Tips for Overcoming Patient Weight-Loss Communication Blues

When once asked what was my least favorite case to manage nutritionally, I replied, “Easy; it’s weight loss.” I received a surprised response, “Really? But weight loss is so simple,” which led me to wonder why obtaining client compliance with a concept such as “feed less and exercise more” is so difficult. Could it be the message delivery (i.e., do we enter “robot mode” when delivering our “weight-loss spiel”)? Are we so frustrated over not seeing weight-loss results or so worried that we will offend clients with our perceived barriers¹ that we skip the conversation altogether?

This article provides communication tips to help veterinary nurses overcome weight-loss communication fatigue, using Fluffy, an overweight dog, as a hypothetical example. Fluffy is a 4-year-old female Shih Tzu cross. The clients have brought her in for annual vaccinations. Fluffy has gained 20% body weight since her last appointment and her body condition score is now 8/9.

Communication Skills

An effective weight-loss plan is multimodal. To be comprehensive, a weight-loss plan should include a proper nutritional assessment, energy calculations, and nutrition recommendations as well as frequent reassessments to ensure that patients meet weight-loss goals. If the veterinary team lacks effective communication skills, the recommended nutrition plan may look great in the patient file but is unlikely to be effective for the patient, especially without client buy-in. Did we ask the client if they are open to discussing weight loss? Do we understand their barriers? Did we ask the client what they know about obesity in pets? Weight-loss communication fatigue could be more of a result of a lack of listening than a lack of telling.

Communication involves a set of skills. According to Becky Taylor, RVT, MA, “Communication skills are like any other skill; they need to be learned, practiced, and coached. That’s how we get better” (B. Taylor, oral communication, July 2024). Mastered skills result in more successful outcomes. Although skills come naturally to some, for others they take practice and ongoing application before they seem effortless. Communication skills include empathy, curiosity (probing), active listening, managing barriers, and incorporating everything you have learned into a plan that is acceptable to the client. The process of mastering a communication skill is similar to that of mastering a technical skill (TABLE 1).

Empathy

Most veterinary professionals feel empathy, at least toward their patients. Empathy is defined as the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another.

Feeling empathy toward clients does not mean feeling sorry for them, taking on their emotions and stress, or judging them. It means taking action to sincerely learn more about their insights into their pet.

Curiosity

Being empathetic requires being curious. Ask clients to provide information about their daily routine with their pet, including how and why they make decisions about their pet’s nutrition. Open-ended questions will encourage them to discuss, in their own words, the information for which the veterinary team is looking. Avoid adding leading descriptors to questions; leading questions may decrease the information obtained from the client. Allow the client to express themselves fully in order to better understand them. For example:

Leading question: “Do you feed Fluffy commercial food or raw food?”

Open-ended question (preferred): “Tell me about all the food you give Fluffy every day.”

Active Listening

When clients are talking, are we truly listening or are we starting to prepare our response? Active listening involves hearing the client and allowing them to finish their thoughts. Take that information and probe until you have gathered all the information you need to help support the client and their overweight or obese pet. Active listening is not a time to educate or defend your position. For example, the client is explaining how they feed a variety of raw meats to balance Fluffy’s diet. As the client pauses to take a breath, suppose we interrupt to give our speech about the risks associated with raw food. If instead we had allowed the client to finish, we might have learned that the client recently read an article by a veterinarian about how raw food can be the best way to keep pets healthy if properly supplemented and that they are already doing that. Thus, they may be likely to tune out what we are saying: a lose–lose scenario. Veterinary professionals should not listen to judge, educate, or defend our position; we should listen to understand and empathize.

