Thank you very much and thank you everyone for joining us again. So this is Obesity Care in practise part 2. Tonight we're gonna be talking about tailored plans and problem cases.
So after a very brief recap, we're going to be looking at body condition scoring again, but this time, some of those finer details. We're then going to go on to talk about communication, of course, vital for what we're doing in practise. We're then gonna move on and talk about solving some of those problem cases, and then looking at nutrient density and calorie control, and finishing up by talking about tailored plans and a calculations masterclass at the very end.
So, just to briefly recap, we last talked about obesity being a disease, a chronic and incurable disease, chronic, of course, because this happens over time. And we discussed last time why we consider obesity to be incurable. And it's this swing that we get from positive energy.
Through to negative energy when we want them to lose weight, that then affects their maintenance energy requirement forever more after that. And what that means is these patients always will have a lower calorie requirement. They will need continued obesity care for the rest of their lives and will be very prone to regain.
And that's why we consider it to be a very treatable disease, but in fact incurable. Coupled together with the fact that we now know that the fat cells themselves, releasing those inflammatory adipokines are detrimental to our pets, it's not just the fact that these guys are carrying around their extra bulk. OK, so last time we talked about body condition scoring, and this time we're going to move on to talk about some of the finer details of doing this.
So we introduced these charts to you. I hope you are all familiar with them, in any case. And we talked about how in body condition scoring, this is part one, the looking and feeling of your patient and determining what you can and can't feel, and then allocating them a body condition score.
And hopefully, For those of us who didn't join us last time, we can all recognise that the picture we have of this German shepherd here is very, very similar to the picture that we have on our condition score of 9. So you can, using visual assessments, pretty accurately start scoring these guys before you even get your hands up. So this evening, now it's your turn.
So just to yourselves, we're going to look at some images and decide on their body condition scores. Before we do that, just to remind you of the areas that we're particularly going to be looking at, so we're going to look for an abdominal tuck, or whether the underneath the abdomen there is very horizontal. We're going to be looking for anything excess over the sternal region here, and of course anything spare over the back of the necks and shoulders is going to indicate above ideal weight.
In practise, you may also be able to look for a waist, the hip and shoulders are the one bigger than the other, and looking at head proportion also will all give you a clue as to what's going on. OK, so I want to introduce you to Lola. Now have a good look at Lola and the body condition score, that chart that I've got here.
This is an appropriate size for her. She is half pug and half beagle, if that does help anybody in deciding what score you would give her. And I'll give you a moment or two more.
Hopefully this one isn't too difficult and you did all spot that she has a body condition score of 9. These are the places that I'm looking for when I look at Lola. So first of all, you may have been slightly fooled by the impression of an abdominal tuck.
However, because she is part pug and is heavier at her front end. This appears to go up, but actually it's pretty straight. But looking at the dog as a whole, as of course we must do, Look how thin her legs look and how inadequate actually they look for the rest of her body frame.
We have a lot of excess tissue over her sternal region here. Her tail base, you can see a lot of spare tissue here and all the way running across her back. We have no impression of her of her rib cage here.
We can again see excess tissue over her shoulders and the back of her neck, and her head does look surprisingly small for her body. So well done if you spotted that she was a 9, I'm afraid they won't all be quite as easy as Lola. Moving on to Sydney, what are your thoughts on Sydney?
So again, we have an appropriate chart here. Having a look, just on shape alone, I'm hoping you will be able to pinpoint where he sits on the chart. Now Sydney is a younger dog, again, if that extra bit of information helps you, he's around 14 months old in this picture.
Give you a moment or two more to pick a number. So Sydney has a body condition score of 4. Well done to anybody who put him at a 4.
Now, when I show this picture, people often ask me, Well, I scored him as a 3, and hopefully you'll remember from the last session that to give them a body condition score of 3, we have to see muscle wastage. And as you can see here on Sydney, he has lovely muscle mass. Areas that I'm looking at here, we have in the impression of his rib cage and the last rib is visible, this is perfectly fine and absolutely normal.
We have got this wonderful abdominal tuck underneath, nothing spare over that sternal region. His head in this particular picture, you could argue, looks a little out of proportion, and it's because he's still a little bit of a goofy teenager. It's the, it's the picture more than anything.
He is nicely in proportion in actual fact, and you can see that wonderful muscle on his back leg here. That's why we sit him at a very comfortable 4 on our body condition score chart. Now how about a cat?
What are your thoughts of tiger? Now, immediately we look at Tigger, we notice something that's going to cause us problems. So what do you think maybe looking at the cat as a whole, not just focusing in on that one area?
Give you a moment or two more just to pick your number. So well done to anybody who scored Tiger as a 7. Now of course this primordial pouch toe warmer or mouse pouch, whatever you want to call it, does cause us problems with cats when we're trying to visually assess them.
And of course in reality, in practise, you would want to be feeling that loose skin under there. Is there a fat pad sat in the bottom or is it quite empty? But there are other places on Tiger here that would make me suspicious, certainly that he's not an ideal weight.
Looking over the external region here, I would wonder if there was a bit too much. Again, it could be fluff, but I would, I would be highly suspicious. And also over the shoulders here, and there is maybe more tissue than I would expect at ideal weight.
