Good evening everybody, and welcome to tonight's webinar with the Webinar vet. My name is Sophie McMurra, and I have the pleasure of chairing tonight's webinar. So before I go on to introduce our speaker, I'll just point out that you can ask questions throughout the webinar.

And if you'd like to do so, if you hover over the toolbar, which will either be at the top or the bottom of your screen, click the Q&A box and pop your questions through to me so that we can ask Georgia at the end. So tonight's webinar is sponsored by Royal Cannons. We'd just like to say a massive thank you to Royal Cannon.

We do also have Lindsay here who's a weight management specialist also, so she's here to answer any questions about the product that you might have at the end. So tonight's webinar, we have the wonderful Georgia Woods. Georgia first trained as a veterinary nurse in a mixed practise in Shropshire.

After gaining a broad introduction to veterinary nursing, she moved to a small, small animal hospital and referral centre in Northwich. After qualification in 2004, she moved to a large 24 hour emergency service in Cheshire as a dedicated emergency and repair nurse. In 2010, Georgia then took the position of head nurse and clinical coach.

And then in 2015, Georgia took the position of Royal Canon weight management clinical nurse at the University of Liverpool Small Animal Teaching Hospital. And this is where she's now dealing with exclusively with obese pets. And Georgia achieved her certificate in canine veterinary health and nutrition in 2017.

And has also now completed her veterinary technician specialist, so she's a VTS in nutrition. OK, I will hand over to you, Georgia. Lovely, thank you very much and thank you to everyone for joining us this evening for, for, for obesity care in practise.

This is part one, essential elements. So in this talk, we're going to start off by talking about obesity as a disease. We're then going to move on to discussing how we recognise obesity and how to get those referrals to the right person.

We're also going to go through the various elements that you'd want in your first consultation, the recommendations that you might want to be making, and how to monitor these patients, not just through their weight loss, but into long-term maintenance also. But before I start, I want to give you this to have a think about. Now some people will say weight loss is easy.

You simply feed less food and get them to move more and you get weight loss. And what's so difficult about that? On the other hand, other people might say weight loss is just too hard.

We've tried before. The pets are hungry all the time. It's too rigid.

The plans are too difficult. They don't like the food they're being given. Nobody stuck to the plan, and this is all just too much effort.

And you may or may not agree with these statements. I personally think weight loss is actually very hard. It's a complex and multifactorial problem to be dealing with.

It's very individual to the patient and the owner that's in front of you. This is a long term issue, often lifelong, there are no quick fixes with obesity care. It's clinically challenging, especially with the amount of concurrent diseases that go alongside obesity, and it can be very frustrating, and I'm sure we've all experienced the frustration, to do with weight loss.

And so often I hear that I just simply haven't got the time, and this is because it is an extensive problem to be dealing with. And so you can kind of see what's happening here. We're getting this really big brick wall, this big barrier to dealing with obesity.

So I am here to blow a couple of metaphorical holes in this brick wall and remind you of the impact that you can have through obesity care for your patients and how rewarding it will be, not just for yourselves to see the success, but also to that pet owner and especially for the pet. Here in the UK, we have one of the unenviable title of one of the worst pet obesity rates in the world. Currently, we think around 65% of dogs are overweight or obese, and 37% of those are thought to be juvenile.

So our growing puppies are already becoming overweight or obese. And so if we think we have a problem right now, the future is not looking so great. The figures that we have for cats are that around 39% of cats are overweight or obese.

But cats are underrepresented in practise, and these figures are a little older and so we actually do suspect that this number probably is quite a bit higher. And obesity now is the commonest form of malnutrition you will be dealing with in practise. And that pretty much is because almost every other patient that walks through your clinic door may have obesity.

So I want to, before we start on anything else, talk about obesity as a disease. It is now being called a chronic incurable disease. And you may look at that word incurable and wonder if obesity is actually incurable, and I will come on to that in a moment, but I'm sure we can all agree that obesity is a chronic disease.

This happens over time. It certainly doesn't happen overnight. And some people will say, well, how does an owner let their pets get into this state?

Didn't they notice that there was a problem? And this is part of the issue with the nature of this chronic disease that it happens over such a long time. Owners become acclimatised, they lose sight of what is normal, and we end up with patients like this.

So to describe obesity as being an incurable disease, we have to look at the maintenance energy requirements for our patients. Now, as you will be aware, they all need a certain amount of energy for their daily life and their daily activities. For our patient with obesity, they've been pushed into positive energy.

So they've taken in too much energy in the form of calories that they've eaten, and they've stored that excess energy in their body fats or their adipose tissue. What we do is we come along and we try and get them to lose weight by, and we need to send them into negative energy to do that. We have to restrict their calories by around 30 to 50% to get the weight loss that we want.

Now once they've reached their target, and we've all celebrated, this is where the problem comes. Their maintenance energy requirement will never return to normal. So it will never be at the level that it would have been had that pet not been overweight and gone through this cycle.

And what that means post weight loss is that they will always need a lower calories requirement. They will need continued obesity care, probably for the rest of their life, and they will be very prone to regain. And because of this lasting effect of this energy swing, that is why we talk about obesity being a very treatable disease, but we do in fact consider it incurable.

And finally on to the word disease itself. If we take a look at the dictionary's definition, it describes a disease as a disorder, a structure or function, one that produces specific symptoms or that affects a specific location and is not a result of a physical injury. And if we think of obesity in these terms, you can see why that is now fitting together with that definition of disease.

