Hello, my name is Georgia Woodsley, and it's my great pleasure to deliver this session to you. How to recommend pet food, tools and resources to use in clinic. So I have been a veterinary nurse for well over 20 years now, and I currently work at the University of Liverpool at the obesity care clinic.

So making recommendations, using all the tools that I'm going to discuss with you within this session is something that I do every day. And I feel so passionately about this topic and the help that there is out there for you. I'm hoping to share with you.

So really when we're talking about nutrition, it's all in the communication. Very rarely are we looking at physical skills, these are all going to be communication skills, getting across what you know and the knowledge that you have to your pet owner, so that they can do the very best they can for their pet. So we're going to start this module by thinking about how do we actually get going with this conversation, how do we introduce these topics to the pet owners.

We're then going to consider, well, what will these conversations include? And we're in within that going to be thinking about the nutritional assessment. The nutritional assessment, it is the foundation to everything that is going to come after that.

So the foundation to your advice, the foundation to your recommendation, the foundation to that pet's health moving forward. We're also going to consider and assess the readiness of that owner for making changes. And when we think about this, it is safe to assume that not all owners will want to make changes.

They may not have considered changes yet. And so we need to deal with those slightly more difficult areas of these conversations, and assessing readiness can be very helpful. We'll also talk through how to support owners to choose a suitable diet for their cat and their dog.

And then very finally, I hope to put everything together, not just from my session, but from all the other modules within this course. And how do we go from that unknown bag of food of a brand we've maybe never met before to an accurate feeding amount that's going to go in the bowl? How are we going to get there?

I'm going to finish this session by sharing with you all the resources that I'm going to mention throughout and so all the links, all the different places and the tools that you have available to you. So let's get started by thinking about initiating that conversation. How do we get going?

And importantly, not is just what you say, but there's so much groundwork that we can put in place first. It's what owners can see, it's how they perceive us. And first impressions count for a lot.

So I wanted to start as far back as we can really with the owner's first experience of our practise. What are they met with when they walk through the door? Is the waiting area that they are being asked to wait in a nice, comfortable, stress-free environment?

If you're not sure, play the owner just for 10 minutes. Go and sit in your waiting room, have a look around at what you can see. What can you.

Can you hear, can you hear the receptionists having their conversation over their cup of tea? Can you hear the vet in the consulting room? It's often not something we think about, but it communicates an awful lot straight off to our pet owners.

And then while they're sitting there and waiting, they're inevitably going to be looking around. So have we got relevant displays up on the wall? Are things they're communicating further to them?

Is there designated space for their species of pets? It would be lovely if we could have separate cat and dog waiting rooms. But what about if they have a rabbit with them?

Where are they going to sit with that rabbit? These things again show a level of care and thought which communicates a lot about who you are as a practise. So for cats it might be nice to have some basket covers, it might be nice to have some elevated shelving and maybe a pheromone diffuser just to try and keep those stress levels at that little bit lower.

For dogs, we might think about having a sign up saying water on request. Don't leave a bowl out in the waiting room, what you will get is a bowl of saliva by the end of the day, not nice for anybody, and certainly we don't want any risk of cross contamination of anything infectious, but it is a level of comfort that we can offer the dogs while they're waiting. If you have scales in your waiting room, we should think quite carefully about where they're positioned.

They should be very stable, and they should be quiet when the dog steps on. We don't want that horrible clang as one end flips up. Ideally they need a non-slip mat.

They could be sunken into the floor, they could be. Under a mat or a rug in some way. Again, it communicates so much about how much you care about that pet's experience.

And of course, there are the cat friendly and dog friendly clinic schemes. The resources list right at the end will show you the websites to go and read more about those schemes. So when we're thinking about having this conversation, we need to ask ourselves, well, where is the space to have this and well who has the time?

So where is it and who has it? And by the way, the waiting room is not the place all the time to be having conversations about nutrition. We need a space that's going to be big enough so that our patients and owners can be comfortable.

It needs to be fully equipped with anything that we might need, measuring tapes, weighing scales, and so on. You need to have resources to hand, not have to be going in and out of the room all the time to go and get X leaflet or oh wait a moment, I'll just go and print, whatever that is, so having everything all in one place. The room or the space needs to be quiet.

Consider that background noise. Again, be the client, sit on your waiting room chairs and just listen. What can you hear?

Remembering owners are not accustomed to our veterinary environments. So are there dogs out the back that they can hear crying? Will the owner be quite distressed hearing those noises from dogs?

Often they are, and they don't understand it's maybe disorientation, rather than we're doing anything awful out the back, which is what owners think we might be doing. So, thinking about these noises. Have we got lots of drip pumps and alarms going off for whatever reason?

Are there phones ringing in the vicinity, people having loud conversations? It's all worth considering. The other thing to consider is the time.

Is right now the best time to have this conversation? Because it isn't always. There's a lot of work that can happen leading up to a dedicated time, because we need to gather a lot of information.

So having formal appointment slots, having devoted people, devoted appointments really helps in terms of the overall outcome that you're hoping to achieve. Next we think a little bit more personally. How are we presenting ourselves?

I created this image to kind of highlight some of the differences. Which one of these veterinary nurses would you rather approach? Which one do you feel is probably going to be more helpful?

And so it's about what are we giving out nonverbally to our pet owners. Are we giving out that we are capable, professional, approachable and ready to help? And if the answer is no to any of those things, well then that's maybe something we could look at.

The other thing is about our body language and positioning within the consulting room. Of course, if you've got an animal to examine, then it being up on an examination table with you one side and the client the other makes practical sense. But take the animal out of that equation.

