OK, good evening everybody and thank you for joining us tonight on this er webinar which is about weighty conversations er and how to talk to pet owners about obesity. So we're very lucky tonight to have our speaker, Professor Alex German with us, who is going to discuss several topics such as psychological and behavioural factors that can lead to obesity and client communication strategies to help us tackle the issue and I'm sure much more. So Alex is a world renowned expert in the field of small animal medicine and pet obesity, and the management of risk in pets is his main clinical and research interest.
Alex holds the position of Roy Cannon, Professor of Small Animal Medicine at the University of Liverpool. He's a diplomat of the European College of Veterinary Internal Medicine, a Royal College of Veterinary Surgeons recognised specialist in internal medicine. A Fellow of the Royal College of Veterinary Surgeons and finally a senior Fellow of the Higher Education Academy.
If anyone has any questions for Alex, please put them in the dedicated Q&A box that you should see on your screens. We'll hopefully have some time to go through a few of these questions, at the end of the webinar, and we'll try and get to as many of those questions as possible. If you get any other comments, queries or technical issues, please pop them in the other box and our webinar vet team should be able to get back to you that way.
So the only thing for me left to do at the moment is to say a very big thank you to Alex for being here. Er sit back and enjoy and over to you, Alex. Thank you very much, Will, for, for the kind introduction, .
That was great. It's, it is great to be here. If anybody, out there has heard, me lecture before, then pretty much all I lecture on at the moment is pet obesity.
This is a subject, I guess, that has occupied much of my life for the last 21 or so years. And at Liverpool, again, you may or may not know, but we've been running. What we used to call a weight management clinic, we've now rebranded it an obesity care clinic, because of the changing nature of treatment of obesity, and that has been, one of the major drivers about what I've learned about this quite difficult, topic and and subject.
So tonight what we're gonna be talking about is talking to pet owners about obesity. And probably by way of introduction, the, the, the major challenge that we find in communicating to owners is actually. We don't talk to them about obesity.
It's a topic actually we prefer to avoid. If there's anything else to discuss, we would prefer to do that rather than talk about what is obviously a difficult topic for us all. And I just want to illustrate that with a subject, with a, with a study which isn't actually a communication study, it's actually a study of, veterinary records of consultations.
As you can see, it's a pretty small study, just over 20,000 records. And what we actually did, we were interested in seeing how often veterinary professionals essentially recorded terms in the veterinary notes. This is in the free text that they record during a consultation.
So terms that suggested the animal to be. In overweight conditions. So we looked for terms such as obese and overweight, and we used various wildcards and alternatives to ensure we captured this as best we could.
OK. To give you an example, the picture's not the real dog, it's just for illustration, but here's a, a, a history we got from a, a border collie dog. I won't read it out cos you can read it much quicker than I can, can say it.
But you can see actually from this history as you read through, this is clearly a dog with osteoarthritis, it's not having a great time, it's on various treatments including meloxicam, and, and that ultimately is the upshot. Now this is the sort of record that flagged, and the reason is because as you can see, the vet has written overweight plus plus plus, so clearly you get the impression that that is a, a, a, a, a dog that is above ideal weight. So just setting thing, that's what we were looking for.
20,000 records, quick question to you, this isn't for, for answering, but just have a think. How often, what proportion of these consultations do you think where there was where a vet actually recorded such a term? And to kind of put it into perspective and just to help you, we currently recognise that about 50% of cats and dogs, pet cats and dogs in the UK, give or take, are above their ideal weight.
They're either in overweight condition or in obese body condition. So having thought about that, are you thinking maybe 40%, so we capture most but not all. Are you thinking 20%?
10%. Maybe that sort of thing. Well, the number we found.
Was 1.4%. So only a small fraction, and this isn't treating obesity.
It was simply recording it in the notes, so actually acknowledging that as a problem. Now what does that relate to communication? You could argue the vets, well they discussed it, but they didn't write it down.
And that's a fair criticism of this study. The counterpoint to that that I would say is that, obviously your clinical record is your legal record. It's what you would rely on in court were you to be challenged.
And. I guess from a legal perspective, if you don't write it down, you didn't do it. So I think we can probably safely conclude either they spoke and didn't write it down, in which case it's of little importance or they didn't talk about it at all.
What does this suggest? Well, as I've said, it's a topic we find hardy. I would kind of look at it as the elephant in the room.
It's something that is obvious and it's gonna be obvious certainly to vets. Many owners, it'll be an obvious problem, yet it's something we choose not to talk about. So with that introduction, this is basically what we're gonna do for the rest of the time.
We'll start by delving a little bit deeper into reasons why the obesity conversation is a tricky one. And that really I guess will, will, will sort of set the scene. It's similar to the hurdles that we're gonna need to get over in order to do a better job.
Then we'll, we'll probably spend most of the time. Covering what I call the difficult first consultation. If you want to do a better job talking to clients about obesity, then actually the first thing you need to do is actually raise the topic, and that's what you do at a first consultation.
So we'll spend most time on that, and then we'll talk about where you go from there, and give you some some tips. We'll also talk about some of the other kind of communication strategies that I've learned along the way, certainly working with our obesity care clinic about how best to gather information, particularly regarding food, and that's something which is often underreported by clients. And also some ways of, of kind of, learning.
