Obesity in dogs and cats is defined as when the bodyweight exceeds the ideal bodyweight by at least 15%, (Laflamme, 2001), although some texts define obesity as 20% greater than the ideal bodyweight (Toll et al, 2010), and others at 30% above ideal bodyweight (Burkholder and Toll, 2000). The incidence of human obesity has increased 400% over the last 25 years (HMSO, 2004), and many studies have been conducted into factors affecting obesity, success rates in weight reduction programmes, and prevalence in order to aid in the reduction of obesity prevalence, and to aid the individual in reduction of mortality and morbidity rates (Figure 1.). Few studies have been conducted into the success of facilitating weight loss, and in particular veterinary nurse-led clinics (Figure 2.) (Anderson et al, 2001), although individual factors have been identified and studied. Human obesity studies have proved that an established education and support programme dramatically improves success rates of weight reduction.
Behaviour and obesity
Weight loss can be theoretically achieved by ensuring that calories consumed are less than energy expenditure. However, achieving the reduction in calories and the increase in energy expenditure can be diffcult and are affected by owner education, compliance, lifestyle and behavioural traits. The complex relationships between owner and pet needs to be discussed as part of the weight-loss programme; these relationships are often compared with the behavioural traits seen in paediatric obesity (Epstein et al, 1998). This is due to pet owners having similar roles to parents inthe supply of food, and in the use of food as a reward.
Obesity treatment programmes for humans that include behavioural interventions in conjunction with dietary changes and increased physical activity achieve higher success rates than those that do not include these behavioural modifications (Cowburn et al, 1997). Such findings have implications for weight reduction in companion animals, with positive correlation identified between the success of obesity treatment in dogs and behavioural changes of the owner (Laflamme et al, 1994). A standard obesity treatment programme that included appropriate energy intake, monthly weight checks, and a structured maintenance period was sufficient to achieve these objectives (Yaissle et al, 2004). It is recommended to have weekly or biweekly weigh-ins until weight loss is stable.
Owners of overweight cats indicate that they have a closer relationship with their cats than do owners of normal weight cats, with the role of their cats as a substitute for human companionship potentially proving more important than that seen in owners with cats of an ideal bodyweight (Kienzle et al, 2005). The role of behaviour in weight loss needs to be discussed during the nurse consultation, and therefore an understanding of feline and canine behaviour (especially feeding behaviours) is required. Paediatric obesity treatment programmes that involved the whole family in intense behavioural interventions were more successful than those that did not. The success of the programmes was related to the intensity of the behaviour treatment (Epstein et al, 1998). All family members and those involved with the care of the pet should therefore be invited to the initial consultation/weigh-in clinic. The total extent of behavioural advice and its role in obesity (especially in cats and multi-cat households) is vast (different resources such as litter tray, feeding stations, etc) and is outside the scope of this article.
Feeding quantities
Success in obesity clinics is partially achieved by gaining a full understanding of feeding quantities by the owner. A 4 kg cat consuming the very small amount of 10 kcal/day in excess of its daily energy requirements (the equivalent of approximately ten kibbles or 10g of tuna) will gain 12% of its bodyweight in just one year (Michel and Scherk, 2012). Accurate measurement of feeding quantities is required, and feeding scoops have proved to be very inaccurate (German et al, 2010). Weighing out of the daily food requirement on weighing scales should be the only recommended method.
Exercise and obesity
If weight loss can be achieved by expending more calories than those consumed, increasing the quantity of calories expended, through increased exercise, will aid in weight loss. More importantly, exercise helps to preserve the lean tissue that can be lost during a weight loss programme, and to maintain metabolism at a higher level. Owners need guidance on the differ-ence between quantity and quality of exercise. A one hour walk where the dog is ‘plodding’ along beside the owner will burn fewer calories than a half hour walk where the dog is engaged in intense physical activity.
Play activity in cats needs to be discussed with the owner. Anecodotally many owners expect cats to play for longer periods than is a natural play pattern to them. Cats will prefer to play for a few minutes each day, than to play for half an hour once weekly. Play activity in cats needs to replicate hunting behaviour, which involves lots of short high intensity bursts (Yaguiyan-Colliard et al, 2008). Types of play activity that can be replicated include the use of toys that move, those that have elements that move (feathers), movement of the toy by the owner, and use of toys that swing. Size of the toy needs to be adequate for the size of the cat. Environmental enrichment for the cat is very important (especially indoor cats), cats explore their environment in three dimensions, and need their home environment enriched in three dimensions. Cats should have the ability to climb and sit up high if they wish.
Diet
The specific diet that an animal receives needs to be the most appropriate for the animal (its lifestage, age, and if any specific nutrient requirements is needed) and their owner (financial, ethical requirements from the owner — organic, natural). Veterinary nurses need to listen to the owner's needs with regards to the financial aspect, and what the owner can realistically achieve. For example if the owner has reduced mobility themselves, achieving the animal's target bodyweight might not be realistically achievable, because sufficient exercise for weight loss might not be achievable as the owner may be unable to provide it. However, some weight loss will be beneficial. If owners are unwilling to stop giving a treat at a spe-cific time of day, these extra calories need to calculated and added into the daily calorific intake. Lower calorie treats can be recommended, or the use of the weight loss diet as treats should be recommended. Treats should not constitute more than 5% of the pet's daily energy requirement, and the owner and all family members will need guidance on this. Owners should be reminded that a ‘reward’ does not have to be food; play, social interaction, grooming, exercise and toys can all be used as a reward instead of food.
Compliance
The success of obesity clinics is in the compliance of the owner and their motivation to succeed. The role of the veterinary nurse in these cases is to provide motivation to the pet owner in continuing with the obesity programme. Motivation can be achieved by educating the owner on the effects of obesity on the animal and the long-term medical consequences. Some owners will require more motivation than others, and even small measurements of weight loss or reduction in waistline, chest circumference and neck width need to be celebrated in order to boost motivation.
Nurse-led clinics
Primary reasons for dog and cat owners to enrol their pet in a weight-loss programme include personal recommendation from a veterinarian or member of the veterinary healthcare team (Roudebush at al, 2008). Where practices have nurse-led obesity clinics, obese patients can be directed towards these.
Marketing is an important element in the success of all ventures in veterinary practice. Marketing is about building relationships and the development of a practice brand — the practice name, practice staff, practice premises and practice values for quality, courtesy, care, honesty, reliability, availability and value for money (Ackerman, 2012). The professionalism and knowledge of the staff are also important.
All events and/or clinics need to be carefully planned, researched and all required resources gathered before implementation (Ackerman, 2012). When launching obesity clinics a number of issues should be considered prior to informing other staff members:
Once these have been decided the other members of staff should be instructed about what is planned, and all training should be completed, if required. The planned clinic or event should then be launched. This will involve staff meeting, possibly client meeting with letters sent out to specific client groups, waiting room displays.
It can be difficult to ensure nurse clinics are available for when clients can attend, as it depends on when resources are available (staff, consulting rooms and time). All overweight animals should be invited; this can be through handouts/invites that are readily available for all staff members to give out to clients (Figure 3.)
Conclusions
Personal recommendation from a veterinarian or member of the veterinary healthcare team encourages owners to enrol their pets in a weight-loss programme. Identification of overweight patients together with client education is therefore essential. Obesity treatment programmes that include dietary changes and monthly evaluations of bodyweight by members of the veterinary healthcare team are reported to be the most successful (Roudebush et al, 2008).