HDCL One Minute PowerPoint on the Stages of Learning to Read
Weight Management Clinics -The 30 minute consultation · What is Obesity? The 30 minute...
Transcript of Weight Management Clinics -The 30 minute consultation · What is Obesity? The 30 minute...
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Weight Management Clinics - The 30 minute consultation
Caroline Burke BSc RVN Weight Management Specialist
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Agenda
What is Obesity? The 30 minute consultation - Stages 1 and 2Body condition scoringThe 30 minute consultation - Stages 3 and 4Measuring Food Follow upMaintenanceTreats and exercise
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Obesity in companion animals
3
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY 4
‘Excess accumulation of body fat’
What Is Obesity?
•overeating, under-exercising or a combination of both.
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY 5
What Is Obesity?
Overweight: When an animal is 10% above ideal weight(Body Condition Score of 6/7 out of 9)
Obese: When an animal is 30% above it’s ideal weight(Body Condition Score of 8/9 out of 9)
© Labat
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY 6
Obesity is
… a CHRONICINCURABLE
DISEASE
* PAW wellbeing report 2012: YouGov & PDSA
What Is Obesity?
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
What can contribute to Obesity?
Pre-disposedIncorrect diet – feeding choicesFeeding ‘extras’Feeding behavioursExerciseStressNeutering
EDUCATION
closettraveler.com
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Owners perception
Media charactersDo not ‘see’ their pets as we see
themRecent studies show owners
underestimate body condition scores
97% of owners struggle to identify a healthy body shape for dogs
Not understand is health issue
PAW Report (2012)
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Consequences of obesity
Decreased lifespan in dogs and catsHealthDecreased quality of lifeWelfare
©ROYAL CANIN Weight Management Clinic
©ROYAL CANIN Weight Management Clinic
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Before After
PostureDepressionFight/FlightSadUnable to move efficientlyPainful?Unsocial
PostureHappyConfidentFight/FlightSociableComfortableImproved Quality of Life
Rocco’s Before Weight: 38.4Kg’s (June 2007)Rocco’s After Weight: 25.8Kg’s (December 2007)
Rocco achieved a 33% body weight loss!!!!!!
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
The 30 minute consultation
11
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
The Clinic Name
• Clinical• Weight Management Clinic, Obesity Clinic
• Positive• Healthy weight service, Healthy weight
club, Fit club• Descriptive
• Chub club, Slimmer's club
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
The Clinic
Be PreparedSet date for clinic start Ensure everybody knows• Start date• When to book appointments and who with• What you will be discussing• How to refer to you
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
How to recruit?
ReferralsAnytime and Everyone Involved• Discharges• Vaccinations• Consultations• Discussions with reception• Owners request
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Why 30 minutes?
Stage 1 (10 mins) – History Stage 2 (05 mins) - The Weigh-InStage 3 (10 mins) – Set PlanStage 4 (05 mins) – Give plan and diet
©ROYAL CANIN Weight Management Clinic
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Be prepared
Appointment pre-booked• Use questionnaire prior to appointment• Give owner BCS Chart
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
All appointmentsHave pack prepared for client Flip chart (30 minute guide)Questionnaire Booklet for OwnerTool KitVet Follow UpFood
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Be prepared
Tool KitTape MeasurePuzzle feeders and toysBCS chartsAppointment CardKitchen scales Camera RosettesCertificates
© ROYAL CANIN®
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Calibrating your scales
©Dr Alex German
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 1History Gathering
(10 minutes)
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 1 – Food Questionnaire
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 1 - Exercise Questionnaire
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Further questioning
Need to understand the root of the issueHow and when did obesity first occur?Have there been changes in lifestyle/environment
that may have attributedCould there be an underlying medical condition
– may need to referSpend time understanding the situation
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 2The Weigh-In
Weight, Photos, BCS, Measurements
(5 minutes)
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 2
Weigh AnimalBody Condition ScoreTake Photographs
©ROYAL CANIN Weight Management Clinic
©ROYAL CANIN Weight Management Clinic
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Facilitate the taking of good before and after photosTake lots of different anglesNice photos too!!Use them for displays
26
©Abbeycroft Vets Willows
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Before
Before 10.5kg
Before 10.5kg
After
After
After 6.5kg
After 6.5kg
Before
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 2
Take morphometric measurements
29
• Thoracic• Abdomen• Neck
© Shelley Holden
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
YES
NO
Do you currently use Body Condition Scoring in practice?
• 5 Point
• 9 Point
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
1 cat and 5 dog shapes:• Chihuahua• Jack Russell• Pointer• GSD• Saint Bernard
5 breed morphologies: Variations in fat deposition Tailored measures for each individual Client-friendly: greater identification with
their pet
31
9 Point Body Condition Score
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Practical 1
How good are your Body Condition Scoring Skills?
32
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
-Palpate the pet by only applying light pressure
-Run your hands along the rib cage (following direction of fur)
-Run your hands on either side of the pets abdomen to see if you can feel a waist
© Shelley Holden
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Look and feel from above to see if you can observe a waist
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Run your hands from the back of the ribcage underneath the abdomen to see if an abdominal tuck
is present.
Using hands apply light pressure over the lumbar region, spine and hips.
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Practical 1
How good are your Body Condition Scoring Skills?
What BCS is my dog?
