Thank you so much. And thank you to everyone, joining me for, for this session. So yeah, so we're going to be talking about challenging cases of obesity and when I was preparing this session, I was thinking about all the common questions that I'm often asked.
And so I am going to hopefully be able to provide lots of practical information throughout this session that you can hopefully use in practise tomorrow. But when I was really thinking about it, I thought to myself, Well, hang on a minute, aren't all cases of obesity challenging in one way or another? And I think they probably are, and this is one of the big issues with obesity.
If it is never straightforward, it is always going to be challenging. So we're going to start off with thinking about some of those problems before we even start providing obesity care to these patients. So we'll be thinking about how we initiate that conversation.
So many people come and tell me that I'm worried. I don't want to cause offence to my pet owners, so we're going to look into that. We then will look at when we have a patient that has a body condition score that simply doesn't fit on our chart, these ones that are way beyond our body condition score chart.
We'll then think what we do when we're faced with elderly patients, when our patients may have a concurrent disease. And then thinking about, well, what happens if this is the second time round. The owners have tried weight loss before and it really hasn't worked for them.
How do we bring them back into a place where they are ready to have a go at this again? We will then also touch upon what to do if the pet won't eat the diet that we're recommending. We'll think about solutions, and a pragmatic approach if the owner can't afford the food that you're recommending.
We'll also think about why the owner cannot use their own food in most circumstances, remembering always that we want safe weight loss. And then we'll think about problems that happen once they are on that weight loss journey. So when we have cases where there just simply is no weight loss, and that can be very frustrating for everyone involved, we'll think about multi-cat households and how to navigate some of those difficulties.
We'll definitely spend some time thinking about food seeking behaviours. Then we'll think about the problems that come after weight loss is achieved as if this wasn't hard enough already. We'll be thinking about what happens if the owner wants to return their pet to their original food, and this will surely they're back to normal feeling that many again will feel at this point.
So lots and lots of different problems that arise. Some of these problems will happen in just one patient. Some patients will have just one or two of these problems, but I hope that there's something within the session that is going to be useful to everyone.
So I wanted to think about those issues that we see before we really even get started with a weight loss programme. And I have two videos here for you to watch. They're only very short.
And what I want you to do is just notice the thoughts and feelings that come up for you when you watch these videos. And there is absolutely no rights or wrongs. It's just noticing yourself what comes up.
So here is video number one. And on to video number 2. Apologies for the slightly poor quality of this video.
Don't worry, it hasn't frozen. So what were those internal thoughts that you had? Was there a gut reaction?
Was there an emotion that came up when you saw those videos, or when you see a picture like of Molly just here? That's what I want to spend a little bit of time thinking about is those just those thoughts and feelings. Did you make an assumption?
You know, did you have any thoughts of how this cat or that cat arrived with a body shape of that size? Was there an element of humour that came up? You won't be alone if there was that first video in particular is specifically made to be humorous.
And that's really the problem we have here is that unfortunately obesity, unlike many other diseases, has quite fixed associations within society. So there are automatic thoughts attached to those with obesity. Humour is certainly one of them.
But then we have to be aware that there is also unconscious bias that affects our thoughts and feelings, and we know this leads to weight stigma, and I wanted to spend just a moment thinking about these two things. So firstly, we think about unconscious bias. There are different types of bias, and the particular types that we are thinking about is perception bias.
So this is where stereotypes or assumptions are made about different groups, and those with obesity are known to be targeted as a source of unconscious bias. Now if you fancy spending a pretty uncomfortable afternoon, you can go to this website and it will tell you what your implicit or unconscious biases are, and I will hold my hands up. I discovered through that that test that I have a slight bias towards those with obesity, and I was horrified to find that out, particularly doing what I do.
But no one should feel bad about that. It is an unconscious bias. This is fixed in the way that we are all brought up, the way that we interact with other humans in our society.
This is, you know, no one is to blame for these unconscious bias. The point is, if we're aware of them, we can do something about them. And that's the real point of being able to go on and find out what those bias may or may not be.
The next thing I wanted to just touch on is weight stigma, and you can see here, from, from the World Obesity website what they classify weight stigma as, and excuse me, turning to the side so I can read this out to us and just spend a moment thinking about this. Is that weight stigma refers to discriminatory acts and ideologies targeted towards those individuals because of their weight and their size. So weight stigma is the result of weight bias.
Not that we can help it, but it is, it is a result of that, and weight bias refers to negative ideologies associated with obesity, and this is throughout society. But in veterinary practise, what is relevant to us? How does this affect patients and patient care?
