1

The Health & Economics of Obesity

Korin Saker

Amy Snyder

? OBESITY ?

• A nutritional DISEASE of excess body fat

• Associated w/ metabolic & hormonal changes

• Obese when ...30% over ideal body weight (BWI)

Body Condition Score (BCS) > 8/9(Global Pet Obesity Initiative Position Statement)

56%

60%

21% dogs overweight by 6 mo old!

2

Who’s at highest risk for OB

• Breed can account for 30-70% !

• Mixed breed cats >>> purebreds

• Free choice feeding of palatable, energy dense foods

• Neutering – risk 2x in neutered bitches

When to Intervene?

• During the growth life‐stage as PREVENTION!• Post neutering• Morphing from ideal‐healthy BW  overweight

(BCS 5/9)  (BCS 6 or 7/9)

• BCS already 7/9 or greater• Acute onset of limitations on mobility 

(trauma, surgery, OA, cognitive dysfunction, etc)

3

#1 Identify your (joint) goals

Vet ↔ pet parent in total agreement

• Achieve SAFE weight loss

• Set “mini” goals (i.e. 9/9 to 7/9, then re-evaluate)

• Prevent rebound weight gain

• Maximize pet’s Quality of Life

#2 ID Current vs Healthy-Ideal

BW & BCS

#3 Simple Calculations

1) Determine Ideal BCS using 1-9 scale (with 5/9 ideal)

2) Determine Ideal BW(a) assume each one unit ↑ in BCS from 5/9 = 10% change in BW(b)  Multiple BW current x appropriate % (based on BCS current) = kg excess(c) (BW current ) – (kg excess) = BW Ideal

Practice ...   50 kg canine, BCS current = 8/9

1) Ideal BCS = 5/9   (8‐5 = 3) x 10% = 30% in excess 2) 50 kg x 30% = 15 kg excess BW as fat3) 50 kg – 15 kg = 35 kg BW ideal

4

#3 Simple Calculation

3) Daily energy requirement (DER) for weight loss

[BWkg x BWkg x BWkg] = ; ; ; x 70 = ____ kcal/day RER

___ RER kcal/day x DER factor* = ___ kcal/day DER

Practice ...  Bwideal = 35 kg for BCS of 5/9

[35 x 35 x 35] = 42875, then  (;  = 14.38), then (x 70 =1007) kcal/d

35 kcal/d x DER Factor of 1 = 1007 kcal/day = DER 

*DER (numerical) factors

CATEGORY CANINE FELINE

Obese prone 1.2‐1.4 1.0

Weight loss 1.0 0.8

#4 Choose Appropriate Diet & Feeding Plan

VERY Beneficial Diet Characteristics:

• Restricted fat calories

• Increased insoluble fiber

• Increased (high quality) protein level

• Omega-3 Fatty acid (EPA & DHA) enriched

• L-Carnitine & Antioxidant supplemented

Recommended diets Fat Protein Crude fiber EPA /DHA L‐carnitine

Royal Canin Satiety 7‐8 31‐36 20‐27 fish oil yes

Purina OM 6‐10 29‐41 11‐18 nr nr

Hill’s r/d 8‐9 25‐35 21‐13 nr yes

Targets (%DMB) < 9% > 28% 12‐25% > > 300 ppm

Calorie‐Controlled Approach for Dogs

Recommended diets Fat Protein Crude fiber EPA /DHA L‐Carnitine

Royal Canin SatietyRC Calorie Control 

7‐11 33‐53 9‐18 fish oil yes

Purina OM 8‐12 45‐56 8‐12 fish nr

Hill’s r/d 8‐9 36‐38 14‐15 nr nr

Target (% DMB)  < 10 > 35 15‐20 > 500 ppm

Recommended diets Fat Protein Crude fiber EPA /DHA L‐Carnitine

Hill’s  Feline Metabolic 11‐13 38‐39 9‐11 nr yes

Hill’s Canine  Metabolic 12‐16 27‐29 12‐17 fish oil/nr nr

Calorie‐Controlled Approach for Cats

Calorie‐Controlled Approach for Dogs & Cats

5

Feeding Plan Tips ...

• Measured meal feeding (gram scale BEST)• Be specific re: daily calorie intake

[meals + any treats = Calculated DER]• Daily treats = 8% total DER calories• Ideal feeding schedule = 3 meals/day

*Diet unit: grams, cans, 8 ounce cup

Daily food dose = DERwgt loss (kcal/day)  diet kcal/diet unit* = diet units/day 

Monitor and Follow‐up for SUCCESS!

Feeding Plan Tips ...

SAFE Rate of Weight Loss per week DOG: 1‐1.5% current BW CAT:  0.75‐1.25% current

DO TRANSITION to new diet slowlyDO monitor BW every 2 or 3 weeksDOmonitor pet’s appetite and attitude towards voluntary intakeDO monitor gastrointestinal intolerance with diet change (D, V, R)

DO NOT allow pet in same room  where you are eatingDO NOT offer table scraps. DO NOT allow to counter / table surf  

Monitor and Follow‐up for SUCCESS!

Feeding Plan Tips ...