So well done to anyone who picked a 7. Now I told you I wasn't going to make it easy for you. So this is Alfie.
This is the last one in these sets. What do you think about Alfie? He is of course a Bonn.
And we have our appropriate size chart here for him also. Looking really carefully in those areas that we've discussed already, what number would you give? OK.
So well done to anybody who recognised Alfie is a 6 on our body condition score chart. Very difficult to see from a visual assessment alone. You would certainly be wanting to get your hands on this patient, but there are things again that would make me wonder.
The first thing is here, although he does have a lovely abdominal tuck, I wonder whether that's as good as it could be. Could that be a little tighter up under there? This is mainly the biggest giveaway for me, that there is some excess tissue here.
Again, it could be fur, but if he is clipped the same all the way over, I wonder why that's being pushed out as far as it is. The other places here, just looking over the back, his back above his shoulders, again, I wonder if there is some excess tissue just there. So very well done to anybody who did score Alfie as a 6.
Remembering when we talk about body condition scoring, this is of course part two of that process. We have to use that body condition score to determine ideal weight. And in our calculations masterclass, I'm going to go through all of this in greater detail.
But what do we do in practise when we're faced with a dog like Ted? Mhm. Now Ted is a patient of ours at the weight management clinic.
And this hurts my heart just a little bit to watch Ted struggle up the corridor as he is. He's such a sweet little boy. He's trying really hard to walk for me, but I think we can all see and recognise just how difficult life is, being Ted.
He's such a sweetheart with that little limp there, bless him. But what do we do when we're faced with Ted in practise? Now, at this point, Ted weighed 17.95 kgs.
And so all we could really do initially with our body condition score chart is think, well, he's a 9, but probably way beyond a 9, as I would imagine you would all agree. But what happens when we try to apply that calculation? So we would do his, his current weight divided by our body condition score factor of 1.4, and we get 12.85 kgs.
Now I'm sure you're all more than experienced enough to know that 12.85 kgs is far too high for Ted. His ideal weight surely must be lower than this.
So what do we do? Well, if your practise has been very good at weighing and body condition scoring throughout every pet's life at each visit they come to your practise, you will have the information that you need, and that's why it's so important to do it. The place that you're going to need to look is just prior to early neutering.
So when we look back in Ted's records, he was 8.2 at 7 months old, so just before he was neutered. Now that for me is a much more realistic figure to be getting going on.
Just to confirm that as far as Ted goes, because he is a patient of ours at the weight management clinic, we have our specialist, DEXA scanner looking at body compositions, so I can tell you much more accurately that his optimal weight is in fact 7.7. Kilos.
But in practise, obviously you don't have access to a DEXA scanner, so that 8.2 kg would be a really good place to start. But remembering when you're doing your calculations, they are only ever a starting point.
Do be prepared to adjust as you go. Now whenever I show Ted's pictures and his videos, people often ask me, my goodness, what has happened to Ted? So I just want to show you very briefly what Ted looks like today.
And this video really does make me smile. He is very much a different dog these days. He has lost an incredible amount of weight so far, as you can see.
He's now 10.8 kg. Still a few mobility problems going on there.
We're not quite there yet, but absolutely within his grasp to reach his target within the next year, I'm hoping. So well done to Ted. So in this next section, I want to talk with you about communication because it doesn't matter how good you are at recognising obesity, it doesn't matter how good your plans are if you cannot communicate effectively with the pet owner.
Now when we start to talk about communication, often people ask us what do we do because they have many different fears about these conversations. And for all those Star Wars fans out there, Yoda had something to say about fear. He said that it led to the dark side, and I have to agree.
That fear leads to avoidance and that's our dark side here. We, if we're worried about doing something, we are much more likely to avoid doing it. So tackling those fears head on is what we would prefer to do.
So I hear quite often that I'm worried about, will I say the wrong thing or will I cause an owner offence by trying to have this conversation? Will I drive the client away and do I even have the right words to be able to have this conversation? And alongside this come lots of barriers, so I don't even know where to start, or I don't know what to do that really works, and who in my practise is the best person to help this owner, and are all things that can cause us concern.
And I want to just for a moment, focus not on this lovely smileytaffy that we've got here, but to focus on her owners. Now the language that we use to talk to her owners is just so important. And there is something, it's it's a turn of phrase that is really important to consider when we talk about pet obesity.
And it is this. They are not fat, they have obesity. They cannot be fat any more than they can be cancer or be renal disease.
They have cancer, they have renal disease, they have obesity. And it's that recognition that what we're dealing with here is a disease. So the language that we use when we talk to these owners must be without prejudice.
We mustn't make assumptions of how we have got to this place in that particular day on that in that consulting room, and we must remember not to stigmatise them, remembering always we are here to help. Now we recognise that there are many challenges with these conversations. The number one challenge I get asked about is what if the owner is overweight themselves?
And there is a degree of discomfort with having these discussions in that situation. Well, the first thing I would say here is that unless you're braver than I am, you're not going to be discussing the owner's weight. We are here to talk about their pets, and you are here to help them.
