OK, hello, everyone. This presentation is going to be on diet discussions and talking to owners about nutrition. So we know nutrition is a very important part of of our daily work with with pets and owners.

It's part of the animal owner bond. And many owners will actually ask their veterinary surgeons or veterinary nurses about nutrition. One study said that 90% of owners wanted a nutritional recommendation, but only 15% perceived that they had been given one.

That doesn't mean they weren't actually given one, but only 15% remembered that that happened and then it actually made an effect for them. In the same study, only 7% of pets that could benefit from a therapeutic food were receiving it. So this isn't adequate.

We need to, we need to do better because this is an important part of our management of dogs and cats. We know that good nutrition maintains and improves health. It prevents nutritional diseases, especially deficiency diseases, also those where an excess of a nutrient might be being provided.

It is often a treatment for a disease, many GI diseases, some urinary diseases. It's the main treatment. It's an adjunct treatment for many, many other disorders as well.

We know that it can improve performance in working dogs, not too many working cats, but it definitely improves performance in the working dogs and improves activity and longevity. It's one of the things that has been shown to increase the lifespan of dogs and cats. So how do owners make their pet food decisions because we need to know what they're thinking before we can interact with them and and sort of help them with this decision.

In one study, nearly half of dog owners said that diet choice was the most difficult part of their pet ownership. And this varied a little bit by age groups. About 2/3 of the younger owners, 18 to 34, felt that dogs' nutrition was more confusing than their own.

The same owners, however, that nearly half of these felt that they were confident that they were feeding the right diet even though they found it confusing, so they still felt that their choice was correct. And nearly half of the owners cited past experience on feeding a pet food. So most owners apparently pay as much attention to their pet food ingredients as those in the food that their family eats.

However, that might also mean that they're not paying that much attention to what their family eats. I'm never quite sure what to make of that study, but we do know that owners do want to read ingredient lists and find that those are more important to them than they actually maybe are to the quality of the food, but it's what they can see and what they can. Sort of understand.

And 2/3 of them felt that the quality of ingredients was extremely important. This is without necessarily understanding what the quality of an ingredient is, but the concept of quality is important to them, although the majority of them felt that their dog's preference was the most important factor. This is a dog study, so I'm not mentioning cats here.

I would say that would probably be the same for cat owners. Again, the younger generation, were 3 times more likely to care about what they termed personalization, and to them again, personalised dog food meant quality ingredients that they're reading the ingredient list and want to see what they perceive as high quality ingredients. Slightly older age groups, still quite young, were drawn more to convenience, and they were more likely to order pet food online.

And to them personalised dog food just meant better for my dog, so very, very vague concepts. There are trends toward the ideas of natural or organic or holistic or hypoallergenic foods. I would note that in particular holistic and hypoallergenic do not mean anything.

There is no legal or regulatory definition for those terms, but a lot of owners like the concept of these ideas, even though they aren't necessarily a real thing in the pet foods. So where owners get their ideas, often from the internet, they may get them from the retailers who are on the internet. They may get them from blogs, either good blogs or bad blogs, one's actually done by by professionals with training in the area or people who just want to write a blog about pet foods.

They may come from the breeders, from friends, groomers, pet stores, and as I mentioned, almost half of them cite past experience. I've had a dog before, so I know what I'm doing. Before COVID, And I'm getting old times now, family and friends accounted for 10% of the recommendations or the ideas where people wanted to what they wanted to feed.

Online was only 5%. However, since then, internet food purchases of it have increased several fold, so we don't know possibly, I would guess that the use of the internet has also increased several fold as a source for getting pet food information for owners. And I think all of us have looked at internet reviews when we're trying to make a decision about whether or not to purchase something, and this is certainly true of owners with pet food.

I wanna just a short story about Patty. Patty belongs to my neighbour who, came to my front porch and I did possibly the shortest obesity, consultation ever, on my front porch and talked about what should she do about her overweight dog. And I recommended, that she use the therapeutic weight loss diet, and I really should have done more than that at the time.

Because then she contacted me, said that she'd gone online and, was going to feed one based on the recommendations online. And it was not the food I would have chosen because it was not low enough in calories for this dog. It wasn't actually a weight loss diet.

So then I actually wrote out a proper referral for her with recommended diets and a recommended amount to feed, and I should Have an after picture as well, because Patty has done very, very well with these. But it just is a good example of how even after discussing it with me, branded without me writing it down, which I'll mention later that my, my neighbour immediately went to the internet to look for reviews about what she should feed, which of course is often based on palatability. Might not be the best thing for an overweight dog.

So what owners want for pet food advice, obviously they vary, including my lovely neighbour who actually wanted veterinary advice, and 70% say they want advice from the veterinary team. There may be an aspect, as in all surveys about answering what you think sounds good. I don't know if 70% actually do, but one study said that.

There's those who may want advice but don't actually ask. They think, oh, the veterinary team is too busy, they don't want to talk to me about this. This isn't what I came in for, it was just for vaccinations or for a cough or something, but these are owners that are, a, a very good population or some population for us to actively engage because they, they do want to talk to us about it.

