Good evening and welcome everybody to another Thursday night members webinar. My name is Bruce Stevenson and I have the honour and privilege of chairing tonight's webinar. I don't think we have any new members tonight, so we don't need to go through all the normal housekeeping.

As usual, questions and answers into the Q&A box and our speaker, Georgia has very kindly agreed to answer and get through as many of those as what we can tonight. So, Georgia Wood Lee qualified as a veterinary nurse in 2004 from Meyersow College in Preston of the UK. After working in Cheshire as a dedicated emergency and critical care nurse, Georgia then gained the position of head nurse and clinical coach, developing successful obesity care and other nursing clinics.

In June of 2015, Georgia took the position of Royal College, Royal Cannon, sorry, my apologies to the sponsors. Royal Cannon 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 clinics, Georgia also assists 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, the VTS in Nutrition Award in 2019. So who better to talk to us about obesity than Georgia.

Georgia, welcome to the webinar vet again. You're an old hand, and it's over to you. Thank you so much for the introduction and thank you everyone for joining me this evening.

This is Obesity Care, the why, the how and the when should we tackle this complex disease? So I wanted to start off by thinking about why we should be worried, how bad this situation is, and what has led us to this place. We're then going to think about how we start dealing with pet obesity, and I wanted to pick out some really specific elements that I hope are going to be useful to you in practise.

We're gonna think finally about the when. When would be the best time to be having these conversations. You guys as vets, of course, have the integral role to be diagnosing obesity, helping prevent obesity, and instigating obesity care for your patients.

So let's take the why first of all, should we tackle this disease? Well, we have one of the worst pet obesity rates in the world. The latest figures we have are that 39% of cats have overweight or obesity, but cats are underrepresented in practise, and this study is now a little bit old, so we suspect that that number is actually a bit higher.

For dogs, 65% of dogs are thought to have overweight or obesity. And if that isn't bad enough, this study showed that 37% of those dogs were juvenile. So when we're observing obesity and overweight in our growing puppies, if we think we have a problem now, the future is not looking so good.

And because of this instance, you will be dealing with obesity frequently in practise, almost every other patient, and it is also the commonest form of malnutrition that you will now have to manage. So why are we so worried about pet obesity? So the two main reasons are, firstly, it reduces quality of life.

You don't need to be an expert to look at these images to see the suffering and to see how poor their quality of life must be. The second reason is, as we know obesity reduces lifespan, and there are a number of studies now looking at this topic. You may be familiar with the longevity study that followed a cohort of Labradors throughout their entire life.

Half of them were kept at their ideal weight, and half of them had overweight and obesity. And those that had overweight and obesity lived on average 2 years less than the ones that were kept at ideal weight. And what's actually really interesting about this particular study is the dogs with obesity didn't look like the white dog here.

They look like this guy here. And so it's to make the point that obesity to any degree should be dealt with, because even actually small amounts of obesity can affect both quality of life and lifespan. So let's think about how obesity occurs, is, I thought a good place to be starting this evening, and we all know, basically what happens.

It's an energy imbalance. We know we get too much intake and not enough energy expenditure. And that is probably the simplest way I can put this, but as you're going to find out through the rest of the session, there is absolutely nothing that is simple about obesity.

So thinking about our patient with obesity just for a moment and let's see what has happened. So as you will all know, the maintenance energy requirement should keep our patient's body weight stable and the same. What has happened for a patient with obesity is they've been pushed into positive energy.

They've taken in too much energy from the food and the calories, and they've stored that excess energy in their adipose tissue. What we want, of course, is to get weight loss, and to do that we need to send them into negative energy. Typically we need a caloric restriction of around 30 to 50% from that MER.

Now the problem comes is after weight loss, whether that's a small amount of weight loss or a large amount of weight loss, the maintenance energy requirement never returns to normal. And what that means is, is that these patients will be forever affected by their obesity. So the permanent effects we see is they will always have a lower calorie requirement.

They will need continued obesity care, probably for the rest of their life, and they will be really prone to regaining that weight. And about half the patients that we see at our clinic do regain some or all of their weight. And so it's for this reason we talk about obesity being a really quite treatable disease, but we can't in fact cure it because of these permanent effects.

Now, obesity is recognised very widely now as a chronic disease, and most of the sort of very familiar large global organisations have recognised obesity as a disease. And the external sort of signs of obesity are quite easy to see, but I wanted to think a little bit more about that adipose tissue. So we know now, a lot more about adipose tissue than we used to.

So we know, of course, it adds weight in bulk for our patient, that its musculoskeletal skeleton is not designed to carry around. But what we also now know is that adipose tissue is an active endocrine tissue in its own right. It releases releases a type of hormones known as adipokines, and adipokines are detrimental to our patients.

So they cause inflammation, they impair immunity, and they are responsible for insulin resistance. So it's the fat cells themselves that are causing us a problem, not just the fact that these pets have to carry around an additional weight and bulk. And for all of these reasons, we have many associated risks with obesity.

