Hi, everybody. Welcome back. I know that was a very, very brief lunch.
I hope you managed to get something into yourselves. Hi, Georgia, just see you put your video on. Anyway, I hope you're enjoying the day so far.
We've had some lovely comments, so thanks for that. I just want to introduce my, my good friend Lord, Georgia Woodsley. She qualified as a veterinary nurse in 2004 from Myerso College in Preston.
And after working in mixed practise, in a multidisciplinary referral centre and a busy out of hours emergency and critical care hospital, she was appointed head nurse in 2010 and clinical coach of a small animal practise in Cheshire. In June 2015, Georgia took the position of our Royal Canon Weight Management clinic nurse at the University of Liverpool, small animal teaching hospitals, and she now deals exclusively with pet obesity care and nutrition. And also, in addition to running the clinic, Georgia assists with the research that the clinic undertakes and has provided education to vets and nurses throughout many countries of the world.
In fact, you've probably already heard her before. She's brilliant. Georgia's gained a certificate in canine and feline veterinary health nutrition in 2017, the American veterinary technician specialist certificate in nutrition in 2019, and she's one of a 25 people to hold this accreditation and a BSC honours nurse training as well to top it all off.
She got that degree in 2022. So, got all tongue tied there. I'm going to pass over to Georgia and I'm hope you're raring to go.
I believe that Dawn's put it in the chat that this is also an interactive session, but interacting via the chat, please. OK, I'll pass it to you, Georgia. Hi, thank you very much.
Can I just check you can hear and see me OK? My slides are up. You are mute Mhm.
Can you hear me? No, we can't hear you. Can you hear me now?
I can, I can hear you, Georgia. So I'm not sure why you can't, Claire. Let me share my screen again and let's try again.
So, can we, can you see me, hear me, see my slides? Yeah, I can do. That's all good, Georgia.
Wonderful, thank you very much. Well, thank you, Claire, for the very kind introduction and thank you to you all for joining me for this session this afternoon. We're very much focusing on the pet owner conversation, and this is of course a topic extremely close to my heart.
This is something I spend an awful lot of my time doing. And so I'm really hoping that I've got something useful for you and that you can take back into practise tomorrow and start using. So we're gonna start by thinking about how communication and how we communicate is really key in having these discussions with pet owners when they have a pet with overweight or obesity.
I then want to be a little bit challenging, and I want to delve into our own thoughts and feelings on obesity, not just us, on pet owners' thoughts on overweight and obesity and society's thoughts on overweight and obesity. Now I know that anything that I say in this session is said with love, but by the very nature of what I'm going to do, some of it might feel a little challenging. You'll see what I mean.
Then I'm going to go on and we'll think about specific words and how we use words in communication really does matter, probably more than we think in actual fact, and I'll give some demonstrations of how if we just make small changes to the words that we use, they can actually benefit us hugely. And I'm going to finish by thinking about, well, what does ideal communication with our pet owner look like and give you some examples of some techniques that I might use in practise that hopefully you would also be able to adopt. So just to start us off, we know obesity happens, doesn't it?
And in its very simplistic form, it happens because of an energy imbalance. We've got too much energy intake and not enough energy expenditure, and so that energy that isn't expended is then stored in the body fat of our patient. Now this really, really is the very, very simplest version of this that I could give, and we know, I'm sure Alex and Claire have given you a very good explanation as to why nothing really is simple about obesity.
And certainly communicating about obesity is not simple either. Now not only do we know how obesity happens, we also know it happens very frequently. So in the UK here, we have pretty high incidence in dogs and cats.
65% of adult dogs, 37% of juvenile dogs are thought to have overweight or obesity. In cats, the latest study that we have was from 2010, and that suggested that 39% of cats had overweight or obesity. But the Association of Pet Obesity Prevention survey of 2022, it was a survey in the US, found that 61% of cats had overweight or obesity.
And so I think we can pretty safely say that our incidence in cats is likely to be similar to that of the US as we of course so commonly follow trends that we see over there. Essentially that means that over every other patient that walks through your clinic door is going to have overweight or obesity. So this is something that we're going to have to be talking about, communicating about very, very frequently.
So how do we tell them, these lovely pet owners with these lovely pets that they bring in, how are we going to deliver this news to them? Now, initially when you are a little trainee, you know, nurse in practise and you're, you know, shoved in front of an owner's like, go on, go and tell them that their pet needs weight management. And of course the thoughts that immediately crash in are, well, how do I get this communication right?
And what happens if I get that wrong? What are the consequences if I don't get that communication right? And we may still feel like this in practise.
So what I want to know is if you could pop it in the chat box, how do you feel about having these conversations, if you've got some adjectives that you would share with me? Let me get my chat box up so I can have a look. What are the sorts of feelings that you would have around having these conversations?
Are you scared? Are you happy to? Awkward, somebody said, emotionally charged, yes, I don't think you're alone at all.
Has anyone else got any other thoughts? Do you feel confident in having these conversations? Do you feel apprehensive, worried, potentially about having these conversations?
You certainly won't be alone, nervous, anticipating a backlash, thank you, Rebecca. Yeah, I, I definitely don't think that you're alone in having those feelings. So hopefully by the end of this session today I'm going to help make those conversations just that little bit better.