There's those who are convinced what they're doing is ideal, regardless of where they source their information. We often hear I'm capable of cooking for myself. I'm at my, I'm capable of cooking for my family, so I can cook for my dog.

Dogs and cats have very different nutritional requirements from people, and we do find that most of the diets that are homemade without the input of a professional service are incomplete and unbalanced. And interestingly, most people's diets are probably also complete and unbalanced. There was a national public radio study a few years ago saying that bad diets are responsible for more deaths than smoking, globally, and we do know that there are a lot of, some clinical deficiencies in, in humans as nutri nutrient deficiencies.

So just because we're not dying from our own cooking doesn't mean that we are on the best possible diet and it doesn't mean that our pets are on the best possible diet if we are cooking for them as well without knowing a bit about what we're doing quite a bit about what we're doing. So owners actually using advice, vet advice, the veterinary health care team for diet information. The studies vary considerably on this everywhere from 9 to about 44%.

That higher number, the 44% was from a survey. And that included 75% of the people having college degrees, so they might be a possibly a population more likely to turn to a professional for advice, and this is compared to 38% of the total US population. So this study had a very strong bias toward highly educated people.

On the other end of the spectrum, in one study, only 9% of people who were feeding raw diets wanted to discuss the diet with a veterinary healthcare team. They kind of fall into the population that may feel they already are happy with what they're doing and feel that they know what they're doing. Now, who actually follows advice, so who actually adheres to the advice given.

Again, quite a bit of variation. One study said that 77 to 80% of people followed their vet's recommendations, although, an American Animal Health Association study showed that only 19% of clients were actually adhering to feeding a therapeutic diet, so quite a bit of disparity in these numbers. It might not be as high as 77 to 80%.

Breeder recommendations were actually higher than than those for the vet, so 86% of people were following what their breeders recommended, which means this is a group of professionals that we need to be in contact with and need to be giving advice to about nutrition because owners who get a puppy or kitten from a breeder are highly likely to feed what that breeder recommends or what that breeder was already feeding. So we need to make sure those are good diets. And we've all seen the the argument or the discussion we have with an owner who you recommend one thing and they tell you what the breeder recommended and the breeder seems to have more clout than the healthcare team.

Online information websites, again, people who actually followed the advice on this was about 2/3, a little bit higher than I'm comfortable with manufacturers' websites, which Could be better, it could be worse than other online information depending on the manufacturer again about 2/3 followed the advice or adhered to the advice from these sides. Interestingly, cat owners are more likely to feed a commercial food compared to home prepared diets, maybe because cats can be a little more difficult to feed a homemade diet too. They're a little, as general a little bit fussier than dogs.

And they were more more likely to consider veterinary nutritional recommendations as well. I don't know the reason for that, but that was what one study showed. So as mentioned before, owners feeding a non-commercial diet, so homemade diets or other non-traditional diets are less likely to discuss the diet with their veterinarian.

They're more likely to learn about diets online or from friends and family. They're more likely to source formulations from the internet or from non-veterinary books. And these formulations, as I noted, are highly likely to contain deficiency, sometimes excesses, when I've looked at some of the ones online and actually kind of ran them through a computer balancing programme.

They are deficient and there's been several studies confirming this as well, that something around 95% to 99% of these diets are incomplete and unbalanced if they have not been formulated by by someone trained in pet food formulation. So how do we get to this discussion? It's an emotional topic for many owners.

They are quite invested in, in the, in what they're feeding their dog or cat. It's what they do every day. It's a change that they feel they have control of that they can actually work with.

However, ideas about nutrition are often not fact-based. There's a lot of kind of just concepts about it that that are not based on science. Younger owners are becoming less reliant on traditional authority figures and experts.

There is an idea that they can learn what they need to from the internet and don't need to work with professionals. They may feel competent to decide the diet based on their feelings that this just seems like it's better, it sounds like it's better, it has a nice idea to it, it's natural, it's whatever concept that they're agreeing with. And it's the cartoon, if you can read it says why don't you think the report has any detailed analysis and just a gut feeling.

So this is what owners sometimes are working on it's in the diet, my gut feeling is that it's better, which is not evidence based and can easily be incorrect. There's the other idea of the internet, Google quote unquote research is a lot of people, if they have looked online, will claim that they have done research on feeding or on other pet management. This is because there is no one making sure that the information on Google or on any other internet search engine is fact-based or correct.

This does not really count as evidence-based. It counts as ideas. So some of the reasons owners may want to feed it, what we would term an unconventional diet, they want to feed their dog like a wolf.

Occasionally there's the feed a cat like a lion, but it's more often my dog is, has a wolf ancestor and should be eating a wolf diet, sort of like the concept of a paleo diet for people, however, Wolves and dogs are are different and and separated in their nutritional requirements quite a few centuries ago. There is a perception that these diets are healthier, that somehow commercial diets are, are bad and only, only produced for profit. Or they want to avoid certain ingredients such as grains, they feel that grains aren't a natural food for a dog or cat and therefore that they cannot eat them, which actually they can even cats can digest and assimilate properly cooked grains.