And so making sure that it's clear who you're talking about using the pet's name frequently will help hopefully to mean that there is no chance of misunderstandings. Within your conversations that you have with these owners, you need to have good rapport. And if the owner with you is overweight or so, hopefully, and what happens often is they will start to say, well, my knees hurt when I walk up the stairs, or my doctor told me about my diabetes.
And the thing that you can do then is say yes, and that is how it is for your pet also. So you're not referencing or making any judgments about them, but what you're doing is linking their very real experience of what it is like to be above their ideal weight to what it would be like for their pets to be above ideal weight. And sometimes these owners have not made those connections, and I actually see this as a hugely positive thing.
They really do have real understanding for what's going on. Other things that we might come up against is that we've got to get the owner's acknowledgement of the problem and their understanding before we can start to deal with it. And they will come with lots of fears and preconceptions of what a diet might mean we'll have to deal with.
This of course takes an awful lot of time. It's often not the owner's priority if they've brought their lame dog to you, they want medication. They're not expecting to walk out with a bag of food.
So being gentle with this information and recognising that is important. And there may be concurrent disease going on. They may think this is not the time to be dealing with it, but as we will talk about later, and there is no need to avoid dealing with obesity with concurrent disease.
But there is one very important thing that we have to consider. Already And who doesn't love a rave on a Tuesday night? I apologise for the retro music, but the point is so important.
Are they ready for this? Is the owner in front of you ready to have this conversation? I want to introduce to you here for those who are not familiar with it, with with is the stages of change.
This was developed in the early 80s and it was recognised as this is a cycle that people go through when they're trying to make different changes. So this also applies to pet owner. And so to go round our cycle, we will meet owners in pre-contemplation.
Now these owners have no intention of changing their behaviour, and it is going to be virtually impossible and to work with these owners if they are in pre-contemplation. We will also meet owners that are in contemplation, so they are aware that there is a problem, but they've not committed to any action yet. Maybe it's not the right time for them.
Maybe they're just not in the right space, they haven't got enough time or ability to be committing to an obesity care plan. Hopefully you will get some owners that are in preparation. So these guys are coming to your consultations ready to make changes, asking you what it is they need to do to improve the quality of life of their pets.
That's excellent. We can work with these guys. Hopefully we get them.
Into some action. So this is where they are actively changing what they're doing at home with their pets and leading on, we hope also to maintenance. So these are sustaining those changes and those new things that you have helped them develop are replacing all their old habits.
Sadly though, what we do know happens is relapse, and at some point they may well fall back into their old patterns or old behaviours. But all is not lost, because with each turn of this cycle, owners learn something. So even if they've ended back in pre-contemplation and have no intention of doing anything, for the moment, it doesn't mean that they haven't taken something away from the experience.
Now I can almost hear you saying, well, you know, can't we shove them along this cycle? Can't we, you know, get them out of that pre-contemplation? Sadly, no.
If the owner has no intention of doing anything at all and it's not recognising that there's a problem, all we can simply do is continue to offer to have the conversation with them. So every time they come in, just checking again where they are, things may have changed and they may now be ready to at least start thinking about it. Even those who are in contemplation, we may not be able to move them into preparation.
They may be fully aware that there's a problem, but they're just not in the right place to be actually doing something about it. What I would suggest though to ease the difficulties with these conversations is this, and it is to be routinely body condition scoring every single patient. And when you come across a patient that is above its ideal weight, we can start having those conversations by saying, I would like to talk about the findings of our routine assessment.
So it's routine. This happens to every pet that we see. Your pet is not being singled out for this assessment.
The next thing I would say is, is it OK if we talk about your pet's weight today? It is good to get consent from them to ask permission to talk about this. This can be a difficult subject for people.
And if you get consent, you will get better buy in to what you're saying and better acceptance of it. So once, hopefully they've said, yes, I'm OK to talk about this today, the very first thing that I want to know from them is how do you feel about your pet's weight. Remembering open-ended questions are going to get you much further than something they can answer yes or no to.
And that's a really interesting question, and People may say to you, well, I didn't think he was overweight. OK, we've got a journey to go on with those owners. Some owners may say, yes, you know, we've been struggling with this for a long time.
I just don't know what to do. Again, wonderful. We know where that owner is and we can tailor our approach appropriately.
So once we've had that, started to have those initial conversations, I would then ask them, you know, can I show you how to body condition score because they can do this at home too. Would they like to have a go? Hopefully again, they will say yes and engage with this, and while they're doing it, you can be asking, well, you know, what can you feel?
And you know, can you feel his or her ribs? And if you can, could you count them if you had to? Many owners will dig in their fingers and say, yes, yes, I can feel their ribs.
But actually, when you press them to count how many there are, they really do struggle. And of course, then you can say that should be easy to do and your pet, you know, you may wish to score your pet higher than that ideal weight. And so this is how we get into this conversation without using uncomfortable words, without, you know, feeling that discomfort, I'm hoping.
Once you've allowed the owner to have that go of body condition scoring come to a consensus, you don't have to agree completely. If you've scored the dog in front of you as a 9 and they're scoring it as an 8, that's fine. We acknowledge, and the owner acknowledges that that pet is above its ideal weight, and we can work with them.
We use the body condition score charts in our calculations, but it's less important for owners, so it's not necessary to force or quibble over a score up or down. So, we talked last time about about what our ideal consultations will look like and the different elements within them. Well we know things don't always go smoothly.
