There she is. Hello. I hope everyone managed to get a little cup of tea or a comfort break.
So I'm gonna move straight into this next session. You've all been well acquainted with Georgia now and she's gonna take you through some practical. Some practical cases and, and work out how, how you can, you can apply all this information into in your real life and then actually, hopefully we'll have some time at the end to answer some questions before we go into our end of session, Q and A round table with the, with the three of us at 3:30.
So, I'll leave it to you then, Georgia. Lovely, thank you very much and Claire, you're gonna help me in this session, I believe. Oh yeah, I better leave my video on then.
Totally up to you. It's absolutely fine. But thank you everyone for either staying on for this second session, or joining me for this session.
We are going interactive, which means this is something a little bit different, but it's going to be pretty fast paced, but what I need is communication from you. OK? We've all been talking about communication.
Now I need you to communicate with me today. So, firstly, I'm gonna test your knowledge. Don't worry, it's not too bad a test, but you're gonna need to answer in the chat box.
There are gonna be 5 multi-choice questions for you to have a look at and then I'll give some explanation. The second part is going to be sharing your thoughts, on some common problems that we come up with a lot when we provide obesity care. These are case-based and certainly things that, I come up against very, very frequently.
So what I need you to do is share your experience with Claire and I. You know, we want to hear what you do in your practise, what do you suggest, in these different scenarios. I want you to I need you to participate because an interactive session without interaction isn't gonna go so well.
So I, I really do need you to, participate and interact with us. I'd highly like you to, think outside the box. If you can think of an answer that I haven't seen before, I'm definitely gonna call that one out.
I would love to see some new things. So basically, you've got to talk to me, OK? Talk to Claire and I.
So your very first job is to locate your chat box, and I want to know who's there, who's listening. Type a little hello or hi, drop us a little emoji. If anyone doesn't want to, do that, then have your chat box open so you can see the stream of people, see the stream of answers coming in.
Oh, hi, from Portugal. Very good. Yes, hello to Samantha and Kate.
And it's probably too many to call out everybody. Yeah, wonderful. Lots of hellos.
Yeah, from everywhere. Yo, Boston. Oh, how exciting.
Pembrokeshire. That's beautiful down there, isn't it? Wonderful.
From sunny Devon, yes, it's sunny Liverpool here too. How about you, Claire? Is it, is it sunny when you watching in my room?
We're all sitting inside wishing we were outside. Hi Jemma from Manchester. Wonderful.
OK, yeah, lots of people from, yeah, yeah, how exciting, wonderful, thank you. So this session is not necessarily delving very deeply into anything. This is much more of us all being able to talk together, share that knowledge, learn from each other.
If you want the background to a lot of the topics that we'll touch on, these 3 webinars hosted by webinar vets on their platform, at a place that you could go, or certainly a place that you could start to look into some of these things that we'll be touching on today. OK. I think we've got a little question of where the chat box is.
If you bring up, your tools, I think they're at the top of the bar, are they, Claire? You should they do move around. They're at the bottom, I think, in most cases, but they do move.
There should be somewhere hopefully that you can, you can find them. OK, so let's test your knowledge. So you're going to be answering A, B, C, or D into the chat box.
So what percentage of dogs in the UK are thought to have overweight or obesity? Is it A 65%, B 82, C 34, or D 57? What have we got?
Coming through. Lots of correct answers. Lots of A's coming through.
Fantastic. Were they listening before, maybe? Yeah, I hope so.
It seems that way. Yeah, wonderful. Well done.
Yeah, absolutely. 65% of dogs thought to have overweight or obesity here in the UK. So well done if you got that right.
I mean, that's a really shocking figure, isn't it? You know, it, and it's potentially higher than we estimate as well. This was the study from, 2018, and things have changed since then.
We've had a lockdown since then, so who quite knows, but we suspect it may have risen again. But what's even worse is these, juveniles are puppies, that already have overweight or obesity, and although we're not going to go into it too much today. Using growth charts to try and prevent obesity and overweight in puppies and kittens is probably one of the best ways to really affect our pet obesity incidents going forward, because if we don't start to prevent it, we're not going to make an enormous dent in what's going on.
We've been trying for weight loss for a very, very long time. The numbers are still increasing, so our focus really should also now be, on the prevention side. Oh yeah.
OK. So question number two, what percentage of cats in the UK are thought to have overweight or obesity? Were you listening to this one?
Is it A 55%, B 23, C 39, or D 41? We've got a few different answers as well C's and then suddenly we have got a lot of A's and now D's. We've got a good pick on C thrown in there as well.
Yeah, I'll give you, give you a moment to share your thoughts. Yeah, lots of D's coming through now. Yeah, on the phone.
OK. Any more for more? I think that's just about done.
So the study that we have from the UK was 2010, and it did say that 39% of cats have overweight or obesity. But I can forgive you, certainly if you chose A, because, we know certainly over in America, the Association of Pet Obesity Prevention survey 2022. Did suggest that 61% of cats there have overweight or obesity.
And again, it may in reality, even be higher than that. But what we also, what we, I think can accept is that pretty much every other cat that we see is going to have a problem, to some degree or other. Excellent.
OK. So now Claire, I think if they were listening to you carefully, they will be able to answer this one. So what would be the most appropriate diet for a dog with a body condition score of 7 out of 9 to achieve safe weight loss?
Would it be a homemade diet, a light diet, a weight loss diet, or an adult diet? Which would be the most appropriate diet? Looking like 100% the same answers.
Oh, just a couple of different ones have come in. I thought someone put F there and I thought I don't. I put up something I hadn't realised, lots and lots of C's coming through.