Well, if we firstly look to the human world and to doctors, the two studies that I've referenced at the bottoms looked at this very question. And 3 words that were discovered that were associated by doctors with those with obesity were awkward, ugly, and noncompliant. Very, very negative words.
And when we think about we're dealing with a chronic disease here and yet that is how human doctors see those people with it, it, it is quite shocking, isn't it? But what about the veterinary world? Of course that's where we are, and similar questions were asked to vets, and they had associations with feelings of frustration.
They very much laid the blame with the pet owner, and they felt very pessimistic that things really were very unlikely to change. So we can see that although it is not within our control to have a bias or not, we can see that we must be very careful not to allow it to affect our behaviours and our communication when we are talking to those or talking about those with obesity. And so it's really thinking about the language that we use, and I am going to use this example of Molly because in fact, this situation really happened.
I was, with Molly and a colleague of mine walked into the room and went, Wow, that cat is fat. Wow, goodness me. And in the back of my mind, I'm like, no, hang on, you know, Molly has obesity.
You know, this, this cat is suffering, you know, with a chronic disease, and I think if we imagine being Molly, we can all agree that you would be suffering at this point. And it's a, it's a slightly different way of phrasing how we think and speak about obesity to say that Molly has obesity. Because they cannot be fat, if that makes sense.
Just in the same way as they cannot be cancer, they would have cancer. They cannot be kidney disease. They would have kidney disease.
And so we very much will talk about patients having obesity rather than they are fat. So excuse me, it is about thinking about, you know, OK, we have this internal conversation, we have these internal thoughts, but what we do have really good control over is our external conversation and what we put out there. And it's just keeping in mind that, you know, we're here to help.
We're not here to point the finger, to blame, to stigmatise, to judge, you know, we're here to deal with this situation with sympathy and often with empathy also. And so it's about taking all this knowledge that we have about how we get pets to lose weight, and I think that's actually pretty well documented now. It's about getting that out and into that conversation with the pet owner so that we can have meaningful conversations that's going to get us on the road to that pet having a better health.
Now what people tell me often is this is that they worry or that they're uncomfortable with this conversation, and unfortunately when we're concerned about something, we're much more likely to avoid it. And of course if we're not having a conversation, these pets aren't getting the care that they need. So these are the sorts of things that I hear, you know, when I say something wrong?
Will I upset the clients, you know, actually I don't not sure what words to use. How do I even introduce this topic? You know, the words themselves can be difficult sometimes.
And so I wanted to give you my favourite term. So I would always talk about a pet that is above their ideal weight. So I'm not using F words and O words to a client, that being fat and obese.
I am talking about something that is much more positive. I'm talking about ideal weight and this pet being above that, and it's a much less confrontational term. The second phrase that I would always like to use and I would strongly encourage everyone to start using is to referring to that cat with obesity that is in that top kennel, not the fat one in the corner or you know that fat dog out at the at the desk, that dog with obesity.
And so when we're talking with our colleagues trying to reframe how we deal with this disease and how we then also discuss it. Now, we understand, I understand this discomfort with the conversation because I have this unconscious bias also. And particularly, it seems to be a problem when pet owners have obesity themselves and people often ask, well, how do you approach this?
And it, and really I would approach this conversation with this pet owner as I would do with any other pet owner, and I'm going to give you an example in a moment of a way that you can introduce this topic without feeling uncomfortable. It doesn't matter what shape or size or disease or illness or condition that that pet owner might have because you're going to be able to introduce it in a way that's specific to the pet, and that's the important thing here. Now of course we've got to get acknowledgement from that pet owner, and they have to understand that there is an issue here, otherwise we're going to get nowhere with our recommendation.
So we have to recognise that this might not be the owner's priority. They may have brought their dog because it was lame and they're expecting medication or they're expecting X-rays. They're not necessarily expecting conversation about weight, so we should be, you know, sympathetic and mindful of that.
We should also think that when we have concurrent disease, it may just feel for a pet owner like there's too much going on. So you know, if we're dealing with diabetes or we're dealing with renal disease, for instance, that's a lot for an owner to be thinking about. Weight on top of that as well can seem like there's just too much to be going up.
But again, we're going to talk about this a little more later on. But the really big question when we're meeting a pet owner that has a pet with obesity is to ask ourselves, are they ready for this conversation? And readiness is something that we now recognise as it's a psychological theory or psychological tool that we can apply to our pet owners to see what stage of change they are in.
Now, the stages of change, this was developed back in the really early 80s and was actually developed around stopping smoking, interestingly enough, but it turns out that change as far as human goes is change, and so we can use a model such as this to understand better the pet owner's point of view. So I'll detail the stages of change for you and hopefully you will see why and how this applies to what we're doing and then we'll put this into a conversation. So our first point along our circle is an owner in free contemplation.