So we're going to deal here with a bit of problem solving for those difficult and problem cases. One of the problems that comes up fairly frequently is that they won't eat the food that you're recommending. Now this is kind of what happens is you get the owners on board, they're in preparation, they're ready to do something, you know, they, they're happy to go with the weight management food that you've recommended.
They get it home, and the pet refuses to eat the food. And of course, this is a fairly negative experience to be starting off with. So what I would say, is to every, pet owner who's changed their pet's food, do it gradually.
Gradual transition is so important, even for those ones who their owners think will eat anything, to avoid digestive upset and to help acceptance of the food, take 4 to 7 days. We've got time, you know, it doesn't have to be rushed. If the pet is a particular picky eater, go for two weeks.
Again, we have time. That's, that's not a very long time actually in the grand scheme of things. For those ones that are particularly resistant, I have taken up to a month or longer to transition.
With some cats in particular can be quite resistant, and we have changed literally one spoonful or one kibble per day. But remembering, these guys have been chronically obese for a very long time. To take a month to transition them on to the ideal food is definitely worth taking that time over, to gradual, gradual transition is the answer here.
Now probably the number one problem that we come across is owners saying that their pets are hungry. The first question I ask myself is, is this behaviour? So were they doing this before we started obesity care?
And if we fed them double, would they still ask for food? Sometimes the answer is yes, and so this could not be classed as true hunger in that case. But we have to help owners through this, and we know it can be difficult.
The first thing I would try is multiple meals. So owners seem quite set on feeding once or twice a day. Let them feel free to feed 3 or 4 times a day.
Meals don't have to be distributed evenly, so it doesn't have to be split into 3 equal portions. The dog or cat can have a small breakfast and then 3 smaller meals in the evening if the owner wished. So those times of day when they are particularly hungry, the owner's got food to give them at those times, and there's nothing wrong with doing that.
Remembering cats will eat up to 16 times a day, naturally, certainly feeding cats little and often may suit the cat much better than 2 meals a day. And I would encourage owners if they are around, to be doing that sort of thing. Alternative interactions, so using grooming play, and you know, sort of outdoor activities for dogs can be a really good diversion, if they are appearing hungry, and using using interactive feeding bowls and toys like we talked about in the last session are vital.
This is my cat here at the bottom. She uses her interactive feeder every single day. There are many of these things out there now, lots and lots of wonderful things to choose from, lots of different ones for the owner to choose for the ability of their own pets.
There are one mats now for wet food and of course all those lovely interactive things for dry food. Owners can home make things, so doing using these toilet roll towels for cats is wonderful. So using an ice cube tray would be fine.
Also, we've got a tea tray here, an egg box, and there's a silicon grilling rack at the top there with those little holes, perfect for wet food, but if an owner is going to be using a homemade toy, they must always supervise the pet using them. One of the other elements of dealing with this appearance of seeming hungry is preventing stealing. So the first thing we need to do is remove temptations.
So making sure that that bin is nice and secure, that the pet isn't positively reward rewarded every time it raids the bin. If there are young children in the house making sure that the children are fed away from the pet and the pet isn't sat under the chair waiting for things to fall. And the second part of this is to remove opportunities.
So using the microchip activated feeding bowls are wonderful for cats and small dogs. We successfully use these for small dogs also in the clinic. Using dog crates for larger dogs so dogs can remain in the same room, but can't barge each other off each of their food, is also a great idea.
And you might be wondering why on earth I've got a washing basket. Well, This was a story I was told. It's a very novel solution that I thought I would share with you.
It's not one I've tried myself. But this was a lady who had 8 cats and 8 cat bowls and 8 cat baskets, and they all wanted to eat in the same room together. So she would put down the cat's food in the bowl, the cat would go and eat the food, and it would then have the washing basket placed over the top.
This meant that everybody could see everybody else, everyone could eat their food in peace, and nobody could steal from each other. A wonderful solution I'm sure, I would love to hear of anyone else who uses this successfully. So maybe a novel solution is needed in some cases, so think outside the box, or maybe the washing basket.
Despite all your best efforts at managing that hunger, we do still get owners that say, no matter what, they just pester all the time, and owners find this very wearing, and therefore the temptation to give extra food goes up. Now remember hugs for hugs for ham that we talked about last time, certainly trying to divert them and With affection, slowing their eating down, as we've already said, more frequent meals, making some food swaps, so maybe adding in some vegetables or some watermelon to every meal or in between meals is certainly something that I would advise, and we certainly do at the clinic and using any alternative interaction that diverts that type of behaviour. But there is a concept that I always explain to my owners when it comes to asking for food, and it's this, it's the three types of reward.
Now type number one is absent reward. So this never happens, and there's no expectation that it's going to happen. And so the pet can be nice and relaxed.
And this is what happens in my house. So I don't feed my cat ham from the fridge, so she doesn't bother asking me for a ham from the fridge. It, it's never an issue.
The other type of reward we have is reliable reward. So this always happens. It's dependable and again we could our pets can relax about this.