They may want to avoid byproducts or meat derivatives, which can be perceived as, also a, a poor quality ingredient. Actually many of these are very high quality ingredients with a with a good amount of very good quality protein in them. There's a distrust of large companies, corporations, the sort of the idea that a corporation is somehow evil or bad or or or not out for the benefit of your pet.

Some people distrust any pet food companies, whether they're large or small, but certainly some of the larger corporate companies, there's a a discomfort around those for some people. Some people just want to have more control of the diet. They feel they don't know what is going into the diet.

If it doesn't look like their dinner, if it doesn't look like human food to them, that they don't trust what that is. Or they have a fussy pet, these are often made and not born, especially for dogs, where the animal, they say, oh, he won't, he won't eat anything. There's no commercial food that he will eat.

I've tried them all, which, of course, I haven't cause there's thousands, . But this is a concept that some people want to be able to control what the pet gets and that they want to feed what they perceive as highly palatable for their pet. Or sometimes there is truly a lack of an appropriate or palatable diet for a medical problem, especially where there are comorbidities, where there's more than one problem, and there's not a commercial diet or a therapeutic diet that works for both problems such as chronic pancreatitis and later stage kidney disease where you need to be lower in fat and lower in in protein and phosphorus, and that can be a difficult diet to find a commercial version of.

So how are we gonna talk about this? In one study, only 60% of veterinarians discussed nutrition during the consult or during the appointment. Only 12% recommended a long-term health related diet change.

In another study, only 21% of Belgian and Dutch veterinarians knew of the Wassava nutritional guidelines. And the diet discussions were more likely for therapeutic diets compared to wellness visits or those for a healthy animal that comes in for the vaccinations or warming. We are better trained as a profession in the concept of a diet for disease than we are for diet for prevention of disease or for health and well-being of an otherwise healthy animal.

So barriers for veterinarians not discussing nutrition during wellness visits. This is actually from a survey and and looking at, you know, why aren't you? There was a limited interest in non-therapeutic nutrition.

So we might be happy to, you know, consider it for renal disease, but not for a 9 month old puppy. Perceived lack of time. This is very real.

I know many consults are very, very short, 10 to 15 minutes. It's very hard to fit in, anything in addition to what you're already doing in that. The perceived idea that the owner doesn't want to talk about diet, and they don't want to change the diet, and because of this we're reluctant to start this discussion, so we don't want to deal with this communication in case it's uncomfortable for us or uncomfortable for the owner.

And many veterinarians feel that they don't know enough. There's a large number of pet foods available, something like 200 new ones come out every year, and we, we can't know them all, and you're not expected to know them all, and I'll talk about how we can overcome some of these limitations. Some of this is that we just haven't been doing it.

It's not part of the practise protocol to have nutrition in the consult. I know this can be changed to big practise in Oregon. I used to work with Greg Takashima, who manages these practises, and they managed to incorporate it in their practise, so it, it is something that can be done, but it is a it is a change from how things were done in the past, and that's always challenging.

We also don't always utilise the whole clinical staff. It doesn't just need to come from the veterinary surgeon. It also is the nurses, it's also the caretakers, it's also the front of house staff, the receptionists, and the management.

So we need to get to where we can have this discussion. Hm So it starts with a nutritional assessment, which is made up of nutritional or diet history. We are pretty good about getting body weights.

We also need to incorporate into our records a body condition score and a muscle condition score. The Wasabi.org nutrition toolkitt has this information and I'll provide references at the end of the talk as well.

So we start with a diet history cause this opens the path for a nutrition discussion. It allows you to discover if they are feeding an alternative or a non-commercial diet. So if they're feeding a raw diet, a vegan diet, a homemade diet, something that is potentially problematic.

You can get an estimate of the calorie intake, possibly depending on what they're feeding, because if you say want to design a weight loss programme, if you don't already know what they're eating, you won't know how to start that. You don't know how to decrease it. It gives you rough idea of the amount fed and the accuracy of this varies, and we have people that weigh it, and people that measure it and the accuracy of those does vary by quite a bit.

We need to find out, in addition to the main diet, treat snacks, any other foods, foods, human foods, foods that are given for medication, any supplements that are being given. I have seen the wrong supplement given to a dog once, that actually was potentially worsening the dog's health seriously, especially in the fussier animals or maybe an older animal whose appetite has decreased, we need to see if they're adding foods to tempt intake, whether it's flavoured paste or whether it's a bit of chicken breast or ham or something going on top of the food, and this needs to go into the veterinary record. I mentioned history sheets.

There are several available with Sava, on the Global nutrition tool kit has one. You're able to download this, print it, hand it out to the owners. ACIM or ACVN is now part of ACIM also has one on their website.

I believe the print Institute might as well. So there's lots of sources you don't need to create your own. There's lots of sources of this that you can use.

This can be filled out during the appointment, although I will grant that that will take a little bit of time. Potentially could be emailed or mailed to the owner ahead of time, although one clinic. That did this told me recently their their uptake on owners filling these out was lower than what they had hoped.

I don't know what they need to do to improve that, but we can discuss that too with them. Or available at reception prior to the consultation, my dentist has me come in and fill out a medical history every, every year or two when I go in to see if anything has changed. So I think just asking an owner, come in 10 minutes before your appointment or making the appointment time slightly earlier than when they're going to see the veterinary surgeon.