So this owner has zero intention of making any changes, probably doesn't even acknowledge that there's a problem. No, seems fine to me, runs about, he's perfectly healthy. OK.
The second stage is contemplation. So now we have an owner maybe that's aware of the issue. Yeah, I know he's a bit overweight, but they're not in a position to do anything about it.
So do you know what? I just got too much on right now, not really in a position to change. The next stage is preparation.
So this is an action. This is getting ready to do something. Maybe this owner is coming to you saying, I'm worried my dog can't jump in the car anymore, or, you know, I've noticed that he is overweight.
I don't know what to do about it. These are owners in preparation. Then we have owners that fall into the action phase, so they are modifying those behaviours with your help to bring about the weight loss, and then we help them maintain those changes, replacing all those old habits with new ones again.
Our last stage of change, unfortunately, is relapse. And we know that not all patients will reach their ideal weight. Some will slip back into their old habits, and weight regain will occur.
The good news is though is this is a cycle, and no matter where we are in the cycle, an owner can travel around it once again, and each time they do, they will learn something. So they say, don't they, that just because you failed once, it doesn't mean you won't do it again, but now you come from a place of experience, and that's where this day would be also. Now at this point, some people would say, OK, well, when we meet those owners in pre-contemplation or contemplation, you know, can't we just sort of shove them around?
Can't we shock them? Can't we persuade them into actually doing something about this? And the problem is, no.
And we have two significant blocks in these places. If you push an owner at this point, you probably will offend them. You probably will get an owner who doesn't want to see you anymore.
Because they are not ready for this conversation, they are not in a place where they are receptive to it. It doesn't mean we should forget all about it. It means that we should make a clinical note of our observations, and we should park this conversation for now and revisit it next time.
Things may have changed. The owner may have gone away and thought about that seed you planted and may now be ready to do something. So how do we make a start, you know, what is this introduction to the conversation?
Well, it relies on weighing and body condition scoring and making sure those recordings are, are, are, are recorded every single visit that that pet comes in. And in this way, pet owners will get really Used to their pets being weighed and talking about body condition score, ideal body condition score, congratulating them or positively reinforcing for them that they are doing the right things. The pet is at an ideal weight and an ideal body condition score brilliant.
Now if there are problems and the The Body condition score is not ideal. We want to discuss that just like if we found a heart murmur, we would want to discuss that with the owner. But it's important to get their take on this too.
You know, are they actually happy with their pet's weight? Did they already have concerns that they've not expressed to you yet? And then of course we can involve them, we can show them how to body condition score and come to some sort of agreement on what that score may be.
All right, that's all very well and good. But, you know, what are the actual words that you might use? Well, this is just an example.
These are words that I might use. You will find words that suit you and fit your, comfort, maybe based on these. So we've body condition scored and weighed my patient, and I'd say I'd like to talk about the findings of my routine assessment.
That's really important. This happens every single time. No one's being singled out.
This is not something unusual. It's very normal. So this is giving them a warning shot and to them they're like, oh, OK, there's something I need to pay attention to.
Next, I would say, is it OK if we talk about your pet's weight today? And it's about getting permission because if they consent to the conversation, they're already much more bought into having that with you. If they say no, and it is their prerogative to say no, OK, we park it, we revisit it next time.
Then, how do you feel about your pet's weight? And it's a wonderful open-ended question that hopefully is going to get you some really good information. This is how you gauge readiness.
If they say, Well, I don't really think there's a problem. I don't know what everyone's talking about, or they might say, Well, you know, Oh, yes, he's snoring a bit more now, or, you know, I've been wondering about that, you know, I've, I've been wondering about him not walking so fast anymore, and you know, you know now where that owner is in terms of ready for this conversation. Then I would say, Can I show you how to body condition score?
Would you like to have a go? And while they're doing it, you know, talking them through what, what can you have, what can you feel? This is involving the owner in their own pet's care, and that is so, so important.
And if they're digging their fingers in, going, Yeah, I can feel the ribs, you, you sort of can ask, Well, could you count those ribs for me? Do you think they won't be able to if their pet has obesity to any degree? But what we have now is a non-confrontational conversation starter, and we can ask the owner to identify this for us.
We can say, what do you think your pet's body condition score is? And it's about coming to a consensus, not saying, Well, I think it's an 8, you're wrong if you think it's a 6. It's just gaining their acknowledgement that this pet has a body condition score that is above ideal weight.
And if we can do that, now we're ready to start to help them because they will now be receptive to that help. So it's that collaborative approach that's actually really important to get this conversation started. Now, we are in the veterinary industry quite prescriptive usually.