Hopefully everyone can see those. The odd be coming through. Yeah, interesting.
Give me a couple more seconds just to add your thoughts to the chat box. So Bs and C's, OK. So the answer is C.
It is a specific weight loss diet. We'll talk about that a little little while a bit more. So question 4, what is the ideal weight loss diet composition?
Is it a high fat and low protein diet? Is it B, a high protein and high fat diet? Is it C, low protein and high fibre, or is it D, a high protein and a high fibre diet?
What have we got a lot of these coming through. Oh yeah there's a sea coming in there. A few more seats, OK.
I didn't say this test would necessarily be that easy, but hopefully it shouldn't be too hard either. Any other thoughts from anyone? Lots of D's, I think predominantly D's coming through.
And yes, the high protein, high fibre diet is what we'd be looking for. So our higher fibre means that we get a bigger gastric volume and we get slower gastric emptying. This is definitely ways of keeping them fuller for longer, and also that we know that we have it when we have increased protein.
That also increases those feelings of fullness. All the other ones, certainly anything high fat is going to end up being high calorie. We definitely wouldn't want that.
And we, we wouldn't want a low protein diet of any sort, either in these cases. So high protein, high fibre is what we would be after. OK, so this is little Ted.
We met Ted in our last session, actually. So if you were presented with a dog like Ted, and he has a body condition score that is, let's be honest, well in excess of our body condition score of 9 out of 9, where would you look for further information to help determine his ideal weight, the weight that he should be? So is it A, you would look at the weight of his siblings.
B, would you take the owner's opinion? C, would you look at the Kennel Club standard for little Norfolk terriers such as him, or D, would you be looking in the patient history? What have we got this time?
C and D, we've got people hedging their bets here. We've got a few A and D's as well. We're a kind of calculator and a winky face.
Lots of Ds, D and C, yeah, OK, so maybe suggesting that you'd look in more than one place. Great, OK, all but B. Fair enough.
Odds more Ds coming through, I think. I guess you have to be able to look at a few other things, patient history if it came to you as an overweight, with an, with obesity, then it would, perhaps never have a, a real ideal weight on its chart. So.
Yeah, absolutely. So I, I don't, you know, I think whoever said all but B is probably getting somewhere near there. The, the answer that I would select is, is D, but as you rightly said, what if we don't have patient history?
What if we don't have an ideal weight throughout patient history, you know, that that patient history isn't gonna be as useful. We would need other information from Somewhere. If you do have patient history and you and your practise have been really good at weighing and body condition scoring throughout that pet's life, hopefully you have the information you need.
And it's looking at the weight just prior to early neutering. That's when, we'd be taking that weight as to be much more realistic in terms of what their ideal weight should be. Of course, we've got to have an ideal body condition score at that point, and if it isn't ideal, then we're going to have to look, somewhere else.
So one thing that we can do is to plot their growth. I don't know how familiar you all are with growth charts. Can I just see a yes or no in the chat box if you are using growth charts at the moment?
Or someone saying really find them useful. Yeah, yeses, nos just started, well done, excellent. Not everybody starting soon.
Brilliant, yeah, and I have that, I do have that session, that recorded session on the webinar platform, if you did want to have some background information on there. Yeah, a mixed bunch, I think, but I think actually when I've asked this question before, far few of you have been using them, so I'm really pleased to see that lots of practises are now starting to use them, so that's great. But that they actually really help in this situation, because what you can do is you can plot the growth, and what they ideally do is follow one of these lines, these centile lines for anyone that's not using it.
And then even if they deviate off that centile line from what's ideal, you can still follow that line along and where that line flattens out. So after a year old, or when they've reached skeletal maturity, that's giving you that sort of early indication of what the ideal weight for that pet should be. So it's about gathering information from as many places as you possibly can to come up with something reasonable, to do your calculations from in terms of, working out a plan for a dog like Ted.
And the reason that finding that ideal weight is just so important is because you're going to be basing that feeding amount on that ideal weight rather than any interim target weights. And if you use the calculation for a body condition score of 9 out of 9, which is to divide the current weight by 1.4, that will be nowhere near the actual ideal weight that a dog like Ted should be.
Therefore, if you feed them for that, it won't be enough calorie restriction, and he may even gain weight. So it's really important that you look as much as you can, to find that ideal or optimal weight for a dog like Ted. Excellent.
Well thank you very much for indulging me for those little questions. Now is the sort of time for you to kind of let loose. Think wildly, you know, think as widely as you can, come up with as many different solutions as you can to these questions.
So let's just start us off. Why should we be worried? Why are we here?
What is the problem and why would we worry about pet obesity? Have a, have a think, pop some things in the chat box. Got Healthspan, Chloe coming in.
You were first out of the box. Well done. Affects the health of the pets.
Yeah, absolutely. Oh, flooding in now, Claire, you'll have to catch some of these too. Quality of life, brilliant.
Yeah, welfare. I think you're possibly looking at this dog here, this this poor girl. Yeah, health, cost of living.
Yeah. Cost of living is getting to be a big one now, isn't it? You know, it's, it is having a huge effect on, on everybody.
We probably won't know the end effects of that for a little while. Yeah, causing conditions such as diabetes. Excellent answer definitely.
Lots of comorbidities. I'm sure Alex was talking all about those this morning for you, osteoarthritis. Yeah, some great answers coming through.
Increasing. We've got some que a question coming in. It's coming in a couple of times about, what happens if you're adopting a pet aged 2 to 3 months old, but it's already overweight.
