Clinical Food

3. Clinical Food

A consultation with owners of obese dogs requires the veterinarian's time. It is important to respect the various steps described above and especially to convince the owner. Such a consultation is of no use if the owner does not want it or if those involved do not have the time. This problem needs at least 30 minutes of everyone's time.

Approach of the Owner

Most owners of obese dogs do not on their own accord schedule an appointment to explore solutions to the problem of obesity in their pet. On the contrary, they are generally unable to evaluate their animal's weight condition (Singh et al., 2002). That means that it is up to the veterinarian to identify the problem, convince owners of its seriousness and motivate them to implement a dietary change. Owners also have to be warned that the diet will not be easy and will be spread over a long period.

Two types of approach are envisaged in terms of communication, positive messages that explain all the advantages of slimming for the dog's health (e.g. greater alertness, etc) and negative messages explaining all the adverse effects of obesity and associated diseases. It is advisable to adapt the approach to suit the owner of the animal. It is not always necessary to put forward a large number of arguments. Select the arguments that are most likely to appeal to the owner, such as longevity, quality of life and the owner's responsibility to keep the animal in a healthy condition. It is necessary to present precise arguments, directly linked to the problems presented by the animal and to focus on the improvement or eradication of the disease to motivate the owner. The owner will also feel that the problem is being taken seriously if the veterinarian or other clinic staff are available during the period of dietary therapy.

Motiving a Change (G. Muller)

Malarewicz wrote "every request for change is accompanied by a request not to change." (Malarewicz & Reynaud, 1996).

With respect to our problem, this could be expressed as "I would like my dog to lose weight but I don't want to change its food" or "my dog is too fat but I love giving him treats and seeing him eat them with pleasure". Every veterinarian knows that simply prescribing a diet will not be enough to obtain weight loss in the dog. The difficulty lies in motivating owners to keep to the diet and to help them remain strong when their dog begs for a treat. Prochaska & DiClemente (1984) have created a model for motivating change, divided into various steps. This model is well suited to guiding your prescription (Figure 11).

• Step one: Absence of awareness

In this pre-contemplation phase the veterinarian must stae the facts of the case: “Your dog is overweight because…” or “Your dog has put on weight since the last visit.” This step lasts until an owner is able to say that the dog is too fat.

• Step two: Contemplation

The owner has become aware of the problem and the veterinarian must invite her or him to contemplate change and the reasons for it. Owners have to be helped if they are not revert to step one. They have to be shown that the situation is abnormal and that change is needed.

• Step three: Awareness of the problem and the necessity of change

The owner has to be shown how the change can be achieved. Clearly, as mentioned above, it is important to monitor that the situation does not go backwards. The benefit of the diet is always situated in the future, while the pleasure of the treat is immediate.

• Step four: Change

The owner must be given permanent support and must not be reproached if results are slow in coming. It is difficult time and it is important to emphasize the importance of results.
English Bulldog. A discussion with the owner will be enough to identify the dog's bad eating habits. (© Diez)

Rationing in Practice

Anamnesis and Dietary History

The discussion must focus on several general points, not the least the dog's environment and specifically the way it is fed. While it is not always possible to calculate the energy ingested by the obese animal, a discussion with the owner will be a source of direct and indirect information and input for the formulation of solutions that avoid pitfalls. The following information may prove useful:

• Regular food: brand, type, energy value
• Daily quantity
• Feeding method: ad libitum versus limited quantity
• Identification of the person who feeds the dog and other people involved
• Distribution of treats, leftovers, etc.
• Number of animals in the home and the obese animal's potential access to food.

In the case of extremely obese animals it is essential to ensure that the quantities of energy given as part of a diet are lower than those typically consumed by the dog. In the extreme obesity phase energy expenditure can be very low.

Clinical Examination and Determination of Weight Loss

The aim of the clinical examination, and where necessary various supplementary tests, is to check that the state of obesity is not secondary to an endocrine disease. The determination or estimation of ideal weight is necessary if an appropriate target is to be set for the owner and to determine the best energy allocation (Table 11). The length of the diet can be calculated on the basis of this data. Bearing in mind this is a consultation by a general practitioner these parameters may appear to be fairly technical, but it must not be forgotten that the interviewee is the owner of the animal and clear, data-based messages ("Your dog must lose x kg in y months") are much more persuasive than a vague approach ("Your dog is too fat. We are going to put him on a diet").

Selection of Food

Commercial foods for treating obesity in domesticated carnivores must have a low energy density. In fact, it is a legal requirement (Diez et al., 1995), albeit a fairly vague one. The various types of low-calorie food are presented above. Whatever the type of product selected, it must be complete, balanced and palatable. A lack of palatability may actually cause the dog to refuse the food, which is not the desired goal. Traditional means can be used to increase the palatability of food, such as adding water or introducing a period of transition.

Rationing and Spreading

The selection of the level of restriction and the type of food depends to a large degree, on the initial situation. The aim is to obtain a sustainable modification in the food to obtain a sustainable reduction in body weight in the long term. In humans, the practice of highly restrictive diets that permit rapid and easy weight loss is advised against. This method does not produce better results and fuels relapse and the rebound effect. The vicious circle of major restriction and compensatory hyperphagia provokes incessant weight fluctuations and in the long term aggravates the situation.