36
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 3Set Plan
Discuss diet and exercise (10 minutes)
© Shelley Holden © Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 3
Educate Owner• Seriousness of Obesity• Health Benefits• Welfare• Quality of Life ©ROYAL CANIN Weight Management Clinic
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 3
Set Plan• Estimate target weight• Decide on most appropriate diet• Calculate how much to feed• Provide diet• Weigh Food• Work out how long the diet will last
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Estimating target weight – How?
HOW?
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Decide on appropriate diet
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Owner to keep record
For feeding and exercise guidesWrite everything downGet owner to record using diaryAssess at every weigh-inWrite down adjustments
42
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 4Send home with plan
Provide diet and written instructions(5 minutes)
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Send home with written instructionsOwner booklet completedInformation on dietExercise planDiary
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Stage 4
Send home with:Diet (STOCK)Kitchen scales (advise on purchase)Toys (may discuss next appointment)Arrange next appointmentProvide contact details (phone/email)Arrange follow up call/email
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
How accurate are measuring cups?
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Practical 2
Using the measuring cup measure……….
Tip amount measured onto scales
Record amount
47
© Shelley Holden
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
How accurate are measuring cups?Methods
• 12 different studies• Various cup sizes• Various diets• Various portion sizes
Results• Accuracy
• Ranged from 18% under to 80% over
• Usually an over-estimate• Precision
• Intra-operator CV: 2% to 15%• Inter-operator CV: 2% to 28%
• Worse for small portions• Scales printed on cups were also inaccurate
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
©Shelley Holden
©Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Behaviour
Discuss changes that will occurMore activeLivelierMore attentionFeeding habitsImproved mobilityImproved groomingImproved QUALITY OF LIFE
After
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Owner Requirements: CommitmentTime:
to monitor feedto complete diariesto attend clinicto weigh food increase exerciseincrease play timeto buy products
Have you tried your own advice?
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
The follow-up (Repeat Appointment)
How often to review?Weight/Measurements/BCSUpdate booklet/filesImplement new ideas, new suggestions
© Shelley Holden
closettraveler.com
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Feeding plan - Advice
How often, when to feed?Change feeding times aroundFeed a combination of wet and dryFeed more meals when owners presentUse feed ball/play time for a meal
Don’t suggest everything at once!!
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Encouragement – even if small lossExplain lossWhat is a safe loss?
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Safe Weight Loss
Optimal Weight Loss per week?
Dog - 1-3% per week• (Average 0.9% a week)
Cat - 0.5-2% per week• (Average 0.8% a week)
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
How to calculate safe weight loss
Previous weight 3 weeks ago was 32kgTodays weight 30.9kg
Therefore 32kg -30.9kg = 1.1kg
1.1/32kg (previous weight) x 100 = 3.4%3.4/3 (number of weeks since last visit) = 1.1% per week
Is that good/bad? What would you do if the dog had lost 0.4% per week?
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Support
Monthly competitions – prizes Certificates / awarded at different stagesDisplays to show enrolled petsMembership cards for clients/benefits
MOTIVATION © Shelley Holden
©Vetfollowup
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Maintenance Post Weight Loss
Which diet to feed?Recent Study shows:Nearly half of dogs who lost weight regained weight post loss
14 dogs (42%) maintained3 dogs (9%) lost more than 5%
16 dogs (48%) gained more than 5%
Most dogs gained just under half the weight of what was originally lost!
German, A.J., et al. Long-term follow-up after weight management in obese dogs: The role of diet in preventing regain.The Veterinary Journal (2011), doi:10.1016/j.tvjl.2011.04.001
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Monitoring Post Weight Loss
Maintain on current dietGradually increase in stages• 0-10kg - Increase by 5g• 10-25kg - Increase by 10g• 25kg + – Increase by 20g
Maintain plan – reweigh every 2 weeksOnce maintaining 4 weeks/8 weeks/12 weeks
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
To Treat or Not?© Shelley Holden
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
= 53 kcals (small)= 20gms K9 Satiety = 45 kcals (100g)
= 16gms K9 Satiety= 191 kcals= 71gms K9 Satiety And 62gms F9 Satiety
= 85 kcals
= 31gms K9 Satiety100g of Ham= 164 kcals= 61gms K9 Satiety
Bonio= 75kcals= 28gms K9 Satiety
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY 65
This is more fun!!
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
© Louise Brennan
Piping & Freezing
Using ROYAL CANIN
Satiety Wet
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
© John Bowen
©Nina Ottoson
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Treat or Not?
It will depend on the individual patient!
© Shelley Holden
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Exercise
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Exercise
Realistically consider the owners capabilitiesTailor the plan for the individual Consistent PlanComplete diary
© Shelley Holden
closettraveler.com
What do you advise?
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Cats
Start with small sessions 2 x 2 minutes daily and gradually increase
Alternate toys/Find what interests themSpread food/move bowls – think of natural behavioursHide and SeekKeep the owner interested!!!
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
TIME TO PLAY
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Dogs
Set Exercise PlanHow Overweight?Injury/IllnessWeatherLifestyle of owner Anybody to help?
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Hydrotherapy
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
The 30 minute consultation
Be preparedBe organisedTool kit• Stage 1 – History• Stage 2 – The weigh-in• Stage 3 – Set Plan• Stage 4 – Send home with plan and diet
Follow up consultationsPrioritiseSupport
© Shelley Holden
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
BeforeAfter
THINK OF ROCCO!!!!!
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
With many thanks:
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Any Questions?
© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY
Thank you!