I, I would say it's unlikely to be very overweight when it's 2 months old because it's only just left its parent, but, I think you give your advice, Georgia, I'd say look at what's being fed and you can correct the feeding quite early, but you shouldn't be putting on a weight loss diet. You can perhaps bring it into line. But if Georgie, you might have more, Yeah, I know, exactly that.
We never attempt weight loss during growth, we cannot compromise the growth. If what we aim to do is to get them to grow properly and if they still have that degree of overweight or obesity as an adult, so the point that they reach skeletal maturity, then we can tackle that weight at that point. You can safely reduce, a growth diet by around 10%, but we certainly wouldn't reduce it any more than that because, the nutrients are just so important within growth.
I think as such a young individual, they are likely to use that during their growth. End up being perfectly fine in another month or so's time, but looking very hard at, treats and extras, probably the food going into the bowl is less of the issue. It's the training rewards and this is an early education, isn't it, for owners.
Yeah, absolutely. To understand what they're doing. Yeah, definitely.
So, yeah, I think you're all very happy with the reasons why we're so worried about these patients with obesity, osteoarthritis, always the top of my list, mainly because I see quite so many of these patients. Airway disease. I seem to see nothing else but pugs these days.
They're all having problems with their airway disease. They've got boas or not, but certainly in the heat, then you add obesity, they really are struggling, particularly at this time of year. Metabolic disorders, diabetes?
Yeah, top of our list for that one, urinary disease, FLUTD syndrome in cats certainly affected by their body weight. Increased anaesthetic complications, absolutely again, and think about those pugs. With their boas, you know, there's such high risk on recovery, because of that tiny, tiny airway.
And as a result, we get, higher risks of surgical complications. We also get increased risks of particular cancers. We see very poor skin and coats.
I mean, simply, they cannot care for themselves. And if we think about a cat who can't groom, who's all matted and dandruffy and You know, from a quality of life point of view, that is really poor for them. Their welfare really does suffer.
And those are really the big reasons that you've already mentioned, reduced quality of life and reduced lifespan. Those are the, those are the big ones really. But of course, this is why I love dealing with weight is because this is something that we can, definitely change, particularly from a quality of life point of view.
Excellent. OK, so were you listening in my last session? What would you list as the causes of obesity?
It's Fire me the list. So we've got humans, genetics, over feeding. That's inaccurate food measuring love.
Yeah. More calories in, less calories burned. Yeah, absolutely, Kerry.
What have we got? Food is love. Oh, it really is, isn't it?
Too many treats. Yeah, we've got some breed specifics. Yeah, quite possibly.
We certainly know that certain breeds seem to be more prone than others, to obesity, feeding the wrong diet, absolutely that can be an issue. Education or lack thereof potentially co-morbidities, yeah, definitely you're obviously listening this morning I go to Alex, yeah. Absolutely.
Not enough exercise, yeah, lack of exercise and activity. Wrong perception of ideal weight. Yeah, absolutely, Amanda, we do unfortunately see that quite a lot.
Working breeds not working. Yes, absolutely. There are, there are many border collies that don't ever see a sheep from one year to the next, aren't there.
Metabolism, yeah, OK, so we've got other things going on there. Active dog food for no active dogs. Somebody talked about adding, they found clients adding supplements of bone meal and milk and things like that in growth.
And of course, that's hugely unbalancing the calcium phosphorus levels and ratio for in growth. So this is an internet driven thing and really harmful for the dog, never mind obesity, but other growth deformities. So.
The, your message has vanished because there's so many other things coming in. But, that it really, there needs to be some education of, of the clients in your area that are doing that because it's, somebody's giving the wrong advice somewhere. Dare I say, possibly a trainer or somebody that's seeing that young puppies.
We see this quite often though. It's the same with coconut oil, isn't it, and cod liver oil. They go spooning it on the food and then wondering why they're not losing weight and calories are just untold in that sort of supplement.
So I always ask about supplements because it could be just about anything. So yeah, great. I think you've highlighted lots and lots of the things I was talking about earlier on.
Just to recap, we are whiz through this very briefly, because it's all in detail in the previous one. But certainly, we look to the owner first of all, often, and start, you know, maybe pointing the finger a little bit, which, you know, we shouldn't do because we can't certainly blame them wholly for the problem. Yes, they do provide the food, but it isn't.
Really as simple as that, because there are all those outside influences. That trainer down the road, Claire, whatever, you know, he or she is, giving advice about certainly is going to be very, very influential for that pet owner. You think about a new puppy owner, they've got no idea.
They are going to people like trainers, who they think are trusted and that are giving them good advice. We can hardly blame them when they just don't know that that isn't good advice. Hopefully they'd like, they'd come to us, but in vet practise, but we know that also sadly doesn't happen quite so much.
So we've got things like food is love, I love seeing that coming through, and absolutely it is. And then we have this family food environment where we have the adults in the house and how people think about food and the amounts of food around affecting children in just the same way. We think it also affects the pets within that house.
So it could have lots of different factors. We could also think about sort of socioecon. Status of those owners, we don't just have an effect and so on and so on.
There's lots of pet owner, sort of focused things that we could consider. But it's not just that simple. Somebody said genetics, absolutely.
We've got the Palm C gene that was identified in Labradors and flat coat retrievers. But it's not the full story, and we'll probably find out in the next few years so much more about genetics, which would be just so, so interesting. To know if there are lots of other common genes that we see that predispose some of these breeds.
But genetics is not gonna be the full story because the environment that they live in, of course, is going to have a really big effect. If there's something metabolic going on like hyperthyroidism, that's gonna have a certain effect on the weight, the type of food, I think you were, I think we had some answers like that, and certainly treats as well. That's a very good one that could come under that category as well.
