Several studies have shown that veterinary surgeons often fail to mention weight in consultations where the pet is overweight (Rolph et al, 2014; Cairns-Haylor and Fordyce, 2016), with a tendency to bring up the topic only when there is a concomitant problem which can be clearly linked (e.g. osteoarthritis) (Pearl et al, 2020). It is clear from the literature that veterinary professionals fear upsetting or losing clients (Churchill and Ward, 2016a), have a feeling of inevitable failure to bring about change, and harbour feelings of frustration and disgust at overweight pets and owners — particularly if the owner themselves is also overweight (Pearl et al, 2020). Veterinary professionals used humour and euphemistic language to facilitate dialogue, in order to try and overcome awkwardness (Phillips et al, 2017). However, a study in equine medicine found that weight discussions couched in humour were not always taken seriously by owners, as they believed that a veterinary surgeon would not joke if there was a serious issue (Furtado et al, 2018).
Examining the conversation from the side of the veterinary professional compared with the side of the owner can help to elucidate why such discussions are sometimes problematic. This approach can shine light on how some approaches from the psychology of behaviour change may facilitate these consultations and help veterinary professionals to conduct discussions in a way that maximises the likelihood that they will help owners to bring about change.
What is actually happening on either side of a pet weight discussion?
Veterinary professionals (particularly veterinary surgeons) are often taught that their role is to impart knowledge in order that the other party can change their behaviour; discussions with clients are often directive and paternalistic, with the veterinary surgeon taking the lead and the owner in a subservient role (Everitt, 2011; Bard et al, 2017). In the case of obesity, the approach taught to veterinary professionals may involve informing the owner that the animal is overweight or obese, informing them of steps to deal with the issue, and leaving them to make the necessary lifestyle alterations for their pet. Indeed, a study mapping veterinary surgeon–client interactions about obesity found that veterinary surgeons tended to raise the issue of weight, mention health risks, and give advice (though frequently only one of these areas was covered) (Cairns-Haylor and Fordyce, 2016).
For a veterinary professional, animal obesity management would be straightforward: feed less and exercise the animal more, and the animal's weight and welfare would be improved. The fact that owner behaviour appears to be so at odds with their animal's wellbeing, and that owners do not always change behaviour following a weight consultation, is understandably likely to be a source of considerable frustration on the part of the veterinary staff. The temptation can be to impart the information even more strongly, highlighting the risks even more severely to increase the owner's motivation to change; however, this often backfires.
The reason that the consultation does not follow the obvious path of imparted knowledge > increased owner knowledge > change in owner behaviour, is because human behaviour is more complex than this chain of assumptions allows. As humans, we do not always behave in ways that appear ‘rational’ to others, because we are affected by numerous factors including our knowledge, motivations, skills, habits, emotions, physical environment, and social environment (Michie et al, 2011).
Owning a pet is primarily an emotional behaviour, as are many of the decisions about how our animals are cared for (Furtado et al, 2021). Furthermore, beliefs and behaviours around food and feeding are likely to be very deeply embedded in our cultural, familial and personal experiences and habits (Klaczynski et al, 2004; Rich et al, 2011). As a result, each culture, family and individual may have different, deeply-held ideas about what constitutes good care; a simple example is that some may consider an animal to appear ‘loved’ when he or she appears well-fed (overweight), while others consider the converse to the be true. Owners' experience of the aspects discussed during a weight consultation may be very different to the experience of the veterinary professional.
A useful way to think about an obesity consult is suggested in this adapted analogy presented by behaviour change theorist Cialdini, who explored how the ‘psychology of influence’ might help us to understand how to empower people to change (Cialdini, 2007). In this analogy, we can simplify a pet owner's psyche into the diagram shown in Figure 1.
The owner's sense of self as a pet owner is represented by the top bar, and it is propped up by various ideas — perhaps being a responsible and ‘good’ owner, having a deep bond with the individual animal, and being a knowledgeable and caring person. These ideas might vary from person to person; one owner might see themselves as a ‘fur mum’ who gives their pet everything he or she wants, while another might have a more authoritarian view on pet parenting, but the model can be easily adapted and applied.
When someone (e.g. a veterinary professional) tells an owner that the animal's health is at risk because of an issue such as obesity, the effect is that some of those pillars are essentially knocked down; the suggestion is that the owner is not being as responsible, knowledgeable or caring as they think — in fact, they are quite the opposite (Figure 2).
When we feel undermined or have our sense of self threatened in this way, often the natural response is to find a way to argue that our behaviour is actually responsible or sensible, and that the other party is at fault (known as reactance theory) (Brehm, 1989). Indeed, several studies have shown that any confrontation around someone's beliefs is a major predictor in that person failing to change their behaviour (Lord et al, 1979; White and Miller, 2007; Miller and Rollnick, 2012). If someone tells us we are wrong, we are even less likely to change than we would have been before the confrontation (White and Miller, 2007). We may even feel that the person who confronted us is in fact a difficult, mean, or ignorant person. This may be part of the reason why owners sometimes ignore veterinary advice, or argue that the veterinary surgeon simply ‘does not understand this breed’ or ‘does not understand my dog/cat/pet’.