Osteoarthritis always comes the top of this list because if we look at this Labrador here and think about those poor elbows of his, probably got arthritic change in there, and then we add a weight that that elbow is not designed to carry, and then that additional inflammation, we can easily see why this guy is going to run into problems. We see urinary disease associated, so RFLUTD syndromes, metabolic disorders such as diabetes, of course, in cats. Pets with obesity have an increased cancer risk.

They have an increased surgical and anaesthetic risk, and they often have poor skin and coat simply because they have an inability to groom and self-care properly, and they are restricted often, from being able to perform their natural behaviours. And so it's for this reason, for many years gone by, we've talked about weight management, but I'm really hoping that you've spotted it already. We now refer to what we should be providing for these patients as obesity care.

Because obesity care far better represents what we need to do for these patients. So how have we arrived here? What are the factors that contribute to the problem of pet obesity?

Well, the moment we start asking this question, probably the first people to pop into our minds is our pet owner. And when we start thinking about a pet owner, we know that people like to try and blame the pet owner potentially. But I want to say at the outset that we cannot blame any one thing or any one factor.

The situation is just too complex, as you will see in a few slides' time. OK, so the pet owner does, of course, provide the food for the pets, but not exclusively usually. Most pets are influenced by other people in their lives, whether that's the dog walker, the groomer, relatives, friends, neighbours.

They don't always have complete control. Even within the pet owner household, there may be some members of the household that are giving more foods than others. What about outside influences affecting our pet owner?

What education have they been provided with? Who are they taking advice from? Are they getting advice from breeders, from the pet shop, veterinary advice, ideally, but are they going online instead and looking on websites as to what the best thing is to feed their pets?

What often happens, I think, is pet owners want to feed their current pet like they fed their last pet. And just because it was appropriate for that previous pet does not mean it's appropriate for their current pets, as we know they are all individuals, but I think this does happen quite often. We as humans all want to celebrate and show love through food.

And it's unsurprisingly, therefore, that pets being so part of our families would be treated in a similar way. If you belong to my household and it's your birthday, this is what you're going to get on your birthday. It doesn't matter to me that this cake is bigger than the size of your head.

This is how I want to show my love and affection for my nearest and dearest. And so it's very easy to see why people would do this for their pets too. The final point here is to talk about the family food environment.

And this is something that is talked about an awful lot in childhood obesity. Because childhood obesity and obesity of the parents is extremely closely linked. In America, they call pet owners pet parents, and it's for good reason.

It's because that relationship between parent and child, and pet parent and pet is very similar. And the thoughts and feelings and attitudes towards foods of those parents or pet parents does influence the entire house, and again, pets being part of the family, we do see this effect filtering to them also. So we've thought about the pet owner, what other factors could be contributing?

Well, you may have read recently in the last few years that there's been some genetic work and quite excitingly, there was a gene, the POMC gene identified in Labradors that was positively associated with obesity. But genes are not the full story and there's been hundreds of genes now, discovered in people. There are too many factors for genetics alone to be the only cause.

What about our wider environments and thinking very much in a sort of cultural environment? We are all living in an obesogenic environment. It means that for people of our time, food is very easy to obtain.

We can get high calorie foods extremely easily without having to work for it at all. And this is one of the reasons why we're seeing human obesity rates grow, and it will also be a reason why we're seeing our pet obesity rates growing. Metabolic disorders are often talked about as factors contributing to obesity.

And of course at this point I'm thinking about hypothyroidism in dogs. But often I think it's jumped to too quickly. At the weight management clinic at the University of Liverpool, we run a specialist referral service.

Arguably, we see some of the most complex and most severe cases, but only just under 2% of our cases truly have hyperthyroid. So I think my advice here would be, unless you are really positive that there is no other cause, I wouldn't jump to spending an owner's money on a blood test for hyperthyroid. It's very unlikely, actually, to be the problem.

We hear quite often that different food types might be responsible for the obesity rates, and I'm not going to get into debates of the rights and wrongs of different food types, but it's just to make the point that it is an energy imbalance. We've already said this. You can consume too many calories, no matter what the food type is.

Understandably, some foods are higher calorie than others because they might be lower in moisture, so they will be more calorie dense. But it doesn't mean that we at the clinic don't see pets with obesity fed every single diet type out there, we absolutely do. What about the pet's behaviour?

We maybe forget that pets are opportunistic, especially dogs, they love a street feast, don't they? And they get really quickly, positively reinforced to repeat those behaviours. Are we educating owners early enough of what those behaviours will mean down the line?

Is it OK to allow a pet to lick your plate after a meal and expect them not to ask to do that again tomorrow? Of course they're going to want to do that again. And so we do get pressure coming from the pet's behaviour for our owners.