Listening to clients, learning and understanding a lot of what they're saying, and also compromising. So a lot of that communication is understanding where the owner's coming from, what their priorities are, and actually setting a plan which is a compromise, and that certainly wasn't the way I used to run things when we started our clinic. OK, so let's, without further ado, let's progress and we'll now start talking about.
Why we don't talk about obesity. And as I've kind of set the scene in that introduction, obesity conversations are difficult. They're, they're tricky, they're difficult for the vet and they're difficult for the owner.
And the reason is there's a lot of baggage that both, parties bring which make the conversation difficult, and we'll talk about both types of baggage as we go on, but we'll start with the veterinary baggage if we may. So the the the kind of reluctance of vets to discuss obesity comes largely from. The societal view of obesity, not just in pets, but also in owners.
This is something which is problematic. There's a lot of stigma regarding obesity, many people call it weight stigma, or or or fat shaming, and I could spend hours discussing that and the psychology behind it, but it's, it is prevalent in society even now. An easier way of introducing it though is to look at the internet, because some people say the internet is the window to our souls.
So if you search the internet, it is, it, it is flush with videos and photos, such as the ones I'm going to show. Without comments, so just look at these and like think about what your reactions are when you're seeing these videos and images. So I think hopefully you get the impression that that we very much think about obesity obesity in a humorous way.
All of this is in various ways fat shaming, but let's all be honest. I think we all maybe find it hard not to find some of those a little bit amusing. Let's be truthful about it.
That is one of the challenges we're dealing with. Now there's good scientific evidence to suggest that we should be viewing obesity, at least in its clinical form, as a disease. It is a complex multifactorial disease that is actually difficult to cure.
We have a very funny, excuse the pun, way of looking at it. It is skewed. We don't really look at other diseases in quite the same way.
So that's the societal impression and of course vet vets are part of society and their judgments are gonna be clouded by essentially opinions that are, are prevalent. What's much more worrying is that health professionals, medical professionals, and indeed veterinary professionals have themselves a lot of stigma around obesity. Not just in terms of fat shaming, but also in terms of their impressions about how that will affect what they do.
And again if you look at the internet, and it's a sad fact I'm afraid. But it's littered with images, you can quite easily find images like this. This is veterinary professionals, yeah, veterinary professionals who are engaging in fat shaming and again humour.
So sadly, it is something that we as vet professionals are guilty of ourselves. If you want more science about it, that, that this is obviously all relatively subjective and qualitative, but if you want more science, there was a great paper published now, a little while ago, but this one looked at the, it was a basically a survey of, of vets and actually veterinary students, and they basically looked at people's impressions of owners who have overweight pets. Now I don't have time to go into a lot of detail, but for me there were 3 key observations that came out of this study, and essentially the thoughts that the owners share, that the vets shared.
So vets Essentially reported feeling blame, frustration, and actually even disgust towards both. Dogs with obesity, the pets that had the obesity, but also to their owners. These were, obviously this was an anonymous er er anonymous study in, in many respects that weren't reported, but that was effectively what a lot of people believed.
It was very common that they believed that the owners were to blame for causing the obesity in their pets, and they were also very pessimistic about what would happen with treatment, so they were really very negative about whether there was any point in treatment and whether the owners would comply. Now these may be the impressions that we wouldn't actually share with our clients, I'd hope we would never share any of that with clients, but if we are going into a consultation. With this sort of baggage behind us, it's not really difficult to see that that ain't gonna make for a very positive veterinary experience.
So that's the baggage. I want to talk in, and I'll come back to this paper a number of times about a great communication paper which, as I'm gonna refer to a number of times, but it's one of my favourite papers I think of all time. This was a paper that came from Guelph and if you know anything about veterinary education, Guelph leads the way in veterinary communication.
They've done some brilliant stuff. Jason Coe, a good colleague and friend, but also many of his other. His, his, his other collaborators there.
This was a brilliant study because what they did was they basically video recorded consultations, vets with owners, and in this particular work they were interested in consultations with owners who had cats that were overweight or had obesity. OK. And what they actually were able to look at was the ways and the styles in which vets communicate to owners, challenges that the owners faced, actually good practise as well as practise that could be improved.
Now from the perspective of, of challenges, remember, vet has come into this conversation with a lot of baggage about what they believe, obesity to be. Clearly it's not something we wanna talk about. It's an awkward conversation.
And, and problematic. In many of the interviews that they saw, the consultations they saw, there were 3 key observations which I'll, I'll kind of explain a little bit more, but I'll show you an example. So they recognised.
So-called communicative misalignment, they recognised oblique or abstent messaging and also absent recommendation. These were the kind of three features. Communicative misalignment is pretty much, I guess, where you're kind of talking at odds with an owner.
OK, so you, so you're kind of talking at cross purposes. Often the, the, the, the vets would kind of subtly hint at the, the issue of obesity without saying it, and the owner was kind of misreading and misunderstanding what was being said. Second one, which is related with so-called oblique, oblique and absent messaging, that's basically speaking in tongues.
We don't want to actually talk about obesity, so we don't, we kind of, as I said, hint about it and it makes it very difficult for the client to really know what you mean. And I'll show you the example in a moment. And the final thing was no sooner did they talk about it, but they changed the subject.
They didn't really wanna cover in any detail, so it meant that the owner was left with not having any particular recommendation about what to do. I'll give you an example, it's actually one example that kind of shows this. So this is narrative from this consultation, OK, and again I won't read it out there cos you can do that for yourself, but you can see from this er initial consultation, but basically this cat's overweight and the vet is trying to hint that maybe part of the problem is he's eating too much food, but he doesn't even say anything about being overweight, you know, wouldn't want him meaning to get any bigger.
