A Population at Risk

Banfield’s 2019 Veterinary Emerging Topics (VET)^® Report looks at the alarming link between pet obesity and osteoarthritis.

First, the good news. According to Banfield Pet Hospital’s third annual Veterinary Emerging Topics (VET)^® Report, done in partnership with the North American Veterinary Community (NAVC), age is not always the main culprit when it comes to changes in pets’ behavior and activity levels.

What is? Well, that’s where the industry has to look at a harsh reality. The U.S. is facing an epidemic of overweight and obese pets. Approximately 1 in 3 pets seen at Banfield Pet Hospital are overweight or obese, the company says. And, the prevalence is trending upward.

“What does this mean for our pets?” the veterinary hospital group asks. “We have a growing population of pets at risk of developing osteoarthritis (OA). And vice versa – osteoarthritic pets are at risk of weight gain, contributing to the epidemic.”

Early detection ideal

According to Banfield, excess weight and OA are conditions that serve as risk factors for each other. “In most pets, it would be difficult to discern which came first,” the report said. “Joint trauma can progress into OA that can lead to reduced mobility, which can cause weight gain. In some pets, there may be no known initiating joint trauma, but the excess weight contributes to the onset of OA.”

Banfield found 51 percent of dogs and 41 percent of cats newly diagnosed with OA were considered overweight or obese in 2017.

For both osteoarthritic and overweight conditions, detection at early onset is ideal, as proper management can stop or slow progression (in the case of OA) and lead to reversion (in the case of overweight) to a healthier condition, according to the report. “Unfortunately, in many cases, veterinarians and owners don’t have serious conversations on weight management until the excess body weight is visible, meaning a larger amount of weight needing to be lost and decreasing the chance of successfully reaching an ideal body weight. Similarly, many pets are not assessed for or diagnosed with OA until they have developed the clinical signs of lameness and/or decreased mobility. Clinical management then is primarily pain management with medications and/or supplements as well as nutritional management and exercise to build and/or maintain lean muscle mass.”

When it comes to diagnostics, fewer than 30 percent of pets receive radiographs when a diagnosis is made. Only 50 percent of dogs and cats are sent home with pain medication at the time of the initial diagnosis, and fewer than 10 percent of pets were prescribed a veterinary diet for mobility or weight management.

Key barriers identified as preventing appropriate care for OA pets include cost of diagnostic services and treatment; owner noncompliance; owner not recognizing their pet is in pain; and owner not accepting their pet is overweight.

Emi Saito, VMD, a senior manager of veterinary research programs at Banfield Pet Hospital, provided Vet-Advantage with some insights into the report, and steps that veterinary practices – and the industry at large – can take to help pet owners better manage their pet’s weight and health.

Vet-Advantage: The VET report says that quality medical management of osteoarthritis requires a multi-faceted diagnostic and treatment plan. Can you provide some examples of what’s most effective? 

Dr. Emi Saito: When we say osteoarthritis (OA) requires a multi-faceted plan, we mean we need to think beyond just treating with pain/anti-inflammatory medications and joint supplements, and include working with owners to detect OA before the pet becomes lame or has noticeably reduced mobility.

There is no one-size-fits-all plan for treating osteoarthritis (OA), so every diagnostic and treatment plan should be tailored to each pet. But in general, there are different components that should be considered as a veterinarian and client develop a plan for an OA pet:

• The earlier we detect and start managing OA, the better. We can start a multi-faceted treatment plan earlier that could potentially slow the progression of the condition, hopefully reducing the time (and perhaps dosage) the pet will need anti-inflammatory and pain management in its life. This means having conversations with pet owners to find out how the pet is doing at home, going beyond baseline questions about a pet’s limping and problems walking to asking specific questions related to a pet’s willingness and ability to do normal activities. Some people may attribute certain changes in behavior as normal for aging pets, when in reality, they can be attributed to OA (or another condition).
• A thorough examination routinely performed by a veterinarian can also help identify changes early. Diagnostics such as radiographs are recommended to screen for OA, and in pets that are lame or showing decreased mobility, can rule out other diseases that might cause a pet to present like it has OA. By ruling out these other causes, we can be surer that we are properly treating the pet. For instance, we don’t want to treat a pet that we think has OA when diagnostics could have shown that it instead has osteosarcoma or has another joint condition that could be surgically repaired.
• As it relates to treatment, it’s important to pair anti-inflammatory or analgesic medications with proper nutritional support. This may be in the form of a veterinary diet or dietary supplements for joint mobility.
• Another critical component is weight management. We found 41 percent of cats and 51 percent of dogs newly diagnosed with OA are overweight. The excess fat contributes to the inflammation in the joint, which contributes to reduced mobility and exercise, which can lead to weight gain and more fat accumulation. Research has shown obese pets that lose as little as 6.1 percent of their weight showed improvement in clinical signs of OA.
• In addition, exercise or some level of activity is helpful in managing these pets, not only by burning more calories, but by building and maintaining muscle mass, which helps the arthritic joints. There are options more readily available today than even 5-10 years ago for helping these pets regain some mobility, keeping them comfortable, and improving their quality of life.