If you're still behind the consulting table, you have this really big barrier, this us and them, this you and me, that actually divides you. What would be far better would be to maybe sit at the end of the table like I'm doing here. So I've got direct access to my owners so that conversation can flow, so that they can feel what I am hoping that they will feel that I'm supporting, that I'm listening, that you know, I'm hearing what they're saying.

So just thinking about these things, you know, just for a moment before you go ahead into a consultation about nutrition can really help the overall conversation. Now, communication is an enormous topic and probably more than an hour's worth in itself. So I wanted to just throw out some thoughts that maybe you could pause the video and have a think about, write some answers down, I whatever helps you to think these things through.

What is going to be your communication approach? Are you aiming to educate the owner? Or are you dictating to them, are you telling them what to do?

Are you providing guidance or are you giving orders? How are you coming across? What is your communication style?

Are you being supportive or are you being prescriptive? And we're very good at being prescriptive in veterinary medicine. This is the problem, give this, it will fix that.

That approach really doesn't work when it comes to nutrition, we have to find a different way round to getting that information across to getting the changes that we might be looking for. Are we coming to a consensus with the owner over what the best way forward is, or are we telling them that there is only one way to do this? Are we listening to the owner's preferences and basing our recommendation on those, or do we think that.

There's maybe only one way to go about this. Are we giving options, or are we only discussing the gold standard or what we believe is the right thing? Of course, owners might not agree, and so unless we discuss options, we're not going to know.

Ultimately, are we going to show them, you know, be there with them on doing this, or are we going to storm off, this is what you need to do and expect them to come along on that journey with us. Ultimately, are we going to work together with our owners, or are we're gonna start pointing the finger and telling them that all they're doing is wrong? These are all things to be thought about, and so I always think of communication, particularly around nutrition as needing to be considered, thinking about what you're saying.

Considerate, so how is my communication going to affect somebody else and collaborative? Am I able to work with these owners? Can we do this together rather than it just being a me and them?

And if we can get these things right, I believe that we can have great communication with all our owners. Now this good communication is really going to set us up for ultimate success, for setting nutritional recommendations and plans that are really going to work to hit everybody's goals as best we can. And I think this entire course, not just this module, is going to help you do this.

So by the end, by the time you've finished, you will have the skills you need. You will have the knowledge that you need. You will also know the pet's medical needs.

You will be able to assess all the relevant information in that particular case. That makes you the trusted resource here, and that's really valuable. And it means.

That you can create individualised nutritional recommendations, and I promise you, there's no internet site that can do what you can do as far as giving good nutritional recommendations. Pet owners cannot get this anywhere else. Because what you're doing is based on that pet, on that pet's preference, it's based on the owner's preference.

It's at a price point that the owner is comfortable with and a work level workload that the owner is going to be comfortable with. You're going to be able to take into consideration all aspects of health, not just what's upfront, but what's happened in the past too. And you can take that recommendation and be adaptive.

You can adapt and adjust as the pet needed because you are able to monitor these nutritional recommendation and continue that support. And this is hugely powerful, this is such an important thing that we can do in terms of caring for pets in our practise. So let's think about that nutritional assessment in a lot more detail.

And as I said, this is the foundation to everything. Without the nutritional assessment, your recommendation could be on rocky ground and it may even be unsuitable or just simply won't work because it hasn't considered enough of the information that you need. So when we think about that nutritional assessment, we have to discover and decide, probably as a practise, why we're going to do it, what the value is, who is going to do this?

What are we going to be talking and asking about? How are we going to ask those questions? When are we going to ask those questions and where are these conversations or these questions going to occur?

So to briefly bring some of these things to light, and again this is a very practised individual conversation, firstly, the why. So the reason for doing it is that every patient is individual. Even though on the face of it you may feel, oh I know all about this, I've seen these sorts of people before, you haven't.

There will be nuance in there that you need to understand. Then we need information to be able to make a suitable recommendation, and some pets' needs can be really complex, particularly when that is put together with preferences of both pet and owner, so we need a huge amount of information, so that's the why. Who is going to do this?

Well, it is a team effort and actually every member of your team can have an input here. So your front of house team is going to be really important in terms of maybe giving or directing owners to answering questions or booking people in with the appropriate people. Again, this is something that you'll have to decide.

Whatever and however that information is collected, and it can be a a front of house team member that starts this process, of course a vet and a nurse and possibly both are going to need to review that information before any recommendations made, but that means that this is a team effort, it's not all on one person. The what we're going to go into in much more detail, we're gonna think about signalment, history, physical findings, preferences and routines. How are we going to do a nutritional assessment?

Well this simply could be on a printed sheet of paper, it could be in a notebook, it could be in digital form. We could send out a link to an online questionnaire. That's much easier in this day and age for most pet owners to interact with.

It could be that we email a document. It could be that in the waiting room we have an iPad specifically dedicated to gathering this nutritional information. What about the when?

Well, a nutritional assessment should be made prior to every new consultation. That would be in a perfect world, and certainly nutrition being the 5th vital sign, should be part of every conversation. So it could be on the day, it could be done the day before, and it may be following the initial consultation where you've highlighted things that are of concern.

And so we have to go back in and follow up on some of that detail. What about the where? Well, these things could be done at home, and in actual fact, having some information given from the owner when they are at home allows them to think better.

When they're in veterinary practise, they're often quite anxious, they may be a little bit stressed, particularly if their pet is very unwell. So we need to give them space and time to really think about these answers for us because they're so important. It might be a quiet consulting room is the right place.