And maybe he's getting more food without saying it, and this is probably his best advice, and I say he, it's, it may be she, but it's probably more likely to be men than women, sorry men out there, but I'm as guilty as the next. Just cut back otherwise. Not particularly helpful.
Now, the client does actually listen to this and, and actually picks up on food and then is worrying about the type of food that they're giving, so talking about possibly is it an organic food, too much fat and things. Obviously, it's nutrition, as vets we hate talking about nutrition and so perhaps he's in the vet's on even more edgy ground. But then he's kind of talking a little bit about well maybe about you know, the, the, the, the, the constituents there, but maybe it's, maybe it's the right food, maybe it's not.
So really, again, there's nothing helpful for this owner. He's raised the problem but not really said anything. And at this point in the conversation, they change and switch to talking about something else.
At the end of the consultation, not the vet, but the owner comes back to this. So they'll talk about all the organic foods, you know, and she's wanting to, to, to see whether there's, a, a, a light version, a lower calorie version, which that obviously agrees with. But really doesn't say anything more than that, doesn't give any recommendation or advice about how to change it or types of food or what to look for or any follow up there other than just checking, oh well, the cat's, other cat's been on the same food and that cat's fine, well, OK, so be it.
So I hope within that you can already recognise the oblique, the absent messaging, you can, you, you can, you can see also this absent recommendation and all of those three features that we were talking about. So I could say a lot more about the psychology behind veterinary communication and why obesity is such a difficult topic, but let's, in the interest of time, let's now focus a little bit on owners, cos it's not just the vets, owners will bring baggage as well. They'll also, they'll partly bring that baggage of, of society, so they'll be aware of that and obviously that will, will cloud their thoughts.
But there's a lot of other owner unique things. First one I want to mention is that essentially obesity is a family issue. OK.
So what do I mean by that? There are very good studies to show that children that are born to parents that are overweight are highly likely to go on and become overweight, develop obesity themselves during their life. Part of that is clearly genetic, but it's not all genetic.
There's a nurture component, an environment component as well. And there's some great work looking at what they call the family food environment. This, these are the kind of attitudes, philosophies and activities regarding food and feeding and other kind of health related issues.
And it's thought to be that that plays a significant component. Why is that important for pets? Well, most owners view their pets as another child, and so they're sharing the same, what some people call obesogenic environment.
It's an environment maybe where there are similar features, and it, and it's likely therefore that those same attitudes are going to spill over. OK, so, that's one thing which is important as well, that not uncommonly we have a situation where, You have an overweight pet and there is an and they have an overweight owner as well, and in fact there are studies that show that. Now, there are some other implications to this as well, .
One of the key points and studies have shown this, again, I'm showing one of, of, of our studies, there's good evidence that owners who have pets with obesity tend to have a much closer relationship. So their, their, their pet, but some of the things they say in surveys, this was a survey, suggest actually a much closer relationship than other pet owners. So in this particular survey.
We found that owners who had pets that were overweight, these were dogs that were overweight, were more likely to let them sleep on the bed than owners that had dogs that weren't overweight, and also were more likely to refer to them as their baby, rather than other terms. Another member of the family, another child, a friend, or a companion or something like that. So the term baby, and, and therefore suggesting a child of nurturing age was a much, much more common thing.
That is particularly important because as we know, the number one way that we show love for our pets is with food. This is critical to the relationship. Food is love, OK?
If we want to show we love our pets, that's what we do. We give them some food, but we give them a treat, OK? And there's evidence of different relationships between owner and pet, where the pet is, is has obesity.
So for example, a couple of studies have shown in both dogs and cats that that owners of of pets that are overweight observe them much more closely when they eat, they kind of pay more attention and more concerned about it. They allow or more likely to allow the pet to be present when preparing the food, and actually, in fact, they, they, they like that, like seeing their pet get excited. And there are other studies that show they're more likely to feed snacks, table scraps and treats, OK.
And, and those themselves have been implicated in, as, as, as a kind of cause of, of, of, of pet obesity. So we've basically got this family food environment that, that is, that is there, and I say that, that love that people use for, for, for, for food, is that you know, comes out and it's critical. So that's important obviously in terms of cause of obesity and recognising it.
It's also important when it comes to treatment because currently still the number one strategy for treating pets with obesity is essentially a weight loss plan, a diet-based therapy. And because that's going to impact on food and how they feed their pet, that they may have greater reluctance to change and therefore to agree with what you're advising, OK. Not only that, if there is an association with obesity, so the pet the pet owner themselves is overweight, they are likely to have been on many diets and have negative opinions about success on that.
People hate dieting. I've been on many diets through my life, and I know how much I hate it. And it's no coincidence that the first three letters of diet, spell, well, you've guessed it, die.
That's how people feel. They, it's a negative, negative thing. So it's not another treatment where they're seeing good.
All they're seeing is I'm depriving my cat or dog, they're gonna hate this. Now you'll be aware that drug therapies have revolutionised the treatment of obesity in people. They're very, very effective, and they are likely to be available for dogs and cats very, very soon, and that's that's a positive.