What we also know is a little bit about fat cells and or adipose tissue and here is some pictured. We know that fat cells add weight in bulk, but what we also know is that body. Active endocrine tissue in its own right.

The fat cells themselves release a hormone called adipokines. Now adipokines are bad for our patients, and they cause all sorts of problems. They cause inflammation, they affect immunity, and they can cause insulin resistance.

So it's the fat cells themselves that are doing our pets some harm, not just the fact that they're carrying around extra weight and bulk that their bodies are not designed to do. And because of these effects, we now know that there are many risks associated with having obesity. Osteoarthritis is at the top of our list, if you think about that Labrador, with those arthritic joints.

It is carrying around more weight than it needs to, but because of those inflammatory diakines, that inflammation is being made even worse by its own body fat. Airway disease, our brachycephalic breeds in particular will suffer at this point. They already have a narrowed airway and you add obesity to that, it's easy to see why these guys really struggle.

Urinary disease are larger male neutered cats in particular, I'm thinking about as with metabolic disorders such as diabetes both in dogs and cats, can be in effect. These guys have an increased cancer risk. They have an increased surgical and anaesthetic risk.

And maybe an owner would argue, well, I'm not planning any surgery for my pets, but what if that pet was in an accident and needed emergency surgery? The outcome from that emergency surgery will be directly affected by the fact that that pet has obesity. These guys also will have poor skin and poor coats simply because they cannot groom and care for themselves properly.

And there is no discipline within your veterinary hospital that won't be affected by the patient having obesity. But the two things that we worry about most of all is that obesity reduces quality of life and lifespan. And it is thought that it reduces lifespan by around 2 years.

And what pet owner doesn't want to have their pets around for those extra 2 years. The quality of life being reduced, I think, is easy to see from some of these pictures. If we look at this guy, the Siame down at the bottom here, you can see how woefully inadequate his legs would be to carry around that stature.

You can also see a pressure sore on his tummy, and this is because he spends his life lying. Eating, sleeping, and, using his litter tray, and that's all he does. This is a really poor quality of life for this little guy.

And it's so for them and so many others like them, this is why I do what I do. I want to help improve their quality of life. And the good news is, we know that weight loss will improve that quality of life.

Now you will have maybe heard me so far, rather than talking about weight management, much more to talking about obesity care. And this is because obesity care represents much better what we are doing now in helping to treat this disease. Just as cancer care or cardiac care or renal care would.

We think of obesity and obesity care now in the same way. So step one along this journey of dealing with pet obesity has to be recognition. Now I'm guessing that everybody does this, that in practise, you weigh your cats and dogs hopefully on an appropriate size scale like this.

But do you calibrate your scales? So at the university, I am lucky enough to have these lovely calibration weights, and every day that I use my scales, I will calibrate them. It is really important that our scales are weighing accurately.

In practise, you do have all you need to calibrate also. If you take a bag of pet food from your shelf, that is a really good way of testing those scales of weighing accurately. Allow around 0.1, 0.2 grammes, sorry.

Kilos for some packaging, but food is weighed very carefully during manufacture, so it'll give you a really good idea if your scales are working properly. But even after you've done all of this, what do we actually get from our weighing scales? Well, we get a number, but it is just a number.

It doesn't tell us anything about the appropriateness of that number for the pet in front of us, so we must have to do something else. And I'm sure you've all come across body condition scoring. And I want to talk quite in depth about body condition scoring and these charts in particular.

I have these up on my clinic wall, you can see one of my patients here having a good look at where he might sit on that body condition score. So to look a little closer, WSAVA, the World Small Animal Veterinary Association recommends that everybody should be using a 9 point body condition score system. We should all be singing from the same hymn sheet ideally.

There are 6 different sizes of dog charts within this set, and that's so that you have something relatable for the owner and pet in front of you. If you have a Chihuahua and you give them a German Shepherd chart, they, that owner will dismiss it as not applying to their pet. Dogs are unique in their variation within their species.

So we have to have something that the owner can relate to. What is also special about these particular charts is that they are validated, and they are validated against real patients that we've seen at the University of Liverpool and the DEXA scans, so our body composition scans that we do on them. The pictures that you see on the charts of the dogs and cats also are based on real patients.

So the body shape changes where they store their excess body fat is as accurate as it possibly can be because it is based on real real patients rather than a graphic designer thinking up what it might look like. At each score, you will get a descriptor for what you can see and feel, and 4 and 5 on our chart is where we'd ideally like every patient to sit and every score above, you would add an additional 10%. So our body condition score of 6 represents 10% overweight, therefore, our body condition score of 9 represents 40% above ideal weight.

And because you have so many points to choose from on a 9 point chart, there are no half points when we use a 9 point body condition score chart. If you are tempted, you have to remember the one rule is that you go up. So if the patient in front of you you suspect is a little overweight, but you don't really want to tell the owner that.

Then you might want to be giving it a 5.5. You must score that as a 6.

We have to be as accurate with body condition scoring as we would do with any other scoring. So body condition scoring actually comes in two parts. And this is part one, so we're going to look and feel your patient in front of you.

Here is Beau down at the bottom. You can maybe be thinking just by having a look what score he would be. You're going to determine what you can and can't feel once you get the chance to get your hands on your patient, and then you're going to be allocating them their body condition score.