How many treats are being given and what for. Again, thinking about those puppies, they need a food, you know, they need some sort of reason to do things, don't they, to be able to train them. So, are we choosing wisely there?
And then the pet's own behaviours. Those behaviours, those, you know, pleading eyes, the food eliciting behaviours, the food seeking behaviours, it's very difficult for owners to resist, and clearly for us as vet professionals too, we had a question on it just before, and I have to say also, my cat is a pain in the bum sometimes when she's asking for food, and we all have to find methods around those sorts of challenges. So the pets can drive quite a lot of the the the reasons why they may consume more calories.
And then we have lack of knowledge and understanding from the pet owners. Pet owners cannot be relied upon to body condition score their own pets. 89% this study suggested, underestimated their dog's body condition score, and even when you show them how, they still really struggle with 65% misperceiving that body condition score.
Then we look at ourselves, so we talked about this a lot more in the communication session before, so thinking about the causing offence and really not wanting to do that, which of course comes from a very good place. Couple that together with lack of time potentially and discussion, sorry, discomfort with having this conversation. Different priorities means that weight might get pushed to the side or have to end up on the back burner because everyone's thinking about fancy imaging or, you know, new drugs or, you know, whatever that is, whereas actually from the long term point of view, weight loss might be the right thing.
For that individual. We have poor recognition, within the vet profession as well, really sadly, and we know that there's a good degree of apathy, which was highlighted very nicely in this study that, of all the records that this study looked at, these were patient records, only 30% were we. So, sorry, 30% were never weighed, so that's only 70% that was weighed.
So we have no idea, do we? If we don't weigh them, we just don't know what's going on with that individual. I'm not very good at weighing with my eyes.
I don't know if anyone else is better at it than I am, but unless you put them on the scales, you just don't know. And body condition scoring really must be used in conjunction with weighing, because body condition scoring is the way that we tell that the weight on the scales is appropriate for that individual pet. If you do one without the other, all you've got is a number from the scales.
It doesn't tell you anything that number, whereas you need that body condition. School to say whether that is a good number for that patient or not. And then in this same study, when they looked for body condition scores for those patients, only one on one occasion had a body condition score out of 148 clinical records, which really is pretty poor.
I really hope that lots of practises are doing much, much better now, which would be great to see. And we talked a lot more about unconscious bias too, and weight stigma. And as I said previously, we know that weight stigma happens with both, human doctors and in vets.
So words such as awkward and ugly, non-compliant, frustration, blame, pessimistic, these negative attitudes towards those with obesity, are contributory to, barriers certainly in providing treatment for them. So hopefully we'd like to avoid them. Of course, the cause is mostly, and it's very simplest form, we have this imbalance between energy intake and energy utilisation.
What we'd like to do is flip that balance so they end up using more than they are consuming so that we then get weight loss. But it really is not as simple as that, and I love this image so much, so I thought I'd share it again. This is how complex the causes of obesity in humans actually is.
So even though we've talked about lots of things today, it is probably way more than we suspect. OK, so moving on to a couple of little cases. So this is Betty.
So Betty is the little, red and white cabby that sat on the scales. She does have obesity, and she lives with her, two little friends, Belle and Bobby. Those two are of a normal weight.
Now Belle, Betty's owner really does want weight loss for Betty, because she, they know it affects her, but they're really frustrated because they've come into my room and they said, we've tried everything. I didn't work. So what are we gonna do with these owners?
What are we going to suggest to them, what are your thoughts on this? Sorry, I hope I haven't asked for big long essays from you, just a few words will be absolutely fine. Feed separately, excellent, yes.
Find out what they've tried, definitely. Yeah. I'll give you a little bit of typing time.
Yeah, try, how long have they tried? Absolutely if they use any puzzle feeders? Go through a day in their life, yeah, wonderful.
Let's find out some information. So excuse me drinking my cup of tea. I, I will lose my voice if I don't.
Yeah, feed separately again. Food diaries, absolutely great place to start. Start at the start.
Yeah, let's, let's draw a line. Let's go back. What is it that's been going on?
Have we ruled out any underlying comorbidity? Great thought, Definitely. Hopefully, by the time it's come to the weight clinic, that's, that should be, that should be standard protocol.
So we shouldn't have people coming in off the street with their, with their dog or cat. Absolutely see it first. Yeah.
Check thyroid. Yeah, the, the check in thyroid is something that, we do very routinely at Liverpool, but then we think about the sorts of cases that we see, so we probably see some of the most complex. We probably see some of the most severe cases.
So they are much more likely to have a thyroid problem. But I can tell you, out of just under 400 dogs that we've seen over the last 20 years, only 7. We truly had an underactive thyroid, so .
So hyperthyroidism is, is way more rare I think than people perceive. Yeah, I've, I, I've had a question in actually, about somebody who's got a 25.7 kg beagle, who's adamant that it's got hypothyroidism, despite two blood tests saying otherwise.
Dog has pancreatitis in the past, so can't use prescription weight loss diet. I would say, my, from a royal canon point of view, that satiety, diet is very low in fat. So if it's a one, one-off bout of pancreatitis, then they may be fine on the satiety.
You'd have to speak to, to the vet to have a look at the history properly, but also, you know, If you've got that owner, I think what is the pre-contemplation stage, if you're, if they are refusing to believe blood tests that tell them to the country, you may just find that they're just not in the right place to do this. And I think for your own, from my experience of, of doing these clinics when I was in practise, for your own sanity, sometimes you have to realise you can't win them all, and you, you can't lose sleep every night, people will be will be ready. Or they won't ever be ready, and you just can do what you can do.