We will not circumvent the issues though with treatment, and the reason for that is they affect appetite. And that means they will change the relationship between pet owner and pet, and that's actually why the previous drugs we had licenced for, for dogs and cats about 1520 years ago failed because owners didn't like the new relationship where actually the pet was less interested in them because they weren't hungry. So I think there will still be challenges here that we need to circumvent.
OK, so food and and and those relationships with, with obesity are important. Couple of other things from an owner perspective, and this comes more for diagnosis, it is well known. That people underestimate obesity in themselves, in people they love, and also in their pets.
So we tend to see ourselves as slimmer than we are. If we have children who are overweight, we tend to think they are slimmer than they are. So in this particular study, which is a meta-analysis, so very high quality evidence, 70% of parents, when asked to estimate their weight, the weight status, how overweight or ideal weight their, their, their, their child was, 70% of parents underestimated it.
And yes, you've guessed it, there's a parallel with our pets. So this was a study we did where we got vets to body condition dogs. This was a 5 point condition score unit.
We got owners to do the same when we compared the owner scores with the vet scores. So just focus here on the BCS 4 to 5, so that's overweight dogs and dogs that have obese body condition. And almost 70%, very similar to the human work, in almost 70% of cases, the owner's body condition score assessment was less than that of the vet, so they tend to underestimate.
Now that could be problematic because you recognise there's a problem medically, but they may not be as convinced that there's a problem because they're not seeing that for themselves. So obesity conversations are difficult and remember it's all that baggage that comes to the consultation room. So that's all the bad news in many respects.
Let's move on hopefully to some of the positives, which is how can we do differently and how can we develop strategies that will circumvent many of these issues and challenges. And as I say, the main thing I wanna focus on is getting the initial message right, and how do we do that and how do we kind of. Yeah, I guess overcome our fears about what might happen if we talk about obesity.
So What I mean by the difficult first conversation is the first time you see a pet or the first time you're gonna decide you need to have a conversation about overweight and obesity with a, with a pet, OK. So it's the, the most, the hard point cos you're gonna have to, to raise the topic and there's a fear about what might happen. And I'm gonna break it down into 3 steps.
Step number one is what I call break the ice, so that's where you actually tell the, the owner about the weight problem. Then the second step is keeping it going, so it's not dropping the subject as we saw in that previous consultation advantage, not changing the subject, moving on, thinking job done, but actually making use of that now you've got your foot in the door. And then finally it's about making a firm and clear recommendation, so what I would call closing the deal.
So we'll look at these three, and how you can best do this in turn. So let's start with breaking the ice. And before I give you guidance as to how to do this, I've got a question for you.
We're, we're not set this up as electronic voting, but if you wish to, if you wanted to, set it up in, if you just wanted to put your answer in the chat, there's, it's a 4, ques, you've got 4 options. So the question is what is the best way of starting a conversation about obesity? And I've got 4 options for you, OK, so have a think about these, if you want to, if you're brave enough, stick it, stick something in the host for us, stick something in the chat for us, and we'll have a look at what you come back with, OK?
If you don't, fine, but at least play the game and think what you think. So, you know, do we tell a joke? Do you ignore the owner and talk to the, the pet itself, maybe you get a more sensible conversation from them.
Do you choose to talk about something different? Or do you try and get them to raise the issue, and I've got, we've got 3 already for D, so that's 100%. Don't be sheep here, I've got an A, crank, thank you.
So someone would tell a joke. Mainly D's are coming out here, which, surprises me, but, you know, interesting. A's or D's, anybody want to go for B or C?
Are they the worst strategies, who knows? OK, so that's good, so it's, so actually I know you, Daniel, Daniel Alcazar, I know you, I know that. But that's it, fair enough, some people say tell it like it is.
Anyway, bit of fun, so. Believe it or not. All of these strategies are possible and all can be effective, OK, you just have to do them in the right way, which is interesting.
So there wasn't a right answer, but I'm gonna talk you through and I'm gonna give you some examples again from, the, the, the, the, that communication paper and also kind of tell you how to do this, so. So I call these icebreakers, remember we're breaking the ice. The first way, believe it or not, could be some gentle form of humour, OK.
And I should stress this, you've got to do it in the right way. It's gotta be with the right client and you've gotta be very careful. And from this study there were examples of very bad practise here where people tried to make a joke about it and it backfired.
So probably for me this would be the my least favourite one because you could be wrong. If anything this can happen spontaneously. So if it's a spontaneous moment that you've not you know, engineered or created, then make use of it.
And I'll give you an example, this actually shows it quite well. So you see here in this, in, in this, interaction. What's happening here is there's two cats, one's overweight, that's the cat, Peanut.
The other one, we don't get the name of them, is, is not. They're talking about food and, and, and the other cat, the, the client's tried to give the food to the cat but didn't like it. When they then look at and talk about Peanut, the vet chips in, you know, and, and, and, so the client says the other one didn't like it, and the, and the, and her sister Peanut, and as you see, the vet said loved it too much.
So actually it was a spontaneous moment. And they both shared it. And, and that was a good way of at least breaking the ice.
So sometimes it works if it's gentle. It's spontaneous, OK, it has to be the right client. One of the things you'll notice here is the vet hasn't mentioned the word obesity or anything like that at all.
They're talking about food, but they know and they've recognised the problems there. OK. So sometimes, but be careful, humour might work.
Actually, the second one, which is what I call patient directed speak, is probably one of the best strategies of all. It wasn't picked by anybody, but it was, we, it was a non-scientific survey. Every, hopefully you know what this is, we do this all the time.
