Latest / Nurse-Led: Nutrition and Prevention in Veterinary Practice / Why the dog in the park makes overweight look normal
Transcript
- Nicola Lakeman: It's not the pet that's made themself obese as such. It's the caregiver. Nicola Lakeman: If one of the, you know, vets or nurses go, "Oh yeah, it's fine," you've undone the work of the other three people that came before you, Nicola Lakeman: You're not saying you're doing it wrong, but in that roundabout way, you kind of are. Nicola Lakeman: Four positive reward areas, and food is only one of them. James Notman: All right, here's what's on deck. I'm talking with Nicola Lakeman about [chuckle] Nurse-Led approaches to pet weight and nutrition. Why we look at an overweight dog and see normal. And why the park has rewired our eyes, plus feeding as love and what else to offer when food's only one reward. Let's get into it. James Notman: Nicola, let's start with the owner who just doesn't see it. UK Pet Food's latest obesity report found that around three in four owners say their pet's weight is healthy. Only 4% reckon their pet needs to lose weight. But the vets in the same report put about half of dogs as overweight. What do you think sits in that gap? Nicola Lakeman: There's a little bit about, um, owner perception. You know, if I said to you, "Do you feel that your, pet's overweight or your child is overweight?" what you think you see and what you actually see in front, you know, what is in front of you can be very different things. That perception is there. We also have, um, issues surrounding what people think is normal for certain breeds. and actually from a, veterinary health point of view, our, you know, technical, clinical knowledge tells us otherwise. So we've seen many, um, you know, Frenchies, pugs, King Charles Cavalier Spaniels that, you know, we look at them as veterinary professionals and like, "Oh, you know, that is an overweight or an obese dog." But to the owner, they're like, "But that looks like all the other dogs I see in the park. He's normal compared to everything else." But when your whole population is really overweight, then that skews what owners think is, normal. I was, also gonna say, you, you also have this whole, what's traditionally called breed standards. So for a King Charles Cavalier, and we use that as our example, the breed standards will say, "This breed of dog needs to be between," I don't know, I'm not too sure what they are, but like 8 and 12 kilos. But if you see a really petite, small-framed King Charles Cavalier, then actually their ideal body weight might be six kilos. But if the owner is adamant that the breed standard says, you know, between this weight and this weight, then that animal will then be overweight. So we need to remember that each animal is individual. They have different body frames, sizes, even in the same breed. It's very similar to us as humans. So we can't say, "A Cavalier needs to be this weight. A Labrador has to be that way." We need to say, "Your pet, you know, Frothy, needs to be this weight, and that's what's ideal for her or him." James Notman: How do you go about making a healthy weight visible to owners if they're seeing something different? Nicola Lakeman: Yeah, I, I think it's, it's a very hands-on approach. and quite literally hands-on. you know, feel here. Can you, feel the dog's ribs? Can you, you know, feel, you know, the curvature in, in their tummy? Does it sort of tuck in at the waistline? So it's a case of really pointing it out and moving through the fur, moving through that fluff. You know, they're not just fluffy and that's, you know, masking their shape. We're feeling, you know, where their body contours are, feeling for that subcutaneous, uh, fat that's, there and really, you know, saying to the owner, "Can you feel the hips of this dog?" You know, or, cat, you know. "Can you feel that ruff that some of them have around their necks?" You know, the tail base fat as well. So it's not just telling them. We're showing that's one thing. And then getting them to feel and telling them what they're feeling as, well. I think that's really important that you see it and you, you feel it as well as you're, hearing the message. James Notman: Do you ever get that, like, active pushback from them, when you're suggesting trying something new? Nicola Lakeman: To start with, uh, the messaging that you're giving the owner that being overweight and being obese is not healthy, that has huge health implications. That's part of the messaging. As soon as you ask someone to change something, you're gonna get a little bit of resistance, even if you, you're aware of it or not. It's like, you know, if I ask you to change your daily routine, it's instant sort of, "Oh, how's that gonna affect me?" sort of thing. So you are gonna get that kickback. But I think what's, um, really important is that everybody in the veterinary practice is saying the same thing to the owner. We're all highlighting that the animal is overweight. Because the more we're giving the same messaging, we're giving credibility to the message that we're giving. If one of the, you know, vets or nurses go, "Oh yeah, it's fine," you've undone the work of the other three people that came before you, and the next three that will come after you because that owner will just think, "Well, that other person said it was absolutely fine." so credibility of messaging comes through that, repetition. I think that's really important. So for some owners where you get that sort of initial hesitation, that, that little kickback, your message might not hit the same way that you want it to straightaway. It might be two or three consults down the line that they immediately, you know, go, "Okay," you know, "we've got to a point now that, yeah, I can do something about it." You know, you don't know what's going on in their home life as well. Things might be tricky at home