OK. The other thing that I wanted to know was, do you think that your own thoughts and feelings can affect this conversation? How you view those pets with obesity?
Do you think that can affect the conversation either positively or negatively? Or do you think that it doesn't have an effect at all? Pop a little note in the chat box if you want to and everybody look out for those coming through.
It does have an effect, said Samantha, yeah, I I would agree it certainly can have an effect, which is why hopefully throughout this session today, we're going to delve into it just a little deeper. So if you will indulge me, I have got 5 very short videos to show you. And what I really would like you to do is note the first thoughts and feelings that come to your mind.
They're not right or wrong, they are your thoughts and feelings, OK, so don't screen them, but just make a note of them to yourself. And here is the first video. OK, and on to video number 2.
Now you may well have seen this. Apologies for the quality of this video. This is a video that I found on YouTube.
And what I was doing on YouTube was looking for funny cat videos. If you put that in the search, you'll find somewhere in the region of 8 million funny cat videos, and this one was on the list. OK.
Then I want to show you some of my patients. So this first video, this is Little Cujo. And again, just noting your first thoughts and feelings when you see these videos.
This is Molly And finally, this is Ted. So what did you think? Obviously it would be over loved somebody who's come straight in there with on the chat just there.
So, did anyone have a humorous thought? Was it funny, some of those videos that you saw, maybe particularly the first one. If it was, you wouldn't be blamed.
And certainly I'm not judging or blaming anybody because we have been laughing at those with obesity for a very, very long time. Simon's cat, which we've got here is a particular favourite in my household, but if we think about it, Simon's cat has obesity. He also has really strong food seeking behaviours which his owner struggles with.
And there are many, many examples. You can now even buy toys for your children called chubby puppies, where that's exactly their purpose, they're there to be funny. So we have been laughing at those with obesity for a very, very long time.
Maybe the sorts of thoughts you had was utter horror, and I can see some of the things coming through in the chat that actually it was, you know, very, very sad some of these, so maybe we viewed some of these pictures and videos with sympathy or even empathy, certainly and potentially with some sadness. And I wonder if there are any thoughts of judgement. Did anyone look at any of those pets and think, goodness, how did they get there?
How did an owner allow that to happen? Was there a judgement that was made? And again, it's very natural and normal to be having these thoughts.
We all do it as humans. If we take this cat here, Molly, would you say that this is a successful case? Pop it in the chat.
Is this a successful case? What do you think? I haven't got much coming through the chat, but that's OK.
So maybe you're undecided, and probably because I posed the question that way. So someone said, no, this isn't a successful case. Well, this was Molly at the start of her weight loss, and the first picture that I showed you was after she'd lost 3 kg.
So to me, that is a really successful case. Does she still have obesity? Absolutely.
But is she in a better position now than when she started? Most definitely. OK.
So what I'm really leading on to is how people, and people in general, us as veterinary professionals, pet owners, wider society think about obesity? And I couldn't do this session without talking about two things, and that's weight stigma and unconscious bias. Now weight stigma, according to the World Obesity Federation, is defined as it referring to discriminatory acts or ideologies targeted towards individuals because of their weight and size.
Weight stigma is a result of weight bias, and weight bias refers to negative ideologies associated with obesity. So that of course is in humans. However, you'll you'll see in a moment, it is not limited to humans.
So with weight stigma, we have a lot of negative associations. This site goes on to describe further that people with overweight and obesity are viewed as lazy or lacking in willpower, and that is really, really common in our society. It all comes from unconscious bias, which I will talk about in a moment.
And really sadly this leads to the avoidance of people seeking help for what we all consider now to be a disease. It also creates barriers to prevention and barriers to receiving and delivering treatment. So weight stigma is incredibly important to consider when we're dealing with overweight and obesity.
So what is unconscious or implicit bias? Well, these are beliefs and associations or attitudes to a group, stereotypes that are hardwired in us. They are unconscious, they happen before our conscious brain can kick in.
So that means that they are also uncontrollable, which was why I wanted you to know, what was your first reactions to some of those videos. Even though your conscious brain might be telling you other things, what was that underlying first reaction? Now an unconscious bias is of course very different from a conscious bias because a conscious one or an explicit bias is controllable.
Now if you would like to discover your unconscious biases, you can go to this website and spend a really uncomfortable afternoon just finding out where your unconscious bias may lie. And I will hold my hands up. When I did this test online, I, my results came out that I did have slight unconscious bias towards those with obesity.
But now I know that, I'm highly aware of it and I make very sure that my communication does not allow my unconscious bias to affect it. OK. So when we think about communicating about obesity and how are we going to tell these pet owners that their pet has obesity, well, a lot of the questions come around, well, how did this happen?
You know, who is to blame for this happening? And what first of all seems to happen is we start with finger pointing. It must be their fault, the pet owner.
You know, they provide the food after all, they just must simply be giving too much. They must be giving too many treats. They're probably far too lazy to be doing anything about it.
Don't they know they're killing their cat with kindness? And I have certainly heard these comments within practise. So I know that they do, they do happen.
And what all of these comments represents is weight stigma. That blame that we are associating with one person, that pet owner being solely responsible for this disease and their pet is due to that unconscious bias that we may or may not have, and it causes this weight stigma. So if you hear a colleague say any of these things or have any of these similar thoughts yourself, because as I say, they might come unbidden to you, try and be curious and think, OK, the pet owner does control the food, but hang on a minute.