Vet-Advantage: What new ways of thinking should the veterinary medicine community consider when it comes to weight management of pets? How can we do this better?

Dr. Saito: At Banfield, we are committed to using our size, scale and resources to advance pet healthcare. We focused our 2019 Veterinary Emerging Topics (VET) Report on the management of osteoarthritis (OA) in overweight and obese dogs and cats to spark conversation and action among the profession given what we have been doing is not working – the percentage of overweight and obese pets continues to increase. As such, we need to find new ways to broach the subject – and have productive discussions – with owners when their pet’s weight is a concern. Similar to OA, there is no one-size-fits-all approach for handling these discussions with owners. The excess weight problem in pets (much like in people) is complex, and much remains to be understood.

What we do know is that there are a number of factors contributing to pets being overweight, and they aren’t the same for every pet. A better understanding of a pet’s life at home and the owner’s relationship with the pet is a starting point, but there are many other factors that need to be discussed to determine a weight-loss plan for an overweight pet, for example recommended calorie intake.

Because overweight pets are increasingly more common, the general impression of what is normal or healthy weight is becoming skewed. This “normalization” of the overweight condition makes it difficult for some pet owners to understand or accept that their pet needs to lose weight. As an industry, we need to do better to improve client understanding about pet weight and body condition scoring to help de-normalize excess weight in pets.

Another area we can do better is setting client expectations of what a weight management plan means. For many pets, getting back to an ideal weight can be a long journey, one that can frustrate the owner. And once they lose the weight, weight management is not done – the pet must maintain that ideal weight long-term. In general, pet owners and veterinary hospital teams need to make commitments to each pet’s weight loss journey and partner together to find what that management should be, based on the individual pet’s needs, medical history and lifestyle – as well as the owner’s expectations of the management plan and outcome.

Vet-Advantage: How can the industry improve in client communication, measurable patient outcomes and participation by the entire hospital team?

Dr. Saito:

• Enhanced client communication. One example could be ensuring additional time is set aside for pets known to be overweight or coming in for lameness/mobility issues. These are not short conversations, particularly at initial diagnosis, and sometimes, veterinarians look at the myriad of things they have to talk about with an owner during the visit and prioritize them due to limited availability due to other appointments.
  • Consider looking at how much time is allocated for an appointment and better elucidate the reasons a pet is coming in for a visit when an appointment is made, so the unexpected are more expected. For example, how can a hospital decrease the likelihood that the owner says the pet is due for annual vaccines as the reason for the visit, but when they come in for the appointment, the staff is asked “Can you look at Fluffy? I noticed he started limping a couple of weeks ago?”
  • Or, because some clients need time to process all of the information the veterinary team told them on Fluffy’s last visit, consider reviewing any educational materials with them and following up a few days later via phone or hospital visit to create open lines of communication and help ensure they better understand Fluffy’s health and what to expect as we go on the OA and/or weight management journey.
  • Often, pet owners may not understand enough to even know what questions they need to ask, as they are expecting their veterinary team to tell them what they need to know. Consider the average client education discussion when a pet is newly diagnosed, and take note when things didn’t go as expected. Use those learnings to proactively identify what the hospital team can include in its initial discussion moving forward to improve client understanding and follow-through. Many veterinary professionals are already subconsciously doing this, but formalizing this process has the potential to improve the client experience and patient care.