Remember, as vets, we, we've got two, patients, we've got the owner and we've got the, the, the pet. And actually I'm sure most of you do this, I do this, you talk, you talk to the, the pet as well. Partly you need to show the lion or at least pretend you love their pet because then they'll trust you more.
OK. This is a brilliant way of raising the topic of obesity, and again, I'll give you another example of, of some. Of, of an interaction here, but this is a, essentially an annual health check, and what the, what the, the, the vet is doing is obviously talking to the, the client, talking to the, to the owner, whilst the client is listening.
This is the beautiful thing. So you can, you can share some gentle bad news this way, but you're talking to the, to the, to the, the, the pet, so the, the owner can choose to ignore it, but they'll hear what you say. So.
They've praised the the the the cat, said how lovely the cat is and how much basically they, they, they, they, they know this cat. Cat gets on the scale and it's gained weight. So they've just kind of said, oh, just a little bit of weight gain there.
Again, talking to the, to the cat. At the same time, if you're using this strategy, you just keep an eye out about how, how did the owner react to that? And if you sense it wasn't them shutting down, that again may be an opportunity at that point to come into the next stage.
OK, so that's icebreaker number 2. Talking about something else, brilliant, brilliant strategy, but you have to talk about particular things that indirectly relate to obesity and overweight. So probably the best example would be rather than talking, saying, your cat's overweight, your cat's fat, your cat's got obesity, .
Talk about body condition. We're talking about body shape now. Now the client will know you're talking about obesity, but you're not making them uncomfortable by using those terms.
It's often the use of the terms as you'll see, which is a challenge. So beautiful, it's great if you've got a body condition score chart in your practise, use it and that's a great way of illustrating things. So what you can do is you can say, well, one of the things we want to do to check for health is just the kind of shape and and you know, the shape and size of your, of your pet, and we use a body condition score and you can actually, if you want, demonstrate how to do it.
Better still, ask the client to have a go based on the chart. Now imagine it's a 9 out of 9 dog and they call it a 6 or 7. OK, they've underestimated it, but at least you're in the same point of the chart, and for me that's an opportunity to, to, to go further.
So again, it's a non-confrontational way. They'll see there are words like overweight or obese on the chart, but you're not mentioning them yourselves and you're doing it in a way about, again, talking about something else. So talking about, body condition's great.
Weigh scales and as we saw in the pre, you know, the the previous consultation, weight gain, talking about oh you, oh, there's a little bit of gain here, what we do like to do is keep them at the same weight, but there's a little bit of gain, again, you're not, they know what you're talking about but you're not saying about it is a great way. And of course the other one would be food and feeding strategies. And then finally, a lot of people chose tricking the owner, I love this one too, .
Now, I'm gonna show you something which is something I learned actually from a French vet, and, and what you'll realise, and I should be honest here, is I don't actually have an original thought myself, I just steal other people's ideas. And this was something I, it, it was in a round table that he said he did, and actually I thought it was a great way again of getting a a foothold. So this is typically very good for the annual health check.
So what he would do is the kind of standard head to tail examination. But he would have a checklist in full view of the owner that he would fill in as he went along. And he obviously made a point that the owner could see this, OK.
So he'd go through his examination, obviously checking things off, everything's alright, ears, eyes, nose, mouth, heart. Get to the body condition one, do the body condition score, and if the cat or dog was overweight, all he'd do was record a cross and then move on and complete. And what he said he found in a significant proportion of of of of situations, not all of them, is he'd somewhere along the line he'd get stopped by the owner and say, oh wait a minute.
What's this here? You've, you've put an, you know, you, you've, you've put an X here, what, what's wrong? And, and then he felt that that would then he could explain, well, I've done the body condition and, and this is what we use to check on, your body shape and, and here's the issues, and, and the difference then is the psychology cos it's the owner bringing it up, but it taps into that feeling of we want to pass everything.
It's like an MOT, it's like a test at school. And so straight away then, for them it's, it's a concern as to why has the vet scored something which isn't optimal. So another great strategy.
Before we move on to the kind of next stages, I just wanted to make a few other general points which I would call top tips. These are things I guess I've learned in terms of how you have the conversation, how you frame it, and a lot of what we've kind of covered already, you'll see within this. So first tip, first rule.
Whatever you do, avoid any blame for the owner for causing the obesity. That means you have to park your prejudices if you have them. So if you're one of the people that say it's all the owner's fault, it's easy, you just feed less, you exercise more, I have to say that is a great oversimplication, having.
Worked in this field, but if that's how you believe it, fine, but park your prejudices at the door, there's no help to be gained in, in blaming the owner, I'm afraid. What you should be doing is looking forward and you should be there to support them and hopefully do less, and you only do that by gaining their trust. As you've seen already, whilst technically obesity is a disease, as I've said, and we should be using the term, it's a hard term to use, so avoid toxic terms, so avoid the F word.
Maybe not the word many of you are thinking about, but fat. And of course avoid the O word or the O words, so obese, overweight, those things. Now studies show that these can be tricky for both people who have obesity themselves and obviously owners that that have pets that have obesity as well.
So better to avoid those in any other kind of derogatory type terms. And as I say, it's better to, if you're talking about, you know, a little bit of weight gain, maybe above ideal weight can, can potentially be used or using a body condition score, so it's a number rather than, a, a, a, a name, I think is helpful. Now one of the things and one of the major reasons vets say for not raising the topic is the situation where the client has obesity themselves and as as you've sort of seen there's it it it's common but there's a reason for it because of that family food environment.