They will all know what time they are fed in the evening and you can almost set your watch by them because they are, there is a reliable source of food coming at that time, and pets don't worry about that too much. The type of reward that causes us real problems is intermittent reward, and this is something that might or might not happen. The pet has no idea when it will happen and when it won't, and what causes it to happen.
And this for our pets causes frustration and confusion. And so what the pet does is they try extra hard to get what they are after. And so the behaviour actually heightens.
And we get this with obesity care because often, you know, maybe one member of the family is still giving treats or extras or sneaking them something under the table, but the other family members are trying really hard not to. And so it's important that we talk to owners about eliminating intermittent reward because pets just find it so hard to deal with. They either have to say it never happens, which can be difficult, so we could always try, it always happens.
So making sure they've got food to give, making sure they know what alternatives are appropriate to give and can make those rewards reliable for the pets. Other problems that we come across are poor compliance, so they're just not good at sticking to what you've suggested. And this is what I call the picture that says 1000 words, and it tells you everything about what goes on in this family's house, not only for the older dog who is my patient, but also for the younger dog who is being brought into their family.
When faced with this situation, I turn this to the owner, and I ask, what do you want to achieve from this? Why are we here? What were your reasons for starting?
And reminding them of those reasons can hopefully kickstart them back into doubling their effort to comply with what you're saying. What we do often get though also, and I do hear it quite a lot, is that you've got no weight loss and yet you feel compliance is really good. And this is a bit of a mystery, you know, so what is going on?
Well, the place to start is to check Check absolutely everything, make sure that body condition score was right. Get somebody else's opinion, maybe. Have you got the food calculations right?
Are they using a cup at home or are they using digital scales? Has that slipped? Are they even buying The the right food.
I've had owners switch food and not tell me. Are there any extra sources of food, so the dog walker, the neighbour, granny who comes around at the weekend, explore everything that you can, and then asking them again, have any of those old habits slipped back in? And the way that we tend to do this is using daily food diaries to get owners to try and explore the possibilities of why this programme isn't working well for them.
Hopefully it will turn something up. The last problem that I'm going to talk about here is relationship breakdown, and I hope that this doesn't happen too often, but we know it does happen. And it's, it's OK if it does.
It does happen. I cannot profess to be everybody's favourite person. My way of dealing, with people may not be for everybody's taste.
It's not personal, and it doesn't say anything about your ability to manage obesity. It's really important to remember that. The thing to do is to try and get some fresh eyes on the problem, maybe ask another member of your team and to come and have a look.
And for that new team member walking in, you know, maybe think of some new approaches or to draw that line in the sand and go right, let's start again, let's work this up as a new case and see where we get to. OK, so I'm now going to talk about nutrient density and why we calorie control. Now you'll remember hopefully from our last session, we discussed the differences between using weight maintenance diets and specialist weight management diets and how if we're trying to get weight loss using a maintenance diet, we run into problems because we know we have to cut calories, so we have to remove food.
But if it's a maintenance food, we're going to be removing nutrients also. And so I wanted to just put this, hopefully in clearer terms. So this is echo.
Echo is a silly girl, she thinks she's a cat. But these are the choices that I would maybe have for Echo. So here is our maintenance food.
And this represents our weight management food, and this red line here represents the calories that are needed to maintain echo at the weight that she is. Now we know all food has nutrients in it, and they're represented by these blue dots. And just for illustration purposes.
Echo needs 13 of these nutrients every day to fulfil her nutrient requirements and make her diet complete and balanced. And you can see here in our maintenance diet, the calories needed for weight maintenance, we have those 13 nutrients complete. Now this is where the problems come.
So when we try and reduce our calories, you can see here that our maintenance food. Is only left with 6 nutrients instead of the 13 that we wanted. But our weight management food, you can see how much more nutrient dense our weight management food is by the number of extra nutrients that are in it.
So now when we reduce the food, we take away the calories. We have still got more than enough of the nutrition, with only cutting calories. And that's why we cannot use maintenance diets for weight loss because we simply have not got the nutrient densities in those foods to be able to do so safely.
Now the other part of this is why we control calories, and it's that age-old question of diet versus exercise. Now this 100 grammes of chocolate here, I love chocolate, I don't know about you, and I can eat this in around 1 to 2 minutes, probably less if I'm totally honest. And 100 grammes of chocolate carries around 500 calories, to my shock and dismay.
But what I also know, because I have been a fairly crazy runner in the past, is that I have to run for 4 miles or for 35 minutes to run off those calories that I would have eaten in under 2 minutes. And so this is what we've got on the one hand, the calories from our food. Come so quick and easily, and to try and burn them off using activity takes a lot of time and a lot of effort.
And that's why we calorie control. We watch very, very carefully what's going in and remembering, as we said last time, the effects of exercise in total is around 5% . Of the total weight loss.
So it really is quite a small amount, which is why even when we have patients with restricted ability to exercise, we can still get weight loss because we can still control the calories. So I promised you I would also in this session talk about how we tailor plans to the individual. There is no one size fits all in obesity care, they are absolutely individuals.
And so these guys here are some of my patients that all have concurrent disease. So just to introduce you first of all to Lulu. She has severe joint disease.
We have Ruby down at the bottom here with chronic kidney disease and lovely Alf on the right here. He has metatastic carcinoma. So all these guys have different things going on, and we would have different considerations depending on what case we're dealing with.
