Good evening everyone and welcome to tonight's webinar which I'm particularly looking forward to as we have an interactive session tonight on obesity care with the wonderful Georgia Woodsley. Georgia qualified as a veterinary nurse in 2004 from Myerso College, Preston, UK. After working in Cheshire as a head nurse and clinical coach, developing successful obesity care and other nursing clinics.

In June 2015, George took the position of Royal Canyon Weight Management clinic nurse at the University of Liverpool Small Animal Teaching Hospital. Here she is now dealing exclusively with obesity care and nutrition. In addition to the day to day running of the clinic, Georgia has also assisted with the research the clinic undertakes and has provided education to vets and nurses throughout many countries on the topics of obesity care and nutrition.

Georgia gained her certificate in canine and feline veterinary health nutrition in 2017 and the American Veterinary Technician Specialist Nutrition Award in 2019. If you have any questions or comments for Georgia as we go along, please hover your mouse on the screen, click on the Q&A box, and we'll cover as many of those as we can at the end of the session. And of course, please do get involved with all the interactive sections when prompted, which will come up in your chat box as well.

But without further delay, let me extend a warm welcome to the webinar Vet Georgia, and over to you. Thank you very much and thank you to everyone for joining me here this evening for obesity care and interactive session. So this is actually something a little bit different.

We're not just here to sit and watch a webinar, I'm afraid. I need your interaction. I'm going to need your involvement for this to work.

So, the first thing that we're going to do is test your knowledge. And to do that, we're going to have 5 multi-choice questions. In the second section, we're going to allow you to share your thoughts, both with me and with everybody else who's listening this evening.

And in our final section, we're going to look in depth at one specific case and discuss the many different elements that the case presents. So, what does an interactive session mean? Well, it means that you get to share your knowledge and your experience.

It also means that I really need you to participate. It means I need you to interact with the things that I've got coming up. And if you can think outside the box, I always love a unique answer.

Something I haven't heard of before, something I maybe haven't thought of. I will definitely give a shout out to anyone who comes up with a really unique answer. Basically, you've got to talk to me in whatever way, as we go through.

Now, there are a couple of ways that you'll be interacting with me. The first way is going to be with those multi-choice questions via the polls that will appear on screen. Hopefully, after 2 years of Zoom webinars, we're all pretty comfortable with how to interact with those types of polls.

They're nice and easy. And then the second way of interacting with me is through the chat box comments. So, if You, locate the chat box and how to write in it just as, we're starting now.

And in fact, to get us started, I'd really like to know who's listening this evening. So if you'd like to say hello in the chat box to me, drop me an emoji, put a little wave in there. Let's see who's listening this evening.

Is there anybody there? I've got a nice little cat face. Hi.

Hi Catherine. Hi, Sally. Lovely, and hi to you too.

OK. So let's get going. As background to this session this evening, because it is an interactive session, I'd really like you to go and check out these two other webinars of mine with Webinarett.

An awful lot of the theory in the background is described in detail in these two webinars. What we're doing this evening is a little bit different, so if there's anything that you want more information on, then these are the places to go. So let's get started, let's test your knowledge with some multi-choice questions.

So the first question is what percentage of juvenile dogs in the UK are thought to have overweight or obesity? Is it 37%, 21%, 49%, or 14%? And if we can launch the poll, please.

So what do you think, what are your thoughts of how, what percentage of juvenile dogs in the UK have overweight or obesity? And you'll have about 1520 seconds to answer the poll before we all see the results. OK, interesting.

So fairly split between 37% and 49%, well. The answer is 37%. And that's a really shocking figure, at least to me, because in the UK we have around 65% of dogs that have overweight or obesity, and we have one of the worst pet pet obesity incidents in the world.

So 65% of dogs and 37% of those are juveniles. If we think we have a problem now, then our future isn't looking so great. One really good way of preventing these juvenile dogs from having overweight or obesity is to monitor their growth.

I don't have time to talk about this this evening, but if you're interested in monitoring growth for prevention of obesity, go to this website, Waltham.com and look up the puppy growth charts, and kitten charts will be available soon also. Excellent.

Well done, and thank you to everyone for interacting with that first poll. On to question two. What percentage of cats in the UK are thought to have overweight or obesity?

Is it 55%, 23%, 39%, or 41%? What do you think? We can launch the poll, please.

So what percentage of cats in the UK are thought to have overweight or obesity? What do you think? Last couple of seconds to make your choice before we see the results.

OK, no one going for 23%. Most of you going for the 51%. Interesting.

Yeah, we know that there certainly is a really big problem in the UK, with cats and overweight or obesity. The latest, or the most recent study we have is that 39% of cats have overweight or obesity. But as you can see from the study, that study is now 12 years old, and we suspect that the number is far, far higher.

What other evidence we have for that is that over in America, in 2018, they actually found 65, 60% of their cats had overweight or obesity, and we being so similar to America, we probably have an incidence that's very similar. So both our cats and our dogs, around 60% have overweight or obesity. These really are very shocking figures.

OK, thank you. On to question three. So we know we have all these patients that have overweight or obesity.

So typically, by what percentage do you have to restrict the calories by to see weight loss? Do you restrict by 20%, 40%, 60%, or 10%? What do you think?

You should see the pole there ready for you. In the last couple of seconds, what percentage do we have to restrict calories by to see weight loss? Last couple of seconds to make your choice.

Oh, quite an even split between 20 and 40%. Well, let's take a look. So the answer is going to be around 40%.

Now, this graph is explained in much greater detail in the first of those webinars that I showed you earlier. But what it's describing is what happens when we have a patient that has obesity. So they've been pushed into a positive energy state.

They've taken in too much energy from the food that they've eaten, they've stored that as body fat. What we have to do is send them into a negative energy state. And to do that, we have to typically reduce calories by 30 to 50% from their maintenance energy requirements.

So, not from what they were eating, but from their maintenance energy, and that's how we get weight loss for these guys. OK, moving on. So, question 4.

What is the ideal rate of weight loss in cats, and this is per week? Is it 0.5 to 2%, 2 to 3%, 1 to 2%, or over 4% per week?

I didn't say these questions were going to be easy, I'm afraid, but what do you think? What is this ideal rate of weight loss in cats that we'd like to see per week? And have the results.