I wanted to kind of come full circle on the pet owner a little bit and talk more about lack of knowledge and understanding on this particular topic. This is highlighted quite well in this particular study, because what it asked owners to do was to body condition school their dogs. Now quite shockingly, 89% of owners underestimated their dog's body condition.

And even when they were given a chart and shown how to use it, 65% of them still misperceived their dog's body condition. And this definitely causes us a problem, and we're getting a normalisation of obesity. And I think if this Labrador was walking down the street, most pet owners would probably consider this quite a slim Labrador.

We know that this guy, he attended our clinic, he has overweight, so he is 20% above his ideal weight. And we know this because post weight loss, this is what he looked like. And this is the normal that I think we're losing sight of, with our pet owners.

And so what we have is this real disconnection between the reality of what obesity looks like and what we, well, as what our pet owners are actually perceiving. And in loads of ways we can't really blame them for that. The images that they are given, aren't always the best.

So if you Google Labradors at a big, very famous dog show, you get images like this guy. I hope that everybody here watching can identify that this Labrador has overweight or obesity, and he is being held up as the best of his breed, a shining example, the breed standard. It's hardly surprising, therefore, that when an owner looks at their own dog at the same shape and size as this one, they wouldn't see that there is anything wrong.

So what other factors should we consider? Well, we should probably wonder if we as a veterinary community have a part to play here. We know that many fear causing offence by having these conversations, and I hope to be able to help with this in this session.

But if we fear something, we're much more likely to avoid it, and so it's trying to get away from that avoidance. Lack of time is a big problem in practise, and this is something that we all have to consider to cater for these patients. We cannot deal with obesity in a 15 minute consult.

And to be honest, even in a 30 minute consult, it's really difficult. So lack of time certainly plays a part. We know also that there's discomfort with the conversation.

We get asked quite a lot, how do you deal with the overweight owner with the obese pet? And that's something that I'm hopefully gonna help with later also. As vets, you may have other priorities when you're presented with these cases and maybe there are more pressing things, but are we making sure we're coming back to dealing with the wait or are we just waiting for that pet to attend for something else?

Pore recognition and apathy probably go hand in hand, and we know sadly, it is quite widespread. This highlight was highlighted very nicely in this particular study, and it looked at 148, clinical records, of, of dogs. So 30% of those dogs had no weight recorded.

It feels shocking to me because I always assume that everybody weighs their patients, and yet the study did suggest otherwise. When it came to body condition scoring, it was only recorded in 1 out of 148 cases and on only one occasion. So who knows if all those dogs had obesity or not?

Nobody is making any assessments, or if they are, they're not putting them in the clinical notes. Finally, I want to talk about unconscious bias and weight stigma, and these two things go very much hand in hand. Weight stigma is negative feelings and assumptions and associations with people and pets with obesity, and we know that it exists in the human world and in the veterinary world.

So doctors when this study was done, described dealing with people as obesity as awkward. They felt that they were ugly and they were probably going to be non-compliant. In a similar study asking vet's opinion, they said they felt frustration that they wanted to put a portion blame onto the owners and were really quite pessimistic about any successful outcome from their obesity care.

And so when we look at these, two wheels here of just some of the factors, it can already feel that there is quite a complex situation going on. Unfortunately, this is a simplified version, and actually this is probably more, more like, the number of factors and interactions that go into, the causes of pet obesity. Remember I said at the start, nothing is simple with obesity, and I think this picture sums it up quite nicely.

But staying with unconscious bias just for a moment. Hopefully you spotted this picture earlier on, in the slides, and I want you to think for a moment about what your initial thoughts and response were to seeing this cat. What were your feelings?

What was your initial reaction? If your initial reaction was humour, I wouldn't be surprised. We have been laughing at those pets and people with obesity for a very long time.

This is very much become part of our culture. Did you have thoughts of horror when you saw when you saw her? Were there thoughts and feelings of sympathy, maybe empathy, or even sadness?

It'd be really interesting to know whether there was any judgement made about this cat, how it ended up in this situation. And I wonder if we were in person and I could ask you all, you know, do you think this is a successful case or not? Well, actually, this is a very successful case.

This is what Molly looked like when she first attended the clinic, and the second picture is after she'd already lost 3 kg. And so it's to call out those unconscious biases, those initial sort of knee jerk reactions. And if you would like to find out what your specific unconscious biases are, you can go and go on this website and spend a very uncomfortable afternoon finding out what your unconscious bias is.

I will admit, when I did these tests, I do have a slight bias against obesity. But I try really, really hard to not let it affect my communication or treatment of these patients. OK.

So let's think now about how we should be tackling this disease. Essentially we are failing. Our obesity rates are increasing.

So whatever we're doing, we've got to ask ourselves, are we doing enough? Is there more we could do? I wanted to share with you one of my favourite quotes and it's this.

