{"id":5264,"date":"2020-09-04T14:26:58","date_gmt":"2020-09-04T18:26:58","guid":{"rendered":"https:\/\/todaysveterinarynurse.com\/?post_type=articles&#038;p=5264"},"modified":"2022-05-25T17:37:54","modified_gmt":"2022-05-25T17:37:54","slug":"elements-of-a-successful-weight-management-clinic","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/nutrition\/elements-of-a-successful-weight-management-clinic\/","title":{"rendered":"Elements of a Successful Weight Management Clinic"},"content":{"rendered":"<p class=\"p1\"><span class=\"s1\">O<\/span><span class=\"s2\">besity in cats and dogs has reached<\/span> epidemic proportions in the United States and around the world. Numerous health risks are associated with pets being overweight or obese; therefore, it is imperative that owners are educated regarding these risks and encouraged to promote weight loss in overweight pets. Weight management clinics led by veterinary nurses allow for creation of more involved and closely followed individual weight management programs. Such clinics benefit veterinary nurses, pet owners, veterinary clinics, and, most importantly, pets.<\/p>\n<p class=\"p1\"><span class=\"s1\">Many elements make up a weight management clinic, and setting up these clinics in practice can be very rewarding for all involved. Veterinary nurse\u2013led clinics allow veterinary nurses to use their clinical judgment and obesity knowledge to take responsibility for weight loss programs. <\/span><\/p>\n<h2 class=\"p2\">Staff Resources<\/h2>\n<p class=\"p1\"><span class=\"s1\">Before implementing an obesity clinic, veterinary nurses need to review what training requirements are needed by the whole team and ensure that all aspects are covered: communication skills, nutritional knowledge, and behavior. Some recommended resources are listed in <\/span><span class=\"s2\"><b>Box 1<\/b><\/span><span class=\"s1\">.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:0px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:0px;border-top-right-radius:0px\">BOX 1 Recommended Resources<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:0px;border-bottom-right-radius:0px\"><\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Ackerman N. <em>The Consulting Veterinary Nurse<\/em>. Chichester, UK: Wiley Blackwell; 2012. <\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Pet Nutrition Alliance <a href=\"http:\/\/petnutritionalliance.org\">petnutritionalliance.org <\/a><\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">World Small Animal Veterinary Association (guidance on nutritional assessments, diet history sheets, and how to implement nutritional assessments in clinics; available at <a href=\"http:\/\/wsava.org\">wsava.org<\/a>) <\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Wortinger A, Burns K. <em>Nutrition and Disease Management for Veterinary Technicians and Nurses.<\/em> Ames, IA: Wiley Blackwell; 2015.<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><\/div><\/div><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Checklists can help in obtaining all the information required from the pet owner during clinic visits (<\/span><span class=\"s2\"><b>Box\u00a02<\/b><\/span><span class=\"s1\">). They can remind veterinary nurses of what questions to ask, ensure continuity between staff members, and be used as records in the clinical history.<\/span><\/p>\n<div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:0px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:0px;border-top-right-radius:0px\">BOX 2 Sample Checklist for Weight Loss Clinic Visits<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:0px;border-bottom-right-radius:0px\">\n<strong>Weight<\/strong><br \/>\nCurrent body weight:____________________________________<br \/>\nIdeal body weight:______________________________________<br \/>\nBody condition score:____________________________________<\/p>\n<p><strong><div class=\"su-spacer\" style=\"height:8px\"><\/div><\/strong><\/p>\n<p><strong>Diet Information<\/strong><br \/>\nCurrent diet:__________________________________________<br \/>\nTreats:______________________________________________<br \/>\nDental chews:_________________________________________<br \/>\nHuman foods:_________________________________________<br \/>\nNumber of meals per day:_________________________________<\/p>\n<p><strong>Environment<\/strong><br \/>\nOther animals in household:_______________________________<br \/>\nAccess to other foods:____________________________________<br \/>\nExercise and play level:___________________________________<\/p>\n<p><strong>Other Information<\/strong><br \/>\nCurrent health status:____________________________________<br \/>\nCurrent medication(s):___________________________________<br \/>\nSuitable food weighing scales at home?________________________<br \/>\nAny hindrances to completing the program?_____________________<br \/>\nAny questions regarding the program?