Hopefully, everyone's identified that Beau here is a body condition score of 9 out of 9, and you can see how similar his stature is to that picture that we have on our charts. So it's always a good idea to have a look before you do anything else with body condition scoring. So places that you might want to focus in on are maybe the sternal region, having a look to see if they've got an abdominal abdominal tuck or not or is it quite flat under there?

Any excess tissue at the back of the neck here is gonna be a really good indicator that that pet is not at ideal weight. And then looking from above, do they have a waist? What is their shoulder width in comparison to their hips?

Is it a little bull breed like this? So is it going to be naturally heavier at the front? And is that normal?

You're also maybe going to be looking at head proportion. Does that head look a little bit small for the body that it's sitting on? This is all really good information to gather before you even get your hands on your patients.

So to delve a little deeper into these different scores. I'm hopefully going to show you some examples. So it's a body condition score of 1 to 3, these guys are classed as too thin.

So you can see from the picture here and I scored this, this little dog here is a body condition score of 2. The ribs, the lumbar vertebra and the pelvis bones are easily, visible, from across the room. And if this little guy was wet, you would see them even more, easily.

There is no palpable fat at this point, and those bone knee prominences are visible. It is really important to note that a score of 1 to 3, you will have muscle mass loss. Many people, when they see a very lean dog worry that it might be a body condition score of 3, but provided it has no muscle loss, it would be a score of 4.

You have to have muscle loss to score it as a 3. This is, of course, what we would like. We would like all our patients to be sitting at a score of 4 and 5.

These ones are well proportioned. The ribs are not visible from across the room, except maybe for the very last rib, and they are easily palpable when we get our hands on. They have an obvious waist and they have an obvious abdominal tuck.

Body congestion scores of sixes and now they are classed as above ideal weight are a little bit more tricky to, see from across the room. But there are things that you can, take as giving you a clue. So these guys, when you feel them, will have, a slight excess of fat covering over their ribs.

They've got a waist, but it's now starting to soften, as you can see from that above picture. They do have an abdominal tuck, but again, it's just starting to soften. And even if you look at this picture of the little Bon and look at his sternal region.

Now that might just be fur, but I would be wanting to check that out to make sure that that wasn't excess body tissue over that area. Body condition scores of sevens are now classed in the overweight category, and I've used my Labrador picture here because how many Labradors do we see of this stature walking around? I wonder if a lot of Labrador owners would actually think this is quite a slim Labrador, but he is in fact overweight.

His ribs are very difficult to feel there is a thick fat covering over them. He has noticeable fat deposits over his lumbar area and tail base at this point. He has no waist.

Or it's barely visible, and his abdominal tuck will be pretty much gone at this point. Body condition scores of 8 are now in our obese category, and the ribs pretty much, you can't feel them, or you have to apply a lot of pressure, to be able to feel them under there. They have heavy fat deposits over the lumbar region and the tail base.

There is no waste and no abdominal tuck and you may even see a little bit of abdominal distention. And what strikes me with these guys when I see them is how rectangular they look. If I apply these rectangles over the top, you'll see what I mean.

Even from above, they're again, a very rectangular body shape. And actually this guy here is a good example of how head proportion is not quite right. His head looks a little bit small, for his body, I think.

Body condition scores of 9. I'm sure you can all spot those from across across your waiting room. We now have massive fat deposits over the thorax spine and the tail base.

We have no waste and no abdominal tuck. We've now got fat deposits on the neck and limbs also. And you can see.

Little Oli here, the tissue just behind his head is almost coming up higher than the head itself, and you will see obvious abdominal distention at a 9. And if I reapply my rectangle, you will see now that he is literally spilling out of that rectangle. So I have a little bit of a video here and just while it's playing, I want you to remember these things, that body condition scoring, we only use a light touch.

We use flat hands and we smooth the fur and try and remember to feel all areas. I'm just feeling for hip bones at that point. Try not to focus in just on the ribs.

So once we've done part 1, and we've had a good look and feel, we then must move on to part two. That body condition score again is just a number unless we do something with it. And so to use a little example, if the patient in front of us is a body condition score of 7, that represents the 20% overweight.

So we take their current body weight, divide it by 1.2, and that gives us our ideal body weight. And I'm going to return to this quite often.

You need to find the ideal body weight. It is absolutely vital to your obesity care plan. And here is why.

You must feed your patient for their ideal weight and not an incremental weight. If you feed for ideal weight, you will get successful obesity care programmes. If you feed for an incremental weight, so you're going halfway and feeding at that point, you will not get enough of a calorie restriction or a calorie deficit to get the weight loss that you need.

And so your weight management plan may well fail. And I'm hammering this point home because this is something I see so frequently that people are just not feeding for that ideal weight. OK, so we now have spotted them across the room.

We've got to get that patient to see the right person. The first thing that we would maybe like to do is a nice system for referral. So little referral cards in every consulting room might be one way, but you might want to have a little bit of a practise decision on that.

What is the best flow or system that you could put in place that makes sure that every patient that needs your help gets to see the right person. You can have waiting room displays and weighing scales displays, something like this. I have in my consulting room a wall of fame.

This is where I put all my successful patients, and this is to not only celebrate, but also to inspire others. Look at the difference that can be made through obesity care. You can do it, they have done it.