The definition of insanity is repeating the same behaviours and expecting a different outcome. And it's really just a little call out to think about what more we could be doing. Obesity care really does start with recognition.

And I'm guessing that most do weigh their pets, although that that study did prove that not everybody is weighing and recording their patient's weight. But are you calibrating your scales, I wonder. Are your scales telling you the correct weights every time you use them?

You can use a set of calibration weights or maybe a bag of pet food from the shelf that will calibrate your scales quite accurately for you. Once you've weighed your patient, of course, what your scales give you is a number. We have to recognise that it is just a number at this point.

It doesn't tell us anything about the appropriateness of that, of that patient, patient's weight, and are we remembering to record it. To see if that weight is appropriate for the patient, we have to do our additional assessment, which is of course body condition scoring. And there are a number of factors that I wanted to just remind you of for body condition scoring.

First of all, have a good look before you get your hands on. I'm pretty sure that everybody could body condition score this pug at at a glance almost. Then when you do get your hands on, make sure you're using a light touch only.

If you have to press or apply apply pressure to the rib cage to feel the ribs, that patient does not have an ideal body condition. Use flat hands, it will help you stop digging your fingers in, smooth the hair of any of the long-haired breeds and make sure you're feeling all areas. Don't just focus in on the rib cage, which I think is quite easy to do.

And then of course you'll want to be allocating them a score on your body condition score chart. But at this point, we have a weight and a body condition score, and we're getting somewhere near assessing, this, this patient properly. The final thing we need to do is to is to calculate optimal body weight if we need obesity care.

And this is a really important 3rd and final step in this process. So to take the example, if we have a body condition score of 8 out of 9, it represents they are 30% above ideal weight. So we take the current body weight, divide 1.3, and that gives us our optimal weight.

Optimal weight is vital because for most therapeutic diets specifically formulated for weight loss, you need to feed them to be their optimal body weight. If you're feeding them for an incremental weight or somewhere in between, you will not get the caloric restriction you need and your weight management or weight or obesity care programme will fail. And finally, are you recording that body condition score so you can track it over time?

So knowing all this is all very well, but I wanted this evening to give you something a little bit more practical and it's about getting that knowledge out of our heads and into a way of communicating it with owners. So to stay with communication for a moment, the first thing we have to think about is the language that we use. So we need to be using suitable terms, terms like cuddly or chubby, they're not suitable in a veterinary environment.

We also need accurate terms, ideally. My particular favourite term is above ideal weight. This is how I would refer to a patient to an owner, because it is at least a very accurate term.

We definitely want to avoid toxic terms, so no F words and no O words, and that F word being fat, although, you probably want to avoid the other F word also. Finally, we should consider how we phrase our our discussions around obesity. And I would like you to remember that your patient is not fat, they have obesity.

In a very similar way to the they cannot be renal disease or cardiac disease. They have renal disease, they have cardiac disease, they have obesity. And it's a really subtle change, but we don't talk about any other disease in this way.

And by doing so, we remember that we are dealing with that chronic disease. So thinking about our unconscious bias once more, and we all have colleagues that maybe do this. They see this cat in a carrier maybe, or in the kennel across the room, and they walk in and they go, wow, that cat is fat.

And even if you don't say it out loud, what I would really like, even in your head, is to say no. Molly has obesity. She's suffering from a chronic disease, and we should be here to help.

And so it's as I was saying, and not letting that unconscious bias or weight stigma affect how we talk about obesity, so changing that internal and external conversation so we can have meaningful conversations with our owners. Now we know there are many challenges when it comes to communication, and I'm hopefully going to provide a communication solution for you to at least help give you some pointers. Let's think about what's so difficult.

Well, first of all, we know that there is discomfort. We've touched on this already. We're worried also about causing offence, and rightly so.

We don't want to upset our owners, we don't want to lose those clients. We don't also want to upset any owner that has obesity. Now, I've been managing obesity exclusively for the last 6 years and probably been involved with obesity care on some level for 10 years prior to that.

And I don't believe I've ever upset anybody or I wouldn't like to think so, and simply because I treat everybody in the same way. I make sure I'm really clear that I'm talking about their pet, and I listen very carefully, and it's, and it's much more about that and not getting caught up with the worry or assuming or anxiety over these situations, just treat everybody in exactly the same way. If we're going to get, anywhere with obesity care, we have to make sure that our communication means that owners acknowledge that there's a problem and that can be difficult.

It might not be the owner's priority to be dealing with this. If they've brought you a lame dog, they're probably expecting a medication or possibly an X-ray. They're not going to be expecting an obesity care consultation.

And finally, where we have concurrent disease going on, it may feel like there's just too much to deal with, but we're going to touch on concurrent disease and how to deal with obesity alongside other conditions a little later. But before we come on to any solutions and some practical ways of communicating, there is a really big question that we should be asking. And the big question is this.