The other cat in their house is of an ideal weight, so they're probably not treating their cats differently. So what is going on? How can we blame just the owner for we can't blame them for it just being one cat and not the other.
And curiosity is actually one of the really good ways that we look at this in a different light. So as I said, weight stigma is really common, not in just in society, but also with human doctors and in the veterinary profession. Now when human doctors, so this is primary care physicians, so GPs were asked about their attitudes towards obesity and its treatment, the words that came out were that they found that they felt awkward towards patients that had overweight or obesity, that patients were ugly and were probably going to be non-compliant.
And that's a hugely negative thing for, you know, someone who is there to care for people to be thinking about anyone with a disease. And unfortunately vets aren't immune to this either. So in a similar study asking vets' opinions and perceptions of of these cases where we see obesity in pets, words that came out with a frustration that they did want to apportion blame, and they felt very pessimistic about the successful management of that obesity.
So there's an awful lot of negativity here, and this is all part of that weight stigma, sadly. Even with us, it will still create barriers to to be able to manage obesity better. And that negatively impacts the treatment that we are able to provide for these patients.
So, OK, so how does obesity occur? Let's look at this in a little bit more detail, because I think if we understand the complexity, and certainly we can explain to the owner some of this complexity, it can help everybody in their communication about this disease. So let's take that pet owner first of all.
They do have a part to play, of course, they do provide the food to the pet. However, they might be influenced by many things outside of their their cells and their homes. So maybe that's social media, maybe that's the breeder or the dog walker, maybe that's the groomer or the person in the pet shop.
They're going to have lots of advice coming from lots of different angles. Hopefully they have advice coming from us as veterinary professionals too. But who do they listen to?
A pet owner has got to decide along the way somewhere. Maybe the pet owner is just feeding this pet as they fed their last one. And that pet wasn't overweight, it didn't have obesity, so they just thought they would do the same with this one, not realising that actually all pets are individuals and we have to treat them as such.
We know that humans show, sorry, show love with food. This is my 10 year old, it was her birthday last week. And of course I couldn't let her birthday pass without a big cake.
Who has a birthday with no cake? Interestingly, the little dog on the right, he's Cosmo. So at the time this picture was taken, Cosmo was under weight management with us at the weight management clinic.
And even knowing what the owner knew, she still felt very compelled to give just a tiny little birthday cake on his birthday. Now, hey, I'm not here to say that anyone can't have a birthday cake on their birthday. I'm using this as an example of that strong drive that pet owners have to show love with food.
And this is a very in-ground method of communication that pet owners use with their pets, and we should appreciate the strength of that. We also should consider the family food environment, and this is something that we know again from people that parents directly affect the weight of their children. So overweight parents are more likely to have children that have overweight too.
And because this is about the attitudes to food within the house and the availability attitudes to exercise, possibly also, we can also add the dog and cat into this wider family food environment. All right, so we've looked at various factors to do with the persona, but what else is there? Well, we know that there's a genetic component, hopefully you are all aware of the POMC gene that was identified a few years ago now.
And certainly genetics may well, be playing well, a sort of a part in what we're talking about. This is just one gene though, and in humans, they've discovered many. Any genes associated with obesity.
But just because you have these genes, it doesn't mean it's a life sentence that you're definitely going to have overweight or obesity, whether you're a human or a cat or a dog. And this is mainly because the environmental factors that you'll be exposed to will trump those genetics every time. We are all living in an obesogenic environment at the moment, and for the pets, it depends where they're living, who they're living with, who are their caregivers, how much activity they're doing depending on that family.
So the environment does have an enormous part to play, and there's a lot that will go into that bucket as such, and that will come into that title. We may also see metabolic disorders such as hypothyroidism in dogs playing a part here, that's where where we see increase in weight and make weight loss very difficult. The food type can make a difference depending on how it's fed, so inherently dry food per gramme is higher in calories than wet food.
So if you have a owner free feeding wet food, that individual pet is going to be taking in much fewer calories than if they're feeding free feeding dry food, so the food type can have a difference. The pet's own behaviours are really important here to remember. Not all pets, just like people will have different priorities in their life, and some pets, food is their absolute top priority.
And so their food seeking and food eliciting behaviours from their pet owners can of course affect their weight. Then we have from a pet owner point of view again, lack of knowledge and understanding, not only of what obesity is and how it occurs, but also when their pet has obesity or not. This study was asking owners to body condition score their own pets, and 89% of them underestimated their dog's body condition score.
And even when they were given a chart and shown how to use it, 65% of them still misperceived their dog's body condition score. And we sort of wonder, well, what's going on, how does that happen? Well, it's because we are losing sight of what normal looks like, and certainly from a pet owner point of view, what normal looks like is now very difficult to define.
So I think if you asked most pet owners, and of course I haven't done the study, but I would like to bet some money that if you said to a pet owner, is this a normal Labrador, they would probably say, actually, yes, it's a pretty slim Labrador, I would love my Labrador to look like that. Well, this particular boy here, he is a body condition score of 7. That means he's 20% above his ideal weight.