I also have another board, and this has all my current patients on it. A lot of owners, I think, feel a lot of guilt when they start, when you start to have these conversations. And so this board is to reassure them they are not alone in having to deal with this, and they most certainly will not be, but owners might feel like they are.

And you may even wish to consider some sort of little support group for owners of pets who are who have obesity. Once they are in your consultation, the first thing you're going to need to do is to ask a lot of questions. And this questioning can take a very long time.

So an extended appointment time of 30 minutes, I would say is the absolute minimum. If you can get more, absolutely do. To give you some sort of clue, when we work up a new patient at the hospital, we will be speaking to owners for around 2 to 2.5 hours.

We spend an awful long time talking with our owners. So I know that's not practical in practise, but to try and carve out as much time as you possibly can is absolutely vital. In this initial consultation, you'll be wanting to talk about their medical history, their diet history, so what food are they on, or what have they tried, what treats were they having?

Their lifestyle, and what play they partake in, what their normal routines are. You're going to be needing to assess their exercise ability, the environment that they might live in, like this family here, they live with other pets within the house and also the owner's ability to comply with the things that you might be suggesting. If you're going to suggest to the owner that they walk their dog for an extra hour a day, does that owner's mobility permit them to walk the dog for an hour a day, or do you need to find a different solution?

These are all things that you're going to want to need to know. One of the things that we do to cut down on the time is we use pre-clinic questionnaires. So these are sent out and returned to me before I meet them, and it saves me a little bit of time getting that background information.

I also ask them to feed out sorry, fill out a 3 day feeding diary. This gives me a snapshot into that pet's life. What do they get to eat and at what times of day and what is the reason for them getting that food is all really, really useful information, for you to be working from.

They say you have to ask 3 times before you get anywhere near what a pet owner feeds their pets. And so in the consultation, I use other questionnaires such as like such as this, and hopefully you can see I'm now asking about things like appetite and activity levels, and what times of day they're fed, that kind of thing. And you may need to use different words in this conversation to get out the information that you need, such as treat or snack because owners might have different words for it and doing all this, you're going to be building rapport with your owner.

You will also need to be asking things like, do they get anything before they go to bed? And using situational questions can get you extra information. So asking do they get anything before work or anything after a walk can also help.

Who is most likely to give treats is a great question that can give you some good answers, as is what is their favourite food and do visitors give them food? This is all information that you would ideally like to find out. As part of this questionnaire, I also offer up a food list and we literally run through this list item by item, and I get them to say yes or no to them.

And hopefully, by this point, you will have reassured them that the more you know, the better you can help them. So they will tell you whether they give some of these things. And really importantly, before you finish this list, I always ask, is there anything else that I haven't mentioned?

And I have stopped being surprised at this point at the stuff that comes out. We've had Nan's sugary coffee, we've had kebabs, we've had they lick the yoghurt pot and the auntie gives pink wafer biscuits and anything else that you can imagine. And of course, we need to know all of this.

You're also going to want to talk about medication. So some medications such as steroids and anti-epilepsy drugs will increase food seeking behaviours. They don't make the pet gain weight by themselves, but that drive to seek more food is what makes the pet, often gain weight.

So knowing that the, the pets may be on these types of drugs and might need extra support as far as food seeking goes, is really important. Some medications and supplements carry calories themselves, so things like lactulose, it's a sugary solution and does contain a few calories. Cod liver oil or coconut oil or any other type of oil, to be honest, will carry very high numbers of calories.

And so if your pet owner is liberally putting coconut oil on their dog's food, that is definitely something you need to know about and have a chat with them about too. The other important question to be asking as far as medication goes is what do you give medication in? If they are giving medication in sausages, they will not consider this something that their pet eats, and they will not consider it a treat.

This sausage is for medication and so you must ask to get that extra bit of information. Now, hopefully, we've gathered all that information. We've now actually need to examine our pets.

So, ideally they would have been weighed at this point and hopefully your body conditions scored them also. I take many pictures, in my first consultation, I actually take around 75 to 100 pictures, such as these, but from all angles, so I can get those lovely pictures for my wall of fame, at the end, so we can use them for comparison afterwards. And I'd strongly recommend that you do so just with a smartphone, it doesn't have to be anything fancy.

We also take measurements, so we will do neck, thorax and abdomen just with a simple tape measure, as you can see here. And most importantly is that you record everything. So all these measures that you are taking, give a copy to the owner.

Owners really like these, sorts of numbers and they love to see them coming down. Now we've made our assessment, we need to move on to making some recommendations for your patient. So remembering this energy swing that we're trying to create, we want to send them into negative energy, so we need to restrict their calories by 30 to 50%.

Now the very minimum that we should be recommending is something that is complete and balanced. It is not right for us to do anything other than that. And Ghana now the days when we say that you can just cut their food down and add in some vegetables.

We can't do that because if we cut the food, we cut the nutrients, and that is just not what we want to do for a patient who is in a chronic disease state. We don't want to make them nutrient deficient. And so because of that, we need suitable weight loss diets.

Now, there are some specific rules depending on body condition. So if you have a pet with a body condition score of 6, you could potentially reduce their current food by 10% only and cut out the treats and extra foods. That alone might be enough to get the weight loss that you want, and it's only in within this first body condition score above ideal weight.