It's definitely not over the reception desk though, and it definitely isn't in a busy waiting room. They might be able to fill out a form there, but with so many distractions, it can be very hard for them to think clearly. So thinking about the what we're going to be recording.

Now, here is our next resource that's going to be really useful to you, and it's the WSAVA short diet history form and nutritional assessment checklist. Again, links at the end. So every patient needs some kind of nutritional screening, and if problems are identified, we then move on to an extended evaluation.

So screening is something that you do alongside normal history and physical examination, whether they're in for a booster, whether they're in for a sore leg or sore ear, this still must go on. And a screening assessment takes into consideration what they're currently feeding, the amounts that appear to be being consumed, the age of that individual, and their activity level. So if they're the average adult doing an average amount of activity, perfect, we may not need to go further.

However, we may identify risk factors, which means that we should be doing something a bit more in depth. There may be a recommendation that we might need to give. Risk factors are going to be extremes of age, so the very old, the very young, they are very delicate in terms of their nutritional requirements, so we need to be thinking about that more carefully.

Activity level, again, the extremes, they're doing hardly anything, and the very highly active agility dogs, for instance, or working dogs, you know, we, we get wide variation. Of course, the presence of disease, any disease, means that we should look at the nutrition in more depth. If they've got poor skin and coat, does this mean they are lacking something in their diet that's being expressed through the skin?

And are they receiving any medications, and if so, what for? And is the owner giving any supplements? Did we recommend that supplement, or is this something that they've got off the internet?

We need to look into this a lot more closely. So in our assessment, we'll be thinking about signalment, the history, making physical assessment, and then the preferences. Signalments, of course, species, breed, age and sex, I'll talk about that more in a moment.

History, both medical history and nutritional history. Typically in terms of nutritional history, 6 to 12 months would be fine, but it does need to be longer in some cases. In terms of a physical assessment, we'll be thinking about weight, body condition, and muscle condition, and I'm going to talk all about these a bit more shortly.

And then preferences, pet's preference, the owner's preference. Do you have preference in terms of your practise? Have you got preferred food brands that you advise or that you recommend?

And what about your personal preferences? I think everybody does, whether they are aware or not, have a personal preference, and how is that influencing your recommendation? So of course, knowing what species we're dealing with is really important because cats are not dogs and dogs come in this wondrous variety in terms of size.

So thinking about what are the differences to their nutritional requirements, what is their growth phase. Durations, how is that differing? When does this individual likely to become senior?

So senior is technically the last third of life. So when do they get there? Chihuahuas are going to get there a lot, a lot later than a Great Dane.

So if you're seeing a 5 year old Chihuahua and a 5-year-old Great Dane, one will be senior where the other one won't. Will be thinking about what their denttician needs, or tells us about how they eat their coat length might have an influence, the food shape either that they prefer or that they find easier to actually prehend, so some of the brachycephalics, for instance, it, it's beneficial for them to have a shape of kibble that they could pick up. The food size, of course you don't want to be feeding an enormous kibble to a tiny dog and vice versa.

The food texture might be of consideration, particularly cats are very fussy at times on texture and even the bowl size and type, we might need to have a chat about that and see what their preferences or needs are. In terms of breed, when certain breeds walk into the room, certain little alarm bells are going off in my mind that I need to think about. So maybe if I'm thinking about purine metabolism, Dalmatians are going to trigger that thought.

Copper storage disease, West Highland White Terriers, Bedlington Terriers and so on, these are breeds likely to have problems here, so that's going to be in the back of my mind. Hyperlipidemia, I'm already picturing a miniature schnauzer, obesity, of course, I'm probably, I'm picturing Labradors, pugs, and beagles when they walk into my room. I'm certainly considering it, although all breeds we should consider it.

Zinc. Absorption. Again, typical breeds, Alaskan malamutes, English Bull Terriers, Siberian huskies, and even things like gluten sensitivity, found in border terriers.

These are all nutritional things that are that are related to the breed of the dog that that's in front of us. Now I mentioned age already and particularly the extremes of age. If we've got a puppy then we probably or almost certainly will want to be using growth charts to make sure that individual is growing properly.

If we have a senior, now seniors are so diverse because that happens at different ages, because 2 12-year-old dogs can look vastly different from each other. We need to think about what are the individual needs for this senior. What signs of ageing have we got in this individual?

And of course, as diseases are far more common, what else are we going to need to consider both now and in the future for our seniors? OK, then we get onto the physical stuff. So I would hope that everybody is very good at weighing all cats and dogs that enter the practise.

So scales need to be suitably sized. They should also be calibrated every single time that those scales are moved, it can cause inaccuracies. So using a.

Set of calibration weights like you can see here, or a brand new bag of pet food that will tell you whether your scales are weighing accurately. If you're using a bag of pet food, allow 0.1, 0.2 for the packaging, but otherwise it should say precisely what is written on the bag.

The scales also should be on a really firm and suitable surface. If it's on a sprung wood floor, the give in the floor will cause inaccuracies. If you're putting the scales on a bed or a blanket, again, that will cause inaccuracies.

So if we're going to weigh, let's. Just make sure that the number that those scales give us is an accurate number for that pet, and also recognising that that's all that scales give us. They only give us a number.

They don't tell us whether that weight is appropriate for that pet in front of us, it is just a number. To tell if that weight is appropriate, we need to do some body condition scoring and there's two resources here, again, links at the end, of which you can access to go ahead and get a body condition score. So, is the weight on the scales appropriate?