We've got this problem. Take this medication, it will fix it. Unfortunately though, when it comes to overweight and obesity, there is no prescription for weight loss.
We have to look at this a different way and take a different tactic. Once we've got going, we can then discuss the consequences. We can relate that body condition score to the snoring, to not being able to walk so far anymore.
And then we can help visualise what is the future going to look like with my help. You know, what can we hope to expect in terms of mobility, for instance, and then reassure the owner, do you know what, I can help you here. We, I know what works.
I can help you. This doesn't have to be unpleasant. You know what we'll do it together.
It's, you know, team fluffy, that we're all working towards the same goal, a happy, healthy pet. So leaving those conversations starts now and on to our next one, that often comes up is what do you do if that patient that you've just been having a conversation with has a body condition score that is way beyond our 9 point scale. Now, hopefully, you are all familiar with body condition scoring, and I wanted to just show you a brief video of TED.
So Ted is a Norfolk terrier, and as you can see, he has extremely severe obesity that is clearly affecting his quality of life, but just looking at his body shape alone, I'm sure everyone recognises he is way off our 9 point scale. So what do we do when we're faced with a dog like Ted? Well, what we have available at the moment is, corresponding calculations depending on the body condition score.
Again, hopefully you're familiar with these. Now, because it only goes up to 9, we only can use that sort of top calculation, that sort of 9 out of 9 is 40% above ideal weight. So we take that current weight, 17.95 kg, we divide it by 1.4.
That gives us an ideal weight of 12.8 kg. I'm sure you're all shaking your head saying it really can't be right.
So the things that we can do is to check back in that patient history. Now, if you have been good as a practise at weighing body condition scoring and recording, you will have the information that you need. And what you'd need to do is check the weight just prior to early neutering because that will be very similar to their ideal or optimal weights, and certainly that's a number that we could be using.
So in Ted's case, he weighed 8.2 kg just prior to neutering. Now that sounds much more reasonable in terms of an ideal weight actually because Ted is part of our specialist clinic, we are able to do a body composition scan, a DEXA scan on him, and it came out that he should be 7.7 kg in fact.
So you can see how that historical weight actually gets us really quite near where we need to be. The point of doing all this is that, we can then start to base a programme around this. However, we do have to recognise that it is only ever going to give us a starting point.
You will need to adjust depending on those, that individual. And when we are waking that plan, we must use specific weight loss diets that are safe for weight loss. We're going to talk more about this in a moment.
And it must be based in the most part on that ideal weight. So if you don't get the ideal weight correct, Your weight loss plan will fail, and this is really, really common. It's something that I get asked in advice calls all the time and I ask for pictures and I'm like, right, OK, I can see where the problems have come.
It's just they're much smaller than we've anticipated that they actually are. Pardon me. So I just wanted to give you a little bit of good news about TED.
So Ted started at 19, sorry, 17.95 kg, and as of, today, he weighs 10.8 kg, that target or ideal weight being 7.7.
So just note his mobility and how he walks when I first met him. And then take a look at TED now. I mean, what a fantastic difference.
And it just shows what a year of weight loss can do in terms of mobility, in terms of quality of life. Yes, he still has a limp. He still has orthopaedic disease.
We can't take that away, but my goodness, he may, he is having a much better quality of life. OK. So we've got to then decide how we're going to feed these patients, and there's quite a few concerns that come up at this point.
Firstly, the amount we're going to put in the bowl, I mean for Molly here, we were giving her 40 grammes. That was her portion, and she weighed just under 8 kg at this point. And of course, to get to a body condition like that, they will probably be used to a much bigger volume than we may be offering, so we can be worried about other food seeking behaviours again, which we'll touch on a little later.
The other big one that people ask a lawful lot or frequently about is hepatic lipiddosis in cats, and what I really wanted to do was to reassure you that this is not something that should be a concern. Firstly, though, to say upfront, hepatic lipiddosis isn't fully understood just yet. However, provided that cat is eating and is consuming around about 40% of their amino acid requirements, It cannot be induced in these patients.
Therapeutic diets for weight loss are designed so that they do meet not just 40% of amino acid requirements, but all nutritional requirements. They should be complete and balanced. We know though from hepatic lipidosis and the studies that have been done is that it is associated with anorexia and a disease state, something like pancreatitis.
It doesn't seem to be possible to induce it in healthy patients. Now you could argue that because obesity is a disease, they are not healthy, and I would agree on that point. However, Putting them on a weight loss diet and feeding them for their ideal body weight, not an interim target weight, will not induce hepatic lipidosis, and I just, we deal with these patients at Liverpool very frequently, and so I just wanted to give you that reassurance.