Once that pet hits a 7 or above, you must use the specialist weight management foods as well as cutting out the treats and extras. So these specialist foods are balanced for the calorie restriction. So they have had their nutrients adjusted accordingly.

They are nutrient dense but calorie dilute. So the only restriction we're making is in in the actual calories that's in there. And of course, there are many specialist weight management diets out there.

Our ideal weight management diet would have a number of elements, so other than being complete and balanced, it must be satisfying. We know food seeking can be an issue during weight loss and so we need to do everything we can to make sure that it's as easy as possible. So using things like expanded kibble, the kibble shape, higher protein and higher fibre within these diets are all things that will help them feel fuller during their weight loss.

The high fibre specifically, slows gastric emptying, and increases gastric volume. It's that fuller for longer feeling, and that is ideal for what we want. We also want our diets to be available in wet and dry forms and of course we want our diets to be palatable.

Just to note that at the weight management clinic, we do use exclusively satiety. But of course there are others available. So now we've chosen our food, we've got to decide how much to feed.

And so the first place probably that you're going to check is on the back of your bag of food. So looking for those manufacturing guidelines. So to take the example here, if we're trying to return our patients to 25 kg, then you might want to start at 291 grammes.

And if you're getting no weight loss, it then gives you another suggestion of 249 grammes. You may as a practise wish to do your own calorie calculations, and I'm not going to go into this here, there are so many, and even if I gave them to you, you would probably need to discuss as a practise which ones you're going to be using. There is also now an awful lot of online technology that can help you do all of this.

So there are online calculators and there are software that will do all those calculations for you. They will map projected weight loss, they will track current weight loss, and they will even suggest plan alterations if things aren't going as she would like. And remembering, this is my point again, remembering always to achieve weight loss, you must feed for that ideal weight.

So when we're talking about food, these little guys often come up in the conversation, and the use of measuring cups is has been talked about a lot, but just to go through it one more time, I would really like to ban these little guys. They do cause us issues, and we know that using a measuring cup can cause you to overfeed by up to 80%. And you think, how is that possible?

And yet every time that we play this little measuring cup game, these are the sorts of figures that we're getting. Even if you're being careful, and the same person using the same cup and the same food tries to measure out the same amount, it will vary between 15 and 28%. If you think about that, you're feeding up to nearly 3 extra food all day, every day, you can see why weight loss, therefore might become a little bit of a struggle.

Small amounts with a measuring cup are virtually impossible. I will frequently adjust a cat's allowance by only 5 grammes, and you simply cannot do that with a measuring cup. And the consequences of all this means that we might not get the weight loss that we'd like.

And that would be a shame when the owners are doing everything else right. We may even get weight gain and this is of course disastrous and will significantly decrease the motivation of both yourself and the owner, trying to attempt this. This of course also wastes money.

They are buying a specialist food but not using it correctly. And it is not too strong to say that measuring cups can lead to the failure of your weight management or obesity care programmes. And so at the weight management clinic, digital scales for weighing out food every single day are absolutely non-negotiable.

They're very cheap, and all owners hopefully can manage to get them. We'd also like our pets to do more with their food, and we'll talk a little bit about working for it. I'm sure you guys will have all seen these types of things before, so interactive feeding toys, slow feeder bowls and mats and various different puzzle toys.

There's so much out there now, which is wonderful. And there's a few things that we know about the use of these toys that are useful to us, but the biggest one probably is the slower they eat, the more satisfied they are with their portion of food. And I want to just play this little video of this dog, Cleo.

She brought her tea with her to her consultation one evening. The owner was looking for a slow feeder bowl and didn't know which one to get. So I said, why don't we let her have a try with this.

Now, Cleo from a normal bowl can clear her food in under 10 seconds. So as we just watched this play, We're going to see what she does with it. So immediately works it out, is working her way from side to side of the bowl.

Biscuits flying everywhere, that's OK, she's gonna go and get those in a minute. And there we see her walking round the bowl. This is probably already double the amount of activity around feeding that she would have normally done, since she's probably already finished.

So what we also know about the use of these types of bowls is that it increases general activity, especially for our patients whose mobility and activity may be restricted. This is a really good way to increase general activity. We also know that it provides variety and it's fun for our pets to feed in this way, and especially for dogs, as we now know that they are called contra freeloaders.

A contra freeloading means that they would rather work for their food in this way, as you can see, Cleo still going, rather than having it handed to them literally on a plate. And it's because of this fact that they find it fun and entertaining for them. So I would strongly recommend that you discuss these with every obesity care case that you have.

You don't have to spend a lot on on expensive toys. Most owners have got things around the house that they can use to either increase general activity or to use as a slow feeder. So things like egg boxes, my little toilet roll tower here, even a tea tray or an ice cube tray, would be absolutely fine.

And remember, if it is these types of toys, they must be supervised at all times when they are using them. And so at some point, you will probably want to suggest that they portion out the food rather than giving it all at once first thing in the morning. And this is really the minimum that we would suggest that they have 2 meal portions and a treat portion.

Now that treat portion should be you should allow the owner to give that whenever they want throughout the day. If they need food because their pet is asking for food, then that's where they take it from, from that treat portion. Cats, however, are a little different.

So cats actually would like to eat up to about 16 times a day, and I can vouch for this, as my own cat will eat between 13 and 16 types a day. So, 2 meals a day for a cat really doesn't suit them very well. So if you have a cat that is seeking food from their owner frequently, I would definitely suggest, more meals per day because they genuinely might just want to be eating little and often throughout the day.