Well, we don't know until we assess their body shape. So we want a suitable scale, we want to decide what we can see, what we can feel. We need to then go ahead and determine that score.

And just one little note, if you're using a 9 point system, there are no half points allowed, so you can't give a 5.5 on a 9 point system. It would be rounded up to a 6.

On a 5 point system, like on the pet sizeome metre, you could use half points to give a 3.5, for instance. The next assessment, and I think probably one of the most neglected and forgotten assessment, but no less important, is the muscle condition score that you should be giving, particularly if you've got a senior pet in front of you or one with a chronic disease.

Now muscle condition scoring. Promise, just like body condition scoring is quick and simple to perform, but often people are less familiar with it. So let's get familiar.

Let's get practising, let's, every pet we touch just subtly and surreptitiously do a muscle condition score as well. I've got a short piece of video for you here to show you me demonstrating muscle condition scoring on this beautiful whippet. So I always start at the head end, nose to tail, so I felt the top of the head for the crest and I felt under the eye socket to see if we've got any muscle loss.

I'm now feeling the scapula to see whether I've got a really prominent ridge, which again might indicate muscle loss. And now I'm rocking my way down the spine, feeling either side of those spinal prominences for the muscle mass. Right down to the hips.

Can I feel the hip bones, or again, are they nicely muscled? And on this particular dog, you can see it from across the room, having a good feel of that muscle mass at the back there, this individual's got a really good muscle mass on that hind leg. And that was just a few seconds, and so I think we can all include this along with weighing and body condition scoring.

Now this is an example where we have an individual who does have muscle loss sadly. This is Alf, and so straight away I'm seeing a really sunken eye socket, and that's because he started to lose that muscle from his skull. You can also.

And most certainly feel that the crest on the top of his skull is very prominent. It's very sharp. It's like a blade, on top there, and it shouldn't feel like that.

You often will feel the crest, but it shouldn't feel really sharp, and it really shouldn't be visible from across the room as it is in his case. When we look at the spine, we don't even need to feel this spine to see that that muscle has melted away sadly, from either side of his spine and with severe muscle loss they almost seem to hang from their spine, and that's because they've lost those lovely muscles that should go either side. And then on his hind leg, OK, we've got some deformity here because of his medical condition that he's dealing with, but you can see that that leg almost appears too straight, that the mass is gone from where it should be, whereas on that whippet, it was big and nice and juicy and you could.

Kind of hold onto it, in this case, it feels far smaller, it feels quite tight and stretched, and that is again because this individual has got quite severe muscle loss. So once you get used to what's normal, spotting what is abnormal of course is then much easier. So that's physical parameters.

Now we need to look at what information we have available to us on our practise management systems. So what are we reviewing? We're reviewing all patient notes, all comments that have been made in the past.

We're looking for information from the consultation if they've directly come to one of us or we're doing a specific nutrition consultation. We want to list health concerns, we want to take into account any blood analysis, again, particularly for seniors or anyone with a chronic disease. We might want to look up some urine results if we have them, and of course we need to understand what's happened in the past.

If the dog in front of us is prone to pancreatitis, for instance, then we need to be very mindful of that, we need to think about how we're going to make changes over what time frame those changes might be made across because we don't want to upset any or or or have a medical condition reoccur because we're changing things or we've changed things too quickly. Then we need a lot from the owners. So we need to understand what is their dog in this case or cat currently being fed?

What brand are they feeding? How much of that food are they feeding? What are the times of day?

What's this is about the routine. Who in their house? We've got 3 lovely owners here, but I bet you only 1 or 2 of them actually feed the dog.

It usually is that way that somebody takes responsibility. So who is that? Then we need to understand about treats, what treats are given.

Let's be honest, they're all going to get treats. So let's be upfront and let's ask how often are they getting treats? How many treats are they getting?

What occasion are they getting treats? Was it for being a good girl? Was it for going to the toilet?

Is it for other training. Is it a signal that they're leaving the house? What is the occasion for getting those treats?

And who is giving the treats? Is it one individual? Is it the whole family?

Because they won't have visibility on everyone else, they will only know what they're giving. So, you know, understanding this and bringing this to light can really help. Then we need to understand the pet's preferences.

Do they like wet? Do they like dry, do they like a mix of both? What's their bowl type?

Is it raised up? Is it on the floor? Do they use a slow feeder, do they use a lick mat?

How are they getting this food across? What's their water container? Now for most dogs this is not a huge consideration, but for cats, it might be beneficial that they have running water, a water fountain might be available to them.

In certain situations, we might want to understand how many water bowls, are they on all floors in the house? You know, there's a lot to ask about here. Then we need to understand the owner's preferences, and we know that we're going to get a hugely diverse range of preferences from owners.

Some owners will only give their cat or dog bottled water. Some owners have have got one type of food that they want to feed and won't consider others. Unless we ask about this and explore this more, we just won't understand to the level that we need to.

Then we're going to need to understand the exercise and activity this pet undertakes. How, what is their ability to be active. Maybe they're very capable, but actually it's the owner that doesn't have the time and that's why the dogs are only getting 20 minutes twice a week.

You know, we don't, we don't want to assume, we need to ask about these things. And then what is that pet's lifestyle? Do they just sit around all day, do they go out and do agility or doggy dancing?

Who do they live with? Are there other pets within the house that we might need to take into consideration? What is the family dynamic?

Do we live with small children? Does this individual pet live with a grandparent who's around all day when owners are at work? What is going on?