OK, quite an even split actually across those, but the majority of you going for that 0.5 to 2%. Excellent, because yes, this is the correct range that we'd be looking for.

Now in dogs, we can go up to about 3% ideally to 0.5% to 3%. Now, some of you I saw did go front to see 1 to 2%, and 1 to 2% is commonly written in literature about weight loss because that's what they suggest can be expected per week throughout weight loss.

However, Those studies where that 1 to 2% came from were colony studies. So they were on cats and dogs in a very controlled environment. What we deal with, of course, is pets, so pet cats and dogs, and what we know from 17 years at the weight management clinic is that pets actually lose weight.

At a much slower rate. And on average, they lose weight at around 0.8% per week, both for dogs and cats.

So the ideal rates of weight loss for me sits somewhere between that 0.5% and 2 or 3%, depending if it's a dog or cat. However, And I can be heard saying this almost daily, that weight loss is weight loss, and I'm happy.

These rates of weight loss are all very nice and all very good, but actually all I want is the weight heading in the right direction. The upper limits of this weight range, weight loss range is probably more important. So below 2% and below 3% is our safety line, for cats and dogs.

So that's why we should be respectful of that percentage. Wonderful. Thank you very much.

Now on to our final question of our multi-choice questions. The dog you are presented with has a body condition score that is in excess of a 9 out of 9. This is little Cujo here.

Where could you look for further information to help determine his ideal weight? Would you look at the weight of his siblings? Would you ask the owner's opinion?

Would you look at the Kennel Club's breed standard, or would you check the patient history? What do you think? Polls should be coming up for you now.

So what do you think? Where are we gonna look for some information when we have a dog that doesn't fit on our body condition score scale and is in excess of a 9 out of 9? See what answers we get.

Here they come. 80% of you, patient history, 20% of you owner's opinion. Well, certainly, looking in all these places might add something, but the one that's gonna give us the best information is this patient history.

Now the weight of the siblings will give you a rough ballpark, but it's not going to give you anything very specific. The owner's opinions sadly probably can't be relied upon, as we know that owners misperceive overweight in their own pets. The Kennel Club breed standards, well, they're all very well and good, but what if you have a cross breed and also they're all individuals.

So, whatever is a standard might not necessarily apply to them. So it's definitely the patient history where we'd be looking. Now, the place that you want to look in history is just prior to early neutering.

Provided the body condition score was ideal at that point, it is going to be very similar to the weight that they should be as an adult. Now, what if the body condition score isn't ideal at that point, but with 37% of our juvenile dogs already overweight or having obesity, it might not be. So what else can we do?

Well, as I mentioned briefly before, we could also be thinking about a puppy growth chart. Now plotting the weights that we have for for this particular individual on the growth chart and following those centile lines, those pink lines, up until they've reached skeletal maturity, will give us a really a good early indication of what their ideal weight should be. So we Even if they had overweight or obesity during their growth, we will still be able to identify which line they should have been growing on, and therefore, that will give us a better idea of what their ideal weight should be.

So it's about gathering information from as many sources as you possibly can. Now, why is finding an ideal weight important? Well, when we're talking about looking for weight loss, When we're using specific weight management foods, we have to base the feeding amount on the ideal weight.

And getting the ideal weight right, therefore, is vital for the success of your plans. This is why we have to go to these great lengths to determine ideal weight. Wonderful.

And thank you very much for your interactions with the poll. OK, so in section 2, this is your opportunity now to show me your thoughts, share your thoughts with others, and let's see what we can learn from each other. So the first question I have for you, and now you're going to be answering in the chat box.

So if you haven't already located that, maybe now is the time to open it up so you can have a look at what others are saying also. And the first question is, why should we worry about obesity in pets? What are your thoughts?

Pop it in the chat box, I will read out as many as I can. So what are the things that would concern you if one of these individuals walked through your clinic door? What are the things that's worried about health, Katherine, yes, I absolutely agree.

I would certainly fear and worry for their health. Health concerns got some osteoarthritis, diabetes. Yeah, Sally, I completely agree.

Certainly be worried about those pain. Yeah, I'd certainly be worried some of these in pain. We've got predisposes to other diseases, yes, it absolutely does, sadly, and we see lots of associated disease, with obesity.

Reduced life span, Jackie, yes, completely agree. We certainly do. Anyone, any other thoughts there?

People thinking it's normal. Yeah, really sadly, they do. And there, I think there are many individuals on this page that some people at the park would think, well, it's just what they look like.

That's what a pug looks like, isn't it? Surely. Greg, what have we got?

Diabetes, arthritis, behaviour, poor skin? Yeah, I couldn't agree more. Breeding problems, and, yeah.

Definitely when we have, very large foetuses and very large puppies or kittens, then we do struggle, when we, when it comes to giving birth, simply, they, they don't fit. Yeah, wonderful. All your ideas, and thoughts are absolutely bang on.

What did I have on my list? Well, the top one I had was orthopaedic disease. I think it's very, very common, especially in, those poor Labradors who are so, driven and so predisposed, to having overweight or obesity.

Airway disease, we see so many brachycephalics these days, those breeds are really gonna struggle with their narrowed airway plus obesity, so definitely we worry about them. We've had those metabolic disorders mentioned already, diabetes certainly in cats is a big worry, can be a bit of a worry in dogs also. Urinary disease.

I'm not sure we have that one, but certainly our FLUTD syndrome and our male cats is affected by obesity quite significantly. We have increased risks all over the place, so we have increased risks of disease later in life. We have increased risks of surgical, surgical complications and anaesthetic complications.

So this is going to be very relevant to every single one of us. Poor skin and coats. I think we had that one, which's excellent.

Definitely. And this is about being able to care for yourself as a, as a pet, and not being able to care for yourself. We do see poor, poor skin and coats.

What do we have here, panting worsens in brachycephalics. Yeah, absolutely. But the biggest reason, and Jackie, you did Say it reduced quality of life and reduced lifespan.

And this is not an insignificant reduction. It's a reduction we think of up to around 2 years they will have, if they have overweight or obesity. So lots of very good and very serious reasons to be concerned, which I'm guessing is why you're all here this evening, which is wonderful.