To fill, you know, please fill this out while you're here. Disadvantage of that would be that they don't have the food in front of them and may not remember it accurately. Then either a vet or a nurse or even a trained receptionist could scan this form, not on a computer, but scan it visually, and say, yes, this is a potential problem that they're, you know, feeding adult food to a kitten or feeding an unbalanced diet, a homemade diet or something else that potentially say this could be problematic.

So some of the challenges in this, they don't actually know what they're feeding. The wife feeds it. It's in a blue and white bag.

They actually don't know what they have bought, accurately. Their recall of the diet is low. Again, the, the referral clinic in Switzerland, did a study on this, and only about 4 to 50% of the owners at a referral appointment could name the specific diet that they were feeding.

They assumed they knew the diet if they knew the brand, so they might know they're feeding hills or Royal Cannon or Purina, but that's that's all they knew and they didn't realise that these companies make more than one food. Or amount fed, they either don't know the amount, and they just sort of feed when the bowl gets empty. That's not uncommon with cats, which if it's a lean cat or a thin cat it's fine.

If it's a fat cat, that's not a good idea, or very big amounts, we get a lot of owners who feed a handful, just for the heck of it in the Elinic one time a bunch of us went in and took a handful of food and weighed it. And the discrepancy and that was, was enormous. We should have written it down.

I don't remember, but I know our smallest nurse had the most in her hand. So volume. Measurements vary.

What's a cup? A cup can be anything from a small measuring cup to a large drinking cup. So if they're using volume measurements that can be extremely inaccurate, as are the handfuls, ideally they should be weighing this.

So, the clinic challenges, we have owner challenges and we have clinic challenges, and we're not always doing the diet histories, we're not recording them. In this same, study in Switzerland, diet was mentioned in referral records where a dog or cat was sent to the clinic for referral. Only 40% of the gastroenterology referrals, and it's vital to have this information for gastroenterology for GI cases.

You absolutely need to know what they have been being fed. And of the non-GI internal medicine referrals, the records sent to them, only 13% of them actually mentioned the diet in the history. So what can we do for this?

Again, getting a diet history ahead of the appointment, either in the clinic or before the people arrive to the clinic, so by email if possible. Diet history as part of the clinical record, so if it's actually in there as the record itself, it's a little less likely to be missed. If you can have the owner when they're at home, take a picture of the bag of the or the box or the package or any treats or snacks that they're feeding, and maybe it's a piece of cheese that might be harder, but just so that we have a, a more accurate idea of exactly what what they're feeding rather than just the, the company name.

Discuss the use of scales to weigh food that can be a little bit more challenging for cats, but these measuring spoon scales exist, they're not terribly expensive. I remember 12 pounds or something like that. I can't remember quite what they cost, and they are pretty accurate for small amounts of food.

This one is weighing out 15 grammes of cat food and you can see that you can get a pretty good measurement of cat food for cats and small dogs. A kitchen scale might work for a bigger dog, but if you're using smaller amounts like 15 grammes, it can be hard to get that. At least on my kitchen scales aren't that accurate.

I think some of the better ones are. There's some communications during the appointment, if you just ask what diet is fed, you probably won't get the full answer. You will probably get the main diet and not anything else.

So you need to ask both about the main diet as well as treats, snacks, supplements, as I mentioned before, food that goes on top for palatability, food to give medications in is sometimes not perceived as part of the diet. It's fed as part of the medication. And some of the ideas that the communication specialists tell us we should consider would be talk me through Sam's food intake from morning to bedtime.

That one kind of horrifies me a little bit cause I feel like I might be in the consult for hours and hours afterwards. So I actually don't use this unless I'm doing an extended. Consultation about diet or an obesity consultation where I really need to know everything that's absolutely going into that pet's mouth, or maybe one for a therapeutic diet to where they might be giving something, let's say a high fat diet to a chronic pancreatitis that would be inappropriate for that pet.

Or tell me what directions you would give a pet sitter, assuming that they give accurate directions to their pet sitters about feeding. And are telling them about treats and snacks, which they may may or may not be doing. Do try to use tell me questions rather than what questions.

Tell me questions have a permissive aspect to them that a what question does not, no matter what your discussion is about or who it's with, if you say tell me about this, it is has a less judgmental tone to it than a what question? What are you doing with this? So again, we need to communicate the importance of the information and we need to communicate the discussion in a non-judgmental supportive manner.

We need to make the owners feel safe about talking to this, that regardless of their diet choice, that this is a This is a calm discussion that we can have and that they won't be judged about feeding a food that maybe is an alternative food, is a non-commercial food, or possibly an inexpensive food that they feel might not be what you want to hear them say. You can often get help from a nurse or a veterinary technician in getting this discussion going, especially about diet history. We know from other studies that, for instance, people giving information about whether or not they gave antibiotics that they were prescribed for their pet.

They're more likely to tell the veterinary nurse about any missed doses than they are the vet. So it might be a good place to get your staff involved in in the communication, especially with diet history. And again, as I mentioned in an obese pad, if you don't get all the, all the pet food information in the diet history and you think, well, they're feeding this amount and I need to restrict it by 80% of that, and they haven't told you everything that's being fed, you could restrict it more than you need to.