There's so, so much here in that ultimate environment that we would need to consider in our recommendation. Now this is a lot and getting at the detail of all this information is really quite difficult. So it's about how we actually ask these questions.

If you say to a a pet owner, so what do you feed your dog? You are likely to get what goes in the bowl. They will say, yes, I feed wet or dry food twice a day, that's it, that's all they get.

And in your mind you're going, -huh, I'm sure there's more. So you ask, OK, do you, do you give dental shoes for their teeth? And they'll go, yes.

And unless you then go, do you give this, do you give that? How many of these do you give? You, it's, it's like pulling teeth, it's really difficult to get that information out because you've not asked the sort of question where the owner can open up and actually divulge this information to you.

So we have better ways and actually this really nice little study er from Jason Coe in Canada looked at precisely this and what types of phrases and what types of questions give you the best results in terms of all this detail. And what they found was it was the tell me questions. So starting first thing in the morning, tell me everything your dog eats throughout the day, start me there.

Then tell me about what treats you give, tell me about who gives treats in your household, and so on, and in by doing that, open ended questions, allowing the owners the the freedom to really talk about this, and obviously you've got to have the time to listen, but allowing that freedom so you can really get at the detail that you need. Then we have this wealth of information, we've got to make some sort of assessments, we've got to make some kind of analysis of it, whether it is suitable and whether this should continue or that you should start making a recommendation of some kind. So is the current feeding suitable?

Is it doing the best we can for that pet? Is it lacking in anything, not just specific nutrients, but maybe something else in terms of how it's being fed? Does it require changing?

The these are decisions that we're going to have to make. If we answer yes to any of the questions in terms of change, well then if a recommendation is needed, how easy is this conversation going to be? Is it going to be a delicate conversation?

And the reason we recognise it as this is because telling an owner they're doing something wrong, needs to be handled with consideration because they are, they think they're doing the best they can, don't they? So, we should also question, does the owner actually want our recommendation? Now I'm not saying for a moment that we shouldn't talk about our concerns and in actual fact we have a duty to communicate any health concerns that we might have, just like if we're looking at a limb or we're auscultating a heart, we would want to communicate our findings.

So it's not to say that, but we shouldn't be forcing an owner to have a recommendation if that isn't what they want, and so we need a way of having that conversation. Even if the owner's prepared to have a recommendation, are they actually prepared to make any changes? And even if they are, are they ready to start making those changes?

And I'm gonna talk more about readiness in a little while. So when we think about this and we think about human behaviour in general, when I'm talking about nutrition to a pet owner. We have to remember we as humans, we can only change our own minds.

Somebody else isn't going to change it for us, so I'm not going to change an owner's mind. Through the information that I give, through the education, through the visibility of the situation, I might get, I might get a result that means they change their mind, but I've not done that. They, it's down to them.

And remembering, of course, they are always just doing what they think is best. Very rarely would an owner be doing something or feeding something that they know causes harm to their pet. So that is their starting point.

I am doing my best. And so we have to be careful in how we're presenting this information if we believe that improvements could be made. So it's about presenting the information, it's about discussing those concerns and then immediately being supportive with the recommendation.

We are not there to disapprove, we're not there to shame the owner into doing anything, and by the way, shaming anyone is not motivational, so that's not going to work in any case. Ultimately, the choice to make a change to their pet's diet is up to them. And not all owners are going to change their mind, and importantly, it is not personal.

It is not that you didn't do a good job or that your recommendation isn't sound, or that you didn't collect enough information. Some owners are simply not ready. And that's why I want to talk about readiness.

So making changes as a human, we have to be ready to make those changes if they're going to be successful. And so I wanted to present the theoretical model of the stages of change because I think if we can identify these stages and apply this to making a nutritional recommendation, it can be very useful in terms of these conversations. So I'm going to talk around this cycle and this has been around a long time.

Early 80s, this was developed actually. It was developed in terms of giving up smoking, but the stages of change remain a sound theory that we are still using today. So at the very top, we've got our pre-contemplation phase.

Now this is a pet owner in this instance who has absolutely no intentions of making a change. There's nothing wrong with what I'm feeding my dog, thanks very much. How dare you as sort of say that I need to be doing something different.

If that's what you're met with in these conversations, we know very clearly where that owner is, they are not ready. The second phase we've got here or stage is contemplation. So this is where we've got a little shift.

So the owner is acknowledging that there potentially is a problem. Yeah, I know this might not be the best, but life is too busy, it's too much going on. I've got another pet who's really unwell.

It is just not the right time. And so even though they might acknowledge what you're saying and agree, they're not committed to any kind of doing, any kind of action to in to change what they're currently doing. So again, we kind of know where they are, it's not the right time, they're not ready.

Then we might have owners that are prepared to make changes, and you'll get phrases such as, yes, I've been really worried about this recently, what do you think I should do? And so they've come to you intent upon acting on what your recommendation would be. Awesome, we can really help these owners, these are ready for change.

And then what we do is we help them into this action phase. Help them to make those changes, those modifications. To either the food type or their feeding behaviour, and then we help them maintain this by monitoring what's going on, we help them sustain the change, bringing in new habits that are going to replace the old habits, ultimately to keep their pet happy and healthy.

Now there is another stage of change and it happens frequently and it's because old habits die hard and it's relapse. And so we see in certain owners and in certain situations falling back into old habits, the treats sneaking back in, the tidbits from the table, you know, those kind of habits, they come back up again. And so we may need to go round this stage of change once more because they might initially be quite defiant.