OK, moving on from our severe cases to thinking about cases where we've got other factors that are causing problems. So that is going to be age and concurrent disease. Now I'm going to talk about these two things together because there are links and ways that we would treat them is quite similar.
So when we have a cat or a dog in their senior years and or they have some of the disease process going on, it's really about giving an individualised or a tailored programme for them. There is no one size fits all when it comes to obesity patients anyway, but particularly for these cases. So firstly, we need a really holistic assessment.
We want to understand every element of these patients' lives, their requirements, their medical needs, their medication needs, and their age-related concerns also. So it's a wealth of information that we need before we even get started. Then we should think about, well, what actually are we trying to achieve for these patients?
Improved quality of life? Absolutely. And we should be, always aiming to improve that.
Improved mobility, particularly with a senior patient, that would be very high up my list. To not compromise the patient further, and that of course is really important. Particularly when we have some of those chronic wasting diseases, we don't want to make things worse with weight loss.
And finally, and this goes alongside that, is that we don't want to reduce their lean body mass. And again, this is because with chronic wasting diseases, their lean body mass is going to reduce anyway. The last thing we want to do is to start that process too early with weight loss.
So it's thinking about what is the right place to aim for for these patients. Now their optimal or ideal weights, maybe like we've just calculated for the previous patient, remains the same, and it is always going to be the same. And so you would always feed them to be that weight.
However, When you are dealing with these patients, we will want that target weight to be a place where you're going to stop the weight loss. So we're not going to take them back to a weight that they would have been when they were 2 years old. We're going to think about what is appropriate for this patient in front of me.
And this really must be a team-based decision, particularly those with complex medical needs. You will need the whole team, the vets, the nurses, everyone to be working together and making these decisions based on those clinical aspects. So if we think about senior patients first of all, so this beautiful ginger boy here, he came to me as a 15-year-old with poor mobility, asking for help, asking for better mobility and better quality of life, and I have so much respect for his owner with a 15-year-old cat to come and do this with me.
So we consider cats over probably 10 to be considered senior and dogs over 8, depending on the breed, of course those giant breeds reaching senior years much earlier on. And the theory that I want to just think about for a moment is the obesity paradox. So the obesity paradox is found, we think, in both humans and in animals.
And what the obesity paradox is, is that when we have higher amounts of adipose tissue mass, so greater fat mass, this gives better survival when we have a patient that is considered senior and with a concurrent progressive disease. So I'm talking about if we've got an 8 year old cat with diabetes or a 10-year-old dog with renal disease, heart failure, or a cancer, if they have got some reserves, if they've got some excess body fat, they do better in terms of survival from those diseases. And as I say, this is true in humans as well as pets.
And so I think it's something that we should be really respectful of and certainly in terms of not making what we're doing put that pet at a disadvantage at any point. So the first thing that we think about is thinking about, well, OK, what is the minimum that I would like my patient to lose? And the minimum probably is 6%.
So studies have shown that at 6% we get noticeable physical benefit from that weight loss. Brilliant. Let's get started with that.
And then it's about tailoring appropriately. So thinking about 6% as the minimum. And then probably only going to 15 or 20% of overall weight loss.
Please excuse me. And we wouldn't really want to go beyond 20%, and the reason for this is because the 1st 20% of weight loss tends to be predominantly fat mass. Once you get over 20% of weight loss, we then start to lose lean mass as well, and we don't want that for these patients.
That's why we stay at a maximum of 20%, but it is really going to be quite dependent on that individual health status. So we know that many of the patients with obesity will have a concurrent disease. Certainly for us at Liverpool, 80% of our patients have something else going on.
So these are cases that we're very comfortable dealing with now. So we are always looking for that individual approach and looking for something that is disease specific as well, always considering that obesity paradox. So to give you some examples, I've got Ruby here, this beautiful taughty girl, she's 12 years old.
We'd identified chronic renal disease. She was in stage 2 at this point when we met her, but she clearly had obesity, and we wanted to make her feel better, and I think we achieved it. We can see that she did lose some nice weight for us.
We only were looking for a 10 to 15% maximum weight loss for her because her chronic renal disease was going to progress in the near future, and we didn't want to put her at any disadvantage. Alpha beautiful chocolate boy with his rosette here. He's one of my favourites.
I shouldn't have them, but he really was. He's such a sweet boy. He had metatastic carcinoma and really, really sadly, he was considered an end stage at this point, but his owners wanted to make whatever time he had left just that little bit better.
So we put a plan in place that, well, OK, let's get him to lose 6% at least. If we can lose 10% of body weight, that would be wonderful. And actually at this point when we met him, Alf had been given maybe 2 or 3 months in terms of survival time.