_________________________<\/p>\n<p><strong>Recommendations<\/strong><br \/>\nDiet and feeding plan:_____________________________________<br \/>\nExercise and play:________________________________________<br \/>\nActions Weight loss graph? Yes\/No<br \/>\nNeck, chest, hips, tail base measurements? Yes\/No<br \/>\nPhotos taken? Yes\/No<br \/>\nFood diary:____________________________________________<br \/>\nNext appointment:_______________________________________<br \/>\n<\/div><\/div>\n<h2 class=\"p2\">Owner Behavior and Pet Obesity<\/h2>\n<p class=\"p1\"><span class=\"s1\">Theoretically, weight loss can be achieved when the amount of calories consumed is less than an animal\u2019s overall energy expenditure. Achieving the necessary reduction in calories and increase in energy expenditure in pets can be difficult, owing to owner education, owner compliance, lifestyle, and behavioral traits. The complex relationship between owner and pet therefore needs to be discussed as part of the weight loss program. Often, when obesity is addressed, the behavioral traits in the owner-pet relationship are compared with those between a parent and child,<sup>1<\/sup> as pet owners have roles similar to parents (caregivers) in supplying food and using it as a reward. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Obesity treatment programs for humans that include behavioral interventions in conjunction with dietary changes and increased physical activity achieve higher success rates than those that do not include behavioral modifications.<sup>2<\/sup> Pediatric obesity treatment programs that involve the whole family in intense behavioral interventions are more successful than those that do not, with the success of the programs related to the intensity of the behavior treatment.<sup>1<\/sup> Such findings have implications for weight reduction in companion animals, with a positive correlation identified between the success of obesity treatment in dogs and behavioral changes of the owner.<sup>3<\/sup> A standard obesity treatment program that included appropriate energy intake, monthly weight checks, and a structured maintenance period was sufficient to achieve these objectives.<sup>4<\/sup> <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Owners of overweight cats indicate that they have a closer relationship with their cats than do owners of normal-weight cats, possibly with the cats serving as a substitute for human companionship.<sup>5<\/sup> The \u201cover-humanization\u201d of the cats in these relationships may be related to weight gain.\u00a0<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The role of patient behavior\u2014both dogs and cats\u2014in weight loss also needs to be discussed during the veterinary nurse consultation; therefore, understanding feline and canine behavior (especially feeding behaviors) is also important. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The extent of behavioral advice and its role in treating obesity (especially in cats and multicat households) is vast. Consultation of resources such as those listed in <\/span><span class=\"s2\"><b>Box 1<\/b><\/span><span class=\"s1\"> is highly recommended.<\/span><\/p>\n<h2 class=\"p2\">Feeding Quantities<\/h2>\n<p class=\"p1\"><span class=\"s1\">Success in obesity clinics also relies on gaining a full understanding of how much food the owner is providing the pet. A 4 kg (8.8 lb) cat consuming just 10 kcal\/day (the equivalent of approximately 10 kibbles or 10 g of tuna) in excess of its daily energy requirements will gain 12% of its body weight in one year.<sup>6<\/sup> Accurate measurement of quantities fed is therefore required. As feeding scoops have proved to be very inaccurate,<sup>7<\/sup> weighing out the daily portions should be the only method recommended for determining the amount being fed. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Diet history forms can be used to gain insight into an animal\u2019s current energy intake and to record the initial nutritional history at the first clinic visit. A sample form created by the World Small Animal Veterinary Association can be seen below and downloaded <a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2020\/09\/Diet-History-Form.pdf\">here<\/a><\/span><span class=\"s1\">. However, obtaining a full nutritional history might need to be completed over a couple of visits, as the owner might not know how much they feed or even what brands.<\/span><\/p>\n<p><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2020\/09\/Diet-History-Form.jpg\"><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter wp-image-5318 size-full\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2020\/09\/Diet-History-Form.jpg\" alt=\"Diet-History-Form\" width=\"576\" height=\"809\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2020\/09\/Diet-History-Form.jpg 576w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2020\/09\/Diet-History-Form-214x300.jpg 214w\" sizes=\"(max-width: 576px) 100vw, 576px\" \/><\/a><\/p>\n<p class=\"p1\"><span class=\"s1\">Owners should be encouraged to keep a food diary for their pet. A study of weight loss in humans<i> <\/i>showed that people who kept a record of what they ate were more successful.<sup>8<\/sup> However, a surprising aspect of this study was the reluctance of people to participate in recording what they had consumed, perhaps because they were worried about being judged for it. For owners who are willing to undertake a food diary for their pet, long-term use of the diary may become a motivator to stay with the program. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Graphs that show weight loss can also be a motivating visual prompt (<\/span><span class=\"s2\"><b>Figure 1<\/b><\/span><span class=\"s1\">). Graphs can be based on biometric measurements, such as weight, or morphometric (body shape) measurements, such as the diameter of the chest, neck, waist, and tail base. It is common for animals to not lose weight according to the scale but to lose centimeters around the waist. Seeing a record of these measurements can act as a real <\/span>incentive for the owner to continue the weight loss plan.