So with this person, you know, practically have a, have a chat with the vet to see whether, you know, how serious the pancreatitis was and also what they're feeding for that now, and might be a good solution, but otherwise, really, I mean, that's got a magic bullet, which I suspect she hasn't, you have to bring them to you, and wait for them to be ready. Yeah, I totally agree, and I, I also totally agree. You've got, you can, you know, you can't win them all, for sure, and if they won't come along this journey with you, they won't believe the blood test.
It's not that much you can do. Certainly from a pancreatitis point of view, yes, I'd want a bit more history on that. It's actually dietary indiscretion that's possibly more of an issue than, what the actual diet composition is.
Yes, satiety is a low fat diet, if they're feeding it exclusively. I would be very happy. I mean, Alex I know is, has joined.
I don't know if he's listening, but please come on and contradict me. But I think if we had that patient, we would certainly be trying a very gradual transition over to a weight loss diet, to then try and manage that weight. And if you get weight loss, then you can reassure them that it probably doesn't have an underactive thyroid because it's very difficult to get weight loss if they have an underactive thyroid.
So, so yeah, some, some ways to go with that patient, maybe. But yeah, thank you very much for the question. OK, back to how we're gonna deal with these people who've tried everything.
Well, they need support, don't they? You know, they're there, remember, in your consulting room, they're still coming along the journey with you. So let's have another conversation.
Let's draw that line. Find out what went wrong, where were the pain points, you know, is, was there an individual in that house that was finding it most difficult than others? There usually is, in my experience, actually.
And then asking them, well, what's the reasons that you want weight loss? What are you hoping to gain here? Because if they don't intend to gain anything, then maybe weight maintenance would be more appropriate for them.
So, you know, it's thinking about what those owners' individual motivations would be. Then if they are certain that they do still want better quality of life, better mobility, and so on, then we can visualise those positive outcomes with them, increase the support. So I know somebody said diaries, which would be a great way of just getting them to focus a little bit more every day on it.
I would bring the owners in every 2 weeks as well. So for some of the owners who do very well, I see them every 4 weeks, but for an owner who's struggled in the past, I would want really quite high frequency of visit because I want to keep them really close. I want to keep them, on board with me and coming through it.
Maybe it was a personality issue, and I don't know, how often this happens, but I certainly know that it does happen. I'm not going to pretend that I am the best person for everybody personality wise, and some people might like me, some people might not. So it may be worth if there has been any sort of disagreement between the staff member and the client who's coming in, that somebody else maybe takes this case on.
And just somebody else sometimes saying the same thing that you said, but in a different way, or the owner hears it differently from someone else can help. So just, just things to think about. And then trying new things.
I know somebody said about interactive feeding, definitely. If they've not tried wet food before, let's add some of that in. Let's think about 4 meals a day instead of 2 meals if food seeking was a behaviour, sorry, a problem.
Let's think about the timings of feeding, how we can increase activities and distract the pet away from something that the owner is finding hard. So there's an awful lot that we can do for those types of patients. OK, so our next little case is Milly, she's 7, golden retriever, as we can see, she's got a body condition score of 8 out of 9.
She's got really poor mobility and the owners know therefore, they, you know, they are fully in that preparation phase, you know, they know that she needs weight loss. However, they're not totally convinced that we need a change in diet, and so they're asking you, well, why can't we use her normal food? What would you reply if an owner's asking you that?
Just want to use what she's on at the moment. What would your thoughts be? Oh we got Chloe, you must have wild little fingers.
You're very quick at typing straight in there. Weight loss food designed to keep them fuller for longer. Yeah, OK, so we're also suggesting we need to check the amounts being fed.
And that's great. More likely to see a hungry patient on their own food, yes, I would totally agree. If we reduce the food, we'll reduce nutrients.
Yeah. Oh, lots of lots of answers coming in, fantastic. It's not achievable to get weight loss on a maintenance diet with her body condition score.
Yeah, OK. That's some great answers. Nutrients are different, yeah.
I don't know if you're catching any others. When you spotted fibre, someone's suggesting, yeah, OK. Can reduce amounts and then in 6 weeks we can then try a different diet potentially, yeah.
Yeah, lovely. You are definitely all on the right lines with these thoughts. So when we're looking for weight loss, we need to restrict calories by 30 to 50% from that maintenance energy requirement.
So maintenance energy requirement is the amount of calories that will keep weight stable. So it's actually a really significant reduction that we need to send them into that negative energy balance and to actually get the weight loss itself. Now the old advice used to be, didn't it, or you know, just cut down the food on it, add in a bit of veg, but the problem is, is that if we cut the food, if it's a maintenance food, then we're gonna be cutting the nutrients as well, which you all very rightly said, and this really is not acceptable and wouldn't be a safe way to get weight loss.
So what we need is those specifically formulated diets for safe weight loss. This is the tool for the job. And it's the very best tool for the job as well.
It delivers complete and balanced nutrition. We can restrict the calories because it's nutrient dense and calorie. Dilute.
So I think lots of you picking up on those. Now there are kind of two situations here where we may be able to do something different. So if we have a patient with a body condition score of up to 6 out of 9, you might be able to reduce the current food by 10%.
Possibly switch them to a light diet and then really cutting out all treats and all extra foods. You might get a small amount of weight loss for them and that might all that's needed to return them to an ideal weight, but you can only do this safely for 8 weeks. We, it's been shown that after 8 weeks, we then start running into nutrient deficiencies again, particularly amino acids.