And they always, it's one of the frequently asked questions, what do you do if they're overweight, how do you raise the topic then? Here's my answer, treat them in exactly the same way, OK, but just don't talk about their obesity. After all, you're not qualified to.
You are an animal doctor, an animal nurse. All you're qualified to do to do is talk about their pet, so ignore it. If they wanna bring it up, and sometimes the some owners will as a, as a way of humour, and again you can, you can use that, but, but just otherwise talk to them as it were.
You're, you're caring about their pet. And that kind of brings on to the, a nice, I'm not us a nice that's the next one, which is to show empathy with the conversation you've got. If you are showing you're caring and you want to do the right for the, for the client, they will never be upset.
Right, final rule, and this comes the, the, I guess bridges the gap between what we've just been talking about breaking the ice in the next stage, and it's something that actually comes from conversations about human obesity, so doctors will have and how they're trained. Major recommendation at this point. Ask the owner permission to be able to talk about the subject.
OK, so you've said, well, you know, we've, we've, we've talked about the weight and there's a little bit of weight gain. Would you be happy having a conversation about this now? Now the owner can say yes, they can say no, it's up to them, so they have some agency.
But the beautiful thing about that is that psychologically they're more likely to say yes just cos you've asked them. It's a great way then of being able to, to put, you know, to, to move forward, and clearly if they say no they ain't ready. So That's, I guess, starting the conversation, that's the icebreaker, and now let's assume we've got our foot in the door.
What do we do then to kind of keep the conversation going? In the obesity communication study, one of the things they reported on in terms of good practise was where vets practise what they called helical conversa com communication. Sounds very technical, all it means is spiralling back to the topic through the through the consultation, so doing the opposite of the earliest example of changing the subject and not coming back to it.
But actually using it, so if there were other medical issues like lameness, building them in your conversation about obesity and continuing, so that probably is the best strategy. If you've got a foothold, don't lose it. Keep it going.
And then ultimately we have to kind of close out and remember you need to make a very clear recommendation, you need to be looking in the eye and say we've, you know, we've talked about this. My recommendation to you is this. Your recommendation at first consultation is gonna be very difficult for later on, but do remember you need to communicate something clearly which is this is what I'm recommending we do, we do it very well for other diseases and other treatments.
We do it very poorly for obesity. Now, the recommendations you give and how you would do it would depend very much on how prepared the client is for change and, and you may have seen this, I'm not gonna dwell on it, but it's a, a kind of psychological er framework for. It's, it was mainly came from the medical side, but people preparing to make life changing decisions relate health relate related to health.
This, the, the first paper was about smoking, as you'll see. And they go through various phases from pre-contemplation where they're not ready to contemplation where they may be thinking about it for the future, preparation where it's the decision is close, and then action, and of course there can be relapse and so on which we won't cover. I just want to kind of show you clients will be at different stages and so what you recommend and what you and and how you do it will depend on the stage.
Pre-contemplation, this is the point where the bottom line is they're not ready. So there's no point in making any recommendations about treatment, you've just got to give them time and hope they'll come round. So for example, a a a client might say, well, my, you know, my cat's meant to be this size cos they're a big breed.
OK. Clearly they're at pre-contemplation. What you do Is you do the ask permission, if you've raised the topic.
You don't make a strong recommendation for action, but you try to leave the door open so you can have the conversation later. So you might say something like, would you be open to chatting about the, the weight, if they're not. Then how about following up with, well, why don't we just book him in again, free weight check and we just see where we are.
OK, that for me would be a good way of at least seeing if you can keep the conversation going and and coming back to it in the future. Contemplation here, remember they're, they know they need to make a change, but not right now. So the priority is not enough.
They might say, for example, say something, well, I know we need to do something, but I've just not got the time or there's too much going on or it's, it's, it's too much to contemplate. Empathise with them is the first recommendation and see if you can get them thinking about a small step that might be easy to build in that that won't necessarily make much difference, but gets them started. So you might say something like, well I know it's hard, yeah, we we're all busy and it's really tough, I know that.
And say, well, you know, maybe could we do something to see, you know, so it might be for example, dropping the treats out or increasing the exercise or or or something like that. But you can actually ask them, and again, sharing that decision making with them is very good, you know, what do you think you might be able to try just to, to give it a go. Preparation is where you want, that's where you want them, OK, that's when they're ready to hear your advice.
So they might be like, I'm really keen to get on, what, you know, what food did you say you know you mention of food. Now they wanna start straight away, but actually it's not sensible to start the plan straight away, you need to schedule a separate conversation about that, OK? So you what you need to do is almost .
Not burst their bubble, but you need to kind of share their enthusiasm, but just, just ramp them down a little bit for when it's ready. So. Be, be enthusiastic, try to start establishing a partnership cos that's where you get most success with treatment.
And one of the things it's nice to do early on is to think about why, what are their reasons for wanting the weight loss, what do they want to achieve? I'm hoping this isn't just, you know, I don't, I don't want the scales to be lower cos that's not helpful, but they might want their dog to be more mobile, they might want better quality of life, they may be worried about future illness, cos what you can then do is come back to that with the plan to make sure you've got setting some smart goals. So you'd say, well, great, you know, let's work together on this, and then you might say, what are you hoping to see, just a few questions now, but we'll, we'll, we the hard work is still to come.