OK. So now that we recognise that pet obesity is certainly a problem, what tools do you have in practise that can help you start the conversation with a pet owner about their pet's weight? What do you, what do you have, available, or what would you like, in your practise to help with these conversations?

What do you think? Answers in the chat box once more. Body condition scoring poster Sally straight off the mark, yes, a prognosis, yeah, absolutely.

We we want people identifying these problems as we're seeing them. What else could we, we have in our practise that might help? Just give you a little bit of, little bit of typing time there, see what comes through.

Any more for more, I will, the need to be empathetic. Absolutely, Catherine, I completely agree. It is, not something, to be pointing the finger or blaming.

Absolutely, we should be understanding. Point out the, problem, be polite and truthful. Yes, I completely agree.

Nutrition and exercise guides, definitely. What do we have here, Greg? I'm not sure changing their name to hovis is quite the approach that I would use, but I, I like your ingenuity.

What did I have on my list? Well, one of the things that's quite easy to do is have something up in the waiting room, have a point, of discussion, something like this. You can see my patients actually have a good look themselves.

Body condition score charts, we definitely had that one already. Having scales out in your waiting room is a really good way of just in prompting an owner to weigh their pet. We could have a wall of fame if you have any success stories, get them up on the wall, celebrate, make a big fuss, show your other owners what can be achieved.

I have my, Wall of Fame up in my consulting room at the university and our orthopaedic service love using my room, because when they're talking about, cruciate surgeries and needing weight, weight loss and this sort of thing, they can show them real life pictures of success and how this can really be done and what difference it can make. Having posters up around the place, maybe in your consulting rooms also is a good idea. Just again, a small little prompt, having referral cards maybe either in your consulting rooms or the reception desk, something that you can physically give the vets when you're consulting, you can physically give to your owners a little prompt to go to reception and to book in other appointment.

To have these discussions in detail. And you may or may not have seen these. This little model here is a body condition scoring model.

It, it's not going to be like the real thing, but it definitely is something to spark that conversation, get people interested, and gives you a way in to start having these conversations. So yeah, great, some lovely ideas coming through. OK.

So we recognise that obesity is a problem. We have ways, hopefully, of being able to, talk about obesity, to your pet owners. But what elements are ideal for a weight loss diet?

When you're choosing a diet, what is it that you want from that diet? What are your essentials, answers in the chat box. So what do you think?

Are we just going to give them their own food? Are we going to change the food? And if we are going to change the food, what different things is that food going to have from a regular food that's gonna help us?

What, what are your thoughts? Lightweight prescription diets. OK.

Yeah. So light, I'm assuming we want reduced calorie diet for sure. High satiety, so nice and filling, low calorie, Nicola, absolutely, totally agree with that one.

Nutritionally balanced, Sally couldn't agree more, experience with Diets that work. Definitely. If you know it works, then absolutely.

A prescription for less calories and more exercise, Greg. Definitely, completely agree with that. We've got to reduce the calories in some way, haven't we?

So yes, we definitely want a diet that will deliver less calories than a maintenance diet. What did I have on my list? Well, above all else and literally above all else, the diet must be complete and balanced for weight loss, and this means that we're going to get weight loss safely.

If we just cut their current food in half, yes, they will lose weight because we're restricting the calories, but we will also be restricting the nutrients, and that's definitely not what we want to do. We want to reduce calories whilst giving them all the nutrients that they need. So we also want our diet to be satisfying.

I think we've had that from Nicolette. We want to prevent food-seeking behaviours. We don't want hungry pets whilst we're doing this, so definitely something that's filling and satisfying.

We also would like a food that allows a decent volume. So not only so we get large gastric volumes, so they feel nice and full when they're eating the diet, but we also, from the owner's point of view, want them to perceive that they're putting a really good amount in their bowl. That's very important to an owner.

If they feel they're only going to get a couple of biscuits at the bottom of their bowl, that's not going to go down so well. So nice volume and things like expanded kibble is the way that we get a greater volume to put in the bowl. We want our food to be palatable.

It's really important, and it sounds so simple, but if your food isn't palatable that you're choosing for that individual, it's not going to be accepted and we're not going to get weight loss. So we definitely want a palatable food that is well accepted. High protein and high fibre.

The combination in dogs specifically, they've been shown to be the most satisfying. In cats, they are more moderate protein with high fibre, and this is because if you're a cat, the more protein you have in front of you, the more you want to eat. So they don't have such high levels as we do as we give dogs.

Finally, it'd be really good if there was something within the diet that would increase chewing, because that will slow down eating, and that will increase feelings of fullness. And again, this is another element, another way of trying to prevent some of those foods seeking behaviours, and that sort of, problems that our owners tell us about so often. Excellent.

Thank you very much for your thoughts. OK, so I've got a mini case for you here. These are something that you will see typically in practise.

So I'd really like to know your thoughts of how you would go about dealing with this. So your canine patient needs to lose weight but is struggling. I wonder what's going on.

What would you suggest to this owner who has 2 dogs and 3 cats? Multi-pet household, very, very common. The dog, unsurprisingly, eats the cat's food regularly and also scavenges any food that's available.

And finally, we also know that the owner likes to feed the birds in winter. So what are your initial thoughts? What can this owner do to help with the weight loss, given these problems that we are faced with?

Multi-pet households, I think are always difficult. Sometimes you have to be a bit creative with our solutions, but what are your thoughts? What would we do for these patients?

Cat food up. Hi, Jackie. Yes, absolutely.

And enclosed somewhere where the dog can't get. Yeah, I completely agree. Great idea.

And there's many ways that we can do that. Certainly. Excellent.

You typed very quickly to get all that text in. So, so quickly, well done. Sally, feed them high up where the dogs can't reach.

It sounds so simple, doesn't it? But I think owners do need pointing towards that sometimes. Microchip feeders definitely are a great solution.

Greg, feed the cats on high. Definitely more walks, possibly when the cats are fed. That would be a good idea.

Don't feed the birds. Oh, those poor birds, Sally. But yes, I mean, we've got to balance everyone's needs here, haven't we?

And certainly if the dog is hoovering up after all those things, then it's going to be a problem. Catherine, puzzle feeders and going for walks? Yes, I absolutely agree.