So owners sometimes feel self-conscious about giving treats or giving human foods other than one owner. Many, many years ago I did ask what treats are you giving treats, which I would never say it that way now. And he said, of course, I I just it was a good experience for me to learn that yes, just assume that they are, so don't say, are you giving treats?

Ask say tell me what treats you are giving. If they're not giving any, they will tell you that, but if you say tell me what treats you give, tell me what extra foods, you know, muffin gets, . The owners are more likely to communicate that and even in a weight loss programme, you can usually accommodate treats, you may have to change the type of treats, the amount of treats, but we don't want to change the, the kind of Habits that the pet and the owner have because we're not gonna be successful in changing their routine, so we need to accommodate their interaction.

If Sam gets a biscuit before he goes to bed, we might need to just use a different type if we are on a therapeutic diet, or he might just need a lower calorie one if he's on a weight loss diet. But if both pet and owner are used to doing this, we're not going to change this and keep everyone happy. So again we need to work with the owner's current practises and habits wherever possible, and it's generally is possible to work with those, although we will need to adapt them in some circumstances.

So, if you're concerned about bringing up the topic with some owners, and I have had some some owners who were obviously very inflexible, I had one owner who used to come in and before either of us said anything, would say, I feed wrong, I don't want to talk about it. So there are owners that are going to be defensive or reluctant or inflexible about having the discussion. So if you're unsure about the owner, consider asking if a diet discussion is OK, you know, are you happy for us to discuss Bob's diet today?

Since you primed the owner with a diet history, they do know that this is of interest to you, of it's of importance to you, . They may not be open to discussion that day. They may not have time.

They've got a dentist appointment right after their appointment with you and they are in a hurry to, to leave, or they may not want to have that discussion with you because they are part of a raw feeding group or something that, that they feel that you're going to disagree with. So provide written information about diets, depending on the owner. A handout, you can have handouts in your clinic and say, you know, well, here's some information if you might want to take this home and read it, it may end up in the rubbish, but at least you have got to start providing website links, write those down, have them on a card or have them on the handout.

Some owners prefer to look at websites. Some prefer to have something, on a piece of paper that they can read. Perhaps address this later, depending on the type of resistance that the owner is reluctant or appears reluctant to have that discussion on the day.

Bring it up at another appointment, you know? Were you able to look at the information I provided and what you think of that or tell me how you felt about that something like this. Do record that this has been discussed.

If this pet is on an unbalanced deficient diet and there are problems later, you will. Both be able to have another, if another vet veterinary surgeon sees that, that dog or cat later, they will know that you have discussed it. So, so it is for continuity within your practise and also if something goes wrong.

You have protected yourself, against any legal ramifications by recording that this has been discussed. I'm not a lawyer so I can't tell you how well you've protected yourself, but it's good to note that this has been brought up, that you have flagged any potential concerns about the diet. If you're unsure about the diet, you've never heard of it, or you're unsure about the diet quality cause you've never heard of it, or just don't aren't familiar with it.

Remember, there's nothing wrong with that. There's hundreds of these that come out every year. There's no way you will know about them.

You can ask first about the reason for their choice. Such as, I'm interested in why you've chosen that diet, or tell me more about that diet. Don't say why did you choose that diet because of that again sounds a little bit threatening, a little bit judgmental.

So just, that's an interesting choice. Can you tell me more about it? .

I was gonna say tell me more about your reasons for that, but I'm not sure that sounds good either, so just tell me more about it. Be willing to find out more about the diet if you don't know it. I don't think I have this on the slide, although I think I have it in my references.

One of the things that I will do first is look on the UK pet food website that used to be the pet food manufacturer. Association PFMA is now called UK Pet Food. If a company is a member of UK pet food, they have agreed, at least by computer formulation for their diets to be complete and balanced for the European FettyF nutrient requirements.

So we know they are at least by computer balancing me. A minimum, and a maximum of some of the nutrients, but that they're at least, trying to make a complete and balanced diet. So that's my starting point.

If they're not a member of UK pet food, then I'm a little, a little less comfortable, with owners feeding those diets. It doesn't mean every company is making, you know, magnificent diets that's a member, but it's a baseline starting point. So empathy, most owners want what is best for their pet.

It's a rare owner who would bring a a dog or a cat and you who really doesn't want the best for their pet. There can be financial limitations to that, but there are very good pet foods, very adequate pet foods that are not highly priced, so we kind of have a way to to fit in a complete and balanced diet for every pet. Owners may react badly when stressed.

I am, I am that client. I know the vets that I take my cats to must dread me coming in to a degree. I've had to apologise several times to nurses and to some of the vets because I react very Badly when my, when my animals are not well.

So just if they are reacting badly, kind of back up a step and ask why. Is it, is it because they are so worried about something going wrong with their animal because they're very bonded with their animal. Sometimes they mostly need someone to listen.