OK, so I just want to kind of end up in the last few minutes just covering a couple of other areas very, very briefly, just to sort of give you sort of heads up about I guess how we can kind of, get the best out of, some of the future conversation when you're actually dealing with weight management. And one of the big areas where I've felt there have been challenges is with gathering particularly information about diet. And that's often a reason for failure cos unless you fully understand what's being fed and how much is being fed, it's really hard.
So typically. When we're talking about gathering food, I have 3 strategies. You wanna make sure you're asking open questions.
You need to ask them more than once and in different ways. And you also need to understand a little bit about why it is that they're feeding things, . For an open-ended question, hopefully we know, that about open-ended questioning for communication anyway.
Open-ended questions where an owner can create a narrative is a really, really good way of actually getting much of the information you need rather than kind of thinking about single points of information where essentially what you get back is, is very limited. So when it comes to, to food, typically people will say, well what do you feed your pet? That's a closed question, so again in studies that the Guelph team have done, most of the time you just get the name of the product, nothing else.
We need more than that, we need how much, how often, but we also need to know about treats. This is actually Guelph, and I think it's brilliant. The recommended open question for getting that diet information back.
Please talk me through everything you feel fluffy in a typical day from first thing in the morning to last thing at night. Why is that good? It's open ended, the client can create a narrative, but you've given them a framework.
So you've said, starting from first thing in the morning, everything you feed to last thing, so as they go through, they will remember things. OK, so that's one way of questioning. The other things we do is that we ask more than once, so we actually have a questionnaire that we send to them before their appointment, so we've got some information there, as well as asking the question in the appointment, we'll also then work through that questionnaire and clarify things, and then actually at the end, the third thing we do.
Is we actually, when they think they're done, we hit them with a list of stuff. There's a list of treats, human foods and other things that we know that mostly do. And you'll be surprised how much information comes out the third time, even though you've gone through a lot, a questionnaire, they've told you, do you ever feed this?
Oh yeah, I feed, occasionally feed popcorn, oh yeah, oh no, you do it, you do it, cause often if you've got more than one client there, it, you know, owner there, it's brilliant cos they, they dob each other in. And then kind of the final thing I just want to mention is that from feeding point of view, and one thing I've learned is it's not just what they feed, but sometimes you need to understand why, because unless you do that, you can't necessarily find a solution, and I'll just give you a case example here. This is a dog called Bailey, rough rough coated collie, very, very overweight when Bailey presented to us, so 38.5 kg, was a, what I'd call a 9 plus so beyond the scale, OK.
And this is a classic example of the not just what, but why. They were very motivated at the start of their plan, so we set a standard plan, we'd gone through all of our, the, the, the, the questions, and, and we kind of started off on the plan, and actually, initially things were very promising. So you'll see actually in the first couple of months, we've got 7% weight loss, which is pretty much bang on what we'd expect.
But then for the next 3 months, nothing happened. Things had ground to a halt, and it was difficult to understand why, and so we actually had to have several conversations with the owner before they admitted. Well, actually I've used to give cheese, but I've been giving cheese again.
And we kind of said, well, this is obviously part of the reason, is there any way we can change that? And they refused to change it. I can't give up giving the cheese, and it, and it's like, but why, this is ridiculous, you, you know, your, your, your pet needs it, but why?
So Here's a great point again. We need to know why. Ask an open question.
So what we said was something like, you know, can you just share with us what, what are the reasons for it? And basically it turns out that what they have always done through this dog's life was prepare the food and the dog would be present, remember that's a feature. And they'd grate a bit of cheese on the top.
And Bailey would get really excited seeing the cheese. And so what we learned was that Bailey loved that ritual, but more importantly, the owner craved seeing Bailey and having that ritual. And so we're talking about that, they kind of understood a bit about that.
And then of course, shared decision making, we actually asked them, well, you know, are there any other ways you could do the same thing? And actually, I never would have thought of this, they came up with a brilliant solution, which was, well, OK, we can, they instead use a water spray, and they found that spraying the food after preparing created the same excitement in Bailey that the cheese did, but without the calories. So I think hopefully that kind of you know really kind of sums up I think a lot of what we need to see.
Sometimes you need to understand why as much as where. So we're out of time, I hope you've enjoyed it. Just to kind of summarise what we've talked about, remember the major issue about talk about obesity is we don't bother because we're frightened to, cos we have stigma, we're worried about how the owner would react.
And you know, there, there, there, there, there's a lot of baggage associated with, with this conversation. I hope if you think about that three stage approach, breaking the ice, keeping the conversation going, and closing, if you can be thinking about those and particularly some of those strategies for, for getting the conversation going, you might find it easier to, to be able to, to talk. And then I kind of talked about gathering information, .
But sometimes compromising is, is a feature as well. So, so just on that, with Bailey, we didn't achieve complete weight loss. Ultimately, the owner had had enough and sometimes talking to the owner and listening and realising that, that there are other priorities.
If you, if you get some weight loss success but no more, you're better off cutting your losses. So with that, I'll, I'll, I'll kind of sign off and if there's time for questions, I'm happy to answer them. So thank you.
Great, thank you Alex, that was, that was wonderful, very insightful, picked up a few tips myself there. So it wasn't the f word anymore. Yes, we do have quite a few questions actually, so we'll just get as many as we can.