We should feeding environment should be restricted for each, absolutely every individual in that house, deserves thought and consideration about how they're going to eat, so that they're not being, pushed off their food or not able to steal someone else's. Yeah, I completely agree. OK, what did I have on my list?

Well, I think you've pretty much covered many of these things here. So I had separate the cats and dogs at mealtimes. Owners need help with this, though sometimes, because they feel that everyone should eat together and it's all very nice, but I mean, we know that that doesn't work for everybody.

Prevent bin raiding. So this dog, I have no doubt raids the bin to having the bin in a different room, having a child lock on the bin, nice, easy solutions. But again, we sometimes have to point the owner that way.

Feed the dogs separately from each other. Yeah, if we're getting bowl swapping, we might need to do that, put the cat's food out of reach. We've already had that one.

Microchip feeders for cats, these are amazing, these bowls. They are quite expensive, but they are coming down in price. They've been around for quite a long time now, and they are an excellent idea.

They also work for small dogs. So it's not just for cats, these bowls. If the dog is small enough to feed from the bowl, they can absolutely be programmed to allow some dogs, and not others.

So, definitely a great solution. Only walking areas where food is not left out. And this is me really thinking about that scavenging behaviour.

If the owner has to walk past the McDonald's or some other takeaway place on the way to the park, well, maybe we go the other way, you know, where we haven't got sort of things that the dog can pick up by the bins and that kind of thing. Feeding the wildlife elsewhere. So certainly a dog is gonna eat fat balls in the winter given any sort of chance so maybe there is a different area, a different part of the garden, where the dog can't go scavenging for those, additional things.

Now, also what I have up in front of me here, is my washing basket. Now, anyone who's heard me before will, have heard this story, but this is a really novel solution that I heard when I was in Canada a few years ago, and it was a lady who had cats and she had washing baskets, and one washing basket per cat. And so what happened was, as each cat went to eat their food, the washing basket went over the top, and that meant everyone could eat their food, no one could steal their food, and this could be a solution in this situation.

So if there isn't anywhere high to feed the cats, well, maybe the cats. Have their own little nice enclosure under a washing basket, while the dogs, are around, so they're not bothered and stealing the food. I don't know what the behaviourists would think.

It's certainly not for everybody, but it's the novel solution that I worked in one particular situation. Finally, I've got here, don't ever leave the food out on either the kitchen table, or the kitchen sides. We know how good Dalmatians are, in particular, at counter surfing and jumping up on tables.

If you leave it out, it's gonna get eaten. So it's about the owners just being really careful. OK, sticking with this case just for a moment and think what else is going on.

So we know that the owner is trying to use a dry therapeutic diet designed for weight loss and she portions it out using a scoop. The dog gets 20 minutes of walk per day and is always begging for food, the owner reports. So what could we suggest, knowing a little bit more now about this family, what else could we suggest that will help to get weight loss going and to stop them struggling quite so much?

I think we had one or two ideas already, but what are your thoughts? So Weigh the food out every time straight in there, Greg, well done, yeah, using scales to measure the food out, exactly. Yeah, I think we in the veterinary profession profession are pretty on board with this, but it's really taking a while to philtre through to the owners the necessity of digital scales.

More walks, Sally. Yeah, I couldn't agree more for a Dalmatian, 20 minutes a day. It's hardly anything, is it?

Play with toys, yes, definitely. Any sorts of activity, would be excellent. Anyone else, any other thoughts?

Yeah, increase the exercise up to an hour, Nicola. Yeah, I completely agree. I would think that this Dalmatian could probably do that and then some.

So yes, definitely, we need more activity. And of course, when more activity, we're not getting so bored. They're not getting so focused on food at home.

They're tired because they've done some decent exercise. Definitely the exercise is going to play a big part. Any other thoughts?

What have we got coming through here? Food games instead of meals? Yeah, I love that one.

Different sorts of reward, Jackie, yeah, like that, definitely. We don't always have to be giving foods and treats. That very much echoes a lot of the things that I've got here.

So way out on digital scales, of course, is going to be my number one thing to do. We could also think about when we give food and how we divide up that food. So, I think most people like to give a morning and an evening meal, just cause that suits us as humans.

But that might not suit the dog. They might actually quite like to have 3 meals a day, or maybe 4. And also, we don't have to split food equally again, as humans.

We kind of like the symmetry of that, but actually, we could give a small breakfast and lunch and afternoon meal and save the majority of the food for the evening when the dog's food seeking behaviours are particularly strong. So by doing that, we hopefully get around some of those behaviours, and we've got lots of food to play with, you know, in the games and that kind of thing. Keep a large reward portion, so making sure we've always got food to give.

Slow feeders, interactive bowls, we, we had that from you. Wonderful. We could add in some green watery vegetables, so things like broccoli, cauliflower, courgette.

These are a great way of adding bulk, but without adding calories. So I would be a huge fan of doing something like this to try and manage some of those behaviours. And it's very much about keeping the dog full and having food available when it's necessary.

Consistent rewards or alternative rewards. Yes, we've had, we had that answer, didn't we? So thinking about maybe grooming or affection and play, that kind of thing as a reward, and making sure that if you're going to give something, you're always gonna give something because if you don't, they're gonna still ask anyway, and they don't really understand when it may or may not happen.

So let's make it, it always happens or it never happens, and then they can understand. OK. What we got also, we could maybe alter the wet and dry portions.

So wet food by nature of its water content is bulkier, so that might help with some of the food seeking behaviours. And of course, we've got increased activity level doesn't necessarily need to be just walks. It could also of course be things like swimming and extra play.

OK. Excuse me. On to our next little case, and this is the handsome Thor.

So you have been seeing 3 year old Thor for obesity care in your clinic. OK. Thor's plan has been going very well, and he's been losing at 0.6% per week on average, but weight loss has now stalled, and he has remained the same weight for a month.

OK, not good. The family have another cat, a dog, and two small children, and Thor has free access outside and is often found counter surfing. So what could be going wrong?

What do you think could have changed over recent weeks that has meant that we've had really good weight loss, but now the weight loss has stopped. What reasons could we have, do you think, of that? What's your thoughts?

Eating the neighbour's cat's food, yeah, sadly, they're so good at it, aren't they? At going round to everybody's houses and, seeing, seeing what's on offer. Probably 2 or 3 houses, no doubt.