This is perhaps more important in obesity discussions than in any other area of veterinary medicine, given that numerous studies have reflected on the close interplay between feeding and love (Kienzle and Bergler, 2006; German, 2015; White et al, 2016). Pet owners' behaviours towards their pet are likely to be very deeply connected with their ideas about good pet ownership, as well as the routines and habits of their pets, and it may be particularly hard for people to change their behaviour. Moreover, pets are likely to reinforce owners' behaviour (e.g. by purring or tail wagging and acting in a loving way when food is given). These well-reinforced daily routines and deeply held beliefs are unlikely to be altered simply through increased knowledge, but it is particularly unlikely that change would occur if confrontation from the veterinary professional makes the pet owner feel that their relationship with that pet has been undermined.
Facilitating weight discussions
Instead of ‘knocking down’ the pillars (Figure 2) and risking the owner feeling undermined, and potentially ignoring the advice they were given, an alternative approach can be to aim to build up the owner's sense of self, by adding further pillars to support and empower them (Figure 3). In this instance, the veterinary professional might make the owner feel that their understanding of the individual animal is invaluable, but can be supported by the professional; they then form a team to best manage the pet. The professional can achieve this by preventing feelings of blame but reinforcing the owner's sense of their own knowledge and motivation to be a responsible owner. For example, the professional might ask:
- ‘What do you think of his/her weight at the moment?’
- ‘I know it's been hard for us all to manage our weight through lockdown! I am sure you already know that being overweight in the long term has some risks. Would you like us to talk about weight?’
- ‘Of course every dog is an individual and you're the expert on your dog, so we always try and work with owners to make a plan for their individual dog. What sorts of things do you think would be the most comfortable ways to diet [Trixie]?’)
In these examples, the professional uses questions to include the owner in the consultation, making them feel that their knowledge of the animal is important and can be supported by the knowledge of the professional. An owner would likely feel that they had an ally, rather than that they are being undermined (Figure 3).
This supportive approach is key to the field of motivational interviewing — a well-evidenced brief technique that aims to support behaviour change in human medicine, and which is gaining traction in the veterinary field (Cairns-Haylor and Fordyce, 2016; Bard et al, 2017; Svensson et al, 2020). Motivational interviewing proposes that professionals use open questions, affirmations, reflective listening, and summary statements to ensure that the client feels listened to, and that change is based on open communication and shared decision making, social support and autonomy over change (Miller and Rollnick, 2012). Rather than clients being in a subservient client role, in this approach, they are treated as equals in working out why and how change could occur for the animal in question.
Working with clients in this way leads to another important advantage in creating individual solutions which are most relevant to that particular owner, as advocated by leading practitioners in human and animal weight management (Becvarova, 2011; Churchill and Ward, 2016b; German, 2016). Individualised strategies will not only be clinically most relevant to the animal, but their development may mirror the approach shown in Figure 3, making owners feel cared for and listened to. Additionally, in the equine field, the importance of discussing positive wellbeing (e.g. enrichment within weight management) has been identified as key in creating positive weight management experiences for both the owner and their animal (Furtado et al, 2021).
These tailored and positive strategies may help owners to feel empowered, but may also help to address the broader range of factors that influence our behaviour. For example, listening to clients' priorities and concerns via those open questions can assist in working together to create a management strategy, which takes account of the client's everyday habits, social norms and physical environment. Rather than focusing on educating owners, this collaborative approach aims to develop a team that can work together to support the owner and pet more holistically (Philpotts et al, 2019) (Figure 4). This may also be rewarding for the veterinary professional, who may be better able to understand and therefore help their clients.
Nurses' role assisting with weight recognition and management discussions
One of the reasons obesity consultations can be particularly problematic for veterinary surgeons is that there is often limited time within a consultation and, given that owners rarely come in specifically to talk about weight, this issue would usually need to be covered within the short time space but alongside the issue for which the animal was brought to the clinic in the first place (Rolph et al, 2014). This may be one of the reasons that veterinary surgeons do not always bring up the issue of weight — particularly as it is considered a frustrating topic (Pearl et al, 2020). Further, every professional regardless of their role develops a way of talking and behaving — a professional persona — which they use in their daily work. Veterinary surgeon personas are often based on the model of being able to identify an issue and offer a solution in a short space of time in a directive manner (Bard et al, 2017). Anecdotally, the types of open questions suggested above can feel quite uncomfortable and at odds with professional identities developed by veterinary surgeons.
Comparatively, veterinary nurses may be more familiar with a conversational and transactional communication style than veterinary surgeons (Johnson, 2013; Espley, 2019). Further, given the increasing role of nurses taking ‘weigh and worm’ visits and suchlike, nurses may be able to build more of a rapport with both the client and their pet. These factors may help to build confidence in clients, who may be subsequently more able to discuss the issues affecting their behaviour in relation to their pet's weight. For this reason, nurse-led weight clinics are becoming increasingly popular (Espley, 2019), with nurses ideally-placed to work with owners over time to improve their pet's health.
Conclusion
While obesity consultations may often be perceived as difficult or problematic for veterinary professionals, a better understanding of the processes involved in human behaviour change is likely to facilitate discussions. An empathetic approach using open-ended questions to create tailored weight management strategies may help to build owner confidence and commitment to pet weight loss.
KEY POINTS
- Consultations involving overweight pets are common in veterinary medicine, but discussion about weight recognition and management can be frustrating and awkward for veterinary professionals and clients alike.
- Human psychology indicates that weight recognition and management are related to deeply held beliefs and values of the pet owner who may feel that their pet owning skills are being questioned during an obesity consultation.
- Behaviour change science supports the use of an empathetic and supportive approach to empower owners, and help them work with their veterinary professional to build a sustainable and tailored weight management strategy.
- Veterinary nurses are often ideally placed to offer appropriate communication and consultations regarding overweight pets.