I know we don't always have time for that, in one of the places where I've seen practise, There's a very good vet there who is medically very, very good. However, when I do a backup and I see the same clients, I often find rather than talking, I am listening to what they have to say. This bet is very interested in giving lots and lots of information and lots and lots of advice because he's, he's studying medicine very thoroughly, but he doesn't always listen to the clients as well as they might need.

We talk now about what's called client centred talk about the pet and owner's lifestyle, the pet's activity. We will get the best adherence to our recommendations if we have some rapport with. The owner, if you think about your dentist, your doctor, your plumber, anybody, well, maybe not your plumber, you don't have to really adhere to their recommendations, you don't have a choice, but in other professionals where they might be making a recommendation to you, if you feel comfortable with them and trust them, you are much more likely.

To adhere to their recommendations, and this is just a little chart that I borrowed you see it's actually a video that I can't put in here from a medic, so they are getting some of the same training about tell me more type questions about active listening, about listening to their patients. Open-ended questions as much as we can. I know they can be time consuming, so questions that allow the the owner to give you more of a like free text if it was written rather than a yes no question.

And I know sometimes you have to cut those short if an owner takes tries to take over the consultation. I'm aware of that and it had to deal with that, do we all have had to deal with that. So some of the nonverbal skills we don't always think about, body language, tone of voice, expression, if you're running late and being impatient, try to take a deep breath before you start so that that does not show because it's not that owner's fault, usually sometimes it's their fault, but usually not that you're running late.

If they were late, it can be hard to kind of calm yourself down and deal with that. How is the room set up? Do you have a table or a desk between you and the client?

And sometimes when we do our physical exam, it's set up so that we have to be that way. But when we're having more of a discussion, try to come around or sit yourself and the client down in a place where you are talking more directly to them. Do not talk to your computer.

This is something that as we brought computers into the consultation room, a lot of us are really bad about facing the computer rather than the client. So if you have to type into your records, turn back around to the client as you ask them questions rather than typing as you ask and facing into the computer, that's, that's not a good rapport building technique. Reflective listening we, we're advised to paraphrase what an owner said.

I have to be truthful here and say I'm not very good at doing this, so you say Buffy is not eating well at night or something. I, I find it uncomfortable to repeat back what the owner said. If you're comfortable doing that, it's supposed to be very good communication, skill.

I'm still not very good at it. Is there a problem in there? Is the pet disruptive?

Is the dog barking or trying to bite you or something? Is the cat trying to climb the walls? Is there a child who needs to go to the toilet tugging on the on the owner the owner's, you know, the their trouser cuff or something, you might need to somehow.

Take the pet out of the room, schedule it later, can't really take the child out of the room, but you might need to find a way to sort of have this discussion when things are not this disruptive. Giving clear recommendations, you cannot say. Bob needs to lose a little weight, that will not work, that will not, that will not achieve your goal.

So recommendations need to be exact, clear, written down. You may not be working with the primary caregiver, in Scotland, sometimes we get a gilly bringing a dog in, and then they, they may be the primary caregiver, but they're not the owner, they're not the person making the ultimate decision. Oral communications are not recalled by any of us.

If you try to remember everything you were told yesterday, you are not going to. It needs to be written down. We only remember something like 15% or something provided orally and that might be optimistic.

Stress affects our recalls, so if you're upset about what is going on, anyway, you're not happy having to bring your cat to the clinic cause he screamed the whole way there. You're not gonna remember what you were told unless it's written down for you to take home and look at, and we found that . Exact clear written down recommendations increase adherence by sevenfold, so 7 times more likely to follow your suggestions, whether it's diet, whether it's.

Warming whether it's anything else, whether it's giving medications. You may need to discuss the consequences of a poor diet or poor dietary management. This takes a little bit of tact, but say for this obese dog, where the only love this dog to death and actually knew that the dog was a little bit overweight, that, you know, if we can improve her weight, it will improve her quality of life, will improve her length of life, and this is true of all of our dietary discussions that we know it will improve quality of life for the pet.

Just to finish off our nutritional assessment, we need to add on for the screening assessment body condition scores again, Wasaba has these, you can post them in your in your consultation room. You could hand them out to owners, obviously not with Victor the. Overweight cat a thin dog, but the body condition scoring charts from Masala are free for you to use as long as they're not published with modifications.

There's also a muscle conditioning chart that you can use. I will say that these aren't. Quite as quantitative or semi-quantitative as body condition.

If you're unsure between mild and moderate, that's OK. Just write down that there's some muscle loss, and where you've discovered it, whether it's over the shoulder, the head, or over the back or over the back of the legs. So you've done your nutritional assessment, you've discussed diet, you've done body condition score, muscle mass score, you've weighed the pet, of course.

If all of those are fine, feeding management is good, body condition is good, muscle's good. Just tell the owner they're going, they're doing a good job, you know, continue with what you're doing. Everything is great.

If you disagree with their diet choice or management, just telling them the evidence-based facts about diet may not be enough. Why don't people change their mind when given facts? This is true of politics.

This is true of diets, this is true of a smoking, all sorts of things, that there's like several aspects to this. I won't discuss Dunning Kruger very much, but if you know a little bit about something, maybe you Googled that and feel that your knowledge is this. We know knowing a little bit about something actually makes you more confident in your knowledge than knowing a lot about something.