So this is not normal. Because Sydney is a patient of ours at the clinic, we know what Sydney should actually look like. This is what a normal Labrador actually should look like, and there are very few and far between, sadly.
So we know that we have this disconnection from what the reality of normal really looks like, but we can hardly blame pet owners for this, especially when the images that we see now so frequently are of those with obesity. This picture I took from a Google search, I was looking for dogs at one of the world's, famous most famous dog shows. So this guy here is, he's very handsome, but he's being held up as the best of his breed.
The breed representative. This is what Labrador should look like. But on his shape alone, I'm really hoping everyone recognises that he does have obesity.
OK, what other factors should we consider? Well, these are maybe now things that come a little bit closer to home. This is about our communication with the pet owner, so it's that fear of causing offence.
If we're worried about something, then we may well be avoiding it. Maybe it's discomfort with the conversation, and I'll touch more on that a bit later. And again, if we're uncomfortable, we're likely to avoid the conversation.
And maybe underlying both of those things is some unconscious bias, which I do suggest everyone goes and finds out it is very interesting and enlightening. Maybe on a practical level, it's lack of time. We all know how tough the last few years have been, and I'm not sure anyone's got any more time these days than they have done recently.
So certainly lack of time for these in depth, detailed conversations is very difficult to find. Maybe it's about different priorities. If we have that lame Labrador come to see you, maybe we're thinking anti-inflammatories, maybe we're thinking some radiographs, some imaging of some sort.
Are we also thinking about weight loss being the long term solution for that lameness? Have we got time to be talking about it? Have we got the right person that could have that conversation?
So maybe we've got some priorities that we could consider. We also know that within the veterinary profession, recognition of obesity is not where we would like it to be, and that goes along with a certain degree of apathy that we again also know exists. This particular study looked at clinical records and it was looking for weights and looking for words that were associated with overweight or and weight in any sort of way and body condition score.
30% of these patients were never weighed. So who knows if they have overweight or obesity? How is anyone going to tell?
From a body condition scoring point of view, only 1 out of those 148 cases had a body condition score, and that was only on one occasion. Now I'd really hope that this is much better in, in many, many practises and hopefully in your practises that you work in. But the point is, is that it's not universal, and we know that within our profession, we still could be doing a lot more of the basic stuff, just weighing and body condition scoring would really, really help.
So when we kind of take a look at this overview, we've already got an awful lot of elements here, which is why we simply cannot start pointing the finger at the pet owner and considering it to be all their fault. This is a systems map of the causes of human obesity. You don't need to see the detail here.
What this picture represents is just how complicated it is, just how interconnected all those factors are. And so if anyone says that obesity is simple, show them this picture. It is very far from simple.
So as I was writing this session for today, I came to realise that there are two really common questions to do with communication that I would really like to discuss with you. The first one is that I'm asked really often, how do you talk to a pet owner that has overweight or obesity themselves about their pet that has overweight or obesity? Is this a concern for you, if you were faced with these owners, would this be a factor?
Would it be a consideration for you when with having the conversation? Would you alter your approach potentially for these owners just here? You can pop that in the chat if you like.
It'd be interesting to know who would make alterations to that. So Diana's in there, no, but in only in the terminology would be different, yeah, OK. So is this a situation where we worry about causing offence potentially?
Does it feel like a, a difficult, you know, a touchy subject and very much more so when the owners have overweight or obesity themselves? Is there just this general discomfort with having to broach this topic with them? As I said before, if we are feeling these things, we are much more likely to avoid that conversation, and that's that bias, that weight stigma coming in and creating a barrier for us.
The second question that I wanted to just discuss with you, and I felt like I had to share this, this is very much a personal thing, and it represents my journey of where I've come, in terms of conversation and communication with pet owners. So I have been asked pretty much countless times at this point over the last 8 years of being at the weight management clinic, and I'm asked, do I feel pressure not to be overweight myself? I will definitely admit that in the past, yes, I absolutely have felt that pressure.
But in much more recent years and with much better understanding about obesity, weight stigma and unconscious bias, now if anybody asks me this question, I was like, well, hang on a minute. How does what I look like or my weight affect my knowledge? How does it affect my understanding or the level of care that I could provide to my pets or my, my patients, or the ability to do my job?
This is judgement. This represents very clearly that an implied prejudice. Maybe that person asking me doesn't feel that, but maybe the pet owner does, maybe that's what they're implying.
This is weight stigma, and this comes from unconscious bias. And that actually reflected my unconscious bias because I did used to feel this pressure, whereas now I may well keep myself fit and healthy for my own reasons, but it's certainly not because of the job that I do. So it's so easy to fall into these traps of being affected by weight stigma and weight and and and unconscious bias.
OK. So what I wanted to do, I wanted to show you the kind of what we don't want to see. OK, the sorts of conversations that we'd ideally like to avoid, but I know because people tell me this still goes on in practise.
So we have a vet, and they are meeting the pet owner and they have their their cat or dog that has obesity, and they've got to break this news to them. And so they go straight in there with, well, you know, fluffy is pretty fat and unhealthy now. So all you have to do is you have to cut out the treats, don't give any dental chews anymore, and you have to feed this food at 100 grammes a day, and as long as you do everything that I tell you, fluffy won't be fat anymore and won't be at risk of dying.