Well, I just couldn't stop and so they've ended up back in pre-contemplation, don't want to make any changes again. However, down the line they might well be, do you know what, I tried, we failed last time, I need a new approach, so now they're ready again. So by assessing the readiness, we kind of can gauge our conversations much, much better.

Now how do we actually do this? What are the words that we can use? Well this is a topic that comes up in my line of work.

I'm predominantly work with those with overweight or obesity, so I'm talking about changes needed for weight loss. So that's why I'm going to use this as an example. So I would start off by saying something like, I'd like to talk about the findings of my routine assessment.

That's weighing and body condition scoring in this example. So this is a warning shot, this is a heads up, this is a kind of, oh you need to sit up and listen, I've got something important to say. And although it seems subtle, it actually just prepares the owner a little bit for what's coming.

They're hopefully listening now. I then would immediately say, is it OK if we talk about your pet's weight today? And maybe that's, is it OK if we talk about your pet's diet today and so on.

The reason for doing this and for getting permission is if they say yes, awesome, and you've now got good buy-in. The owner has consented to listening to what to your thoughts and your feelings, they're much more likely to actually take on that advice. It.

Also offers them an opportunity to say no. And we should do that out of respect, we should give an owner an opportunity to go, no, do you know what? This isn't what I want to talk about.

I'm not prepared to make any changes anyway. I've been judged in the past maybe. I don't want to have this conversation.

And in that case, fine, we can't force them, they are not ready, so we park it. And we make a note on our clinical notes saying spoke to owner about weight, owner not ready to make changes just yet, revisit this conversation. At next revisit or something to that effect.

So we're not dropping the conversation, we're not forgetting about it, we're just waiting for a time that an owner is receptive to having these conversations, and as we've already talked about being ready is really important for getting an action. OK, I might then lead on to how do you feel about your pet's weight. So I haven't said anything just yet.

I'm gathering information, I'm asking an owner, where are you? What are your thoughts, what are your feelings? And this big open ended question hopefully will give you.

Any information that you need to be able to gauge the readiness and how and if they are prepared to make a change at all. Where are they? Do they feel that there's nothing wrong with how they're feeding?

Actually, are they quite worried about their pets at this point? You know, what are they feeling? What are they thinking?

Then, and maybe this is more specific to weight loss, I might continue with, well, can I show you how to body condition score and would you like to have a go? Cos I want to involve the owner in this. I'm not there to dictate, I'm there to educate.

So how can I educate here? How can I provide that information? How can I allow an owner to make this recognition for themselves?

And in doing so, I am doing it in a non-confrontational way. So what are your thoughts on what you can feel? Can you count the ribs or how many ribs can you count if you had to?

And again, this is information seeking, this is supportive way of having this conversation. And I might end the conversation with, well, what score do you think they have or how well do you think your pet's food meets their nutritional needs or whatever that is. And again, this is a way of collaborating.

This is a way of guiding rather than telling or dictating. And it is a way to, to shared decision making, which is ultimately the what we want to be doing in this situation. OK, so that's how we start the conversation and how we get at all the information that we need because we need to be recommending some suitable foods.

So starting with making a choice for an owner. Now I feel for owners because there is so much to choose from. There are a million different forums, there are so many social media pages devoted to this one question.

What is the best food for my pet? So let's think about how we go about doing this in the best way possible. If you're looking to make a direct recommendation, your pet has got kidney disease for instance, I would like to recommend you foods that are going to support the the health of your pet.

So that's gonna be based on the nutritional assessment results, it's going to be based on the benefits that that particular food is going to give, and then of course we need to discuss through all the options, and this obviously is going to be an evidence-based discussion and an evidence-based recommendation. What about more broadly though, an owner maybe has got a new dog or a new cat from the cat shelter and they're asking, well, what's the best thing to feed them? And that is a really difficult question to answer because there's just so much choice.

But we should help them and not just say, well, anything that you like, you know, so these resources that you can see pictured here, again from WSAVA are really helpful in terms of signposting owners too, to give them that information that they need to then go ahead and make an informed choice. We probably should also talk them through what's on the food label, what's important information, what's just marketing, and then help them to prioritise what are the main things that this cat or dog needs. Let's list them, you know, these are the things that you might want to be looking for.

And also making sure that we're discussing nutrients and not ingredients for the vast majority. If you have a patient with a known adverse reaction to a particular ingredient, OK, we might need to think about that, but for the vast majority, it's the nutrients in that diet that really matter, not the ingredients, and it's very different, in terms of the approach to what they will find on social media, which seems to almost be exclusively about ingredients and not nutrients. So I like to talk about a principle-based recommendation or a principle-based way of deciding on on what is a good food, and it's covered by seven key nutritional aims.

So the first one is the food must be complete and balanced and suitable for that pet. So cat for cat food, cat food for cats, dog food for dogs. It then must contain nutrients that are bioavailable and so the pet can actually extract them from the food and use them.

Now the importance about bioavailability is, well, who's tested that? Has the company tested that? If they have, wonderful, but if they haven't, well how do we know?

So these are questions that will come up. Our third key nutritional aim is, is it going to be appealing for the pet? You can make all the best recommendation in the world, but if it's not suited to the pet's preferences, they won't eat it anyway.

So it needs to be palatable, it needs to be appealing. The food that is going to be fed must be fed in controlled quantities. How are we going to do that?

Ideally on digital scales, how do they know how much to feed? Well, we're gonna come to that shortly. Is the food safe?