Eating elsewhere, yeah, fed up and moving off. Yeah, well, potentially. But hopefully not.

Secret treats from the kids, yeah. Kids, relatives, babysitters, anybody really, isn't it? You know, that could be feeding the cat behind the owner's back, potentially.

So yes, we'd want to explore those sorts of avenues for Thor. OK, let's see what I have on my list. Lots and lots of different things to consider here.

The first one I have here is, has the owner changed the food? It's one of the first questions I always ask because it's surprising how often this happens without me knowing. So I always ask, just in case, maybe their regular food ran out, and, you know, maybe.

They had to buy something else or give, another food. We've got Nicola here and put, put the food on the surfaces away at all times. Yeah, the same as with the dog.

Let's just not leave food out. Are they getting additional food? So has the hard work become really hard and then now are they starting to slip and old habits creeping in?

The amounts of food might not be being weighed anymore. The cat might be seeing the dog's food. I've certainly seen that.

Cat is eating elsewhere. We had that. Cat could be hunting, certainly could be supplementing its own food, children bin raiding, licking the saucepans.

Absolutely. I think we've had lots of these ideas. Change in activity level or if they've started training, so if they, are they doing some cat training and are using some treats potentially.

Is there something Medical going on, of course, I will always be asking that. Have they started a new medication or new supplements? You know, sometimes we do see that, and of course, food is used to get these things into them.

So asking lots and lots of questions, one very good way of doing that is by using food diaries, asking them if you, even if it's just for a couple of weeks to write a really detailed food diary, might get you at some of these answers so you can pick out the problems and work towards fixing them. OK. So into the last section this evening.

So now we're going to discuss one case in particular. Now, there's a lot of information that's going to go alongside this case and lots of questions that we're going to have about this case. We're going to walk it through, we're going to take it step by step and nice and slowly together.

All right, let me introduce to you the handsome Chester. No Chester is, I shouldn't have favourites, but he is a particular favourite of mine at the clinic. So just to tell you a bit about him, he is, of course, male, domestic shorthaired, he is neutered.

He's 7 years old and he weighs 9.1 kg and has a body condition score of 9 out of 9. Little bit about his owners.

Of course we always should be asking. He's owned by two female owners, one of which works from home, and they live in a ground floor flat. The owners are both of average weight.

One owner has had cats all their life, so they're not novice cat owners. They kind of know what they're doing. A little bit of background about Chester.

So he's a really bold cat. However, he is described as very sedentary. He will sleep for over 12 hours.

He can be aggressive if he gets frustrated, which of course is always a problem. He's allowed outside any time of day, so he has free access, and he lives with the little kitten, Timmy, that you can see just here now, he hates Timmy, sadly. The cats really don't get on very well at all.

And of course, that is something that we will have to consider. Chester prefers dry food, and we also know that the neighbour when the owner goes away, does feed the cats if they go on holiday, it will be the neighbour that picks up the feeding. Finally, just a bit of medical history about Chester, because nothing ever happens in isolation, does it?

There's always other things going on. And actually with cases that have obesity, certainly ours at the clinic around 80% of us have something else concurrently going on with the obesity. So you will see these more complex cases, fairly frequently in practise also.

So, In his history, Chester has urinary problems noted. Nothing really more specific than that because they were treated, with anti-inflammatories and nutraceuticals, and it, it, you know, it's something that has happened in the past, but has now resolved. He is up to date with his vaccine history.

He's regularly fleaed and wormed, and he is insured. So, quite a lot of information here. What are we going to do to try and help Chester, to lose some weight.

Now, to answer that question, we are going to ask lots and lots of questions and think about all these different elements. So we will work through each one of these one by one. Firstly, we're gonna consider what medical things are going on and what we should be considering when we're choosing a diet.

What suitable diets are there, and why we, why do we choose these particular diets? Is there one that we prefer over another? We'll also need to be working out, therefore, Chester's ideal or optimal weight.

We'll need to think about how we divide Chester's food, how we'd introduce this new food to Chester, how we could manage these behaviours, because if he already gets a bit aggressive with frustration, then we definitely need to be dealing with that. We need to be thinking about how we increase his activity, and then all those other essential problems, and we also probably should think about what do we do when the owner goes away, how do we not let this get off track. OK, let's start with what are the medical considerations that we are thinking about when presented with Chester's case.

So what do you think medically is going on here that we should be wanting to deal with? What sort of major diseases, major system problems that we will be facing. What are your thoughts?

I think we've got Greg with diabetes on the list, absolutely. Yeah, another one for diabetes. FLUTD Nicola, yeah, totally agree.

Diabetes and early kidney disease. Catherine, yeah, I, I agree with that one. Should certainly be on the list.

Oh, yeah, potentially. He's 7 years old, isn't he? So we should be thinking about pain, associated with the, with the obesity also.

Anyone for any more on what medical things, I think we've pretty much got them all. So our biggest one, of course, we've got HCM, yeah, potentially, for, for our larger cats. So obesity, of course, is top of our list.

We know that that's what we're here to deal with. And obesity is also a risk factor for urinary disease. So if we can deal with one, we are very likely to be dealing with the other.

And so, of course, weight loss in this case is going to be strongly advised. Come one on our list is urinary disease. So very much we need to be considering that, as well as any stress considerations, living with this new little kitten, is not going to have made Chester particularly happy.

And of course, dilution is going to be one of the major things that we'll want to be considering, for, for a urinary disease. Also, I'm really pleased to see diabetes coming through and especially pleased to see early kidney disease or renal disease. He's being on that list.

At 7 years old, he's headed for those senior years. You'd be starting to think about now of what are those diseases that he is more likely to get. So definitely renal disease would be on our list.

And of course, to make sure that there's nothing really going on, you'd want to be running some bloods. For the purpose of this evening, we're very much going to be focusing in on these two elements and how we balance the needs of the obesity management with the urinary disease. Now, knowing that dilution is one of the major factors that we need, how can we increase Chester's water intake?

Straight away, what can we suggest to the owner that's going to help that water intake increase? Wet food, yeah, Sally, totally agree, great. Nice and easy, isn't it?

Immediately you're going to be putting more water in. Water fountains, soaking the dry food. Yeah, Greg, that's a great option if potentially don't like wet food, but it's no reason why we can't soak the dry.