Y'all ready for Are you ready for this? I used that video and I make no apologies for taking us back to the 90s and giving you a too unlimited earworm for the rest of the evening. Because are they ready for this is such an important question.

Now, to gauge readiness, I wanted to introduce to you a psychological theory known as the stages of change. This was produced early in the early 80s and it described the phases that people go through to stop smoking. But in years since, it's been used in many different situations, and we can also use it in our situation with our pet owners.

So I wanted to describe each phase to you. We start with the pre-contemplation phase. So owners in this phase have no intention of changing their behaviours and probably don't even recognise that there is a problem.

The next phase we have is our contemplation phase. So owners might well be aware that there's a problem here, but they are not committed to making any changes, it just might not be the right time for them. Our next phase is our preparation phase.

This is where we hopefully have owners intent upon action. They may even have come to you for help. Ideally then we can get them into an obesity care consultation and get them into the action phase where they start to make some changes to bring their pet's weight down.

We then hopefully can support them to maintain those changes, and we get sustained change, those new behaviours replacing the old behaviours. But this is a cycle, and to close the cycle, unfortunately, we also have a relapse phase, and we know many owners will fall into that relapse phase where old patterns of behaviour start to come in. But owners can travel round this cycle many times actually, and they will learn something each time they go round it.

So all is not lost if they've tried and failed before. We can try again and we can try and get owners to attempt weight loss loss again. Now, at this point, you might be wondering, OK, if I meet an owner in pre-contemplation or contemplation, maybe I can shock them into doing something about it or apply a little bit of pressure to get them moving around.

Well, unfortunately, we do have some really significant blockers, one here and one here. And if we do try that very direct approach with these owners, we probably are going to risk losing that client or seriously upsetting or offending that patient's owner. So it's to be really careful when we are met with this sort of resistance.

We don't just forget all about it, we park it. And in your clinical notes, we need to note down that we are going to revisit this topic at the next appointment. You won't remember, probably, the next time you see that client and your colleague, won't know also, unless you put it in your notes that this needs to be assessed the next time that client comes in.

So I thought we'd try and combine these things and talk about ways that we can start having a conversation with an owner of any shape or size about obesity in a non-confrontational way. And it really starts with weighing and body condition scoring every patient at every visit, and making those assessments very routine and making owners really familiar with these assessments being made. Then we can move on.

So if you have a patient that you've identified has obesity, I personally would be saying something like this. I'd like to talk about the findings of our routine assessment. Remember, it's routine, they should be familiar with this being done.

Is it OK if we talk about your pet's weight today? And by asking that question you will hopefully gain consent. And if you can get consent from your owner to have that discussion, they will get, you'll get much better buy in to what you're about to say.

So it's an important question to not miss out. The next question I might ask is, how do you feel about your pet's weight? And the answer that you get to that question will gauge their readiness.

They will either say, Oh, there's no problem at all, I don't think there's anything wrong with them. Or they will say, Yeah, I had a suspicion that my pet may be overweight. Great, we can now try and work with these owners.

So we move on and we say, can I show you how to body condition score, and would you like to have a go? Because what I want the owner to do is recognise it for themselves. I want to gain their acknowledgement, and that will happen much better if I haven't told them.

So we go through body condition scoring, we show the owner how to do it, show them the chart, and ask them to body condition score their pet. And wherever they put them on the chart, you need to be guiding them, but ideally what you will get is recognition that that pet is not an ideal weight. Now, if you body condition scored this cat is an 8, and the owner is saying a 7, it's perfectly fine.

All we want is to come to a consensus and acknowledge that we are above our ideal weight for this patient, and now we can get going with obesity care. So ideally, now we, we've got the acknowledgement, we can start discussing any clinical signs that might be related to obesity, and then helping an owner visualise what improvements they may experience to the health and well-being of their their pets, should they get the weight. I have this before and afters board up in my consulting room, and I know that our orthopaedic surgeons love using this room because before and after pictures are such good examples of how health can be improved.

You can see it within a picture. You then also need to reassure the owner at this point. They probably are quite worried about what a diet is going to mean.

It's they're worried that it's going to be painful, so it's saying to them. We can help, we can do this together, and I have strategies that will work. And so then within your practise, you will have to decide what the patient journey is going to look like.

How are you going to get this little dog to look like this little dog? And so it starts with that recognition and gauging the readiness of your clients. It will then move forward to making that recommendation for obesity care.

You may want to give some brief advice at this point, although I would maybe add some caution here because until you have a really full idea of what's going on, giving advice is actually extremely difficult. My preference would be if your veterinary nurses within your practise are the ones running. Your obesity care clinics, get them to do the thorough investigation, get your client booked in with them in whatever system that needs to be, and let them do that extended obesity care consultation to find out all that information and deliver a really thorough recommendation.

So at this point, it would make a lot of sense to think about some of those elements within obesity care, but I'm not going to dwell here. I have recorded webinars for webinar on this subject. In fact, there were two full webinars if you would like to go and check them out.