So safe to feed in terms of is it gonna cause harm to either the pet or a pet owner, and is it nutritionally safe? So do we have a fixed formula, do we have a variable formula on that particular diet? How do we know?

If the ingredients are changing, then actually what they're feeding is going to be the same each time, so we need both pathogenic safety and nutritional safety. Whatever the recommendation or whatever the choice, it must be achievable, achievable in terms of getting the food, actually physically getting it. Is it an elderly person who isn't very good with the internet and can't order things?

Or do they not have transport, so bringing a 15 kg bag home from your practise or from a shop, that's just not achievable for them. So we need to just consider, can the owner do it in terms of time, in terms of the practicalities, and in terms of affordability. Many owners will say yes, yes, that, that sounds great, I'll go right ahead, work out how much it will cost and have a small heart attack because they can't afford that and then they're stuck.

So we have to have these conversations about is it achievable too. And finally, is it sustainable, and again, this kind of ties in with that a little bit. Can they spend that much going forward for the foreseeable future?

Can they get the food in an easy way? And then bigger sustainability questions in terms of pet foods in general, not a topic for this module, but it is something that we should be thinking about in a much wider sense. So resources such as this help the owners to determine what they're really looking for on that pet food label.

I know that there is another module that has talked about this in detail, so I won't bore you any further, but just remembering to focus in on the nutrients from the analytical constituents, not the composition in the vast majority of cases. OK, so we've gone through this huge process now of all the information gathering. We've come to our recommendation.

We've got a bag of food in front of us. How much do we recommend to feed? And this is where your expert advice comes in because it is taking into consideration everything that's gone before it.

So maybe you've made this recommendation, maybe we need a change in diet to support a disease of some kind, or maybe, which also sometimes happens, an owner walks in, plonks a bag on your table and very proudly says, I've bought this food for Sandy, how much do I feed her? And you've never seen this food before, it is utterly unfamiliar and it wouldn't be a surprise, hundreds of new foods come out every year. So we have to have a way of going, OK, let me calculate that for her.

And so that's what we're going to, think about just now. So this is about the steps to that full recommendation of going from the bag of food or the tin of food to how much is going to go in the bowl once that pet goes home. So we think about first of all, how many calories does this pet need?

Then we think about how many calories are in the food that we're recommending. Does this pet want a wet food, a dry food, or a mixture of both? How many meals are we going to feed this food over and what are the costs per day going to be of that?

We need to go through that process to be able to make this recommendation. So in terms of calculations, the more sources that you look for for calculations, the more calculations that you will find. So my best advice to you would be is pick a calculation, pick a way of doing this and stick with it.

Stick with it as a practise so that everybody knows what we're doing. Now the choices that we have are maintenance energy requirement calculations, resting energy requirement calculations, and then from that daily energy requirement calculations. Our maintenance energy requirement calculations, they're for moderately active adults, they don't need to keep themselves warm, they're not fasted, and it's to maintain weight.

Brilliant. For the vast majority, that's going to be what we need. Our resting energy requirement calculations again for normal adults in a stress-free environment, and again it takes into account some energy losses through digestion, metabolism, absorption, and importantly recovery.

Then our daily energy requirements, these are actually adjusted versions of either the MER or the RER. So maybe we'd make an adjustment based on activity level, maybe we make an adjustment based on weight loss or the need for weight gain. Maybe we'll adjust it because we're slowly reintroducing food.

Whatever the reason, it's then called a daily energy requirement. So for these reasons, MER is going to be most suitable for patients that are at home. They've come in for an appointment, but they're going to return home.

Resting energy requirements are most appropriate for our hospitalised patients. They're doing very little, they've not got that opportunity or really the desire for a spontaneous activity, and we've got a calculation that accounts for recovery. Now it's not perfect because they are meant to be stress free and clearly within our hospitals they're not always, so it's, but it it is at least an adjustment that we can make and so DER daily energy requirement can be either can be used for at home or or in the hospital.

So for maintenance energy requirements, we can use this great resource, it's the NRC 20064 step method, and these calorie calculators are of course at uk petfood.org, and they take all the pain out of what we might be doing here and . Working these calculations out very quickly and efficiently for us, and you fill in a form like this, so in this instance we've got a 28 kg dog.

We're adjusting for activity, so this is a moderately active individual, and so we get a daily energy requirement out, this case, you can see 1,338 calories. Per day, and that is quick and simple and really nice and easy. Then our resting energy requirements depends on how big the patient is.

So if we've got a a patient between 2 and 30 kg, we're going to use a different calculation to if we've got a very small patient of under 2 or a very large patient at over 30. These calculations, remember, for hospitalised patients, they're to support recovery. This is not a time for weight loss, so even if they do have overweight or obesity, maintenance of weight is what we're looking for, and they need to be weighed daily to make sure that we're being successful.

And in, in actual fact, in the hospital every 24 hours that nutritional plan needs to be assessed and adjusted, particularly if we've got weight fluctuations that aren't to do with fluid loss. So here we've got a couple of examples. Do feel free to pause the video and have a closer look at these.

So in this case we've got a 28 kg dog, and we can calculate that his calorie amount per day for resting energy requirement is 910. Then we have a really large fellow, this is Beau, so Beau is 76 kg, does need weight loss, but this is not the time. So we use the second RER calculation to get his calorie amount per day.

Now in terms of our second step, so now we need to know the energy content of the food, we can contact the manufacturer for that. Or we can use modified Atwater calorie calculations to actually do this manually. And again, on UKpetfood.org we've got all this.