He actually ended up surviving for 10 months, and the owners credit that little bit of weight loss for that additional time and was so grateful to have that, of course. Now for a different patient that may not be the story, but in this particular case it was. And so again, I have so much respect for them for trying to make those last few months with as good as they possibly could be.
For Ellie, a lovely rotty girl just down at the bottom, so she was diagnosed with bilateral hip dysplasia and joint disease of a hocks meant that she wasn't a surgical candidate for a hip replacement. So we've really only had weight loss in terms of what we could do for her. And actually in her case we did return her to an ideal weight, her ideal weight, because that was going to maximise the benefits that we got in terms of her mobility.
And actually when she was reassessed post weight loss, our orthopaedic surgeon said that she now didn't need her surgery. The improvements had been so great. She'd had so much benefit from her weight loss, she would have never have been considered for surgery, and that is a wonderful story for her and of course her quality of life.
So is always worth considering for these patients to get those noticeable benefits. We can improve or preserve health. We can improve quality of life, improve or preserve mobility.
We can reduce general anaesthetic risks or risks of surgery, and we are much more likely to be successful if we are only asking for a small amount of weight loss. And this diagram here shows you the sort of laws of diminishing returns, and it really applies to weight loss. And that's where we have the time taken along the bottom and the effort up the side.
So we can see in the early stages, you know, we've got a smaller amount to lose, we're more likely to succeed because fewer changes are made. The weight loss duration, the time it's taking to lose the weight is much shorter. So again, we're going to get our owner coming along with this journey much better.
The more they have to lose, the less likely they are to succeed, and that's really sad. So for a doc like Ted, he is far less likely to succeed than Peppa, who was on the previous slide, because we've got to make massive changes to how that patient is being managed, and it's going to take an awful long time. So get in there early, get those small wins whenever we can, particularly for these complex patients.
OK. Now, I've dwelt quite a long time on those three elements, because I think those are the ones that really do complicate our programmes. But now I wanted to run through some more rapid fire, issues and hopefully give you some solutions.
So, our first one, really common, we tried before and it didn't work. All right. Don't give up.
It doesn't mean it won't work this time. Find out what went wrong. You know, what was it that was, really causing an issue?
Maybe bring the owner back round to, why did you want the weight loss in the first place? What were your goals? And then go through that process of visualising that positive outcome again, and then try some fresh approach.
I try new things, maybe a different type of diet, maybe wet or dry. Maybe a different team member within your team will have better success this time if you feel like you've hit a brick wall with them. And really for these patients, they're going to need a bit of extra support, a bit more hand holding, because they're going to be worried that it might fail again.
Diaries are a really good tool to use for these cases because it really helps you to see what's going on and help owners identify for themselves where those pain points are. The next one is, well, we tried, but they don't like your food, you know, you'll get the blame obviously, and this might be the pet just resisting change, you know, it's . It, you know, cats in particular don't like it when things change.
It could also be that the owner now is hyperfocused on that pet eating and watching every move and every morsel that that pet eats, and the pet is just going, What are you doing? Please just leave me be. And so they know something's off and so may not eat so well.
Now because getting them on the right diet is central to our success, we've got to get it right. So really don't rush the transition. 3 to 4 days is fine if they'll literally eat anything, maybe a Labrador, but for most, you're going to have to be a little slower than that.
So most can be transitioned over 4 to 7 days. Icky eaters slow right down 10 to 14 days, don't rush it at all. And if it takes you up to 8 weeks to make this transition, so be it.
We've got time, and it is more important that we're successful than we do it quickly because diet is so vital. All right. Our next problem, we can't afford the food, and I think in these times where, where money is just so tight for so many people, it's such a concern, and we really need to have these conversations.
Now, in years gone by, so in 2015 when this was looked at, in fact, it turns out that it's usually cost neutral to feed a weight loss food when you've added up everything that the owner was previously feeding. So maybe you just need to prove it to them, write those lists. You know, show them, like all that chicken, all those treats that you're buying, all those dental shoes, that plus your food adds up to an awful lot.
This is what I am going to propose that actually could save you money. So you know, get them to write everything down, get that sort of detailed history, and just try and work it out for them. Work it out in a cost per day point of view, you know, talk about it in terms of buying a cup of coffee or not, you know, hopefully they can see that although on their perception that big bag of food costs a lot more than they used to, actually, overall, it should hopefully not cost them too much more.
But what if in reality it actually does, and you know we have to take and accept that this may well be the case. We can get some very cheap pet foods. So where is our pragmatic approach here?