and, stuff, so they might not be at the right point themselves. And you see this with the NHS. You know, how many human healthcare professionals tell people every day just to, you know, stop smoking or, you know, reduce the amount, the alcohol they're drinking? Everyone doesn't immediately stop straightaway. That's human nature. and you need to remember that feeding a pet is a way that owners show that they love their pet. they're not gonna go out there and deliberately feed the wrong food or deliberately feed the wrong amounts. They're trying their very, very best to do their very, very best for their pet. You're not saying you're doing it wrong, but in that roundabout way, you kind of are. It's a sort of quite a negative impact on that owner, like, "Oh, I thought I was just showing him love." so we need to be really mindful of that to our owners, that we need to, you know, celebrate that they, you know, they really love their pet, but we need to find different mechanisms for them to do it rather than just giving food. James Notman: How do you navigate that, you know, and make sure that they understand, uh, what you're trying to say without making them feel like they're, doing the wrong thing or, you know, they're not looking after their animal the right way? Nicola Lakeman: If we go back to, you know, the owner is showing love to the pet by feeding it, we have to give them a different mechanism for them in order to do that. And with, with our pets, we normally have four positive reward areas, and food is only one of them. Their toys and possession is another. their environment is, is one. And then, social interactions. So if we're removing the food element, then we've still got three other areas that we can look at, and we need to talk to owners and encourage them to use those three areas as a reward. environment's a tricky one, so we'll, scrub that one for a minute. But if we're looking at social interaction and then sort of possessions area, toys comes into that possession area. So yeah, getting some new toys, finding out what that pet likes. So I have a spaniel, a King Charles Cavalier Spaniel, but I also have a Jack Russell. Now, I know my Jack Russell, she prefers a certain type of toy as opposed to the Cavalier. So, you know, you need to find out what is best that breed, that personality of dog. And we want to be advising about what exercise is the best type of exercise for weight loss. And we don't want the animal, like, chasing a ball and stopping suddenly and twisting, because those jarring movements can be really quite harmful on, their joints, especially when they're overweight. So giving that advice is important. So possessions is a, is a good one. social interaction is a really big thing, and we forget about that. So rather than give the dogging, you know, a treat, what about grooming the dog? and it sounds like, "Oh, well, I've already groomed him today," but to a dog, you know, it's not about brushing their hair, it's that mutual grooming kind of thing. So grooming the dog or massaging them. Lots of dogs have mobility issues, so doing some form of massage can actually be a really positive thing. So there's other ways to show love. It doesn't just have to be around food. But we need to educate owners so that they know to, to do that. James Notman: Absolutely. Nicola Lakeman: Yeah. And we can still use food, we can still use treats. We need to educate owner about the right type of treats, the right volume. It should only ever between 5 and 10% of the daily calorific intake should be in the form of treats. But owners underestimate the amount of calories that are in treats, so if we help them to find a low-calorie difference, then, you know, we can do that. We can use their main food instead of treats. We can, you know, put their main meal inside a interactive toy, so they're playing with the toy whilst getting their food. So there are lots of mechanisms that we, we can use. Yeah. It's, it's about using the right words in the right situation. You know, your body language is really important. You know, you, you need to be very positive about introducing new things. You know, if I stand there, you know, with, you know, without a smile on your face looking quite dour and you're like, "Oh, I'm going to introduce the new toys," then it's not a positive thing. It's how you present it as an opportunity rather than as a, a negative thing that they need to do. James Notman: Yeah. And I guess it's, a tricky part to navigate having to explain that without having it come across the wrong way. I, I suppose with the idea of resistance to diet change, it can come up fairly immediately. I've heard that a lot of the time when you mention the word like diet, in a consultation room, that's when that kind of resistance comes up. I suppose, is there a way that you approach that? first of all, making sure that maybe you're making it clear you're, uh, working with them in a way that's, uh, collaborative instead of kind of giving advice which can sometimes maybe feel like it's being like, uh, forced upon them or that it's, uh, critical. Nicola Lakeman: Yeah, so we're used to talking in terms of compliance, and compliance is I'm gonna tell you to do something, and you are gonna do it. You know, you're compliant in that fact. What we need to be looking at, and, uh, you really touched on it, is something called concordance. So concordance is where you and me are gonna make a plan together, and you're, you're the one that's gonna obviously go out and, you know, conduct this plan and, you know, do everything we need to. But we're gonna make it together. I'm gonna guide you to create that, whether you want to call it a nursing care plan, a management treatment plan, a feeding guide plan, but it's that concordance. So it is, it's teamwork between you and the owner to create that plan. And we actually find that owners they're gonna be more able to, to do