And that's it, job done, couple of minutes, there's your weight loss plan, away you go. And of course this is not what we want to see from this conversation. So what this person would be doing here and in many other situations is trying to use a shock factor.
They're trying to shock the owner into doing it. Don't you know you're killing your pet with kindness, and that's a really, really risky tactic. It might be effective for some people, but it's gonna be utterly potluck.
I don't respond well to that sort of derogatory shock factor, and I know an awful lot of pet owners don't either. What's the worst that's going to happen, they're probably never going to go back and see that individual. They may well even leave your practise.
And clients leaving your practise is the last thing that you want to do. This doesn't represent the level of care that you can provide to this pet and this pet owner. So the shock factor, as tempting as it might be, I would steer well away.
The other thing that is very common and is represented by that very short example is prescriptive direction. And that makes sense in veterinary practise, doesn't it? We are very prescriptive usually in our advice.
So dog's got an infection, you need antibiotics, that will fix the infection. Here's your bottle, off you go, and that will fix it. But when we're talking about infection, the owners don't have the sorts of emotional feelings that they would have when we're talking about obesity.
So when it comes to obesity, we need a different tact, and a prescriptive direction is not the way to go. I'm going to talk much more at the end of this session about how we can have that conversation in a much better way. Maybe these conversations are also going on in the wrong environment, so you don't want to be having this conversation in the waiting room with dogs barking and cats hissing and just general noise.
You want to be able to be able to dedicate your time to your pet owner so that they know that you care about delivering this information. It's important information that's worth taking your time to deliver to them. And time is, I know, a really big issue.
So if you feel like you're going to be rushed, organise the time to be allocated. Where is the time, who has the time, and how can we get this pet owner to that person to have this conversation. We also see problems with lack of continuity and certainly when we're thinking about providing obesity care, support is really important.
And so actually one of the things that can be very off-putting for a pet owner is to see a different person each time they visit, or even 2 or 3 people, they will probably prefer to see just one person given the choice. And because they end up with no relationship, this is a very emotive topic for them. You have to have a good relationship with them if you're going to be able to support them and get good success for them.
The other thing that this conversation that I showed you doesn't do is it doesn't, it doesn't ascertain whether the owner actually wanted this advice. It was just thrown at them, wasn't it? Nobody asked whether they could actually afford the food that was being recommended and nobody even thought to ask whether they could actually do the plan that was being suggested, and that there was no direction of what they would do if they couldn't follow the instructions.
Who were they meant to go to? Those owners will feel really abandoned if they haven't got any, if they, sorry, if they haven't got a person that they can contact because this person's information was do everything and you'll be fine. So, This is the kind of all the bad stuff, and now what I want to come on to is let's do better.
How can we get really good client communication, really good pet owner conversations. So firstly, I wanted to look at our interte communication. So this is with our colleagues down the back in our vet practise.
Now I know because we have some nameless vets at the University of Liverpool that may say things like this and have certainly I have witnessed this. So we have a cat like Molly in the kennel, and this person, this vessel, this nurse walks in and goes, wow, that is a fat cat. And what I'd really like everyone to do, even if you don't say it out loud, is just correct that in your own mind and say no.
Molly has obesity and she's suffering from a chronic disease. So Molly cannot be fat. She has obesity.
Just in the same way as that she can't be cancer. She would have cancer, she can't be renal disease, she would have renal disease. And this is where those words matter.
It's that very slight shift, but it is incredibly important when we're talking about what we consider to be a chronic and incurable disease. They cannot be fat, they have obesity. So let's look at ourselves first, and that's why I wanted to be a little bit challenging within this session.
What do we think ourselves, what do we feel when we are met with a patient such as Molly? What do we assume, what are the things that are underneath? Do we make judgments and what are therefore our unconscious biases?
If we can become aware of any unconscious bias, we can then have these conversations where we don't stigmatise either the owner or the patient, and we can talk to that person owner without judgement and without prejudice. One of the biggest compliments that I was ever given by a pet owner was that she said she loved coming to see me because she didn't feel judged by me. And I was really touched because even though I know I have that very slight unconscious bias towards those with overweight or obesity, the fact that I am able to overcome that and to make my clients feel like I do not judge them is really, really vital to me.
So it meant an awful lot that she said that to me. So it's very much thinking about our internal communication, the thoughts that we have in our head, and then how we talk about obesity in practise externally with our colleagues. We are here to help.
So what we'd want to do when we're talking to our pet owner is modify our words a little more, so thinking about not using the shock factor and not using F words and O words, and of course I mean fat or obese. There are lots of other words to avoid in my opinion, so referring to the dog in the corner as the coffee table is, is not great for me, or the whale, or that he's a bit of a bigon, or he's got a bit podgy over Christmas, or, or isn't he a bit of a chunky monkey? He's got Like portly or cuddly, well padded, stocky, chubby, a bit of a bit of timber being added there or tubby, none of these words are appropriate to be used with our pet owners.
Now I understand why we use them. Because this allows us to use humour, and that's very, very common that people want to use humour to have these difficult conversations. However, we are dealing with this chronic disease and we should not be making fun in any way.
So my personal preferred term, and you may have your own, but my personal one. Is that I would refer to them as being above their ideal weight. So I'm not using toxic words.