Well, we should just explore what options there are out there, not just be tied to what we stock in our particular practise, thinking about switching to dry foods because it's much cheaper than wet foods, for example, using different manufacturers, there are many out there. That make weight loss foods some are going to be cheaper than others, so explore those price differences. OK, the next one.
My cat wakes me up very early in the morning. Oh, cats can be such a pest, can't they? And we all know that this is possible.
So firstly, I'd be asking them, well, when was that last meal? You know, do you feed wet food? Do you feed dry?
Do you feed a mixture? You know, can we add some moisture? So moisture is inherently more filling.
So giving a wet or a moist meal late at night is going to hopefully get them through to the morning. Feeding them as late as possible, saving food for last thing at night again is hopefully going to get them through to the next morning. If it really doesn't, then there are time food bowls out there that could really help with this problem.
The next problem is quite common actually, and it follows on from the cost of the food is that I want to use my own food. Now I would want to explore the reasons for this and you know, just make sure that there is no misperceptions creeping in there that we might want to provide some education on, particularly when it comes to the home prepared recipes, raw meat-based diets, we need to be very, very careful about what we're recommending here, and I would strongly suggest. Excuse me, that these cases are passed and referred to a board certified veterinary clinical nutritionist who may be happy to do a formulation, but for the most part, this is not something that we can deal with in practise because we cannot guarantee that nutritional adequacy or safety, if an owner is doing it without the help of someone who knows what they're doing.
We also know that maintenance foods are not suitable for weight loss, and even light diets, which are actually just maintenance foods, they're just slightly reduced in calories. They're not suitable either to feed at a reduced amount for more than 8 weeks. So we've got to be really careful when we have a patient like Harry here, and we're thinking about restricting their current diet because if we restrict the current diet, we'll also be restricting the nutrients, and I wanted to just dig into this a tiny bit more.
So what I want to show you is the differences or a visualisation of the differences the nutrients between maintenance foods and weight loss foods. So here is our maintenance food. Our nutrients are represented by the blue dots, and we would suggest that 13 of these dots just for this graphic purposes means you've got complete and balanced nutrition.
Let's compare this now to a weight loss diet, and the red line represents the number of calories, so the amount that you have to feed to keep the weight stable. What we can see straight away is that the weight management food has lots and lots more nutrients in there for the same number of calories that will keep the weight stable. What we want, of course, is weight loss, so we have to reduce those calories typically by 30 to 50%, and that's when we'll see a successful weight loss.
But now we can see we've run into a problem because here when we try and do it with the maintenance food we now don't have enough nutrients because it's not balanced correctly, whereas with our weight loss food we've not only got 13 nutrients, we've got more than enough that we need because this food is balanced specifically for calorie restriction. And so it's for this reason that we must use those diets if we're going to do weight loss safely. All right.
Our next problem. No one sticks to the plan, and it's all on me. I actually hear this quite often and I feel quite sorry for those owners.
And maybe we do need a family consultation here, get everybody involved in, you know, has weight become a bit of a battleground? Now I'm not suggesting you become their social worker, but maybe we could come to some sort of agreements together, you know, identify who's finding this really hard, what do they think about it, you know, what do they really feel. And then maybe I'm asking that person to make the suggestions, you know, what is going to work for them, what changes can they make that actually would be, you know, good in this situation, because if it's come from them, they're much more likely to stick with it.
And so we talk about compliance. It's actually about, you know, working together, isn't it, for our end goals that's going to be much more successful if they've suggested the changes. OK, this is one of the big ones.
They're not losing any weight. Everyone's trying really hard. Please, just don't feel that you need to give up.
There will be something there that's causing an issue, so you check everything. The the original weights, they check the body condition score, check the calculations were right. Have they changed the food?
People do this and don't tell you. You have to ask, were they using digital scales? Are they now using measuring cups?
Is double feeding going on? There's poor communication within the house. Is there extra food sources somewhere?
There must be something, or it, it really is very unusual if there is not something. Again, our diaries play a huge part here. Now if you have explored all of these things and you are 100% sure that that owner is doing everything, then we can reduce the food by 5%, and we recognise that they are all individuals.
Maybe this individual's calorie is just slightly less than the average, and so we'll make that food restriction. If that still doesn't bring about weight loss back on your inspector, you know, mission to find out what's going on, and it will be, detective work to, to figure out exactly what the problem is. Our next issue, we have a multi-cat household, and you know, I know this is really hard, and in actual fact it's one of the hardest situations we actually see in weight loss.