It's probably why as you went through that school, you started to doubt some things a little bit because you actually knew so much that you knew what you didn't know, whereas people who only know a little bit about something actually don't know what they don't know, and it's impossible to know. So what you don't know, and we all are done and Kruger about something. We all have some aspect of our lives where we think we know more than we do, but diet is a very common one.

And when faced with a fact contrary to our beliefs, Or our desires and smoking is one of these people may become more determined. It's called cognitive dissonance and we tend to kind of dig our heels in a little bit when we don't want to believe something that we're told that we do suspect could be true. Our self-confidence could be rattled by facts which intrude on our beliefs, and this turns people into stronger advocates.

So if I presented some political idea to you that is that I can prove is true, but it is contrary to your political beliefs, you would not say, oh, OK, you're right, and I'll change my mind. You would be more determined to support the view that you have. And again, this is called cognitive dissonance, and it is a somewhat uncomfortable feeling with the conflict that it Doesn't make people change their minds when when they are .

Being taken over by cognitive dissonance, and we've all had this someplace to where we kind of know maybe our spouse is right about something, but we're pretty determined not to, not to agree with him or her. So how we get around this, we need to make sure that our owners are relaxed, they feel safe, that they feel like we have a commonality about wanting the best for their pet. So start there, make sure you listen to their own to the owners, try to respect their feeding decisions, you may disagree with them.

You can respect the decision without agreeing with it before discussing potential changes. If you can, Have owners discover the facts themselves, so we, none of us like to be told something. We don't like to be told we're wrong about something.

So this is challenging again if you have an owner that is digging in their heels about a feeding practise that you feel is not the best. Provide references, pictures, handouts, you can't argue with them, you're not going to make headway in there. You need to have them in a receptive mood.

So, but if you can provide them information about it, they may be able to think about it more after they get home. Small changes are more likely to occur. You're not going to change the world in one visit very often.

If you can maybe get the owner of an overweight pet, even though they think their pet's body condition is perfect, and you know it's an 8 out of a 9. You might only get a small change. That golden retriever I showed a picture of this owner was only willing to have that dog lose, I think it was just maybe 4 kg and then he didn't want to go any farther, but It was a starting point.

So small changes might be the only change that we get. Some owners won't be open to change. If they are really digging their heels in, you can't change everyone's mind.

Again, the owner that I had who had several dogs started out every consult, no matter what I was seeing her for. I wasn't seeing her for diet consults usually with IP draw, I don't want to talk about it. I don't think there was a way to make much of an inroad for that owner.

Certainly, I didn't at the time, in retrospect, maybe I could have given her some information. Interesting idea. I don't know what would have happened with her.

We do have more resources on for Waaba on selecting pet foods. That talk about this is for owners as well as vets, what to look for in a brand, what to look for on a label, about what sort of statements are on the label that owners can use. There's no reference to supporter advocacy of brands or companies.

Wasaba sometimes I I see things about, oh, it's a wasabi recommended brand. We, we don't make recommendations. It's not what Osaba does.

It's unbranded, just ideas to to think about when you're selecting a food. And again, these can be handed out toers posted in the clinic. They are free to use as long as they are not altered in a publication.

So some of the things we talked about time restraints, incorporating the assessment into the record kind of helps that, make sure it's done. The diet history is part of the history, the body condition score, and muscle condition scores as part of the physical exam. They don't really take any additional time to do.

You've already got your hands on the animal. Just make sure you default to a 0 or to a blank, not to 1 or normal. If you default everyone to a 1/9 for the body condition score, it's gonna look like you have a lot of very emaciated pets in your, in your clinic.

So default to a 0, which will be obviously not a true value or a blank. Don't call them normal. I've seen this for dentals when I knew when I knew the teeth weren't looked at.

Nutritional recommendation comes under the treatment plan. So as far as not knowing enough, which is also sometimes perceived as a, as a problem and being comfortable in discussing nutrition with clients. Assess your learning style and time.

This would be true for anything, whether it's nutrition or surgery or ophthalmology or anything else. What works best for you? Are you a visual learner?

Most of us are, but not everyone. Are you an auditory learner? Do you need to hear it?

Do you need to write it down? When I attend conferences, I take notes by hand the whole time, even though I obviously don't always, not obviously, I don't always reread them, but it helps me listen and pay attention and remember as I go on. So reading or writing kinesthetic kind of hard with nutrition, but that would be a hands-on type of learning, certainly for body condition muscle mass scoring, that's very kinesthetic, otherwise we're into.

Physical exam stuff and surgery. So do you wanna go to courses? Do you want to do lectures?

Do you want to do workshops? Would you rather learn online in your own time, such as webinars? I in theory like webinars in reality.

I'm always signing up for them and I don't listen to all of them, so it's better for me to be there live where I actually have to listen. Podcast. A lot of people quite like podcasts.

I find that I quit paying attention sometimes, but they are quite useful. I do like the YouTube videos because they're short, and I think YouTube videos are very useful for getting information in very small bits when you do have time. So whatever works for your lifestyle and your learning style.

We do have websites. I'll give you a couple of references to those in the end. I've mentioned theava, the Prea Institute also has a very good one.