Yeah, another one for water fountain. Multi-cat households, we need multiple resources. Yes, I completely agree.

Some outside water, Catherine, really like that one. Yeah, definitely. Cats would always rather drink from a puddle or a plant pot, wouldn't they, for some reason.

So yes, having some outside water probably that doesn't have, any of the things that we have in our tap waters that they might pick up on. I would certainly be, thinking that that would be a good idea. Adding salt to diet, I'm not too sure whether that one is a great idea, but it would increase water intake for sure.

But I think we have to be very careful, with adding sodium, adding sodium to our diets. Let's see what we have. So, I have very similar things.

So water fountains, maybe having a dripping or a running tap. My cat, as you can see her here, asks to drink from the tap. She hops up there, we turn it on for 5 minutes, and she has a nice little drink.

Adding in wet food for sure. But there's actually one really good way of increasing water intake and managing a patient, that has obesity. Now this is a little bit left of field, but cats, believe it or not, will eat courgette.

Here he is. Here's Chester. And Chester, as I said earlier, is one of my favourites.

He is my courgette superstar. He loves courgettes. And the really nice thing about courgette is it's extremely low calorie.

It is very high in water. So as an additional method of getting water into him, using courgette is an excellent one. But we also managed to give additional food without adding additional calories.

So I am bigging up the courgette this evening. Great. All right, so aside from the courgette, what foods would you choose?

And what are the things that influence your choice? So what type of food would you choose for Chester? What are your thoughts?

What diets would you go for? What do you think? What sorts of food are we gonna stick the same foods MD coming from Greg?

OK, yeah. Satiety, we want to try and alleviate some of that frustration and aggression. Definitely, Jackie.

It'd be nice to keep him nice and full with a diet like that. A senior diet, potentially, Catherine's wondering about, OK, with a side of courgette, absolutely, Greg. Everything with a side of courgette these days.

High nutrients, yes, we definitely want our diets to be a high nutrient diet. If we're wanting weight loss, certainly to do it safely. Any other thoughts of what diet type we should be choosing?

Yeah, we all, we're all done. OK. So one of the things that interesting, interestingly, hasn't come through so much, high fibre, I can see coming through.

Yeah, we want to keep him satisfied, don't with this, if we're gonna be getting food seeking, that's definitely gonna be a problem. So often when I ask this question, certainly we think about our weight management diets, as we have done this evening. There are also multifunctional diets, so they, they sort of cover two bases.

So then there are diets that will cover weight loss, but will also cover for urinary problems. So those would certainly be a good option. What wouldn't be a good option, however, is a urinary diet, because urinary diets alone are not suitable for weight loss.

Even the lower calorie versions or the light. Versions. They're still not suitable for weight loss.

The lower calorie versions are only there to maintain weight for those prone to weight gain. They're not designed for weight loss. So we really do want to be thinking about a weight management diet or a multifunction diet that's going to, tick off all those bases for us.

We certainly want whatever diet we're choosing to come in a wet option. We want to get as much water as we can in there. Our choice will probably depend on availability.

So how easy is this for for the owner to order or collect from your surgery? We also probably will want to consider what we have in our stock room. Maybe that will influence our choice.

But definitely, as you've said, high nutrient, fibre, all those sorts of things are going to be very important, for thinking about, getting weight loss. Whilst promoting fullness, definitely. Our senior diets, Catherine, in this particular instance are not suitable for weight loss either, sadly.

So although senior diets are a very good idea for any cat that you suspect might have reduced kidney function or are heading for their senior years, the obesity in this case does take precedence. So that's why we wouldn't use one of those. But no, great thinking, great ideas.

OK, moving on. From the information that we have here, what is Chester's ideal weight? Now, would anyone like to have a stab at this?

What weight do you think Chester should be? Straight in their neck of 5 kg. Probably not too far wrong.

Anyone else, any other thoughts? 4.5 kg, correct.

OK. I. 6.5, Sally?

OK. Yeah. Anyone else, any other?

Thoughts on whatchester should we? No, we all, we're all done at 6.5.

OK, 5.5. They're coming in for you.

Thank you very much. OK, so this is a tricky one. Needs, needs to make an initial goal that's achievable.

Couldn't agree more, Nicola, but for the purposes of creating a food recommendation, we definitely need to find out what that ideal weight is and then set them a goal that they can achieve. So yes, definitely. OK.

So when we think about calculating an ideal weight, the best way of doing that with the information we have is to look at that body condition score chart and use the corresponding calculation. And you can see here, hopefully, that for our body condition score of 9 out of 9, the calculation we will use is the current body weight. Divided by 1.4.

Now, if we do that calculation, we get 6.5 as a result. And Sally, I'm guessing that you might have done that very calculation to get there.

Now, it's really good that others of you have chosen different numbers, because you're right, 6.5 actually does seem pretty high, doesn't it? So where could we look for that other information?

Where else could give us a guide as to what that ideal weight maybe should be? The breed, yeah, he's domestic short hair, they're all very, you know, fairly similar in size, Greg, so yeah. Weight before neutering, Jackie.

Yes, well done. Looking at the growth chart. Excellent, Sally.

Yeah, I completely agree. So again, just like the dogs I mentioned before, very similar. Check back in that history.

Looking for that weight just prior to early neutering should give us a really good idea, good idea. And actually, I can tell you, that his weight as a youngster, just before neutering, he's a big lad. He was 5.5 at that point.

So, you know, he is, he is large for a domestic short hair. OK, excellent. So, we have got to, at some point, of course, calculate a feeding amount, but probably what's more important, also is to think about, well, how are we going to divide up, that portion per day?

What would you suggest, given the owner's circumstance, how many meals, how would you suggest that Chester's food and allocation is divided up? What do you think? Any thoughts of what would be best.

Now we've got one owner that's working from home. What do you think, 3 meals a day coming through? Yeah, great idea.

Anybody any other thoughts of how many meals a day? Two meals? Yeah, I mean, it might suit them very nicely to have 2 meals per day.

Sally can be multiple meals. Yeah, definitely. Similar to when the kitten's fed.

I have no doubt that Chester will be furious if the kitten is being fed and he's not. So definitely hide food is that 13 times a day, Katherine? Wonderful.