So it's one to be very, very careful of if you're not using a specifically formulated weight loss diet. For the vast majority of those that have overweight or obesity, we are going to be using these specific weight loss diets, we really must do to avoid those nutrient deficiencies, control the food seeking. Now lots of you have mentioned that added fibre, added proteins, we've already talked about, those are the elements that go and so.
Make this as painless as possible, because if it's difficult, owners are likely to give up. So we do want to make it as easy as possible whilst at the same time cutting out treats and extras and possibly replacing them with the green watery ones, the vegetables and and maybe watermelon that we spoke about earlier. Great.
OK, so these owners are like, right, OK, we fully accept now that we have to, we have to use this the specific weight loss diets, but you can see Mr. In this picture going, how much? And this is a question that I think is very relevant right now, is that owners are feeling that this food is just too expensive.
They may be fully on board with why they have to use it, but they feel it's too expensive. So in this situation, what is it that you're going to be discussing with them? What is the sort of information or the questions that you might be asking?
Answers in the chat box I mean I can feel you almost furiously typing away break down the costs yes sorry I was just saying that's that's a perfect answer and compared to the current cost per day of all the. Treats and snacks and toppers and additives and Absolutely. All that chicken, so expensive to feed cats and dogs, you know, meat from the supermarket, but yeah, it's perception, isn't it?
After overfeeding, yeah. Yeah. Yeah, lovely.
So yeah, you are all absolutely there with the sorts of things, that I would be thinking about. We really need to provide education, don't we, at this point? We're not here to sell, you know, to sell anything.
We're here to allow them to understand why it is so important firstly that we use this diet. We must do this safely. It would be unethical of us to do anything other than that, we've got to avoid those nutrient deficiencies, help them stay full.
Maybe there's a pragmatic approach here though. We know that dry food inherently is cheaper than wet food, so maybe we could add something else to the dry food to make it moist, some warm water or some no salt chicken stock or something like that. So getting away from maybe tinned food, which owners are finding too expensive, so we could make some alterations there.
Looking into cheaper alternatives, if we're talking from a pet first perspective, then maybe that is necessary. And then exploring sources of food for those particular owners. So of course we would far rather above anything else that pet is fed the right food for for weight loss.
So it might be that owners need a little bit of help finding that food. At a price they can afford. And then as you all very, very rightly said, we've got to show them, haven't we?
We've got to write down or get them to write a diary for a week or so and add up all those costs, the wet food, the dry food, the gravy, the cheese, the bones, the, you know, all that, the Sunday roast, you know, all this sort of thing that we know owners give and work out that cost per day and compare that to what you're recommending. And in most cases, it is cost neutral. What owners react to is that big outlay for that that bag of food, but what they don't appreciate is not one drop of that food is, is wasted.
Every single piece of that food is necessary. It's nutrients, it's filling, it's going to get us to the place that we want to go. So it's just having these sorts of, conversations and sometimes you have to just prove it to the owner.
But yes, you're all on board with that, which is excellent. OK, so, all right, they've bought the food, they understand why she needed the food. They did go and get it.
They get the bag of food home, and Milly's like, Nope, I am not going to eat it. I don't like your food. And they come to you and say, Yeah, well, my cat Fluffy didn't like it either.
So what are we gonna do now? We've gone so far into persuading them or educating them why we need this food, but the dog's not eating it. How would you help?
What would you suggest? Furiously tip tapping away, palatability guarantees. Yeah, absolutely.
Asking how are they giving it? Yeah, smooth transition, appetite stimulants? Well, potentially, hopefully, we don't need to use those.
Pretend you eat it yourself. Why not? Yeah, absolutely, anything.
Did they do a transition? I definitely want to know that. Lots of thoughts on transition, which is great.
Introducing it very slowly. Yeah, perfect. So absolutely.
How did they present this food to their pets first of all? Did they just dump it down and go here, here's your new food now, you know, eating it or eat it or don't, who knows? So certainly a bit of questioning about what went on.
Now cats in particular can be resistant to change alone. They will reject it just because it's different. Dogs less so, but can also, not be particularly happy about change, so we do have to do that really gradual transition.
When I say gradual transition, what do you consider to be gradual? What would you suggest in this situation? How many days would you say a gradual transition needs to be taken over?
7 to 10 Oh, lots of 7 to 10, 2 weeks. Yeah, so I don't think we've had anything under a week so far. OK, great.
Yeah, as long as needed. Yeah, marathon not a sprint, absolutely. Yeah, over a week.
Usually change by 5% per day, yeah, you absolutely can do, I think owners struggle to know what 5% is, unless you work it out for them, but certainly that would give us a really nice gradual transition, so yeah, definitely. Yeah, I agree with all of that, but I think it really depends on the individual a bit. So we tend to, I mean, you guys actually are doing great, you know, suggesting sort of 7 to 14 days, but often the advice that's given is kind of 4 to 54 to 7 days, something like that should be sufficient.
I think it might be if they hadn't rejected the food already, but in this case, where we do have the food has been rejected, we need to go really slowly. So if you have a dog or a cat that will literally eat anything. 2 to 3 days should be enough that we don't cause any gastric disturbance and that should help them to eat their food quite happily.
You know, these are the dogs that would eat cardboard and straw, you know, so they don't need too long a transition. For most though, 74 to 7 days is fine. For picky eaters or for those that have failed to transition, definitely, sorry, 10 to 14 days is what I would be recommending.
And for the very, very fussy ones, you know, yes, over 8 weeks actually may be necessary. And even if it's just one kibble at a time that you're switching, we've got the time. These Individuals will have had obesity for months, if not years.
We've got another 2 months to make that transition to make sure that they are on the right food for them, that we can do this safely, for them. So take your time with the transitions. Owners are so keen sometimes, they just rush in, but we really, really must slow them down and try and get them to go slow.