I'm talking about something positive because I'm talking about ideal weight, and an owner fully understands what I mean, but this is not offensive and it's not derogatory to say this. So this is the term that I personally prefer. So back to these two owners, with that you have recognised probably have obesity themselves and maybe you would think, well, you know, they're not very successful at losing weight themselves, and yet that owner on the left there, she's lost 10 stone at this point, she has been incredibly successful at losing weight.
We are not doctors, we are unqualified to be making a diagnosis, in terms of the owner's weight, whether they have overweight or obesity or not. And so it is not our part to make judgments on them and not our part to make any assumptions. We are there to discuss their pets only.
If you're worried, then you can use the pet's name frequently, just so that there is absolutely no misunderstandings of who you're talking to. And remember, these owners only want what's best for their dog. They're in your consulting room wanting your help and advice, so let's approach that with understanding, empathy and sympathy.
So what does ideal communication look like? Well, again, I wanted to start internally in our veterinary practise. What about team communication?
This is going to be very important for how we manage these cases. How are we going to refer to the right people to manage this obesity? Who are we going to be referring to, and when are we going to refer?
Having something like referral cards in the consulting room is a nonverbal type of communication that will assist these patients to see the right people within your practise. And that needs to be really efficient, and everyone needs to be aware of what that is, so that it really works within your practise to get those patients the help they need. Then we could think about some visual communication, something like the images that I've got here.
So we've got some weighing scales displays, we've got waiting room displays, advertising your services, say, you know, to your clients, we are here, we're happy to help. We're fully equipped and prepared to help you with this issue. I like my Wall of Fame.
Other than that they are all very dear to me, but what my wall of fame does is it says to other pet owners, you can do it. And our orthopaedic service love using my consulting room because they will take them to my Wall of Fame, show them the Labradors and say, look, this is what's achievable through weight loss. I also have an ongoing cases board because this tells pet owners, you are not alone.
They certainly will not be alone, but in pets and cats and dogs, it's not common like it is with people to have group sessions. Maybe that is something that your practise would like to set up, but at the very least you can have this up on the wall to let pet owners that they're definitely not on their own, having to manage this problem. Then let's create the ideal environment for this conversation.
This is my consulting room at Liverpool, so someone that's nice and quiet and private, remember this is important information you're delivering, somewhere that's dedicated, which means it's well equipped with cat and dog scales, and then we've got some typical steps to follow. We've got to gather information. We've got to get the pet owner to communicate with us this time.
We want to do a physical examination and then we want to communicate our findings. That's what I'm going to talk about just for a moment now. So then we can go ahead and make a plan for the weight loss.
So the first thing that we need to do is gather all this information, so thinking about the medical history and then of course thinking about diet history of foods, treats, lifestyles, plays, play routines, that's the communication that we need from the pet owner. Now we can do this in many ways, so pet owners can communicate with us in pre-appointment questionnaires or in food diaries, and what we have now at Liverpool is also an online questionnaire. This is really quick and easy way for a pet owner to communicate all that background information that is going to be vital to us to understand what their plan needs.
Then the actual questions that you ask a pet owner can really make a difference to what communication you get back from them. So if you ask the question, what do you feed your dog? The pet owner will answer something like, well she only ever gets dry food twice a day.
That's it, absolutely nothing else. Whereas studies have shown that if we ask a slightly different question, so something like this, starting first thing in the morning, tell me everything that your dog eats throughout the day, we get much, much more information. So then we get told about things like this, she has a piece of toast with me before her breakfast, and she has her breakfast.
Once she's had a walk, she gets a treat before she settles down for the day, and so on and so on. And so the the actual words, how we speak to the pet owners does make just such a difference. Now they say you have to ask at least 3 times to get kind of anywhere near what a pet actually eats, so we could look at the clinical notes, we can compare them with the notes that you've taken in your consultation.
Maybe we need different words to get different answers out of the pet owner and then some. Situational questions I quite like. So anything before bed or before you go to work, after a walk, who's likely to give treats in your house?
What's their favourite food, and do your visitors give food or? These are all really good questions to ask. And you can see my example here of one of my questionnaires.
I've scribbled all over it because I'm able to get a really nice conversation going with the pet owner. They're telling me lots of extra information, which, of course, is what we want. Then I also offer up food lists, something like this, so for dogs, I'll ask about cake and cheese and burgers and fruit and yoghurts, all this sort of thing, and ask them to say yes or no.
And similarly for cats, we'll be asking about meat and fish, whether it's tinned fish or fresh fish, and so on. And even once they've said yes or no to many of these things that you didn't already know about, make sure you always ask, and is there anything else? And I don't know why I'm still surprised, but I am still quite surprised when people then come back with, yeah, nan's pink wafers when she has a cup of tea, or she gets a bit of kebab on a Friday night when we come home from the pub, lots and lots of things will come out at this point, so multiple asking these questions.
You'd also want to delve into the medication and what's going on there, so what's being given and how often is that medication likely to have increased the appetite, such as steroids and anti-epilepsy medications certainly can do. And then also not forgetting about supplements and nutraceuticals because we might have some hidden calories here, whether it's cod liver oil or coconut oil and really high in calories. So we definitely want to know if that's being slapped on the cat or dog's food.
And really, really importantly, what are you giving the medication in is a great question to ask because pet owners won't consider this food. It's not food. This is to give medication in.