<\/p>\n<p class=\"p1\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2020\/09\/TVN_Fall20_WeightMgmtClinics_Figure1.jpg\"><img decoding=\"async\" class=\"aligncenter wp-image-9075\" src=\"http:\/\/tvn.tv-multi-theme.com.216-70-96-51.jvv2-rfnp.accessdomain.com\/wp-content\/uploads\/sites\/3\/2020\/09\/TVN_Fall20_WeightMgmtClinics_Figure1.jpg\" alt=\"\" width=\"500\" height=\"431\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2020\/09\/TVN_Fall20_WeightMgmtClinics_Figure1.jpg 879w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2020\/09\/TVN_Fall20_WeightMgmtClinics_Figure1-300x258.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2020\/09\/TVN_Fall20_WeightMgmtClinics_Figure1-768x661.jpg 768w\" sizes=\"(max-width: 500px) 100vw, 500px\" \/><\/a><\/p>\n<h2 class=\"p2\">Exercise and Obesity<\/h2>\n<p class=\"p1\"><span class=\"s1\">If weight loss can be achieved by expending more calories than consumed, increasing calorie expenditure through increased exercise can aid in weight loss. More importantly, exercise helps to preserve lean tissue during a weight loss program and to maintain metabolism at a higher level. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Along with a food diary, owners can be encouraged to keep an exercise diary. For dogs, exercise can be monitored accurately with movement devices, GPS collar monitors, and apps that map walks with the owner. In the author\u2019s experience, some dog owners have difficulty judging walking distances, and most overestimate the exercise their dog gets. As part of increasing exercise, however, owners need guidance on the difference between quantity and quality. A 1-hour walk with the dog \u201cplodding\u201d along beside the owner burns fewer calories than a half-hour walk during which the dog is engaged in intense physical activity. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Cat owners can benefit from a discussion of natural play activity in cats. Anecdotally, many owners expect cats to play for periods longer than a natural feline pattern. Cats prefer to play for a few minutes several times each day than to play for one half-hour session. Play activity in cats needs to replicate hunting behavior, which involves many short, high-intensity bursts.<sup>9<\/sup> These types of activity can be replicated through the use of toys that move on their own or have elements that move (e.g., feathers), toys that are meant to be moved by the owner, and toys that swing. The size of the toy needs to be appropriate to the size of the cat. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Environmental enrichment for cats (especially indoor cats) is very important. Cats explore their environment in 3 dimensions, and their home environment should take this into account. Cats should have the ability to climb and sit up high on safe platforms if they wish.<\/span><\/p>\n<h2 class=\"p2\">Diet<\/h2>\n<p class=\"p1\"><span class=\"s1\">Once food and exercise amounts have been recorded, a feeding plan and an exercise plan can be created. In some cases, decreasing the pet\u2019s daily energy intake to the correct level and instituting an appropriate exercise plan can be enough for the animal to attain and maintain a healthy weight. However, some pets require weight loss diets. The Pet Nutrition Alliance website (<\/span><a href=\"http:\/\/petnutritionalliance.org\"><span class=\"s2\">petnutritionalliance.org<\/span><\/a><span class=\"s1\">) is a good resource for details on how to create nutrition plans and it even provides species-specific calorie calculators. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">The specific diet recommended needs to be the one most appropriate for the animal\u2014its life stage, age, and any specific nutrient requirements (e.g., for animals with chronic health conditions)\u2014and the owner. Owner considerations may include financial constraints, personal mobility, and ethical requirements, such as the desire to feed \u201corganic\u201d or \u201cnatural\u201d diets. Veterinary nurses need to listen to these needs with regard to what the owner can realistically achieve for their pet. For example, if the owner has reduced mobility, they may not be able to exercise an obese dog to attain its ideal target body weight, but some weight loss will still be beneficial for the dog. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Treats should not constitute more than 5% of the pet\u2019s overall daily energy intake, and all family members need guidance on this restriction. If an owner is unwilling to stop giving treats, these extra calories need to be calculated and added to the daily intake. Recommendations could include using lower-calorie treats or using the weight loss diet as \u201ctreats.\u201d Owners should be reminded that a \u201creward\u201d does not have to be food. Play, social interaction, grooming, exercise, and toys can all be used as rewards. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">All topics discussed should be written down for the owner so that they have the details to take home with them. A copy of the completed checklist in <\/span><span class=\"s2\"><b>Box 2<\/b><\/span><span class=\"s1\"> may be useful in this regard, as well as placed in the patient\u2019s medical record.