it because they've been part of the planning. You're gonna take into consideration, you know, their mobility. You know, you want them to walk the dog more, but if they're not mobile, it's not gonna happen. So there's lots of words we use nowadays like narrative medicine, contextualization, all those sort of elements, but it, concordance is what it comes down to. It's, it's creating that care plan together. The owner is more likely to be able to, uh, undertake it, and therefore we're gonna get those clinical outcomes that, that we want. James Notman: That makes a lot of sense. Nicola Lakeman: Yeah. Let's scrap compliance and move on to concordance. James Notman: I like that. It's, uh, going for a more collaborative approach. how do you make sure that that sort of approach is consistent across the practice? You were talking earlier about how every, uh, member of the practice needs to have a consistency in the messaging that they're giving out. Nicola Lakeman: Yeah. It's, it's that all, are you singing from the same song sheet sort of element. So yeah, everyone needs to be saying the same. and you are gonna get differences because of people's opinions or the case might be slightly different. But majority of the time, we're all saying the same thing, it helps. And we only know what each of us think or our opinions by talking to each other. So it's really important if you have team meetings, staff meeting, clinical meetings, you know, M&M rep, whatever it is, all of those different things to understand each other. So yes, we have ward rounds looking at the ward cases, but you need to be talking to the veterinary surgeon, um, that you're working alongside, the one, the one you're working under the, the delegation of, to understand, you know, where that person feels about, you know, certain cases. Having clinical guidelines, protocols, care bundles, care frameworks, there's lots of different names for them. But those guidelines can really help cement the collaboration between everyone in, the workplace and make sure that we're all on a similar song sheet, so to speak. James Notman: Yeah. I, I think that makes a lot of sense, and it feeds into this idea of concordance because if you've got that, uh, conversation happening with the owner and you're making a plan together, you want that plan to be consistent with what they're hearing from everybody else. Otherwise, it kind of undermines that collaboration that you've made together. Nicola Lakeman: Yeah. And if you're the nurse that's created that plan, and we're doing a weight loss clinic, and then one week you're not there, maybe you're on holiday or you're sick or you've, you know, you've got to cover a different shift, someone's doing the clinic, all of you need to do the same thing. you need to be giving the same advice to that client as well. So that, that's also really important. James Notman: Is there any part of the clinic in terms of, uh, making sure that everybody's on the same page that is, uh, kind of formally done? Like any sort of, uh, guidelines or, um, ways to formalize that kind of consistency? Nicola Lakeman: Yeah, so, you know, if you're starting off to do obesity clinics in your practice, have a, practice meeting so that everybody knows who's running those clinics and at what time and how much they're gonna cost And I would really recommend using a checklist within your clinic so that you're all, you know, quite literally checking off the same things, that you've all, you know, taken the same measurements. when you put the tape measure around the dog, you're all, you know, just holding it next to the animal. You're not pulling it really tight or, you know, having any, like, loose bits. So there is that uniformity between you all. You know, you're all, measuring the same thing. when it comes to recommending diets, it's gonna be very dependent on the, animal and the owner as well. So that, that bit's a bit trickier. But those checklists, um, and clinic guidelines can be really useful. James Notman: A diet history often shows that owners might mention things that they don't think of as part of their diet. So, you know, treats are one thing that you've mentioned, but scraps, chews, the lot. What does a really useful diet history look like in practice? Nicola Lakeman: Part of your, you know, as a nurse would do in a, you know, a clinical sort of exam is your five vital assessments. The first three are temperature, pulse, respiration. Number four is a pain score or, you know, a pain awareness, and then number five is the nutritional assessment. Now, the nutritional assessment will really vary depending on the, animal, the situation you're seeing and, and everything. But baselines are what we need, so we need a weight, a body condition score, a muscle condition score, and then, you know, what are you feeding the pet? Now, it might be that they go, "Oh, I'm feeding brand X, and I'm feeding this," and, you know, that's it. You're done. Your nutritional history is, is, is there. It's exactly what you want. The animal's at his ideal body weight, and all, is good. It might be, like you said, that they're feeding lots of other things and, and so on, and you can use the, um, World Small Animal Veterinary Association, the WSAVA, um, nutritional, um, assessment guidelines, and they have a short form and then the long- longer one where you do need more information. And you can use these forms to take that nutritional history, and it does ask the questions. So you work your way through the form, you know, what brand of food, how much food, what are you feeding? You know, what scraps are you, you know, uh, table leftovers, you know, what treats, you know, all of that sort of thing. So using those nutritional history forms can be really useful for teasing it out. I would recommend, however, sending these to the client, a week, maybe two weeks before a consultation, if you have that