It’s not what he eats, It’s not what he eats, you know?you know?

David WatsonDavid Watson

BVetMed MA MRCVSBVetMed MA MRCVS

Editor, Editor, vetpulse.tv & VNJvetpulse.tv & VNJ

Where emotion meets factWhere emotion meets fact

• Is he?!Is he?!

• It’s not what he eats you know!It’s not what he eats you know!

• Ignorance, not intentionIgnorance, not intention

• Profound reflection of ‘the bond’Profound reflection of ‘the bond’

RustyRusty• 12 y.o.12 y.o.• 74.2kg74.2kg• RSPCA cruelty caseRSPCA cruelty case• ““unnecessary suffering unnecessary suffering

caused by obesity”caused by obesity”

Just who was Just who was responsible?responsible?

Human medicineHuman medicine• Mayo Clinic, Rochester, USMayo Clinic, Rochester, US• Only 1 in 5 ‘charted’ as obeseOnly 1 in 5 ‘charted’ as obese• 2,500 obese patients for check up, 2,500 obese patients for check up,

but most no weight loss planbut most no weight loss plan

Doctors’ excusesDoctors’ excuses• patient in denialpatient in denial• embarrassedembarrassed• time constraintstime constraints• lack of relationshiplack of relationship

Veterinary medicineVeterinary medicine

• UKUK

• Vets’ excusesVets’ excuses– owners were overweightowners were overweight

– preferred to talk to dogpreferred to talk to dog

– job for nursesjob for nurses

– no other clinical signsno other clinical signs

– no time to talk about weightno time to talk about weight

Who initiates discussion?Who initiates discussion?

Hill’s US Study - 2006

53%33%

14%

Client

Vet

DK52%40%

8%

Client

Vet

DK

Cat ownersDog owners

Client Excuses - 1Client Excuses - 1• Want to feel happy when feeding Want to feel happy when feeding

their pets their pets • Denying their pet something it wantsDenying their pet something it wants• Old habits are hard to breakOld habits are hard to break• Difficult - busy lifestyle and Difficult - busy lifestyle and

schedulesschedules

Hill’s US Weight Studies - 2002

Client excuses - 2Client excuses - 2• Losing weight - slow and frustrating process Losing weight - slow and frustrating process

– 49% of cat owners49% of cat owners– 26% of dog owners found no success in 26% of dog owners found no success in

changing their foodchanging their food

• No time for exercise and other non-dietary stuffNo time for exercise and other non-dietary stuff

Didn’t realise how serious it wasDidn’t realise how serious it was

Question of caloriesQuestion of calories

• Energy is the keyEnergy is the key• Metabolisable Metabolisable

energy (ME)energy (ME)• Controls food intakeControls food intake• All other nutritional All other nutritional

components must be components must be balanced to itbalanced to it

Three sources Three sources • CarbohydratesCarbohydrates

– monosaccharides & disaccharidesmonosaccharides & disaccharides– polysaccharides (starch)polysaccharides (starch)– fibre (cellulose, beet pulp)fibre (cellulose, beet pulp)

• FatsFats– twice as much energytwice as much energy– highly palatablehighly palatable

• ProteinsProteins– inefficient sourceinefficient source– muscle breakdownmuscle breakdown

Energy requirementsEnergy requirements

• Body sizeBody size

• Life stageLife stage

Age to maturityAge to maturity2 years2 years

8-10 months8-10 months

Energy requirementsEnergy requirements

• Life styleLife style

• Environmental factorsEnvironmental factors

• Individual Individual variationvariation

Question of balanceQuestion of balance

• Obesity = Energy in, exceeds energy neededObesity = Energy in, exceeds energy needed• Extra calories stored as fatExtra calories stored as fat• Serious consequencesSerious consequences

– arthritis arthritis – heart disease heart disease – diabetes diabetes – liver dysfunction liver dysfunction – reduced resistance to diseasereduced resistance to disease– reduced life expectancyreduced life expectancy

ActionAction

• Reduce energy intakeReduce energy intake• Keep other nutrient intake balanced to Keep other nutrient intake balanced to

caloriescalories• Take time to explainTake time to explain• Be positiveBe positive• Aim for successAim for success

Practical approachPractical approach

• Weigh & set initial target (15% of now)Weigh & set initial target (15% of now)

• Feed 60% calculated amount at targetFeed 60% calculated amount at target

• Weekly weigh-insWeekly weigh-ins

• Plot progress (if none, reduce food 20%)Plot progress (if none, reduce food 20%)

• No tit bits, snacks or treatsNo tit bits, snacks or treats

• Everyone involvedEveryone involved

Appetite managementAppetite management• Prescription dietsPrescription diets

– high moisturehigh moisture– high fibrehigh fibre

• Metabolic diversionMetabolic diversion– low fatlow fat– L-carnitineL-carnitine

• Slentrol (dirlotapide) reduces absorption & Slentrol (dirlotapide) reduces absorption & distribution of fatdistribution of fat

• Yarvitan (mitratapide) suppresses appetiteYarvitan (mitratapide) suppresses appetite

Exercise & lifestyleExercise & lifestyle

• Regular, graded Regular, graded exerciseexercise

• SHARED plans SHARED plans (e.g.PPET)(e.g.PPET)

• Combine with Combine with physiotherapyphysiotherapy

• ClinicsClinics

TheyThey““They should do something about it.”They should do something about it.”• roadsroads• education systemeducation system• economyeconomy

But who are But who are theythey??

the weatherthe weather

OBESITYOBESITY

They are…They are…

• Pet ownerPet owner

• VetVet

• Vet nurseVet nurse

• Pet food companiesPet food companies

• MediaMedia

Education, Education, Education, Education,

EducationEducation

Pet ownersPet owners• Recognise and own the problemRecognise and own the problem• Separate affection from feedingSeparate affection from feeding• Understand there is no magic bulletUnderstand there is no magic bullet• Professional supportProfessional support• Shared exercise and healthy eatingShared exercise and healthy eating• Licensing?Licensing?

VetsVets• Ethical & moral obligationEthical & moral obligation

• Animal advocatesAnimal advocates

• Legal liability?Legal liability?

• Routine part of every consultRoutine part of every consult

• Compliance strategiesCompliance strategies

• Empower nursesEmpower nurses

Vet nursesVet nurses• Closer & better communicatorsCloser & better communicators• TrustTrust• Chance to ‘own’ preventive healthcareChance to ‘own’ preventive healthcare• Nurse clinicsNurse clinics• Explain behavioursExplain behaviours• Weight and body condition scoreWeight and body condition score• DiaryDiary

Pet food & Pharma companiesPet food & Pharma companies• Prescription dietsPrescription diets• Palatability in perspectivePalatability in perspective• More on-pack educationMore on-pack education• Wider dissemination of educational materialWider dissemination of educational material• PFMA Pet Size O-Meter (www.pfma.org.uk)PFMA Pet Size O-Meter (www.pfma.org.uk)

MediaMedia• Stop glorifying the grotesqueStop glorifying the grotesque• Cross links with human obesity storiesCross links with human obesity stories• Shared platforms with WeightwatchersShared platforms with Weightwatchers

• Focus on health benefitsFocus on health benefits

• Encourage pet/owner Encourage pet/owner exerciseexercise

Thank youThank you