I know we're going to put the links, for you in the end, if you'd like to, if you'd like to look at those. But I wanted to just give you a very brief overview of what obesity care is going to entail. So first of all, we're going to be gathering information.

So that's going to be medical and dietary history, but also pets and owner preferences, lifestyles and routines. We're then going to be doing a full physical examination, so thinking about weighing, body condition scoring, ideally muscle condition scoring also, taking measurements and taking photos so you can get those up on your before and after board afterwards. Then there will be a recommendation, and this is about setting that obesity care plan.

And within that, we'll want to be calculating the optimal body weight as well as calculating some target body weights, potentially. We're going to think about what caloric restriction we're going to need, what diet alterations absolutely will be necessary, and thinking about activity and exercise for that patient. We then also need somebody who's going to be troubleshooting along the way, so they're going to need to be coming up with solutions for food seeking behaviours and helping with client compliance.

And finally, we need to support and motivate our pet owners, and that is through regular monitoring and making alterations as they're needed. But for the purposes of this evening, I wanted to focus in on just one element of this setting of the obesity care plan. And it's very specifically how we tailor plans in certain situations.

And this is to remind everybody that we should be very much taking an individualised approach to these cases, and in particular, a holistic approach when we have concurrent disease and we have age to consider. So our aims for when for these patients, when we have these two elements is of course to improve quality of life, just like any other patient. We probably also want to think about improving mobility.

We definitely want to prevent any further compromise to that patient, and by doing that, we want to preserve all their lean tissue mass. And so this very much becomes a team-based decision between the vets and the nurses if you guys are running obesity care clinics in your practise in that way. It, where these targets fall, what that specific plan is for those individuals really should be a conversation rather than just porting it along and forgetting about it.

So what are we considering here? So, for senior pets, and that's cats are roughly over 10 years and dogs roughly over 8 years, so that is very much age breed dependent, and it's actually quite difficult to isolate exactly when pets do become senior, but roughly at those ages, we must consider the obesity paradox. And for those that aren't familiar with the obesity paradox, it states this.

That in senior age, higher amounts of adipose tissue gives better chance of survival in the face of progressive disease. So that's things like diabetes, renal disease, heart failure and cancer. And so that is really at odds with what we want to do for our obesity care, because we want them to lose weight and improve their quality of life and maybe their lifespan, but we don't want to disadvantage them in any way, in case they do get one of these progressive diseases.

So for these guys, it's very much thinking about how we can make them feel better. And so probably much more modest weight loss in these instances. So thinking about these tailored plans then, and that will depend on the age and the disease status of that patient.

We would like to consider a minimum amount of weight loss of 6%. Now, 6% might seem like a bit of an odd number, but this is actually grounded in science because it's at this point that we start seeing noticeable physical benefits from the weight loss. So at the very least, we would like these patients to lose 6%.

At a maximum, we would be looking at 20%, and there's really good reason for this in these patients. So predominantly during weight loss, the 1st 20% is comprised of body fat mass. After 20%, if you have if your patient had to go further, we then start to see some lean mass loss.

And for a patient that may be getting a progressive disease as it ages, the last thing we want to do is to take away any of their lean mass. And we also want to leave them with a little bit of reserves, remembering that obesity paradox. We don't want to take everything they've got.

They may well need it in the future. And so concurrent disease in senior age is actually really common in our pets with obesity. So we see this at the weight management clinic around 80% of our pet, our patients have concurrent disease of one sort or other.

I thought I would briefly give you some examples given the pictures that I've got here. So this cat, Ruby, up at the top here, you can see that she did lose some weight with us. She's 12 years old, and when she came to us, she had chronic kidney disease and was an Iris stage 2 at this point.

But she was having some quite significant problems with her obesity, hampering her mobility, and her owners were very keen to improve her quality of life. So we suggested a 15 to 20% weight reduction, and you can see she was very successful and it really did improve her quality of life, which was excellent for her. If we move down the pictures here and we think about this lovely Labrador Alf, sadly, Alf at this point, he is 9 years old and he has end stage metatastic carcinoma.

So his owners came to us because really bravely they wanted to make the most of what weeks and months Alf had left. And so for him, we thought, OK, let's get a minimum of 6% off if we can, but with a maximum of 10%, we didn't want to risk any of that lean tissue loss, and we definitely wanted to leave him with some fat reserves, and because he was going to need them right at the end of their life. His owners were actually over the moon with the results that they got.

He really did have some significant improvements to his mobility, and it was a wonderful outcome for them, for the last few months of his life. Finally, we have our Rati here. This is Ellie.

So Ellie is 8 years old and she was referred to our orthopaedic service, for bilateral hip dysplasia. Now, initially, she was, thought to, need a bilateral hip replacement, but on further examination, she wasn't a surgical candidate candidate. Her hock joints, and there was disease there too.