Now microchip food bowls are an excellent solution to this problem, but they're really expensive and it's unfortunate that they are because they are, they are just so good. Microchip activated cat flaps are maybe a bit cheaper, so maybe we could control access to a room or to a cupboard again working a bit like the bowl, so some can enter and some and some don't. I did once hear about someone using washing baskets, so they used, they popped a washing basket over each cat as they were being fed in their multi-cat household, meaning that no one could go and steal food from.
Anyone else that they were managing their feeding like that. It worked for them. Sometimes we do have to think, you know, outside the box, but it is trying to work really hard with the management of these cats within the household because particularly if you've got these two problems going on together and there's an extra food source in that house, it means that weight loss will be very difficult for those cases.
OK, here's the common one. And I think if, you're not getting this from, from your weight cases, I want to know how because I think this happens at some point for all of them. They are hungry all the time.
Now, We should recognise that it is normal to some degree because we're getting the body to use its reserves, so it naturally would want to put them back. But we also should recognise that maybe that patient's existing behaviours have led to this in the first place, their own motivations. So we're not going to change that.
But has that behaviour intensified, we'd want to understand. We'd want to know if it's new behaviours that we're getting. We'd also want to understand, is this actually true hunger?
You know, would they eat anything that's offered? Do they ever leave food? Because if they do, they're not truly hungry.
They just want something nice out of the fridge. One of the things that we'd be thinking about is increasing meal frequency, particularly for cats. So cats naturally will eat up to 16 times a day.
That cat's pestering all day. It might genuinely once a week frequently, so thinking about 4 meals or more for cats in those situations. We can distribute meals differently, particularly if the owner goes out to work, we could offer a small breakfast, leaving larger meals for the other end of the day when the dog is around the owners and can pe for them, so just being a bit more flexible.
And then thinking about, well, what other alternative interactions could we offer grooming, play, you know, distraction, chewing, you know, anything that doesn't involve calories could be a solution in these problems. Ideally we want to slow that eating down, get them working for that food if we can. Make meals last a lot longer.
Preventing stealing is really important because they'll be very driven to doing it again. Using green watery vegetables, if you've heard me talk before, you'll know that courgette is the most favourite vegetable of mine. You can feed it freely to cats and dogs.
And finally, getting owners to understand the reward types. So there are essentially 3 types of reward and that will make sense in a moment. So the first type of reward is absent reward.
So this never happens. So I never give my cat hand from the fridge. She never asks me for it.
It's not an option, so I don't get pestered. The second type of reward is reliable reward, so this is something that always happens. My mom gives a biscuit to her dogs every time they come in for a walk.
So the dogs sit there, they're quite relaxed. They know it's going to come. They wait for their biscuit.
All is well. The problem comes when we have intermittent reward, and this is where things might happen. This will cause frustration because the cat or dog doesn't know what they had to do to get that reward.
But actually what they'll do is increase those behaviours. They'll actually escalate those behaviours to try and get at whatever it was. And so it's this that we need to get away from, so talking to owners about either always giving something or never giving something.
So now we come to the problems that we see after weight loss has been achieved, and probably the most common one is I just want to go back to my normal food. Well, we know that if they stay on the weight management food, they're 20 times less likely to regain that weight. So we really should be talking to the owners about the benefits of staying on that weight loss food.
It gives us a bigger feeding volume. It helps with satisfaction and prevents food seeking. We get much better control and we're much less likely to let those old habits sneak in.
Now, if they're dead set on this, OK, we're not here to dictate to them, so let's let them try, but agree with them. Let's see you back in a month, and if it, is not going well, maybe we need to switch back. We'd never cure obesity.
This is going to be something that they will have to deal with lifelong. And so we will need to continue those high levels of support and maintenance, maybe giving little rewards because it will be tough for them to maintain it. Something like this.
This is my annual reward if you state your ideal weight. Finally, our final, problem, surely my dog or cat is back to normal. Well, as I said earlier, we have had to restrict calories by 30 to 50% to achieve that weight loss.
And following the weight loss, what we also know is that the amounts of energy they need to keep the weight stable is much less than it would have been had they not had overweight in the first place. It's only usually 5 to 10% more than they were getting during weight loss. So we always have to be on a calorie restricted diet, unfortunately.
So in summary, if we're going to be successful, we need to start the conversation, and, you know, get them on board with the weight loss. We must make sure that our own thoughts and feelings aren't affecting our approach to these patients. Owners must be ready if they're going to make the changes that are required to be successful.
And then if we've got those difficult cases, we need to be accurately determining their ideal weight so our plans don't go awry, and we'd just be there ready to solve those problems. There'll be so many along the way, so have those solutions at your hand. But if you can do this, we know we'll improve quality of life for every patient with obesity.
It has been my pleasure to speak to you this evening. Thank you very much for listening.