OK, so I wanted to use this photo because it's possibly one of my all-time favourite pictures, actually. This is Ben, he's the black Labrador in this situation, and Sam is his little chocolate friend. So Ben is, of course, my patient.
He's 9 years old and weighs 55 kg. Body condition score of 9 out of 9. And he hasn't had any weight loss for the last 5 weeks.
So the owner lives with her elderly mother. And so I'm really interested, why do you think this case is not successful? What's going on?
Nanny biscuits. I love that, yeah, OK. I, I, I do love this picture an awful lot.
It's, it's the picture that speaks 1000 words, isn't it, about what's happening here? Yeah, we've got snacking, possibly going wrong. What are your thoughts.
Mother is not on board. Yeah, I think so. A mother has dementia.
Now that actually is a situation that comes up quite frequently, you know, and pet owners and their family do need to try and help those people, that can't remember when food is. Being given or not, there's lots of ways that they could do that. With setting up charts or having portions that that person can give.
But yeah, what, what I, can I just step in and say that Dementia UK and, Alzheimer's UK offer services to help, with With things like, like this for people with dementia. And they might extend that to, to being the, the dog food giver or to being able to help prepare those meals, but there's a lot of resources there, so it maybe that you can have the family involved in that. And then, and then work together with them and with the dementia charities, because they, they want to do practical things to facilitate, an easier life.
So speaking as somebody who's working, you know, who has dementia in the family. So there's a lot of help out there, but it's hard to do on your own. I had no idea, Claire, that's really interesting that that they're offering that support.
How fantastic. That's really, really good. Yeah.
And it may vary region to region, but it's worth looking and there's lots that they, they want to do to get into people's homes. Yeah, yeah, absolutely. Yeah, fantastic.
So I think we can all kind of see what's going on here. We've got problems, we've got issues with additional foods being fed for whatever reason and from whatever source they're coming, I think that picture says undeniably that that is happening. Maybe also we've got problems with the wrong foods being fed.
Remember we've got puppy food in the house, you know, I know we talked and I, you know, dementia wasn't actually part of my thinking here, but, you know, again, maybe there was a mix up in the food, the puppy food was fed to the older dog, you know, so we can have these things that we should think about too. Maybe they're not weighing the food out on scales anymore. We've got old habits returning, we've got additional food sources too.
But that is maybe stealing, you know, maybe Ben is stealing Sam's food, maybe he's raiding the bin. Maybe he's getting food from friends, neighbours. Maybe there's a new medication being given, and the only way that he'll eat that is in cheese.
You know, there's, there's lots of very good reasons why this happens. And clearly we've got lots of high food seeking behaviours going on here. And I know that that particular lady, because she did come in and see me, she's lovely, but she said they stare at me all the time.
I feel guilty all the time. And I tried to explain to her that when she puts her plate down for them to lick after every meal, that's a really good reason for them to do that again. And so I tried to work with her for a very long time in that understanding, but, it is, it's difficult because it's, in different generations, our older generations, dogs and cats were fed anything that was around, you know, they remember a time when there wasn't really pet food, you know, and their dogs were fine.
So it is, it is much harder, I think, for the older generations sometimes to understand quite what we're saying. I know dogs are good at, sorry, George, I was gonna chip in again. I think dogs are good at seeking out the person that's most generous and e and most easily, tricked into feeding.
Yeah, definitely. And actually this fairly weird image that I've got up here is to remind me about a situation just as that. This was actually a misunderstanding.
And it was an older couple who had a dog, they their retirement age, and they were swearing to me that this dog was eating just what I'd recommended. There was nothing else that she was having. And then it was just a little throwaway comment from the male owner who said about giving the dog toast.
And I, I sort of, oh, does, does she have toast? And she's like, yes, well, every morning I cook her two pieces of toast, and I spread the wet food on the toast and then I give it to her. And I was like, oh, OK.
So he had just not understood that the toast was possibly not the best idea, and he thought he was giving her something lovely and I asked, you know, what was the reason? And he said, well, she likes it. Of course, you know, but not quite the plan that I'd set for them.
So sometimes you do kind of have to be a bit of a detective when it comes to these cases, but obviously in that case, we've got lots of very good reasons. OK, so how can we improve success? What are the things that if this owner was in the clinic, what would we start doing with them that might help?
I think we've discussed quite a lot of these already. I've got a little comment about cats roaming to other homes. Yeah, absolutely.
And there's lots of solutions for that too, whether it's don't feed me collars and, that sort of thing. My little tip would be always, if you're gonna have a, a message on a collar, rather than saying, I'm on a diet, which where people think, you know, they feel sorry for it because they, they want to feed it, you say, I'm on a special diet, so you make out really that it's something that's, that's gonna be dangerous to feed and it creates uncertainty. One idea.
Absolutely. So, so we've got a nice little idea here of giving the mother a treat pot. Definitely allow her to have that interaction.
Allow her to give food, but keep it within, what we're trying to do here. Yeah, definitely. OK, so I've got things like food diaries.
We can just sort of get a better idea of what's going on. Again, I'd increase support for these. Yeah, we've got another leave portion, for the elderly mother to feed.
Definitely. I want to talk to all members of the family in this situation, particularly if there are older relatives there, get them in for that family conversation, see what they're finding difficult, and then try and refocus everyone as a family. Sometimes we get a little bit of conflict in the family.
One owner is trying really hard, the other owner is sort of, they feel that they're undermining everything they do. Let's try and bring everyone back together and moving forward together. So asking, you know, what do you want from the.