Articles, review articles, there's always good nutrition review articles coming out, and I do know a lot of people like being able to have the time, maybe when you're on public transport or something to sit down and read a review article. It's a very good way to gather a lot of knowledge. So veterinarians were asked their solution to addressing nutrition conversation roadblocks, and they said we need more information, articles, videos, handouts, better training for staff, unbranded information on non-therapeutic diets, and resources to offer clients such as handouts for owners.

All of these exist. I'll give you some more resources at the end, but as I've mentioned, they, they, we have all of these available. Here's what I would mention again it's a wasabi one.

Excuse me, this is a module on how to do. A screening nutritional assessment as well as an extended nutritional assessment where you find some sort of problem on the, on the screening assessment. And I want you to notice this is free.

So this is a very easy way to do this in your own time. It was set up by a professional company, so it's very visual. It's got a lot of interactive things on it, and it, it's quite a fun set of modules that you could go through in your own time.

Again, that's on wasava website. Wasaba also has, this they have a dog one and a and a cat one, but for owners, their guide to looking at information on the internet. This is something you could hand out for owners.

It it's highlights of this cause I know you can't read those when I flash them up like that, says to discuss the information with your veterinarian. To research the credentials of the site's author and check the source of their information, there's one pet food choice site run by a dentist who likes dogs, so that's not really a credential for that. Is it recent?

Is it from 20 years ago, maybe not 20 years ago, I don't think any websites from that long ago, be aware of anecdote, anecdotal information does not constitute evidence-based information. As the plural of anecdote is not data. Lots of stories are just lots of stories.

They are a good basis for the starting point of research, but they are not research and they are not data. Watch out for the ratings ratings website. They are usually based on non-evidence based criteria.

And be sceptical of anyone who has grand claims or easy answers. I guess this would be any website you look at, you know, if, if you take this it's gonna make you 30 years younger, it's probably not real. So getting nutrition assessment and discussions into the clinic, you need to have the whole staff on board, you need to have them educated.

And this is important. We know clients want this information. If we are not taking the time to provide it, we are not providing a good service for our clients.

Many of our patients are in obvious need, are being fed deficient diets that are going to affect their quality and their length of life. So not being interested in nutrition is not an option. This is a dog from a practise I've worked with, not in with in Glasgow, this dog's crooked legs are from being fed as a growing puppy and incomplete and unbound.

Diet. It happened to be a raw diet. It wouldn't have improved it if it was cooked.

His legs are permanently crooked. His radiographs of his bones, show a lot of mineralization disorders and, and retained cartilage courses. So not being interested in this when this dog was a puppy certainly would not be an option.

This, this clinic, by the way, didn't see the dog as a puppy. They saw him after, after things were a little bit too late. So appropriate nutrition and advice is absolutely in the best interest of the patient and of the client or owner.

Your entire staff can be looking at the Wasa the Global Nutrition Committee tool kit and the other resources. It's important to have everyone on staff on board with this idea, and this is a slide that I have taken from Rachel Lumbus who. Registered veterinary nurse who is a member of the Osama Global Nutrition Committee.

This was when she was still at the Royal Veterinary College, so I've left that on the slide because I pretty much just took this slide wholesale from her just to remind us that there's a place for the veterinary surgeon to be. Part of this discussion, there's also a place for the nurses to be part of it, for the animal care assistants to be part of it. They are seeing what's actually being eaten when pets are in the clinic.

There's a place for reception staff to be part of this as they are often the The first and the last people that the clients will see, so having them reinforce that discussion as well, maybe having some of them who are nutrition champions who are willing to learn more and interact more directly with the client. So it's not falling completely on the shoulders of the vet during the consult. The rest of the team has a place in this discussion.

These are the resources that I mentioned, the Purina Institute, which is not actually part of the Purina company, although they're loosely affiliated with that, but they are, in spite of the Pera name, they are non-branded and their information has something called centre Square on their website which has all sorts of good information. It has sort of Articles that have been written, it has websites from all sorts of people like on the microbiome, on all sorts of things like that that you can link to. It has some short videos on communication in diet and nutrition conversation.

I've mentioned the Wasabi GNC toolkit several times which has lots of references on there. The Wasabi nutrition modules again are free. AADN, the American Association of Veterinary Nutrition, has site, as does the European Society of Veterinary Comparative Nutrition.

Obviously one slightly more US based, one slightly more European-based. Pet Foodology is a blog by a couple of on board certified veterinary nutritionists out of Tufts University in the US. Some of it's a little bit United States oriented, but a lot of it is very general and applicable to the world.

The Global Alliance of Pet Food Associations, or GABA is getting more information on their website, which again they try to make applicable to the entire world. The European Pet Food Association or FEIA has information on their website, including handouts and fact sheets. As does UK pet food, which is our the United Kingdom member of FEDA, does a spectacular job in providing information about, oh, everything, how pet food is made on our, you know, grains, grain-free diets, raw diets, all sorts of great information, some of which is similar to what's in Fetty F and Gampa, as these are all associated organisations.

And that's the end. I don't know if we'll have a place for questions, but if we can, I'd be happy to take those at some point.