And so weight loss for her really was the only option. Now, being an eight year old dog with nothing else going on and no sign of a progressive disease, we decided to maximise the benefits for her mobility was to go the full way with her weight loss. And so we did take her down by Around 30% and for Ellie, for the rest of her life, the focus very much is on keeping that weight off to maintain those mobility benefits as best we can.

So these are just a couple of some of the ways that we would alter these plans and tailor them for the individual. So we've thought about the why pet obesity happens and a couple of reasons and ideas on how we can start to manage pet obesity in practise. And I really wanted to finish with talking about when would be the best time to tackle this disease.

You probably have already guessed it. The best time to tackle obesity is before it happens. It's prevention.

And so it's thinking about our puppies and our kittens. Prevention is always going to be better than cure, and we now have a really good evidence-based way of doing this. And this is through evidence-based growth charts.

If you go to Waltham.com, there is an awful lot of information on these charts, much more than I can talk about here today. There and there is some instructional videos and you can download all the resources from that site.

Currently we have dog charts up to a 40 kg dog. Kitten charts hopefully won't be too far behind. We're expecting those soon as as we should do for our giant breeds also.

So I wanted to have a look at these grace charts this evening, because they're probably one of the best steps we can make towards prevention. So these charts, as I said, they are evidence-based, so 50,000 healthy puppies, their growth was tracked, not just through their growth, but beyond growth. These were ones that grew in a in the correct way and also as adults, maintained a healthy adult weight, which is really important.

6 million body weight measurements went into the construction of these charts, and don't ask me how that was done, that statistical analysis and number crunching that is way beyond my capacity. There are 10 different charts to choose from, from different sizes, and you have male and female charts. And what these charts show is ideal growth, and that's really important.

And it's important to recognise from for, sorry, to highlight to an owner that there is no right or wrong centile on this chart. Whichever centile their puppy is following is the right one for them. So to look a little bit closer at this chart, you can see in the top right hand corner that we have a female chart in the weight range, and that's the adult expected adult weight range that we have up there.

And then we have our weight at the side and our age along the bottom and you will need to know the age in weeks of your puppies. And these are the centre lines that you've got crossing here and I've just highlighted those numbers a little bit more clearly for you. Now, looking at the chart, you may initially notice that there's this big gap in the 1st 12 weeks.

And there are no cent our lines here because, growth does all sorts of funny things in the 1st 12 weeks. It doesn't settle into a nice growth pattern until the 12 week mark. But it doesn't mean you can't start plotting, before 12 weeks, you absolutely can, but don't expect it to fall into any sort of, centre line until we're hitting that 12 week mark.

So just to show you a very brief example, if we take this 15 week old puppy here, we find our 15, week mark along the bottom, and she weighs 10 kg at this point, so we intersect it and then that is where we put our plot, and you can see that she is on that 75th centile there, which is absolutely perfectly normal, for her breed. So when we're weighing our puppies, we need to make sure that we are doing it with no collars, harnesses or leads. We don't want anything artificial, adding anything, we want to weigh in kilos, and we also want to make sure those scales are calibrated and giving us the correct number.

So this is what normal growth will look like. Now you will notice it's tracking that centile that I've highlighted. It's bubbling about a little bit.

The the points are sort of destroying a little bit up and down. That's perfectly fine and very normal. This is also normal growth.

So this is where the growth is falling in between the two centile lines. And again, a little bit of bubbling, but that's perfectly fine. What the growth charts allow us to do is to spot points of concern, and I'm going to mention just 4 here as we finish.

So the first point of concern is where our puppy is going right at the very top or beyond the top centre of the chart. And the reason that we'd be concerned about this is that puppy is very large for age and being large for age predisposes them to obesity later in life. There may be no problem.

This may be normal growth for that individual, but it's probably one that you want to, weigh much more often and keep a much closer eye on, and owners need to be aware of that. The second point of concern is where we see accelerated or too rapid growth, and it's no, and it's spotted by the crossing upwards of two centiles. And once they've crossed that 2nd centile, then the alarm bells should be ringing, the red flags should be waving because accelerated growth.

Predisposes to obesity later in life. And so we have to be looking at that puppy and thinking, what's going on? Why is it growing faster than it should be growing?

Do we need to be making any changes? Again, it might be perfectly normal, but it's definitely something you'll want to look into. What if we have this situation?

So this puppy here has actually dropped down to centiles. So again, red flags waving because we've crossed two centiles. This may be due to illness or disease.

It could be due to poor diet, whatever the cause, it certainly needs some sort of investigation. This puppy isn't growing correctly. And finally, it's where we get what's called rapid catch up growth.

So those are those very small puppies, potentially those that are very ill, are very early in their lives. And what the owners want to do is feed them up, help them catch up with their peers. But again, we get accelerated growth, we might get the crossing of To centiles again, and that accelerated growth, rapid growth, is going to predispose to obesity later in life.