In the case of dogs the problems are not the same at all, because in principle the diet is controlled after weight loss has been achieved. That means that a severe restriction is not necessary if the dog is moderately obese and does not present clinical signs, and if weight loss is not considered necessary due to the appearance of a pre-diabetic state. A moderate restriction and a relatively slow loss of weight can certainly be contemplated in these cases. On the other hand, a much more radical approach will be necessary when the dog presents for example, severely obese and with a torn cruciate ligament, especially if the surgeon refuses to intervene before the dog has lost a significant amount of weight. Such a pathological history makes the owner highly vigilant with respect to the risk of relapse. In this case, his motivation is high enough to allow a severe restriction.

Figure 11. The Diclementé and Prochaska model.

The principles of rationing and the way the consultation of the obese dog is conducted as shown in Tables 15 and 16 are inspired by the recommendations of several authors (Andersen & Lewis, 1980; Lewis et al., 1987; Parkin, 1993; Laflamme & Kuhlman, 1993b; Laflamme et al., 1994b; Wolfsheimer, 1994b; Diez et al., 2002). The daily energy allocation is calculated on the basis of the initial obesity: 50 - 85 kcal /kg BW 0.75 is ideal and varies depending on the sex and the desired speed of weight loss (Table 11). Such rationing leads to a weight reduction. If the weight of the animal does not fall, the intake will have to be reduced again after verifying that the owner is not giving the dog extra food or treats (Markwell et al., 1990). The aim is to induce a weekly loss of 1 - 2% of the initial weight. Spreading the daily ration over three or four (and at least two) meals will increase postprandial thermogenesis (Leblanc & Diamond, 1985).

Behavioral Support

Dietary habits must be changed to produce weight loss in the dog and then stabilize the weight. Giving leftovers and treats may lead the dog to beg (Norris & Beaver, 1993). The dog should be fed only in its bowl and should be kept at a distance when the humans in the household are eating, especially if they are used to giving the dog food at these times. Bad habits can be repla-ced with new rituals.

Monitoring the Dog During the Diet

Scheduling Checkups

It is reasonable to ask the owner of an obese animal to bring the dog for a checkup every month to evaluate the speed of weight loss, conduct a clinical examination and adjust the energy quan-tities and so the food given if necessary. The dog must be weighed once a week, however, at the same time and with the same scales, if at all possible.

Establishing a Weight Loss Curve

A weight loss curve enables visualization of the development of the dog's weight and is a moti-vating factor for the owner. During the first visit, it is advisable to establish an individual weight loss curve showing the initial weight and the curves for 1% and 2% of initial weight loss per week. There are computer programs for quickly visualizing projected weight loss. The owner's reference is to keep the dog's weight between the two curves. The prognosis depends almost exclusively on the owner's motivation (Markwell & Butterwick, 1994).

In practice, the initial weight loss target is rarely achieved: the actual loss is generally lower than 1 - 2% of initial weight per week. In two control studies the weekly losses were 0.78% and 0.86% respectively. In a third study on 9 obese dogs the rate of loss varied between 0.8% and 3.1% (average: 1.9%) per week for a length varying from 4 to 38 weeks (average: 18). All the dogs achieved the target weight established at the start (Diez et al., 2002).

Yorkshire terrier. The increase in activity must be gradual. A brisk walk of 30 minutes 15 minutes twice daily is recommended every day. (© Lanceau)

Causes of the Rebound Effect

• Absence of awareness that the maintenance of ideal weight is a long-term target
• Absence of long-term changes in dietary habits and the return to a certain laxness, due to either ignorance or ease. The owner starts to give the dog treats and leftovers or stopt weighing the daily quantities.
• Absence of exercise: reduction in walks, reduction in available space after moving house, etc.
• Changes to the environmental conditions that favor a constant weight: the dog is put in a vacation kennel (absence of the owner), arrival of another animal in the home, absence of control of those that feed the animal (children, neighbors, friends, staff, etc.)
• Changes to the food initiated by the owner or the veterinarion: switch to a higher-energy food without adjusting quantities
• Changes in the dog’s living or health conditions: appearance of anxiety, aging or disease.

The list above is not exhaustive. It would appear that maintaining the ideal weight is a target that necessitates the active involvement of the dog's owners.

There are many reasons that may explain these differences and they all deserve attention. The first is clearly the owner's lack of motivation when at home: giving the dog quantities in excess of the amounts agreed, as well as treats and leftovers. The complete lack of control with respect to total food ingestion is another problem: knowledge of the energy value of a staple is often poor. The lack of exercise is also to blame. Lastly, not adjusting the ration during the diet is a major factor for failure.

Physical Exercise

The aim of physical exercise is to increase energy expenditure and prevent the loss of muscle mass and bone mass. The effect of weight loss associated with physical exercise generally improves the animal's endurance; these are the positives for owners. There are pathological conditions, however, including an osteoarticular complaint or a torn cruciate ligament, that make exercise impossible, at least for a certain period of time.