Now if you don't ask, you probably don't know. And of course we have some much better options than the sausage for giving medication in. Then we come on to the physical examination, and I always feel it's really important to explain to an owner what you're doing while you're doing it and why you're doing it.
So what are we looking for when we do this physical examination? When we weigh them, is that weight different from last time? What Is body condition scoring?
What's muscle condition scoring and how could you go about it? Why do we take measurements or what are the pictures going to be used for, or why would we take video? Owners want to know, this is their pet.
And so it's important that we communicate the physical examination too. I have a very brief video here, because there's actually someone else that quite likes communication. Come here then.
Oh, she's a good girl. You come in here? Good girly.
OK, wait. What a good girl, good girl. There's that one.
This is Nelly. Well done, yes, good good. Can you just do this one?
Yes. Isn't she a clever girl. And this is of course to show that actually the pets like communication too.
If we just stand there stony faced and like, what on earth is going on? So don't forget to communicate with your patient too. Now we must include the owner in this journey with us.
It is their pet after all, and if you can do this and build that relationship, you can become that trusted expert for their pet. And it means that you can collaborate with the owner, and by collaborating, you're going to be far more successful than if you're prescriptive, like that first example. So it's about finding the right space and time, keeping really good continuity, working together as a vet nurse team.
But before we get started, there is one important question that we actually haven't asked yet. Is is the pet owner ready to start managing their pet's weight, and did anyone think to ask? Does anybody ask their pet owners whether they are ready to start weight loss?
Probably doesn't go on as often as it maybe could do. So to describe what I'm talking about, I wanted to discuss with you the stages of change. So this was something, a theoretical chart that was, that was developed back in the early 80s, in fact, and it was to do with stopping smoking.
However, this study here in vet records has showed quite nicely how now we can apply these stages of change to pet owners with a pet that has obesity. So I'm gonna describe the stages to you and you will see just how closely this does fit and why it would be so important to gauge readiness of the pet owner. So at the top here, we have the pre-contemplation stage of change.
So this is where the owner has absolutely no intention of changing anything. Probably won't even acknowledge what you're saying in terms of whether their pet has overweight or obesity. You're not gonna get very far with them if they're in that phase.
You may also have pet owners in a contemplation phase. This is where they're aware that their pet has overweight or obesity or certainly accept it, but it's not the right time for them. They've got lots going on or they're about to go away on holiday or whatever that is, then they are not prepared to commit to doing anything about it at this point.
Then we have the preparation phase, so these are owners that are more than happy to do what your recommendation. They are there ready and waiting, potentially, they've asked for your recommendation, they've asked for help because they're preparing to do something about it. Then you can help them in this action phase where we're suggesting these modifications of their current behaviour to get the weight loss, and then maintain that weight loss, and sustain all those changes, all their old habits being replaced by healthy and new habits for their pets.
Now this is a cycle, and unfortunately, part of this cycle is relapse, and we all know that this certainly happens with our patients that have obesity. So this is where pet owners would fall back into old patterns of behaviour. Weight gain is probably seen at this point.
And this is, you know, very difficult for us to accept sometimes. However, it is a cycle, so owners can go round and round this cycle a number of times, but we mustn't forget that they will then go back into pre-contemplation after relapse. They won't be prepared to do anything, and if you try and force them around, you're not gonna get anywhere and probably going to damage that relationship that you have with that pet owner.
Even if you have pet owners in contemplation, whether they've tried before or not, again, we've got quite a significant blocker here. They're not ready, they're not in the right frame of mind. They haven't got what they need to be able to be successful here.
And so if we have these owners we identify as being in pre-contemplation or contemplation, we should just park it. Make a note on the file. This must be revisited in 3 months, or next time the owner comes in, discuss weight again.
We don't forget about it because that pet still will have obesity, but if the owner isn't ready, then we're trying to force them to be ready or shock them to be ready is not going to be successful and it's probably going to have the opposite effect. So the way that we do this in practise is to weigh and body condition score every single patient at every single visit and make sure that that is recorded. And in that way, pet owners become very, very used to having a body condition score done, they've seen the charts, they've seen you do it, you may have had a chance to explain it to them, maybe when that pet was younger, so it's very familiar to them.
Then it gives you that opportunity to discuss the findings, which we'll come on to in a minute. It also gives us an opportunity to find out how they feel about their pet's weight. Are they happy with it?
If it's not ideal, were they aware that there was a problem, or are they worried that they have any specific concerns? So what are the actual words that we would need to use in this situation? Now this is just my example, you don't have to follow this, it's just just my thoughts.
So I'd start off by saying, I'd like to talk to you about the findings of our routine assessment. Remember this happens every single time they come. It's a routine assessment.
Is it OK if we talk about your pet's weight today? And then by asking permission and gaining consent, you will have the pet owner along with you much better. You get much better buy in if you ask like a question like this.
Then you would ask, firstly, tell me, how do you feel about your pet's weight? And in this very good open ended question we can fully understand where the owner is, how they feel, are they ready for weight loss, are they in denial of that there is a problem, we get an awful lot of information from that type of question. Then hopefully we can lead on by saying, I'd like to show you how to body condition score.
Would you like to have a go? And as they're doing it, say, what can you feel? Can you feel the ribs?