Jackie in at 4 meals per day, some scatter feeding, definitely. Some ad lib feeding. Well, we can try, but I probably suspect that Chester might hoover up all that food quite quickly.

You'd have to see whether he would leave any. But yes, multiple meals. Excellent, excellent.

That's all the things that I had. So I would be thinking of at least 4 meals per day. But yes, as one of you mentioned, cats will eat up to 16 times per day.

And in, you know, in a sort of in a natural state, they like to eat little and often, and it's only we as humans that really wants them to eat twice a day because it suits us very nicely. So making sure we've got lots of small meals and probably saving some as a reward portion or as a portion that can be given freely in between meals is also going to help with a lot of that frustration and food seeking type behaviours. Wonderful.

Great answers, everyone. OK, so we've got the plan together, but we've got to transition Chester onto this new food. So what would your suggestion be to change the food?

I think just on the previous question, got puzzle balls and making him work for food, yes, I agree, and, great answer. So yeah, let's think about how we're going to transition the foods. We've got coming through 3 to 5 days.

Yeah, sounds very reasonable. Anyone, any other thoughts of how, how quickly or not, so you're gonna do it straight away, we're gonna take our time? What do you think?

Asking for your fastest finger first on a Thursday evening this evening. What have we got here? Yeah, we've got splitting the food up.

Definitely, yeah, changing it over nice and slowly, slowing down if we get upset tummy gradual mix. Yes, we're drawing the food. I think, yeah, that's absolutely right.

We need to be doing a gradual transition. Jackie, 5 to 7 days onto the new food sounds very reasonable to me. And in fact, yeah, that's, probably the gist of it.

It's a gradual transition, but how gradual really depends on the individual. The things that we want to guard against is digestive disturbance, and we of course want good acceptance. If we don't get good acceptance of a new food, that's our weight management programme, dead in the water.

Owners are very like unlikely to continue if we're getting resistance to the food. So really quite slowly is what I would suggest. But these are kind of what we typically see over sort of 4 to 7 days, something like this.

But these are my kind of rules. So if I have a dog or a cat that will eat just about anything, 3 to 4 days should be enough not to upset the tummy. If they're happy with most foods, OK, 4 to 7 days is perfectly fine.

If they can be a tall picky, I slow right down and we're gonna take 7 to 10 days. If they're described as fussy, I'm gonna go up to 2 weeks to make that change. And if they're really resistant, OK, we might have to, take over 2 weeks to get that transition.

And sometimes, and I have done it, I've done it one kibble a day. And if you have to do it like that, so be it. Getting them on the right food is so vital and it is so important for safe weight loss that it is absolutely worth taking your time.

The chances are your patient has had obesity for months and potentially years. So we've got a week, we've probably got a month to make that transition and really get it right. So, yes, gradual transition is the name of the game here.

Well done, everyone. All right. I think we've, you've all been very good at thinking about this already, but how can we manage Chester's behaviour and frustration and also increase his general activity?

What are your ideas, for doing this? So, to manage behaviour and increase general activity? What are the things that we've got?

And walk on a lead. Wonderful. Yes.

That's not one I've got down. Great. I'm keeping a walking diary.

Brilliant. Yeah, lots of play, interactive feeders definitely would be things I'd be thinking about, . Yeah, nice.

So yeah, either solo activities or something interactive, Katherine, yes, definitely love these ideas. Any more for more, but I think you're all absolutely on the right lines. So all of these things, that we're mentioning, working for food, yes, toilet rolls, stuff I've got a picture just there, Jackie of just that.

They're really cheap, really easy to make these sorts of toys, with toilet rolls, and you can see some of my cats just enjoying some of the things that I've provided for them. So for dry food, there's so many different options that we can use ice cube trays. It doesn't have to be something bought from a shop.

But then dealing with those things, to do with frustration, and maybe some of the stress that we've got in this environment with the kitten having lots of high places around the room, certainly will help, lots of hiding places. Was definitely going to help. He has outdoor access, so a do not feed me collar is probably a good idea.

We also know that cats like to eat at dawn and at dusk, so restricting them at those sorts of times so they can't go and eat the neighbor's food is probably quite a good idea, and making sure we've definitely got Timmy and all his resources, elsewhere. You will also see just in the middle there, we've got, a licky mat. So these mats are wonderful now and we can use them for wet food, which is excellent.

And there's more and more of these things coming on the market. And there are ridged mats if you've not seen them, and you literally press the wet food into little squares and grooves, and the cat has to spend a lot of time, a lot of energy eating that food, which makes mealtimes last an awful lot longer, allowing them to feel full with the portion, that they're being given. Yeah, Greg, hiding food in different places is one I don't have on the list, definitely.

As long as little Timmy doesn't get hold of it, but yes, mix it up, give them a different challenge, something else to think about. We always think of cats not being as trainable as dogs, but they are, if they're given the right sorts of motivation and food, of course, in this case is a great motivation for Chester. Fabulous answers.

OK. So, what am I missing? What are the things that we so far haven't talked about that would be essential to Chester's plan?

What do you think? What haven't I mentioned just yet? We've had some of them this evening already, but what else would you be thinking about with your pet owners?

Let's see what we've got coming through. Do you think we've covered everything? Is there anything else that you think we should add into this plan or something else we should be discussing?

Excuse me. OK. 2 owners measured out, no duplication.

Yeah. Maybe a feeding chart or something. That's a great answer, Nicola.

I don't have that one actually. Making sure we've got a nice routine, absolutely. When the neighbours feed them, measure it out already.

Great one, Sally. Definitely, because we've got to deal with that. We don't want the neighbour derailing this, do we, by feeding them too much if the owners have to go away.

Yeah, excellent answer. OK, let's see what I thought. So the first one, digital scales, it probably seems too glaringly obvious, doesn't it?

But certainly we should always remember to mention our digital scales. Pre weighing for the neighbours, yes, I already had that done, . OK.

Follow-up appointments, we should maybe book one before they leave. We certainly arrange to have some follow up in some sort of way. We could also be talking about how long this weight loss is going to take.

Now, although, you know, I try not to give too many specifics, actually. We, I always make sure owners know that we're going to be at this for Months. It's not going to be weeks.