luxury, because then people forget things. They, they might not be aware of some of the habits that they're, they're doing. You know, they might forget about the odd treat that they give when they come home. And, keeping like a food diary or filling out this form, they've got time to do it, and you'll find it will be more complete when the owner is a little bit more relaxed and a little bit more able to, to answer all the questions. James Notman: Even sending those questionnaires through, they might not include everything that they don't think is part of the diet that maybe they don't think is relevant or worth mentioning. Nicola Lakeman: Yes, some people will even, um, send like a list, but the problem is of a list, um, you know, and the owner will tick what they feed, is that list will, never cover everything. You can't... You can imagine having a list of every single foodstuff in the world. It would be pages and pages and pages long. So that does make it, quite difficult. But things like, um, milk, people think that milk isn't a food, um, it's a drink. but they're really high in calories, you know, all of those sort of things. So you do need to be a little bit think outside the box when it comes to asking for that nutritional history. James Notman: Right. How do you go about navigating that? Nicola Lakeman: Yeah. So I think we've talked about it before, but owner education and owner awareness. So some owners just might not even be aware that whatever it is, like the milk, contains calories. So calculating that animal's, uh, daily energy requirement can be really useful. so I know my dog is, you know, yeah, 520 calories per day. She's quite small. so I know how many calories per day she should have, and I can look at some of the packaging and some of the things that will tell me one of these treats contains 50 calories. So that would be 10% of her, uh, calorific intake, that treat would, would be her, you know, the maximum that she could have. And it's really difficult because, you know, you're eating an apple, and you're giving them a bit of the apple and, you know, all of those sort of things, it all adds up, and I think that awareness of, of things can be, you know, quite, quite surprising. So food diaries can be useful just, just for them to jot down everything that they're giving the dog and, you know, at the end of the, you know, periods that you're monitoring, the nurse can then just have a little look, maybe work out the calories. You can use some of the, um, human food apps that, you know, you, you log what food you're eating. You can log the food that your dog is eating. Um, obviously the amounts, you can log it in grams and these sort of things, and it'll work out the calories for you if you're feeding lots of human foods. So it, it, you can unmask things that way. So it is very much, I said it before, you know, think outside the box. What things can we use to help owners make this an easy process? James Notman: Let's take the measurements themselves. The scale can stay flat, but the animal might be losing fat. You might use, um, waist or tape measurements alongside the body and muscle condition scores. How do you use those measurements in practice, and what do you show the owner when the scale hasn't moved? Nicola Lakeman: Yeah, and sometimes the, the weight scale doesn't move and it's really disheartening and really demotivating. But I think if you've taken all of those other measurements, so I tend to use, um, a measurement around the neck, you know, where their collar would, would sit. Around the chest, so just behind, you know, level with where their elbow is. Waistline at the narrowest point, hips, and I also do tail base. Tail base is really important in cats as well. And even if the number on the weighing scale is staying the same, but you've lost, I don't know, a centimeter around the waist or something like that, then that's a really positive thing to really celebrate. the subcutaneous fat is going down, maybe we're exercising more, so the muscle bulk is going up. so any measurement, whether it's the weighing scale, the tape measure, muscle condition score, and I know some people are using, um, ultrasonography for muscle condition scoring. So we're actually measuring the muscle depth. You're getting an actual number, a measurement, um, rather than that palpative sort of, "Oh, I think it might be a two." that's a really good measurement to take if, if you, you know, you have those facilities within your practice. But take as many measurements as you can and celebrate, you know, if we're losing a centimeter, really celebrate it. We need to keep the owner motivated. It's the dog or the cat losing the weight, but it's the owner that's feeding that pet. So it's the owner that needs to keep motivated. obesity in pets is a difficult thing. It's not the pet that's made themself obese as such. It's the caregiver. So there's huge links with childhood obesity and pet obesity and the, psychological mechanisms behind them. So we need to keep the owner, the caregiver, um, motivated as much as possible. they're not feeling the benefits themselves of losing weight. when you lose weight yourself, you're like, "Oh, I feel so much better. I feel healthier. I can run up a flight of stairs now without having to catch my breath." You don't feel that when it's not you losing the weight and it's your pet. So we need all of those different things, all those different measurements to help keep that motivation going. James Notman: We heard how you build a weight plan with the owner and keep the whole practice on the same page. Celebrate a lost centimetre even when the scale hasn't moved. Thanks, Nicola. If this sparked something, share this episode with one person who'd find it interesting and subscribe. Goodbye. See you all next time. Thanks for listening to Nurse-Led. Until next time, keep the conversation going in your consulting room.