Now, I've talked an awful lot about food. I'm now coming on to talk about exercise. And it really depends on the ability of your pet, what in front of you, that what you can suggest.

Ideally, we'd just like them to do more. If you can increase it by around 1/3, that would be wonderful, but we know this is not always going to be possible. If they can, things like longer walks or more challenging terrains on their walks would be a good idea, as would increased amounts of play.

Those slow feeders, interactive feeding toys and interactive toys for cats are sort of fish on a string type things are all good for increasing activity levels and little and often for these guys. And don't rush in and increase gradually. Don't let owners get excited and take them for a 5 mile walk when they're not capable of doing so.Build up slowly to that.

And so what I tend to recommend for cats is if they can get their cats to do 2 2-minute play sessions per day, I would be happy with that. Even if the cat is just lying on its side, batting a toy out of its face, that is more activity than it would have been doing if it was asleep on the sofa. For dogs, if they can do 3 or 4 little walks a day and maybe an extra play session, that would be wonderful, but again, very much dependent on a on ability to do so.

But I don't want to overstress the element of exercise too much, because what we know is in fact exercise only accounts for around 5% of total weight loss. It's so important for health and well-being and mental stimulation, but when it comes to actual weight loss, the Small, that the effect is relatively small. And so for those owners that say, don't worry, I'm going to exercise my dog more and he will lose weight.

We need to be explaining to them that unless we deal with the food as well as increasing the exercise, they really are going to struggle with weight loss. Now at some point, the owners are going to bring up the subjects of treats, and this is because owners need treats. But pets need treats also in as far as this forms part of their normal routines, this is something they will be expecting.

And this is what you get. And I call this ham face. These are some of my pets.

You can see my cat here literally trying to grab the ham out of my hand with her whiskers. She's so intent upon it. And this is what owners are faced with this high pressure from their pets.

I had an owner once say to me that her dog's life would not be worth living without its dental chew. And although that might seem quite extreme, and you might wonder how on earth we're going to get those dental chews away, I had to put it to them that if I allowed that dental chew, I would have to remove a significant amount of the food that I was allocating. In fact, for this particular dental chew, it would be 44 grammes of our weight management food, and that's pretty much what I can hold in one hand.

That food is nutritious, that food is filling where that dental chew is not. That amount of food could also last them an awful long time in some sort of slow feeder, whereas again, that dental chew will be gone very quickly. And so when you present it to an owner like that, rather than saying, no, you cannot do that, hopefully they will make the right decisions and choose not to give them anymore.

Those bedtime boos, I would be having to take 28 grammes away, so I'd be having a similar conversation about those. And even the old weight loss favourite, the carrots, I'm not a huge fan because they do carry a few calories, and 16 grammes for a decent sized carrot is what I would have to be adjusting by. So we have to find some sorts of alternatives because we can't just take away, we have to give away, give a little for our owners too.

And so one of the things that I totally stole that I am definitely a fan of is the concept of hugs for ham. It's the, it's the thought of giving affection rather than giving food. And of course, affection can last so much longer, as can play than a food than food that will be gone in under a second.

Owners also might like to give a couple of these. So we frequently use watery green vegetables, so broccoli, cauliflower, and maybe some cucumber. Ice cubes might be good fun and watermelon is also perfectly fine, to give, and these things can be given and not affect the weight loss, and we do so frequently.

But my absolute favourite to give is courgette, because cats as well as dogs, believe it or not, will eat courgette. And before you think I've gone crazy, I'm hopefully going to show you a bit of the video. That is a bowl of courgettes.

And this is Ollie. Ali is one of our courgette eating cats at the clinic. Ali has eaten courgettes throughout his weight loss, and his weight loss has progressed extremely well, and this is one of the ways that his owners manage his food seeking behaviour.

And there he is just quite happily chowing down. On that courgette, which is wonderful. And so every cat owner I do suggest this to and most actually are quite happy to have a bit of courgette.

There is. OK, so we have done all our questioning. We have set our plan, we've made our recommendations.

The owners have bought the food, and we've sent them away very enthusiastic. We now need to monitor, what's going on, in this programme. So I would say initially you must see them all back after 2 weeks and until you're really happy, continue to do so, both cats and dogs.

Longer than that, it's just too easy for them to fall off the wagon. Be available to your pet owners by phone or by email. Let them have a direct way of contacting you if you're the one managing their case because owners often have questions and things get lost on in inboxes or they get lost via reception.

It's really important for owners to be able to contact you easily. Only move to monthly visits if the pet is losing weight very well. The food seeking is not too excessive and it is manageable for the owner.

The owner is confident in what they're doing, and the owner doesn't need a lot of support. If you can't tick all those boxes, I would definitely continue seeing them every 2 to 3 weeks. Owners also need to understand that this takes a lot of time.

Average weight loss is around 9 to 12 months, but many of my patients I will see for over 2 years. And so because it takes such a long time, I like to reward them along the way. And my first little certificate here is at 6%, and I know that seemed like an odd number, but it is actually grounded in science.

6% is the point where we see noticeable physical benefits of the weight loss. And so even if they lost no more, they've already improved the health and the quality of life of their pets. And so that's definitely worth celebrating with them.