80% of our cases at the weight management clinic, in fact, do have concurrent disease, so this is something we're very used to dealing with, and you will find it also common in practise. What we would aim to do for all of these guys is to try and reduce their weight by over 6% if we can. 6% is the point where we get noticeable physical benefits.
Especially for mobility, for our patients, so definitely over 6% for all of them. Those who have medical concerns, we would be aiming to reduce their weight by around 10 to 15%, and there's good reason for doing this. We know that once you get over 20% of weight loss, we also get some loss of lean tissue.
And when we're dealing with chronic disease like the kidney disease, like the cancer, we don't want to take away any of their lean tissue, but we do want to help them feel better. So a small modest weight loss of 10 to 15%, depending on their health, of course, will get you some quality of life. Benefits for these guys.
For the cases of severe joint disease and where mobility is a concern, we want to go all the way with these guys. We want them at their optimal weight, because there is no drug that is that is as effective for improvements to mobility as weight loss. So unless there's a really good reason why not, we would definitely be aiming to send these guys back, .
To their optimal weight. This lovely rotty here, in fact, has bilateral hip dysplasia, and we were looking at a hip replacement for her, but she wasn't a surgical candidate. And by the time she'd lost 10 kg of her body weight, the orthopaedic surgeons deemed surgery unnecessary.
She was coping so well, so the difference is huge for these guys. The second lot, that we often see are seniors, so those are the guys that are roughly over 8 years old, and I say roughly because it's different for cats and dogs. So Lucy here is 12, we have Nelson here at 9, and this lovely ginger boy down at the bottom.
He's 16 years old and all respect to his owners for bringing him to us at that age. 37% of our patients at the weight clinic would be considered in that senior category. For dogs, we would consider that to start at around 8 years old, but that's very much breed dependent and for cats it's over 10 years old.
For these guys, if it's just age alone, we would be looking to reduce their weight by around 15 to 20% for the same reasons we want to preserve that lean tissue. If they have concurrent disease also, we may be a little more modest, as we were talking about before. So again, a tailored approach for the individual is needed for these, for these patients.
So the last bit of our session here is a calculations masterclass. Now I know how much pressure you can feel to do these calculations in your consulting room. It's OK to step out for a moment to say, I'm just going to work out these calculations.
So you're not sitting there or standing there sweating and fretting in front of the owner getting hot and flustered. There's there's really a good way to avoid them. Please feel free to take screenshots of these pictures if they are helpful to you, or I'm more than happy to share them, later on.
We're gonna start off with hopefully one that you are comfortable with and it's determining ideal weight. And we're going to use lovely Arthur here as the example. So Arthur, currently weighs 26 kg and has a body condition score of 7 out of 9.
Remembering these calculations here that we're going to use, so this is the one that we're particularly interested in for his, 7 out of 9 body condition score, and this is how it looks like. So 26 kg, his current body weight divided by 1.2, that's our body condition score factor, and that gives us an ideal body weight of 21.7 kg.
Exit. The next thing we might like to do, once they are on their plans is work out what they lost since their last visit. Again, hopefully this one is nice and straightforward.
I'm going to use Dora this time as my example. So last time she weighed 12. 3 and today she weighed 11.9 kg.
So we simply take one from the other. So we have 12.3 kg minus the 11.9 and that gives her a 0.4 kilogramme loss since we saw her last.
The next step on from this is to work out her percentage of weight loss from the last visit. And this is a really good figure to be looking at. It kind of means more overall.
Owners don't understand what 0.4 of a kg means. They don't know if that's good or bad.
And also this is the way to calculate the percentage of total weight loss. So this time we're going to take the weight lost, divided by the weight they were last time or their starting weight and then times by 100 to get the percentage. So here we go.
She lost 0.4% last time. We're going to divide that by the 12.3, that was her weight at the last visit, times by 100, gives us 3.25% that she has lost since her last visit.
And this is good for also working out the average weight loss per week. I'm going to use this lovely lady here because she completed her weight loss plan, and we'd like to know the percentage that she lost, over, over the time per week. So we take how much she lost.
Divide it by the weeks on the plan. So here she is at her target weight, and she lost 38% in total and it took 57 weeks. So our calculation looks like this.
We have 38% divided by the 57 weeks. It took her to reach that target weight, and that brings us out as an average weight loss per week. Of 0.7%.
Now safe weight loss per week for dogs is 0.5% to 3% and for cats it's 0.5% to 2%.
The average weight loss at our clinic though, over all the, over the whole weight plan for both cats and dogs is around 0.8% per week. Now you may have frequently seen that 1 to 2% is what you can expect and in lots of literature, it's written as 1 to 2%, but those figures come from colony studies, and we're not dealing with a colony, we're dealing.
With pets and pet owners and pet owners, neighbours, and so we know that that 1 to 2%, you can expect that at the start, that's fine. But it will slow to under 1% usually as the process goes on. For me, I always reassure my owners, weight loss is weight loss and I'm happy.
As long as it's moving in the right direction, I am happy. So when we are doing our workups, we will often be looking at working out the calorie amounts. And these can be a little bit more complicated, but you all have the ability to do it.