Managing Barriers

After listening to the client, their concerns, and their needs, the veterinary nurse can use communication skills to tailor and communicate a nutrition weight-loss plan to meet their needs. The 2021 AAHA Nutrition and Weight Management Guidelines is a complete resource for nutrition and weight management discussions with pet owners.² It breaks down weight-loss issues into 3 areas: animal-specific, diet-specific, and feeding management. Surveys have shown that some pet owners do not perceive their pet as being overweight, are frustrated with efforts to decrease their pet’s weight, and/or continue to give their pets treats.³ By engaging clients, and not jumping to preconceived biases, veterinary nurses can better identify and overcome such barriers

Putting It All Together

Now that we have some communication tools to practice, here is an example of putting our skills to work in weight-loss conversations.

Veterinary nurse: “Good morning Mrs. Smith! I’m happy to see you and Fluffy today. I can see that you are a fabulous owner and care a lot about Fluffy. As part of the nutritional assessment component of our examination, could you tell me all the things that Fluffy eats or chews on in a day?”

Client: “Fluffy eats Brand X, and she is good at self-regulating, so we just keep the dish full. My husband likes to give her snacks during the day, and she has a few chews for her teeth.”

Communication coach suggestions: What could we do here to gain more information to help us? We could start by asking the client a few questions such as:

• What are your health goals for Fluffy?
• Tell me more about your nutrition choices for Fluffy.
• With all the pet food choices out there, how did you decide to feed Brand X?
• Tell me more about the snacks Fluffy gets.
• I love that you care about Fluffy’s dental health. Tell me more about the chews you are giving her.

Client: [Responds]

Veterinary nurse: “That is so interesting. From what I am hearing, Fluffy is getting [relay back what you heard]. Do you have anything else to add?”

Coach: Be sure to pause for a response.

Client: [Responds]

Veterinary nurse: “Wonderful. From my assessment, I can tell that you have done a fabulous job caring for Fluffy. Thank you for being such a great pet parent. When I assess her body condition, Fluffy’s body condition score, which is a measure of her weight, is higher than we would ideally like to see. Tell me about Fluffy’s activity, how much she moves in a day.”

Client: “We go for a long walk every day. My husband has a bad knee, so we are walking slower now.”

Coach: What could we ask to get more information? Remember to be empathetic. Suggestions include:

• That must be hard for your husband to slow down. Tell me in detail about your walks as if I were going to walk Fluffy the same way you do.

Client: [Responds]

Veterinary nurse: “That is fabulous information. I hear that you walk around a large block in town, with Fluffy on a leash in the morning.”

Coach: Ask the client if they have anything else to add about Fluffy’s activity level.

Client: [Responds]

Veterinary nurse: “I love being on team Fluffy with you! I would like to recommend that you have a consultation with our veterinarian so they can assess Fluffy’s body condition and make a plan moving forward with you to ensure we do our part in keeping Fluffy healthy and match your health goals for Fluffy. What are your thoughts on that?”

Coach: Do not forget to pause and give clients a chance to think and respond fully. Do not interrupt. Allow time for the client to ask questions. Here are some suggested ways veterinary nurses could inform clients about weight-loss initiatives:

• We aim to work with our clients and provide opportunities to improve their pet’s health. Tell me about your health goals for Fluffy.
• I would love to hear about your interest in improving Fluffy’s body condition. What questions do you have?
• Such techniques can be used in other situations:
• Thank you for sharing your concerns about the cost of the food. It sounds like not knowing potential costs may be stressful. Tell me more about your cost expectations.
• I hear that you are concerned about a few weight-loss barriers for Fluffy. It sounds like you have a lot going on, and it must be difficult to hear that I am asking you to change your routine. My goal is to help you create a viable plan and support you and Fluffy in her weight-loss journey. Tell me more about your routine surrounding food in the house, and let’s see if we can overcome barriers together.
• I am happy to provide you with more information about obesity. How would you like to receive that information?

Summary

By actively practicing and using communication skills, veterinary nurses can better understand clients’ perspectives and tailor conversations to be personal and empathetic. Allowing ourselves to be curious without judgment and using affirmation sentences helps build trust and lower defensiveness when discussing possible negative information with clients. Effective communication involves actively listening to clients and pausing to let them speak. Communication is a skill that requires practice and coaching and is the key to improving patients’ health.