You know, what are your reasons for starting this in the first place? Let's remember what they are, and what you finding most difficult, and what can you suggest. I had a very long term case that until the owner suggested themselves that they would like to feed the dog watermelon, we had zero weight loss.
The moment the owner chose to use watermelon, we then got slow but consistent weight loss. And I'd suggested a million things to that point, but because it came from them, then they were more happy to do it. So brilliant.
Let's have a look. I'm gonna whiz through the stealing ones because I think we are going to be all over those, just in the interest of time as we finish. There's lots of ways that we can stop stealing, whether that's separating, using technology, using all these things here, boxes or washing baskets over the cats or the dog potentially when they're eating their food, so that they can't go and steal anybody else's might be a suggestion that could work.
OK, let's look at our last little case. So this is Poppy, golden retriever, 10 years old. Another body condition score of 7 out of 9.
Now she's only been on the plan for months, but we've got the onus who's saying she's asking for food all the time, driving them crazy. She's, it's a busy family and they've got a 9 month old baby. So what are the sort of questions that we'd want to ask when we first meet, this type of question?
What do we want to know before we can start making suggestions? Do you think? Pop your answers in the chat box.
OK. I want to ask about walks and play, yeah, absolutely. How many times are being fed a day?
Yes. Are they asking for attention more than food? Great answer.
And I think we should always consider that. How many meals a day is she being fed? Yeah, how often do they feed her meal frequency?
Yeah, all those sorts of things I'd be very interested in. So I'm firstly trying to work out, is this genuine hunger? Or is this for some other reason, you know, is it normal for them?
Have they always done this, or is something, or is this a reaction to going on a weight loss plan? Is this new for them, therefore, and if it is, then I would be quite keen to try and make this better. Is it boredom?
So are they not going out because they've got a young baby, so dogs walks have fallen by the wayside and so they're becoming very focused on food simply because they're a bit bored. And is this reinforced behaviour, you know, as a dog, if you raid the bin and there was lots of nice things in there, it's a very good reason to do it again. So have they been positively reinforced to do this type of behaviour?
I'd also want to know if it's getting worse. Just to ascertain again what the causes and what the reasons are. And do they pester everyone in the house.
This is my cat here. No, she doesn't pull this face at me. This is, the face that I call ham face, and she pulled this space at my ex-husband because he definitely fed a ham from the fridge, and of course I never did.
So I, I caught her one day and him, and I was like, oh right, OK, that's what's going on. OK, so how can we manage some of these behaviours? What are the things that we would like to suggest?
You can just throw things in that chat box just as we finished, split the daily allowance into smaller meals, absolutely. We've got play. Yes, definitely.
Puzzle feeders, perfect. Any other thoughts, yeah, using the daily light snuffle mats, they're great, aren't they, for getting them busy, keeping them entertained. We could definitely do more.
That might help with some of the boredom as well. Lick mats, yeah, while the people are eating, definitely not near the baby. Yes, keep babies.
And dogs and food, very, very separate. Definitely, yeah, wonderful answers. So small and multiple meals might well help in this situation.
We could also think about an uneven meal distribution. So small breakfast before the adults go out and during the day, big evening meal and then something before bed. Someone's added in quality time, yeah, this dog may just be looking for attention, you know, this baby has taken up a lot of this family's attention recently, maybe they're just feeling they need a bit more.
Interactive feeding you mentioned, this will slow down the food consumption. We could think about alternatives such as that affection and just quality time, maybe some grooming. We could think about bulking it out, we've talked about vegetables today also, we could add water, we could also switch some of the dry food for some wet food, which again is inherently bulky and and that could certainly help.
So, I think I'm just going to, yeah, yeah, this is our last very last question. Sorry, so how could we prevent Poppy obtaining extra foods in this situation? What are the other things or the other sources of food that she might be getting?
I think you've mentioned lots of them already, in fact. Some owner compliance, making sure that they're doing the doing the suggestions, following the plan, that kind of thing. Yeah, baby's food falling from the high chair.
Definitely puts food in sealed containers, clothes bins, cupboards. Wonderful. Yeah, you've got them all pretty much.
So making sure that bin is not open to, raiding, keeping the children in the high chair well away, not leaving food out on the worktops. We all know that there's counter surfers out there, don't we? Put shopping bags away one of my patients once stole an entire loaf of bread from the owner's shopping bag and ate it, bag and all.
Control the access to the food, yeah, getting rid of the treat cupboards so that they can't be pestering there and providing those alternatives and using distraction also with play, positive distraction can really help. So thank you so much for interacting in this session. Doing these kind of interactive sessions is so fun for me, and it's a way of really sharing knowledge.
It's a great way to learn. And obesity is complex, as we've seen throughout today. I think it's not just about getting the food right, it's about so, so much more than that.
But you guys clearly have the skills and knowledge that you need, to improve the quality of life for your patients. And sometimes, you know, you do have to come up with some novel solutions and, you know, think outside the box where you need to. So I think we're just on time, so I'm gonna say thank you very much for taking part.
Excellent. Thank you very much, Georgia. There's been so many comments coming in all the way through this, which is really nice.
I've tried to chip in with some of the questions and comments. There was one about, pet food manufacturers, putting cups on bags, and I can say from our point of view, we, I believe Americans use cups for cooking as well. And so we have an international feeding, You know, feeding guides to suit all all all nations.
But we have at least gone as far as taking the cup off the weight loss diet, so they, they can't use that on there at all. But I would say better to give a vague idea of the cup than to not have any information at all. You know, so at least you can rein them in slightly.
But, yeah, we just need to educate and we need your help to educate on, on grounds and, and why they're so important.