I'm thinking you probably all have a smartphone, and you need to just turn it on its side and you should get this scientific calculator that looks something like this. And this is the button that you're looking for. It's the to the power of button, this X to the Y here.
The next thing that you need to know are the calculations. So when we are looking at maintenance energy requirement, this is just one of many calculations that can be used, and it's using a coefficient of 95. Now these coefficients will change depending on what you're doing.
So for our energy requirement for weight loss, you can see that depending if you are male or female, neutered or entire, there are different coefficients for each calculation. These are for dogs, and this is our one for cats. So our maintenance energy requirement here has a coefficient of 77.6, and this time instead of being to the power of 0.75 as it is for dogs, it's to the power of 0.711.
Our energy requirement for weight loss is then using the coefficient of 42. Now this all sounds fairly complicated and you know, don't worry too much. I'm going to work an example that shows you actually it's not as bad as you think.
This is Bertie. He is a neutered male and his current weight is 13.1 kg with an ideal weight of 8.3 kg.
Let's bring up those coefficients to remind ourselves, and this is what the calculation looks like and I'm gonna walk you through. We first of all choose 70 as our coefficient because he is a neutered male. We are then going to times that by his ideal weight, and then we're going to use our to the power of button, that X to the Y before typing in 0.75.
And hopefully if you're, if anyone is doing this along with me, you're all Getting a daily calorie amount of 342 calories. Now there are, of course, many other ways of working this out. You don't have to do it this way, but it is important that we all understand what goes into these calorie calculations.
Now we have our 342 calories. We've got to do something else with that. We've got to convert that into the amount of food that goes in a bowl.
So how much do we feed? First of all, we choose our food, and in this case, I have chosen Royal Cannon satiety Small dog as the most appropriate diet for him, and that comes in at 270 kilocalories per 100 grammes of food. So this is how our calculation looks.
We take the calories he needs per day. We divide that by the calories per 100 grammes of the food that you wish to feed and times by 100 gets us our grammes. So here we are, 342 calories per day, divided by the 270 calories in the bag, times by 100, gives us his allocation per day of 127 grammes.
Remembering though, of course this is only a starting point, and I can be prepared to alter this if we're not getting the results that you want. Finally, to summarise, I really hope that these two sessions have given you a firm understanding of what obesity is in pets and the quality of life benefits that weight loss can bring them. You've hopefully honed those body condition score skills and are feeling confident, in those, in that.
Good communication is essential for what we do here. So it's worth giving some thought of the language and the way that we speak to our pet owners. And hopefully I've provided a few tools to help solve all the sort of manner of problems that an owner might bring to you, although I recognise, of course, these are infinite.
We have talked about why weight management diets are so specific and why we simply cannot use the pet's own food and how to tailor a plan to the individual based on their age and what else may be going on. And finally, I hope I've given you something that will help. Give you confidence with your calculations, ultimately to improve quality of life through obesity care for your patients.
Once again, a huge thank you to Royal Canon for sponsoring this session this evening and thank you to you all very much for listening. Georgia, that was absolutely fascinating. Thank you so much and I can now fully comprehend and understand why you've shown us so many success stories with your knowledge and passion and the support from Royal Cannon.
It's no wonder you have such great success. So thank you for your time tonight. We really appreciate it.
Thank you. And thank you to Royal Canon for sponsoring not only tonight but part one as well. For those of you that have enjoyed part two, and maybe missed part one, remember that these webinars are all recorded, and the recordings are up on the website of the webinar vet.
We have a load of questions coming in, Jona, Georgia, so brace yourself. I'm going to, take some liberties here and put a whole lot of questions together because we do have a lot of them coming in that are very, very similar. And one of the themes that is running through the questions is this idea of how many meals a day, you know, there's always some research that comes out that proves the previous research was wrong and one meal a day is better or 4 meals a day is better.
What is your opinion on this? Yeah, sure, and thank you to everybody who asked that question. I have also seen the recent research about feeding cats in particular, I believe, on one meal a day and there being some benefits of that.
I think the the thing that we have to think of is that pet owners have to live with their pets. And so if their behaviour is is improved by multiple meals per day, then for what we want to do, then that would certainly be my preference. You sometimes get individual preferences.
So some cats, For instance, want to eat little and often throughout the day and give their owners much less of a hard time if they're able to do so. Sometimes they want to feel really full, maybe it's each end of the day, and that is also fine and it's whatever really suits the individual. The study of feeding cats once a day was very interesting, but it, it, I would be much more looking at the behaviour side and actually living with these cats.
For dogs, I, I don't think it really matters as long as they are fed at least twice a day. You can feed the dog as many times as the owner would like to and feel free to do so, especially if it helps the behaviour. Wouldn't it be nice if we could just say, well, why don't you ask your dog or cat what it wants?
That would make life very simple, wouldn't it? Yes, it would. Georgia, we've got a lot of comments coming through here about, fantastic presentation and so informative.
Thank you very much. And, as Anthony of the webinar vet would always like to say, if we were in an auditorium now, you would be hearing thunderous applause. So it's lovely to see these comments coming through.
Thank you again. Thank you very much. Jose has asked here, do you routinely test or recommend testing for thyroid in overweight patients?