We also mark the halfway point. It's very nice, and just to tick that off and 3/4 of the way. Also, this is where things are getting really tough.

So definitely reward them then if you can. And I also have Star Slimmer awards that I give out to my patients. They don't know that everybody gets aar Slimmer award.

It's just another tool that I have to encourage owners that they're doing a really good job, and I'm happy. And there is a really cheesy saying that I'm going to share with you and I apologise in advance for this, but it is true. There is no prize for first place when it comes to weight loss.

Every finisher is a winner, so everyone who reaches their target weight is absolutely a winner. So as long as I'm getting weight loss during, from my patients, I am happy. It's all very well doing, you know, averages per week and that sort of thing, but provided they're losing weight and not putting it on, I am happy.

Of course, once we get to that target weight to that optimal weight, we need to celebrate, and I am able to give certificates and rosettes, which hopefully you might be able to do also. I get their pictures up on that wall of fame and people proudly come in and and look at their pets' pictures. And I would also maybe think about doing them a little weight loss report like this and comparing their pictures or maybe some of their measurements, and really make a fuss of these owners.

They've achieved something really good. Now at this point, owners might think that the hard work is over. I'm afraid the hard work has only begun and long term maintenance can be quite difficult to achieve.

And this is because we know that around 50% of those who lose weight will regain some or all of the weight. And this is a very sad fact indeed. And so we must do everything we possibly can to prevent that happening.

One easy thing that we can do is that we know if they stay on the weight management food they used for weight loss, they are 2 times less likely to regain. That's a nice easy one. We also know that continuing all aspects of the plan helps them to stay on track.

The only thing you're going to do is increase the food to stop further weight loss. And that initial increase will be a 5% increment from their weight loss amount and then weigh them again in 2 weeks' time. If the weight has decreased further, that's OK, but you can go up an additional 5%.

So now we're 10% above the amount they were having during weight loss. The amounts aren't huge, and it's probably worth forewarning owners of that also, that you're not going to be able to double the amount of food during maintenance. And continue to do this, continue to weigh and make sure that you then have that point of stability.

If you get weight gain at any point, you know, therefore, you've got to reduce that portion back just a little bit and continue to weigh, every month until you're absolutely happy that you have good stability. You then at that point, can extend the visits to every 3 months. And after that, you might wish to go to every 6 months as a minimum.

So I try and see all my patients back every 6 months and for every year that they remain at their target weight, they get a certificate from me because long-term maintenance is really hard and we need to try and help our owners to do it. So just to finish, I hope now that you are confident in recognising every pet with obesity that walks through your clinic door. You know what sorts of information that you need to gather from your pet owner, and what elements you're going to need to set manageable plans for the individual.

We've talked about how closely we need to monitor these guys and how you're going to support your owner and hopefully to improve the quality of life for that patient, just like Lulu here. I want to thank Ro Cannon for sponsoring this session this evening. And I would love it if you would join me for part two of this set.

We're going to be talking about tailored plans and problem cases on the 22nd of October. It has been my pleasure to speak to you this evening. Thank you very much.

Thank you very much, Georgia absolutely brilliant webinar, really, really jam-packed, full of information. We do have a couple of questions that are through already. OK.

OK, so the first one is when you feed courgette, do you recommend raw or cooked? So it pretty much depends on the pets. Dogs are normally quite happy to eat it raw.

Cats, we find just steamed, microwaved, grilled lightly, just to take the edge off, is, is usually pretty fine by them. Cats don't tend to like the peel of the courgette very much, so it's maybe worth trying to peel it first before cooking. But yeah, dogs will pretty much eat most things.

Lovely. And if you do give courgette watermelon, cauliflower, do you usually reduce this from their food allowance? So, no, these are water enough and therefore low calorie enough that I don't adjust their portion to give these.

And it's one of the good things about them that owners can therefore feed them fairly freely without causing too many problems. I mean, obviously if they're feeding 1 kg of watermelon a day, that might cause an issue, but certainly, some pieces of melon every day is perfectly fine. Lovely.

And if you have an extremely large amount of weight to lose, would this be the point where you'd consider incremental target weights? So in short, no, we still use the ideal weight for those guys. I'm actually going to talk on this subject a lot more in part two.

So, if you want some more specific detail, then that's the, that's the place to get it. Perfect. And would you charge owners for this service in a general practise?

And if so, what would you recommend charging for a week clinic? That's a really difficult question. I, I have mixed feelings about charging, for these sorts of consultations.

On the one hand, it is, you know, part of that sort of client bonding that you offer this to your practises, patients, on the other hand, as Veterinary nurses, we need to value our time. I don't think there's an easy answer. I think it's something that within the practise you would want to be sitting down and thinking about, and where the sort of comfort level sits.

I don't think it should be an incredibly expensive thing if you are charging. I think most practises charge a nominal fee of maybe 5 to 10 pounds if they are charging at all. But I recognise that it can help with compliance and people valuing your service, certainly, but yes, difficult question, nice one, thank you.

Lovely, thank you very much. And if you have a client that is unable to afford a specialist diet, are there any particular foods you would recommend? So, I, that I know that comes up an awful lot.

The first thing that I would do with an owner who says they can't afford it is work out what they were currently paying to feed their pets. And often owners are really surprised when you add in all the treats, all the chews, all the chicken or tins of tuna or whatever it is that they might be feeding. And work that out per day if you do it in front of them and then work out the per day feeling of a specialist weight management food, usually they are comparable.