They're ready for you. It's part of the four-step approach where you can put in the analytical constituents and it will tell you the calorie content of the food. And these fact sheets here, they go into this in a lot greater detail, so I'm not going to spend a huge amount of time here.

Now although those calculators exist online, I do feel quite strongly that we should all really know how to do this, so we understand what's behind the calculation so that if you're in a situation where you can't use this, you can still work that out. So our first job is to look at the calorie giving nutrients within the analytical constituents. They are, of course, protein, fats and carbohydrates.

But you will notice straight away that carbohydrates and moisture are not stated or not always stated on the analytical constituents. If you have a wet product, the moisture will be there, but the carbohydrates won't. So we need to find those missing numbers.

So job number one, to find the carbohydrate content of the food, and that's done using this calculation. You take the percentage of protein, fat, fibre, ash, and moisture. And you take that away from 100 and that gives you the amount of carbohydrate.

So in this instance, this food contains 48.6% carbohydrate. Why isn't it on there?

There's no legal requirement for it to be on there, so manufacturers don't put it. The second thing we need to find is that moisture content, and you'll notice in these calculations I used 10, even though it doesn't state it on the analytical constituents, and that's because if we don't want to phone the manufacturer, we can assume 10% moisture for all dry foods. As I said, all wet foods or moist foods will give a moisture content.

So now we have the missing numbers, we can go ahead and use the modified Atwater calculations to come to a feeding amount. So again, if you want to pause the video and have a closer look at these, this is the calculations worked out for you. We determine the calories per 100 grammes coming from those three calorie giving nutrients, the protein, the fat, the carbohydrates.

Add them all together and we get a calorie amount per 100 grammes. Excellent, we're one more step closer to putting food in the bowl. But how do we do this?

So let's look at this dry food example. First of all, we've got our 30 kg dog Ollie here. And so firstly we need to know his energy requirements.

1,217. He has low activity, and that was what was determined. Then we need the carbohydrate content, we've done that already, and then the energy content can be worked out subsequently.

Brilliant. So we've got those pieces of information that we need, and this is how we go ahead and calculate a feeding amount. So we take the calories required, that's his energy requirement, divide that by the calories in the food times by 100 will give us a feeding amount per day, and in this case, 335 grammes.

Now it's worth just going, hang on a minute, can I use something that's going to speed up this process? So yep, great, I can use the calculators and then does it seem right? Have I just prescribed or have I just calculated this amount of food for a cat?

That's clearly not right. Have I calculated 20 grammes per day for a Great Dane? OK, clearly that isn't right, and it is important to just pop one of these sense checks in there just to make sure.

What if though they want to feed some wet and some dry and they want to feed one brand in wet and one brand in dry? Well, that causes us a few more problems. And of course there's going to be no feeding guide that's going to allow this to be made easy.

So we need to know the energy content of the foods we're going to feed. So firstly, the dry food, which we've done, and then the wet food. The next step on with the wet food is we need to know how many calories per unit.

And you can see in this case, we've got 110 calories per 100 grammes. I've got a 400 gramme tin, nice and easy calculation, to 440 calories per tin. Now the reason that that's important is how we're going to go on and allocate calories for the wet food.

And that's always my next step. So I take that energy requirement that little Ollie needs. I then take away the calories that I'm going to dedicate to wet food, so in whole or a half unit.

So it looks something like this. If I want to give him a tin of food, 1,217 calories minus the 440 in that wet food, leaves me with 777 calories to then be. Used up in dry food.

So then, just as we did before, we take the remaining calories of what's left of his requirement, divide that by the calories in the food times by 100, gives us 214 grammes that's going to be coming from the dry food. So drumroll please, putting this all together means that we're going to be feeding Ollie one tin and 214 grammes. And again, does this seem right?

Yeah, I think this is reasonable. So very briefly, just as we finish, I wanted to kind of put all this together for us, the steps that we need to think about. Choice number one, MER or RER using online calculators or RER calculations, depends on the situation.

We then need the energy content of the food, and again we can do this with the online calculator or modified our water energy calculations. Then we decide on the feeding quantity. We take the calories required, divide that by the calories in the food times by 100, or again we can use those calculators which makes life easy.

Then we need to split that up depending on how many meals that cat or dog needs. It might be 2 for a dog, it might be 4 for a cat, so making those calculations nice and simple. And then the costs per day.

So this is a two step process to get the costs per day, but I think it's important to be upfront about this. So we take the amount in the bag, and it must be in grammes, not kilos, divide that by the daily ration, gives us how many days that bag will last. Then we take the price of the food and divide that by the number of days that we've just calculated.

It will last and that will give you the cost per day. Finally, we then come to a schedule of monitoring, and that's going to be really individual. Is it going to be every 2 weeks?

Is it going to be 3 or 4 times a year? You will have to make that decision. So to wrap it all up, these nutrition conversations are central to health and disease management for every single one of our patients.

To start doing this properly, we need all that vital information from our nutritional assessment so that we can set individualised plans that are likely to work, that's so important. And it's a plan that we've collaborated on with the owner, so we can support them within their choices and ultimately make this a really sound evidence based recommendation. We can go from any food now that we might be presented with or we might recommend to a feeding quantity, telling an owner how much it will cost, how long the bag will last, how many meals to feed it across, and ultimately this means that we can do the very best for every single one of our patients.

Now I promised you lots and lots of resources that you can access. This is page one of those resources, so please feel free to pause the video, go and have a look for them, and this is page two. And so that leaves me just to say if you have any questions, please don't hesitate to contact me at the below email address.

And finally, it has been a pleasure, thank you very much for listening.