That's a very good question. So we at the clinic, yes, we do routinely check for thyroid. Arguably though, we are a referral clinic, and so, it is that sort of next level that we would that we can do for them.
Underactive thyroids in dogs are actually really rare. In the 15 years that the clinic has been open, we've actually only had 7 confirmed cases. So although the the finger often points towards an underactive thyroid, it's pretty unlikely, but not impossible if they're of the right age and, you know, you've got other telltale signs maybe.
That you're suspicious of, then certainly running that blood screen would be a good idea. I would probably reserve it for the absolute last ditch attempts though to find what's going wrong. I would be looking much harder at everything else, especially the food amounts, before sort of going down the road of, of blood tests.
But yes, we do do it. Also, sometimes maybe not testing for the sake of testing, but testing for the sake of convincing the owner. Yeah, for sure, yeah, if they're happy to do that, then absolutely.
Wouldn't it be nice if there was a test for, oh, but he's got heavy bones. Yes, well, our DEXA scan does precisely that. We can see how big their bones are, so we, we can at least answer that question.
Jade's got a fantastic question. She wants to know, when do you introduce these calculations? Do you do it right at the beginning, the first time you're meeting with the owner?
Or do you get through that initial, maybe slightly awkward consultation and bring in the calculations at the next meeting? I think it probably depends in which way your consultations work. So if I'm the one introducing this topic to the owner, no, I'm probably not going to hit them with it all at the same time, especially because it all takes a lot of time.
What I would probably do is have that initial conversation, let them think about it, gather some background information, and book them in for another extended appointment at a different time. That means that I can probably get a lot of these calculations done ahead of time, so I can be working out based on my body condition score, an ideal weight of food amount, feeding options of wet and dry to offer the owner, you know, a lot of this can be done without being and it's sort of in the consulting room. They do all get done eventually and for accuracy, either doing the calculations yourselves or or using online softwares and that sort of thing, or even looking on the back of the bag is perfectly fine.
But for those of you who want to check and want to work it out yourselves, you most certainly can do the calorie calculations also. Yeah, and get the owners on side. Otherwise it's I think we've all seen it those consultations where the owners start out all enthusiastic and after a couple of minutes, you could just see the comprehension shutters closing down across their eyes.
Yeah, there's only a limit to how much people can take in at once. So, sometimes, you know, reading your own. You know, how much have they so far?
Do they need a second, you know, go at this? That's perfectly fine. Yeah.
Another theme of questions that we've got coming through here is, as the pets weight, should you be recalculating the amount of food you're feeding, or do you stick to the original calculation and to what point? So, really here, if it isn't broken, try it, don't try and fix it. If the amount of food is getting weight loss, fabulous, stick with that.
It is recognised and with most cases, I will be reducing the food at some point during their weight loss journey. It usually happens around the halfway to their ideal weight or just over when things are getting quite tough weight loss might slow at that point. And this is actually because the body tries to adjust, it tries to hang on to the reserves that that pet has got.
It alters its metabolism, so we need to be a step ahead of that. But if you're still getting weight loss at decent rates and remembering a decent rate is 0.5% per week, I'm happy and I leave them be.
The other problem You know, it may be tough at that point and the owners are gonna think, oh my goodness, I simply can't reduce the food anymore. Well then doing things like switching it out for some wet food, adding in some watery vegetables can make that transition to lower calories easier on everybody. So yes, you may well have to.
It doesn't always happen, but it is common to happen. Yeah. Another thing which surprised me a little bit, I must be honest, I knew it didn't play a big role, but I didn't realise it was as little as 5% was the effect of exercise cause some of the questions that are coming through are about, you know, should you adapt the amount of food to the amount of exercise?
Yeah, it's distressing to me also, who, you know, I, I try and stay fit and healthy and, you know, knowing I can undo it all with a few biscuits is, is terribly distressing. But yeah, I certainly don't alter the food amount depending on how much exercise they're doing. If they are doing a sort of can cross or, you know, eyeball or very intense exercise like that, chances are they wouldn't be seeing me in the clinic anyway.
So I, I, I don't, if they're going up, you know, for a one off long walk or something, I certainly wouldn't, be altering the food amounts for that. I would just be very pleased that good steady weight loss is which you will get as a result. Yeah, slow and steady in the right direction is what it takes with weight loss.
Absolutely. Excellent. And I think sometimes it's, it's equally important to keep the owner happy with the weight loss while we are achieving it in the pet.
Yes, very, very much so. If your owner is not on board with what you're doing, it's not going to be successful. Although the pet is the sort of end user of what we're doing, it's really the owner that we're talking to and, you know, managing as such.
Yeah, fantastic. Georgia, I can't thank you enough for a really, really interesting webinar tonight and your, your passion for the subject really comes through as you're speaking. So thank you very much for your time tonight.
Oh, it's been my absolute pleasure. Thank you very much for listening. And once again to our sponsors, Royal Cannon, thank you so much.
For your, your efforts and your sponsorship of this. Without you, we would not have been able to bring this very worthwhile talk to all of those. And last of all to those people who have attended.
Thank you, Dawn my controller in the background, as always, thank you for making everything seamless. And from myself, Bruce Stevenson, it's good night.