So first question was just around the study in the beginning, I think the one where it was talking about. Looking for the words obesity and things like that. Yeah, sure.
Was, was body condition scar also checked in that search? So we, in that one where we were looking in, for, for, for particular terms, that wasn't one of the things we did, but we did actually interestingly do a separate study where we looked at owner records. It was slightly smaller, it was about 2000 consultations, as I recall it, where we actually looked at how often.
Vets recorded weight in the records, body weight, and also body condition score. Now in the 2000 consultations, I think it was about 10 or 20% of the time there was a recorded weight. So, and, and this was a few years ago, so it may be better now.
But for me that's a massive missed opportunity cos it's a great metric for health and you know changes in weight is a good way of identifying, you know, weight loss before maybe the illness appears but also weight gain where you can change it. Body condition score, 2000 consultations, we could open the debate up again, but let's not. We found one, a single body condition score recording in the 2000 consultations.
Again, I think it's better than it was there. This was now probably 1015 years ago, . The pro but but so what I would say is that you know, body condition scoring is a great tool, but it's underutilised and one of the major issues is we have, you know, we have a often on in, in vet software there's, you know, temperature, pulse, respiration.
There is a weight thing that you can, that, that you know free that a text field that you've got should be a body condition score one as well, and then hopefully it would encourage greater, greater use. Surprising on the, on that same topic actually, another question I've had, is there any benefit of using the 9 point body conscious body condition score of a 5 point, because this person's feel like that might be more complicated. Sure, the, that one, the 5 in fact was, was just that happened to cos, cos it was a computer record that was one where, they had to actually have that in there and so it was just easier as I recall to, to, to use that one, but.
Bottom line is they show the same thing, and typically a full point on the 9 point is about equivalent to a half point on the 5 point, so they do correlate. Personally, the 9 point is favoured. It's the one recommended by WSAVA, it's also the one that actually has the greatest scientific backup.
So yes, I would recommend using 9 point. Obviously whatever you use, use needs to be consistent within the practise, so, and hopefully, people, you know, you can check to make sure everyone's scoring similarly. There's a challenge with all body conditions called systems because they were designed at a time where we assumed 40% above ideal weight was as heavy as a dog or cat became.
From experience in our clinic, we have a DEXA scanner so we can check body fat percentage and we have at least half of our patients that are well above that, so some of them are 100%, 150% above your ideal weight, so it, they, it very much doesn't capture the kind of extreme, . Hold that thought because we've been working on a development of the 9 point system to capture the what I call 9 plus, the ones which are beyond, and some of, some particular characteristics you can look for in a physical examination that would suggest they're beyond the, the scale. So yes, 9 is out of there, but hopefully our new and improved version which may come at some point in the future, will be even better.
OK, Bob. You touched there on consistency actually, in practise, there was a question around, what do you do when you've had multiple touch points in that practise, multiple, different staff members trying to bring up the obesity, question, with, with a client, and then they just won't hear of it. Are there any tips when you have that situation?
If it's, I mean if it's long term and they won't hear it, then ultimately you're not going to win every fight, so you pick your battles, . There could still be things that you could do as I kind of suggested that you might even get them to compromise without going further, so let's typically. If you, if you know kind of.
What happens in terms of evolution of body weight over time both in individuals and in groups, weight is gained through early life, most of that's growth, but you do get some overweight ones, then during adult life typically, Weight is gained gradually till you get to kind of early senior years, it varies depending on the breed. And then they start losing weight again. So very rarely are certainly the overweight pets, they're usually always on an upward trajectory until they get old and chronic disease means they lose weight, but that's not a healthy weight loss.
So what I would probably say is, could I stop that pet, you know, this is the kind of the, the, the lowest bar in terms of doing something positive. Can I make sure they don't gain any further weight? And it may be they need to lose a lot of weight for their health, but if I can stop them from getting worse, for me that's a win, and it might even be then 6 months or 12 months later, a chronic, you know, an obesity associated disease has kicked in and they may be more.
I'm able, so I think the main thing is keep the conversation going, but you might recognise you won't ever win with them going as far as you want. So just to sort of reframe it as a, we're not adding weight on rather than losing. No, exactly, can we just do that, or would you be happy for us just to record what's happening?
Sometimes actually it gives some accountability, there there's some great studies that people who weigh themselves regularly have better weight outcomes. They're more likely to keep stable weight, they're more likely to lose weight on a diet, and they're more likely to keep weight off, because it, it makes, it establishes accountability. So that would be the first start, maybe looking, as I say, about little, little wins and compromises which probably won't make a difference, but gets them thinking about the process.
Yeah, great, OK. So it's 9 o'clock, so I think we've probably had, we have a few more questions, but yeah, I think we're gonna have to leave it. I mean, I don't know if it's possible, if they, if they could be shared, I can, I could answer them and they could, we could maybe share them with the, with people who attended if, if that would be of interest.
Yes, I believe that that is possible. So yeah, we can get the questions across and then we can get those answered. Thank you.
Thank you for the offer. So great, so thank you everybody for listening, and thank you obviously to Alex as well for that fabulous webinar. So that's all from us.
Thank you once again to Alex, for delivering this fantastic webinar, and thank you to everybody for watching, whether you watched it live or whether you're watching it on demand. On that note, if you want to go over anything again, the recordings will be available within the next 24 hours, as well as your CPD certificate, so look out for those. So have a good rest of your evening and hopefully we'll see you next time.