• Measurable patient outcomes. Reporting and monitoring tools are a win-win situation – for the veterinarian, the owner, and most importantly, the pet – in getting a measure of response to treatment and influencing patient outcomes. We send an OA pet home with medication to treat pain with the purpose of improving its outcome (comfort, mobility and quality of life), but do we measure whether it’s effective? One of the barriers to care reported by our veterinarians is the pet owner not recognizing their lame pet is in pain or improvement after a treatment trial. Tools exist that enable clients to report or monitor pet behavior at home, particularly those behaviors they might think are “normal” for their aging pet but are actually due to OA. Utilizing these tools can help facilitate the conversation with pet owners about what is really “normal,” and help them appreciate improvements and milestones achieved along the way. Conversely, if the treatment isn’t leading to notable improvement, such a tool can also help the veterinarian tangibly recognize that and adjust treatment as needed.

• Participation by the entire hospital team. Traditionally, the management of a pet at a veterinary clinic is a one-person effort, that of the veterinarian. However, we encourage the hospital to work as a team, with everyone playing a part in patient management. For example, everyone at the hospital who sees that pet from the moment it walks in the door to the moment it leaves could play a role. The receptionist may notice Fluffy is walking a little stiff at check-in and recommend the owner talk with their veterinary team about it – and mention the observation to other hospital team members who will be interacting with Fluffy and his owner during that visit. Similarly, the veterinary assistant or technician who walks Fluffy to an exam room could notice something and mention it to the owner, as well as the attending veterinarian. Then the veterinarian could perform the examination and have a conversation with the owner. Each of these touch-points can facilitate the acceptance of the recommended diagnostic and treatment plan.

These are just a few examples of opportunities – and aren’t limited to the treatment of OA in overweight pets. It’s an opportunity for veterinary hospitals to look at how they operate, provide care, and self-assess: Are we providing the care we want to be providing? What’s holding us back? What can be done to lower those barriers and provide the best care for pets? Are we leveraging our staff to their full potential to provide the best care and client experience?

Vet-Advantage: Why do you think pet owners may be more receptive to managing their pet’s weight by focusing on the pet’s pain or discomfort?

Dr. Saito: As an industry, what we’ve been doing in managing overweight and obese pets (and preventing excess weight gain) has not been working, even when we know excess weight is associated with a number of serious conditions. We realized attacking excess weight alone wasn’t likely going to move the bar at this stage, given it hasn’t yet – and because it’s difficult for many owners to understand the implications of that excess weight when their pet seems otherwise healthy.

So, as a first step in trying to move that bar, we chose to shift the focus of conversation to the pain/discomfort associated with OA to provide a more tangible reason for owners to prioritize their pet’s weight loss. OA and excess fat are inextricably linked; a research study found obese dogs that lost weight showed improvement in clinical signs due to OA and quality of life. Given owners don’t want to see their pets in pain, we are hopeful that by appealing to their desire to keep their pets happy and comfortable, they can begin to understand why their pet’s weight loss is so important.

Vet-Advantage: Why is an early diagnosis so key when it comes to overweight conditions or OA?

Dr. Saito: Early diagnosis and treatment of OA can improve and help maintain the pet’s quality of life earlier than if treatment didn’t start until much later stages of disease. The earlier we diagnose OA, the earlier we can start management, which may only necessitate starting the pet on a mobility diet or nutritional supplements. With early diagnosis, we have potential to slow progression of the arthritic condition and may be able to enable a delay in the pet needing anti-inflammatory or pain medications. Further, the earlier we can start pain management for a pet beginning to exhibit signs of pain, the easier it is to bring pets back to comfort when pain levels are lower. Similarly, the earlier we recognize a pet is gaining excess weight, the easier it tends to be to revert back to and maintain a healthy weight, as there are fewer pounds to lose.

Vet-Advantage: What can the industry do to help overcome cost as a barrier to care?

Dr. Saito: Unfortunately, there’s no easy answer to overcoming cost as a barrier to care – and it can’t fall solely on veterinary hospitals to solve the problem. But I would encourage the industry to look inward at their organization or hospital to see what’s driving cost of goods and services and identify what, if anything, they can do to help reduce the barrier for owners. We may never completely overcome it, but even small reductions have the potential to increase the number of owners able to provide recommended care, and thus the number of pets receiving the care they need.