We are talking about months. Average weight loss is around 9 to 12 months, but that really depends on how much they have to lose. We think that Chester is at the top of our body condition score scale, typically, therefore, he's going to take 12 months or beyond, depending on how it goes.

So it's making sure we're managing expectations as we go along. Finally, we should always make sure our owners could contact us, to be available to them. You know, make sure there is an email address or a phone number or you can text your owners, because if they have problems or questions, it's really important to deal with those quickly because otherwise it's just too easy to let things slide and to fall off the wagon.

So being as available as you possibly can to your owners. OK. And lastly, right bang up to date, for so many of us, COVID has been really, influential in these weight management cases.

So, how can we keep Chester on track if we can't see him in practise? What could you do, do you think, to help with, with this owner engagement, Greg? Yeah, great.

Email, phone calls with pictures, Sally, wonderful to hear that you're doing that. Virtual consults, Jackie, love it. Text and email.

Yeah, I am fully on board with those, Nicola. Wonderful. Any other ideas?

I think. Ask Boris. Not sure what Boris is going to do about it, but yeah, he hopefully, is letting us see people a little bit more from today, I believe.

So yes, I think you've got everything that I had covered. I have spent the last couple of years doing Zoom calls and remote consultations with all of my owners. But in between I've also been phoning them.

I've been emailing them, I've been texting them. But this doesn't stop the problem of it being difficult to weigh cats and dogs at home. Have any of you got any ideas?

Have you done anything about weighing at home? How have you managed that problem with, getting weight updates with your patients? Has anybody had any nice ideas or any success with owners weighing at home?

Using a fishing scale, wonderful, yeah, or a luggage scale I guess would be, would be fairly similar. Get on the scales yourself, and then weigh the cat with minus off the combined. Yes, that's nice and easy with a cat.

Not so easy with a 60 kg mastiff, but yes, certainly for our cats, we can weigh them. Hopefully, most people have got bathroom scales. That's certainly a really good way of doing that.

Well, I wanted to share with you, actually, how Chester got on during lockdown, and also what they did, his owners, about Wayne, because I have to say it is fairly fabulous. So, here he is. I mean, isn't that just fantastic?

He's just like, yeah, well, that's great. That's easy. I can just stand on my own home scales here.

How many cats you will get to do that? I have no idea. But Chester and his owners are absolute megastars, and yeah, this is a really good option for them because they could make sure, that they can weigh properly.

I totally take your point, Sally, that some owners can weigh at home, but also the pet shops are open, and they have scales in them. And definitely, I would agree that certainly for the big dogs. That's the best way of doing it if they can't come into your practise to weigh there.

The only thing I would say about pet shop scales is we need to make sure they're weighing properly, because they'll be moved quite a lot and used quite a lot. And what I always do to do that is pop a bag, a brand new bag of food on the scales, allow a little bit for packaging, but that will tell you if those scales are weighing accurately. So then owners can be sure that the weight that they're getting from the pet shop scales is nice and accurate.

So. Yes, wonderful. But another idea, tape measure?

Yeah, absolutely, we can measure them. That's something that an owner definitely could do at home. Tape measures are a little bit more subjective than weighing scales, but definitely something very nice that an owner can do to help monitoring, monitor these situations, and monitor their own pets.

Wonderful. So I couldn't finish this evening without giving you Chester's full story. So here he is at 9.1 kg, which is what he weighed when I first met him, and here he is.

Just now. Now, he weighs 5.9 kg currently.

OK, not quite at that target weight that, or that ideal weight that we set for him, but my goodness, what a difference between these two pitches. You can see from the front paw position alone, the amount of weight that he's lost and how Significant that's been to him and all with the help of his favourite courgettes. So he has been eating courgette throughout his weight loss, and as you can see, has been extremely successful and even better than that, we've had no recurrence of any of those urinary signs throughout.

So it's absolutely wonderful for him. So, this has been wonderful this evening and thank you so much for joining in and participating and making this session amazing and sharing your knowledge because it is a really great way to learn, from everyone. As we've seen this evening, obesity is a complex disease to manage.

There's so many different elements, so many things to think about. It definitely is. It isn't just about choosing the right food.

I know that you guys all have the skills and knowledge that you need to improve quality of life for your patients and to really make a difference. And what's I think really important to remember, finally, is that sometimes you have to think outside the box for those novel solutions, or maybe just outside the washing basket. Once more, thank you very, very much for making this an excellent session this evening and thank you to Webinar vet for allowing me to do something a little bit different.

Thank you, everyone. Thank you so much, Georgia. I'm just gonna, I know we've gone over a little bit, but I'm gonna give everyone just a few minutes in case there's any questions that they want to put into the Q&A box.

I know it's been very interactive all the way through, so we've probably, dealt with a lot of things as we've gone along. But I just want to give everybody that opportunity. I think for myself personally.

You know, you, you've got my brain going again, Georgia, which is a rare thing on a Thursday evening. So thank you for that. I thoroughly enjoyed, which you can probably tell because I couldn't help but comment on all the on all the points and interact myself.

You couldn't hold me back tonight. Have you got any questions going through? I know, Georgie, you have said if, if there was any that came afterwards, you know, that people can contact you and, you'd be happy to answer any questions on, on that, hopefully that's still the case.

I just put you on. No, no, absolutely more than, more than happy to. Oh, brilliant.

Thank you ever so much, . Everybody's just saying how much they've enjoyed it. It has been, it's, it's just been such a wonderful, wonderful session.

Greg, no need to apologise about the jokes. Very much appreciated. Absolutely.

Well, I like to keep it lighthearted as well, don't we, but, no, everybody's just very, very positive. Lots of good, lovely feedback, everybody saying thank you so much. So it's been an absolutely wonderful session and say I've enjoyed it thoroughly.

I hope everybody that's attended tonight has as well. Thank you so much for your time. It's very much appreciated.

Thank you to Dawn, our control of behind the scenes here for making sure everything ran smoothly. And most importantly, of course, it goes without saying a huge thank you to Georgia for covering such an engaging session. It really has been fantastic this evening.

I will let you all head off for the evening now, maybe to have some courgette for your tea because it's definitely spiked a little bit of something for me in that. I'm thinking about courgette constantly. And I look forward to seeing you all again soon on another webinar.

Thanks ever so much, everybody. Have a great evening.