Can you count them if you had to really involve the owner in this process. And then look at the body condition score chart together and come to a consensus. All you're looking for is them to identify that their own pet has overweight or obesity.
And then of course you can go and discuss your findings, relate them to clinical signs, like that snoring that, Rocky has been doing recently, that might be weight related. Visualise the positive outcomes, it's why the Wall of Fame is so important. And ascertain, you know, how does the owner feel?
How much do they already know, what journey have you got to go on in terms of education, and then reassure them. I know what works. It can be done.
I'm gonna show you how I will be there to help you. We are going to do this together, we will be Team Fluffy. And so instead of expecting complete compliance at all times, because that is going to again harm your relationship, this is very much about aiming to work together, identify the priorities both you have and that the owner has, and compromise.
I cannot stress how important compromise can be for these patients. Then of course you've got to communicate the plan. Firstly, this will be done verbally discuss and agree on those main elements, but back that up with some written information too, on either by paper or email, and then make sure you've got follow up booked before the patient leaves the building and again make sure that they've got it written down or it's text to them or emailed to them and be available.
They need to know who to ask for for help, where do they go to, how do they contact you. So in summary, Communication does hold the key to success, it really does when it comes to managing overweight or obesity. We know though sadly that negative attitudes towards those with obesity, whether it's human or pet, such as implicit bias and weight stigma, will cause problems with management.
So we need to avoid those toxic words, those toxic phrases, create the ideal situation for these discussions. Ask if an owner is happy to have these conversations. Ask if they're ready to have anything put into action and create that supportive relationship.
And really when it comes to discussing obesity, communication should be considered. Considerate and collaborative. It has been my huge pleasure to talk to you this afternoon.
Thank you very much for listening. Thank you, Georgia. That was absolutely brilliant.
Always learn something from you. So, that's, that's excellent. I, I think we've got a few minutes for questions.
So I'm gonna see if, if any came in. I, I think everyone was so intently listening that they, they weren't. There's a one, delegates just asking for specific tips to deal with her own pet that constantly begs.
How do you shut your eyes and ears to that? Well, I'd probably say you don't kind of need to, you just need to have food available at those times and decide when those times are going to be and try and create some sort of routine. So splitting the food allowance up throughout the day, so you've got things to give.
We are a big fan at Liverpool of using green watery vegetables because you can literally feed them freely. So in those situations where there is that constant food seeking, you've at least got something to give. So whether that's sort of broccoli, cauliflower, courgettes or a big freeze.
Cucumber, green beans, sprouts, you know, there's a, there's a big long list and watermelon is actually a really good one. And just try and manage those behaviours. I would be interested to know what their normal diet is too, because something like the weight loss diets are of course going to be inherently much more filling, which should control those behaviours too.
And also interacting with food, making food last a lot longer can definitely help. I mean, I, I could talk for another hour on this, but those are, those are the top lines. I think we've got, yeah, that's OK.
We've got 3 more minutes till our, till our little tea break. So I think it's important because actually what it's, the messages that are coming through are that we, we all, we know all this, really. We understand that it's our own fault.
We understand that we are. You know, giving into these, these questions, but we, we're still doing it. So it's very difficult to explain to our clients.
So, you know, I, I guess you've said to go for a weight loss diet that you're using, and we know that we formulate those to be higher in, protein, higher in fibre and to help them feel full, which is a, which is a, a key. So several people are talking about their own animal. Was begging.
And I just want to say when Georgia says that watery green veg, I, I think, you've got some great success with cucumber. And I found that my dog likes, sorry, courgette, and my dog likes cucumber. So that's based on your ideas as well.
Is there an ideal reduction in food you advise the clients to start with in terms of percentage? So we're gonna, yeah, so we're gonna talk much more about this actually in the next section, so hopefully you're gonna hang around for that, but yes, we, I will come to the answer that question in the next. OK.
And this one might also be covered, but we've got one minute if it's a, doesn't, it's probably not a one minute answer. How do you deal with clients who do not apply the advice given and the animal's weight increases each way in? Yeah, I mean, yes, we are going to deal a little bit with that in the next session too, but I think you need to have that conversation with that pet owner to understand what is going on, you know, what is it that they're finding so difficult?
Do they not accept what you're saying? Do they accept it, but it's very, very difficult for them. And if that's the case, what is it specifically that are they finding hard?
Can you make changes to make that easier for them? I think, yeah, we are going to talk much more about that, but those are very difficult situations. But the positive is, is those owners are still in your room, still engaging with you, still looking for your help.
So it's, we shouldn't give up on them and just go, well, you know, if you're not going to follow my advice then what can we do? We, you know, we have to go with them. Probably asking the pet owner, what would you suggest?
What can you do to help the situation is a, is a good place to start. Yeah, and, and maybe restarting the conversation and, and restarting the questionings to find out because if they've had their medical check and they're. And they say they're following the advice, something's gone wrong somewhere, hasn't it?
It, it, yes, unless it's a medical miracle, it absolutely. I have to say, somebody said that cats aren't keen on veggies, and I just would like to say to that person, you'd be surprised. I've seen several videos of cats eating lightly steamed courgettes that's chopped into little mouth-sized cubes.
So just give it a, give it a go. You never know. You'd be surprised that a cat that wants to eat might eat anything.
Right.