Week  Anticipated BW Actual BW Comments

0 ‐ 110 lbInitial consult prepared regarding a weight loss plan.  Assume new diet change will occur over a 1 (dog) or 2 (cat) week period

3110‐4.125 =

106 lb

Reassess!  Please contact the Nutrition Service to report on body weight and overall progress.

6106‐4.125 =

102 lb

Reassess!  Please contact the Nutrition Service to report on  body weight and overall progress.

“x”

Congratulations! (Pet) has reached his/her ideal body weight!  Please contact the Nutrition Service for maintenance recommendations.  Great Job!

6

It takes a village to lose a pound

I do not have time to discuss this with every client.

Nutrition 411

• American pet owners spent $29 Billion on pet food in 2017

• Amazon sold $1.4 Billion of pet food in 2017– This was a 38% increase over 2016 sales

• Nutrition sales account for 3.5-6% of total revenue on average– $34,000-$60,000 revenue from diet sales for a

practice generating $1M in revenue

• Rise in online pharmacies and direct ship programs decreases the hassle and cost of stocking large quantities of food

7

What Owners Gave Up for their Pets

OR

Discussing obesity and diet is uncomfortable

• Societal stigmas around weight

• What we eat, how we eat is an emotionally charge subject

• Food = Love

Access to misinformation abounds – the Internet, TV commercials,

clerk at the local pet store

8

Veterinary professionals need to regain our role as nutritional

advisors

We can do this by:

• Focus on “Why” not “What”

• Get our whole team on message

“People don’t buy what you do, they buy why you do it.”

-Simon SinekStart with Why: How great leaders inspire everyone to action

https://www.youtube.com/watch?v=IPYeCltXpxw&feature=youtu.be

Traditional Approach

• In order to help your pet lose weight we recommend feeding XXX diet formulated for weight loss.

• Unlike other weight loss diets, this diet has been shown to be more effective at helping pets achieve their ideal weight.

• Would you like to start XXX diet?

9

To improve compliance we have to start with WHY

• We know your pet is a member of your family and we want to ensure that your pet lives a long, happy, health life

• We also know that pets who are over weight, have an increased chance of developing additional medical problems such as painful arthritis, and do not live as long as pets who are not overweight.

• Prescription weight loss diets such as XXX enable us to get your pet back to ideal body weight safely and effectively

• Would you like to start XXX diet?

https://www.youtube.com/watch?v=jnq4LzQy0Tk&feature=youtu.be

It takes a village

10

Provide Team Training

• Discuss risk factors for obesity• Explain how to determine BCS and MMI• Explain how to calculate DER • Explain the diet options• Discuss how to effectively communicate

above information with clients • Provide resources for staff and

opportunities to role-play interactions• You do not have to do it all! Invite a

guest speaker!

Ensure team members can communicate the “WHY”

• Our clients want their pets to live long, healthy, pain-free lives

• Our role as veterinary professionals is help pets live long, health, pain-free lives

• Early detection and appropriate treatment of obesity prolongs a pet’s quantity and quality of life

• Determining and the conveying the right diet plan for every pet is an essential part of our role as members of the pet health care team.

Ensure Team Members Understand Their Roles

• Reception– Schedule appointments and set expectations for visits

• Technicians/Veterinary Assistants– Screen patients for potential risk factors and educate clients on

the value of early detection– Obtain detailed diet history and educate clients on the value of

appropriate dietary management for ideal weight– Perform BCS & MMI and educate clients on ideals– Calculate DER for ideal body weight each patient– Explain diet options and how to transition to new diet

• Veterinarian– Review BCS, MMI, DER calculations and all comorbidities– Recommend appropriate diet options– Recommend appropriate follow up

• Manager– Organize meeting to educate team members and ensure the

team is sending a consistent message– Ensure appropriate resources are available

11

Designate a Nutrition Coach

• Identify a team member who is passionate about nutrition

• Provide additional training/coaching

• Enlist this person to discuss diet recommendations with clients

Nutrition Coach

Team Approach to Weight Management

Doctor

OwnerTechnician/Assistant

Tech-Owner

• Technician/Assistant Role:– Obtain diet history and

preferences

– Determine current weight, BCS, MMI

– Calculate DER for ideal body weight

– Listen to owner concerns

12

Tech-Doctor

• Technician– Review diet history

– Relay current weight, BCS, MMI

– Relay DER for ideal weight

• Doctor– Verify BCS, MMI and DER

– Determine appropriate weight loss plan

Doctor-Owner

• Doctor– Discuss with client why

maintaining ideal weight is important

– Recommend appropriate weight loss plan

– Address owner concerns

Tech-Owner

• Technician/Assistant– Review and provide written copy of

recommendations

– Discuss different diet options

– Supply owner with small quantities of preferred diets

• Charge appropriately for diets!

– Discuss how to transition diet

– Address owner concerns

– Follow up with client • Trouble shoot problems

• Ensure appropriate ordering of diet in the future

13

By working together we can achieve more!

Thank you!

Contact Information:Korin Saker kesaker@ncsu.eduAmy Snyder amsnyde2@ncsu.eudu