<\/span><\/p>\n<h2 class=\"p2\">Prevention<\/h2>\n<p class=\"p1\"><span class=\"s1\">As with most things, prevention of obesity is better than treatment, but once a pet becomes a candidate for a weight loss clinic, only management is an option. Veterinary nurses should start the conversation about appropriate weight early and continue it often with pet owners. Teaching new puppy and kitten owners about monitoring body condition score (BCS) rather than ideal breed weights is recommended and can be facilitated through a hands-on approach. Every time an animal visits the practice, it should be weighed and have its BCS and muscle condition score (MCS) assessed and recorded on the clinical history. Weight changes should be highlighted to the owner and addressed. Long-term weight charts can also be used to visually show any increase (or decrease) in weight. During a weight loss program, MCS should be monitored to ensure that muscle mass is not also lost.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Discussions about obesity prevention at key times has been shown to decrease obesity prevalence later in life. Veterinary nurse\u2013led post-neutering clinics that showed owners how to judge BCS, discussed obesity prevalence, and gave dietary recommendations halved pet obesity rates later in life in one study.<sup>10<\/sup> Neutering has been highlighted as a major risk factor in development of obesity, so reiteration of key messages about preventing obesity when a pet is neutered is a vital role for veterinary nurses. <\/span><\/p>\n<h2 class=\"p2\">Follow-Up and Monitoring<\/h2>\n<p class=\"p1\"><span class=\"s1\">With all nutritional consultations and veterinary nurse\u2013led clinics, it is important to monitor and follow up on the progress of clients. Making clear recommendations to clients is key to success. The CRAFT model (<\/span><span class=\"s2\"><b>Box 3<\/b><\/span><span class=\"s1\">), developed in 2009, shows that for compliance to be successful, the <i>follow through<\/i> aspect of the equation is required.<sup>11<\/sup> Following through can take all different forms of communication with an owner, such as a phone conversation, email, text, or repeat consultation. Discussing with the owner at the initial consultation which form of communication works best for them can really aid in following through.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:0px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:0px;border-top-right-radius:0px\">BOX 3 The CRAFT Compliance Equation<sup>11<\/sup><\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:0px;border-bottom-right-radius:0px\"><strong>C = R + A + FT <\/strong><\/span><\/p>\n<p class=\"p1\"><strong><span class=\"s1\">Compliance = Recommendation + Acceptance + Follow Through <\/span><\/strong><\/p>\n<p class=\"p1\"><span class=\"s1\">Achieving compliance requires a good, clear recommendation, as well as client acceptance of that recommendation. However, even with client acceptance, compliance is often poor because the follow-through component is lacking. Reasons for failure of clients to follow through include forgetfulness, financial and time constraints, and unclear recommendations. Follow-through by the clinic is therefore essential.<\/div><\/div><\/span><\/p>\n<h2 class=\"p2\">Motivation<\/h2>\n<p class=\"p1\"><span class=\"s1\">The success of an obesity clinic lies in owner compliance and motivation to succeed. The role of the veterinary nurse in these cases is to help motivate the pet owner in continuing with the weight loss program. Motivation can be achieved by educating the owner on the effects of obesity on the animal and the long-term medical consequences. Some owners need more motivation than others, and even small reductions in weight or waistline, chest circumference, and neck width measurements will need to be highlighted and celebrated to keep them on track. <\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Primary reasons for dog and cat owners to enroll their pet in a weight loss program include personal recommendations from a veterinarian or member of the veterinary healthcare team.<sup>12<\/sup> Identification of overweight patients, together with client education, is therefore essential. Obesity treatment programs that include dietary changes and monthly evaluations of body weight by members of the veterinary healthcare team are reported to be the most successful.<sup>12<\/sup><\/span><\/p>\n<h2 class=\"p2\">Key Points<\/h2>\n<ul>\n<li class=\"p3\"><span class=\"s1\">Owner motivation needs to be maintained throughout the weight loss program, and the practice needs to provide support.<\/span><\/li>\n<li class=\"p3\"><span class=\"s1\">If weight loss is not being achieved, all factors need to be reviewed: diet, lifestyle, and quantity and quality of exercise.<\/span><\/li>\n<li class=\"p3\"><span class=\"s1\">All practice team members need to promote obesity clinics. A recommendation from a veterinarian always helps with compliance. <\/span><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Many elements make up a weight management clinic, and setting up these clinics in practice can be very rewarding for all involved.<\/p>\n","protected":false},"author":187,"featured_media":5266,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":0,"footnotes":""},"categories":[150],"tags":[145],"class_list":["post-5264","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-fall-2020","tag-peer-reviewed","column-nutrition_notes","clinical_topics-nutrition"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Elements of a 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