So it's not something we want to do. Whatever centile line they're on, we want them to follow that cent line, for perfect growth. So anytime that you see any of these growth patterns, we need an appropriate and responsive nutritional recommendation.

We can't leave it too long because if we do, we know how fast growing puppies grow, we know how quickly weight can go on, we can run into problems significantly. So, growth charts allow us frequent monitoring, which is great. It means we get good client bonding and it also means we have lots of conversation opportunities, so maybe it will tie in nicely with your way and worm policies.

We also get to identify those at most risk and to make those changes early before we get obesity developing in our juveniles. It also allows us to provide education to our pet owners. Now at the moment, what I think typically happens without the charts is something that looks like this.

So initially we get the pet owner obtains the puppy, you won't probably see the puppy for a weight check at 1st and 2nd vaccination. We potentially don't then see the puppy until neutering, and then after neutering, we might not see it until it's annual booster. But at this point, that puppy, potentially, especially if it's the large breed puppy, still hasn't reached skeletal maturity.

And so you can see quite obviously here, we've got these 3 big voids of time where growth is happening and we've no idea really what's going on and whether that growth is, optimal or whether it's too fast. So, by using the growth charts, we, and the advice for you, their use is that we weigh once a month until they're 6 months old. And then after that, we weigh them once every 3 months.

And so we get this sort of weight pattern and this number of check-ins, which is much, much better, to be able to track their growth. I would actually like to add in just one more little weight check, and that's just after neutering. Because if we're getting a sharp spike in weight at that point, we definitely want to be doing something really soon, to be, to be undoing whatever is going wrong, because by the time a month or two has gone by, we may have seen it, we may have obesity already.

Once these puppies reach skeletal maturity, that weight, provided it is at an ideal body condition, gets set as its optimal weight throughout their adult life. We are OK with a 5% increase or decrease from that point, but ideally they shouldn't vary more from that, from that weight at that age. And so wherever we can, we really should be preventing obesity occurring if we're going to be successful at bringing down those obesity incidents.

So to summarise very briefly, we've talked in this session about why we should be so worried about pet obesity and those many, many factors that contribute to this problem. And we can't be blaming any one of those things, it's just too complex a picture. We've also talked about how we can make improvements potentially to what we're currently doing, how we can communicate better with pet owners, and how we can try and avoid the effects of our unconscious bias or weight stigma in those conversations.

And finally, we thought about when would be the best time, and that is of course before obesity even occurs, and that is done through prevention. So whether you're presented with guys like this, or guys like this, your take home today is that you must talk about it and try and prevent it. My apologies.

Thank you very much for listening this evening. Georgia, that was absolutely fascinating. It really was.

I've been a vet for a long, long time, and I wish I had had somebody like you in the beginning to help me with those difficult conversations. And I, I love it. They, they, you know, they have or they are suffering from obesity.

I mean that in itself is Absolute gold. It's, isn't it? It's amazing.

It's it's a, it's a, it's a realisation as well with the the term you're using that you are subtly letting the client know that, you know, you're recognising that it's a disease process, but that the pet is suffering and we really need to be helping it. So Yeah, I think that's amazing. As I say, that's, it was a completely fantastic talk all the way through, but that itself was, to me was absolute gold.

Oh well, thank you and if that she'll take home, I am very, very pleased. It really is fantastic and I'm sure everybody else on and those that are going to be listening to the recordings are going to enjoy it just as much as I did. At the moment, we don't have any questions coming through, but what I would like to point out people is in the chat box.

Dawn dropped in the link to the other talks by Georgia. I'm sure that you would want to go and have a look at those after you've heard the fantastic talk tonight. I promise you I've heard them.

They are just as good. So do yourself a favour and go and look at those. And then the other thing to ask you that Dawn has dropped in the chat box there is the survey monkey to our annual survey.

Those of you that attend regularly with me on a Thursday will know that I always say it and I'm gonna say it again. Folks, this is our channel. This webinar vet was created by Anthony for us.

It's ours. But the way that the team in the office know what you want, what we want, is by doing the survey monkeys. Give us feedback.

Let us know what's good, what's not good. Where can we improve and what do you want? You know, go on.

And say we want more Georgia. Come on, Georgia, Georgia, Georgia. After tonight you've got to be with me on this one.

But seriously, guys, go in and do that survey monkey and give us feedback. Go and listen to Georgia's other talks. They really are fantastic.

Georgia, I think you've done such a good job tonight that you haven't left any doubt in anybody's mind because we've got no questions coming through. I'll take it, fantastic. I will too.

So thank you for your time and to everybody that's attended tonight, thank you as well for your time and to my controller in the background, as always, Dawn, thank you for all your help and making things happen so smoothly for us. From myself, Bruce Stevenson, it's good night.