So it usually doesn't cost them any more. It's their perception that it's costing more because it may seem like a big outlay, whereas they were spreading their costs over different things before. Really, if we're going to do the best for our pets, we must be recommending the weight management diets is the only one of choice to do weight loss safely for those ones with body condition score 7 and above as I was talking about.

For body condition score of 6. Owners might want to try a light diet, but you can only restrict that, by a very small amount by around 10%, and it certainly isn't going to be appropriate for any, that are bigger, than, than that body condition score of 6. Perfect, thank you very much.

And what should we advise clients who would like to return to their normal diet after the ideal weight is achieved and how much can you reduce their standard? By standard diet by in terms of the percentage. So, the first thing you need to do is stabilise the patient on the weight management food, and then you will know how many calories that patient needs for stable weight.

Now, what you will then look at is how much of their maintenance foods, so their regular food would be the equivalent equivalent in calories. And if that is more than a 10% reduction on the manufacturer's guaran sorry manufacturer's guidance for that weight that you're aiming for, you wouldn't, I wouldn't advise using Maintenance food for that. The other thing that they're going to find is that they're going to be putting significantly less food in that pet's bowl, and it's not going to have all those elements that are going to be filling either.

So not only are they going to be hungrier because they haven't got all the fibre and things in there, they're going to literally be having less food in their tummy. And so I'm always happy for owners to try it, if that's what they would like to do. I never say no, but most often they will struggle and need to come back onto the weight management food.

Lovely. Brilliant. And how would you recommend transitioning onto a prescription diet, taking the old diet into account?

So transition is something that should happen really gradually. If you have a dog that will eat just about anything, I would still transition it over sort of 4 to 7 days, something like that. We don't want to cause any gastric upset.

We want to make sure acceptance is good. For picky eaters and cats in particular can be tricky to transition food, take at least 7 days to transition. And I have actually taken up to a month to transition them.

It's perfectly fine as long as we get there in the end, even if it's one kibble at a time or one spoonful of food, it will be worth it to get them on the specialist food. And I haven't to date failed to get one on it. It really is down to the very, very gradual transition time.

Perfect, thank you very much. And regarding the advances in technology with 3D scanners, have you ever considered this as a tool and can you have so that you can have the volumetric model of the animal and use the software to compare between consultations? I mean, I think that would be wonderful.

I don't believe that there's anybody currently doing those 3D modelings just yet, but I wonder if we will see much more of that in the future. I think the metrics that we have and, are pretty good and certainly weighing scales are pretty accurate, when it comes to actually, determining whether they've lost any weight or not. Their shape, therefore, becomes a little less relevant if we know from the scales that they're absolutely losing weight.

But yes, it would be a very interesting tool for the future, and I would certainly like to try it, not on me, obviously, but, on some of our patients. Perfect. And we've had one about, specifically about the Coronavirus pandemic.

So how are you performing these consults during COVID? And are you seeing them in practise or are you doing them over the phone? That's an excellent question, and thank you for whoever sent that one in.

Yeah, time is really tough at the moment. I haven't until really recently, been able to see any of my patients, which I've been very, very nervous about. I have been doing a lot of telephone con consultations, especially with new patients, getting them started off.

But this is proving, obviously, quite difficult. It's hard. To get owners to send us pictures, but it's always worth trying.

If they're tech savvy, then doing Zoom consultation, so you can actually at least see the pet. That would be really good. But I am now at least things are easing a little bit, so I will see them in the car park, so I can at least take them inside and weigh them, for the owner.

And I hope to be able to continue to do that, but who knows at this point? Lovely. And this is quite an interesting one.

What would you recommend for owners who are using a raw food if they refuse to use the dry food? What I would say is, first of all, I cannot guarantee that using raw food will deliver in complete and balanced diet. And so for me, I cannot advise, I can't advise that ethically.

I can't do that. So if they want my Help and they want, you know, to come and see me, we have to come to an understanding about complete and balanced nutrition and the benefits versus the risks of using raw food versus a commercial food, which I would have much more security in using. Again, because obesity is that chronic disease state, and they're probably more vulnerable for deficiencies, but the fact is, is we just don't know.

Excellent, thank you. And would you ask us whether the patient is neutered or not? Sorry, say that again.

Do you think it matters whether the patient is neutered or not with regards to the weight gain? So we know neutering certainly has an effect, if adjustments aren't made. So from the day that they are neutered, they require a third less calories than the day before.

So it is about being really quick about making that adjustment. So that evening, that next day, that food reduction, should be made, maybe onto a lighter diet or a neutered diet or something of that kind. And to get a small calorie restriction going already and then monitoring weight really closely after neutering, is vital.

We in the UK neuter a lot of our pets, the majority, in fact, in other countries where pet obesity isn't so bad, they don't tend to neuter so much either. And these things are definitely, linked to neutering definitely does cause a problem if it's not managed properly. Other than to say thank you very much, for joining us this evening.

I know Bakeoff's on and it was probably a tough choice. It would be lovely, to be able to speak to you again on the 20th of October and hopefully answer some more of those difficult questions. Thank you so much, Georgia, and thank you, Lindsey for helping out as well.

And a big thanks to Royal Cannon for sponsoring this webinar tonight and hopefully we will see you on the 20th of October. Have a good night, everyone.