obesity is commonly defined either mathematically or descriptively. Alternatively, obesity is described as a clinical condition characterized by excessive accumulation of body fat the leads to pathology or impaired function.
• Overweight means all body weights between obese and ideal weights or is a six out of nine BCS.
• Obese means weight exceeds 120 to 130 percent of an ideal body weight or is greater or equal to a seven out of nine BCS.
• In 2019, the Banfield VET report focused on trends and opportunities in osteoarthritis (OA) management. It included a multi model approach that includes not only pain but also nutrition and weight management. This study explored barriers veterinary teams face in diagnosing and treating excess body weight and OA.
• The 2020 Banfield VET report has a mobility theme, focusing primarily on excess weight in pets.
• Of more than 1.9 million adult dogs seen at Banfield in 2018, 51 percent were classified as overweight. Of those, less than 10 percent successfully lost weight following an overweight diagnosis, regardless of age. Of the limited number of pets that do lose weight, roughly 40 percent regain weight and overweight status within 12 months.
• Overweight prevalence increases with breed size, but smaller breeds topped the list most affected breeds.
• Smaller dogs were more successful at losing weight, but within each breed size category, there was variation by breed.
• The veterinary and pet care industries need to continue efforts to address the obesity issue in partnership with pet owners, especially because current approaches have not effectively slowed (much less reversed) the upward trend in proportion of overweight pets.
• In addition to examining its veterinary medical records, Banfield conducted a random survey of the owners of overweight dogs to better understand how pet weight management recommendations were received and adapted- and found that having multiple dogs in the house, the ability to consistently measure feeding amount, and use pet care services (like a pet walker) are associated with successful weight loss.
• A survey looked at medical records from more than 500,000 cats cared for at Banfield hospitals. They discovered that felines are faring even worse than their canine counterparts, with more than a 169 percent increase in overweight cats over the past 10 years.
• The top five states with the highest prevalence of overweight cats included Minnesota (46 percent), Nebraska (43 percent), Iowa (42 percent), Idaho (40 percent), and Delaware (39 percent).
• A recent study demonstrated that active dogs fed a VTD formulated for weight loss used approximately 25 percent more energy than inactive dogs while achieving two percent weight loss weekly. Each 1000 step interval was associated with an approximately a two percent increase in daily energy expenditure.
• Other studies suggest that, for each km traveled, caloric expenditure of dogs on a VTD increases by approximately 2kcal / 0.75kg
• Underwater treadmill therapy has been part of a successful weight loss program in combination with owner education, a high protein low fat diet, and owner supervised exercise.
• A recent study demonstrated that a healthy dog, walking at a normal pace in elbow height water for 30 minutes daily, would use 2.5 percent more calories per day. For example, a 25kg dog consuming 1000 calories daily uses 25 additional calories.
• Many manufacturers claim their diets facilitate weight loss through alterations in nutritional composition or via inclusion of dietary supplements. But, a recent study of such foods demonstrated significant variability in caloric density as well as in the provided feeding instructions. Product labels are, therefore, an unreliable source of nutritional guidance for obese animals.
• Most commercial diets are formulated assuming a higher caloric intake than that consumed by most pets. As a result, a reduction in the calories fed further reduces intake of essential vitamins and minerals. A study that evaluated the essential nutrients provided by a maintenance diet when hypothetically fed for weight loss found that intake of multiple nutrients may be suboptimal.
• Caloric restriction is considered the primary treatment of small animal obesity. However, reduction in volume of food and number of treats fed is often a significant barrier for owners.
• High protein diets are recommended during the weight loss period.

  • Animals have well defined amino acid requirements, so providing additional protein can prevent possible deficiencies of taurine or other amino acids
  • High protein diets preserve lean body mass during weight loss.
• Research has shown that:

  • A high protein diet (120 mg/Mcal) allowed cats to consume about 10 percent more calories to achieve the same degree of weight loss as those fed a lower protein alternative (90 mg/Mcal)
  • Cats fed a high protein diet consumed a higher number of calories than those on a lower protein diet and maintained their weight following weight loss
  • Cats fed ad lib on a high protein diet showed an increase in daily energy expenditure. This may be due to dietary thermogenesis, in which different energy substrates have different energy costs associated with metabolism
• High protein diets may increase palatability of reduced calorie diets, as cats typically prefer protein to fat and carbohydrates.
• Modifications in carbohydrates and fat concentrations are variable in therapeutic weight loss diets.

  • Fat is often reduced since it provides over two times as many calories by weight as carbohydrates or protein
  • However, essential fatty acids are required and fat cannot be reduced below a certain threshold.
  • Carbohydrates and protein are commonly increased in a diet when fat is reduced.
• Fiber is added to increase both volume and weight of a food, while minimally affecting its caloric content. It is the most controversial nutrient modification for obesity because studies examining rate of weight loss or satiety have mixed or poorly controlled results.
• Insoluble fiber, like cellulose or peanut hulls, is eliminated in the feces and increases fecal volume, which can be negatively perceived by some owners.
• Diets with large amounts of insoluble fiber may reduce food consumption in cats.
• Soluble fiber, generally fermented by intestinal bacteria, is employed in other weight loss diets.
• Crude fiber percentage on most product labels refers to insoluble fiber, while total dietary fiber (TDF) reported by some companies better reflects both soluble and insoluble fiber sources.
• A recent study in obese dogs demonstrated that a high protein, high fiber diet (103g protein, 97g TDF/Mcal) produced greater weight loss (one percent vs 0.7 percent/week) than a high protein moderate fiber diet (104g, 56g TDF/Mcal).
• Diets formulated for weight loss may increase moisture content of canned diets during extrusion to increase food volume during caloric restriction.
• High moisture diets reduced ab lib caloric intake of cats in one study, while another showed no intake difference during the weight loss period. The latter study did show that weight regain was significantly reduced.
• It has been hypothesized that some animals find canned food more palatable, but this likely depends on pre existing preferences.
• It is important to develop stronger partnerships with pet owners to improve their commitment to their pet's proper weight, helping them understand is importance to overall health, activity, mobility, comfort and quality of life.
• Talking about weight loss

  • Incorporate a complete nutritional assessment into every veterinary visit
  • Create a customized weight loss plan
  • Position pet weight loss as a team effort
• Incorporate a complete nutritional assessment into every veterinary visit. This enables:

  • Guidance on nutrition and may increase an owner's ability to provide a diet history
  • Facilitate discussion about healthy body weight
  • Identify increasing body weight trends sooner
• Create a customized weight loss plan because there is no one size fits all approach to weight loss

  • Each plan should be tailored to each pet and owner
  • There should be a target healthy weight, as well as improved quality of life, mobility, activity, and comfort.
• Position pet weight loss as a team effort

  • Arm the entire hospital team with consistent messaging to keep clients engaged and committed to weight loss or maintenance plan
  • Accurate weights during check in
  • Educating clients on the dangers of excess weight
  • Recommending a specific diet, discussing portion size
  • Recommending weight loss activities appropriate for the pet
  • Following up with the client throughout the pet's weight loss journey to provide encouragement and support
• Talking points to starting and engaging in weight loss:

  • Effect of obesity (OA, expense, lifespan, quality of life)
  • Owner's role in pet's weight
  • Food isn't happiness
  • Techniques to change diet and feeding habits
  • Making exercise fun for the pet and owner, once it is a habit, the pet will expect it
  • Showing the pet's weight graph to the owner
  • Celebrating success with owners, incentivizing them to continue to engage and show that the hospital team supports the client
  • Get to know clients and what will work and what they will commit to
  • Personal story or experience.
• Prevention for obesity is key, so have cat friendly strategies in the hospital.
• There are some resources and strategies related to cat friendly practices through the American Association of Feline Practitioners (AAFP):

  • Designate separate areas for cats in the waiting and treatment areas
  • Provide a cat only exam room
  • When possible, complete procedures in the exam room
  • Consider providing a hiding place for the cat by utilizing kennel covers, when medically appropriate
  • Use calming pheromone sprays or diffusers
  • Brush up on feline and low stress handling techniques