Weight Management Clinics -The 30 minute consultation · What is Obesity? The 30 minute...

© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Weight Management Clinics - The 30 minute consultation

Caroline Burke BSc RVN Weight Management Specialist

© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Agenda

What is Obesity? The 30 minute consultation - Stages 1 and 2Body condition scoringThe 30 minute consultation - Stages 3 and 4Measuring Food Follow upMaintenanceTreats and exercise


Obesity in companion animals

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© COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY 4

‘Excess accumulation of body fat’

What Is Obesity?

•overeating, under-exercising or a combination of both.

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What Is Obesity?

Overweight: When an animal is 10% above ideal weight(Body Condition Score of 6/7 out of 9)

Obese: When an animal is 30% above it’s ideal weight(Body Condition Score of 8/9 out of 9)

© Labat


Obesity is

… a CHRONICINCURABLE

DISEASE

* PAW wellbeing report 2012: YouGov & PDSA

What Is Obesity?


What can contribute to Obesity?

Pre-disposedIncorrect diet – feeding choicesFeeding ‘extras’Feeding behavioursExerciseStressNeutering

EDUCATION

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Owners perception

Media charactersDo not ‘see’ their pets as we see

themRecent studies show owners

underestimate body condition scores

97% of owners struggle to identify a healthy body shape for dogs

Not understand is health issue

PAW Report (2012)


Consequences of obesity

Decreased lifespan in dogs and catsHealthDecreased quality of lifeWelfare

©ROYAL CANIN Weight Management Clinic



Before After

PostureDepressionFight/FlightSadUnable to move efficientlyPainful?Unsocial

PostureHappyConfidentFight/FlightSociableComfortableImproved Quality of Life

Rocco’s Before Weight: 38.4Kg’s (June 2007)Rocco’s After Weight: 25.8Kg’s (December 2007)

Rocco achieved a 33% body weight loss!!!!!!


The 30 minute consultation

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The Clinic Name

• Clinical• Weight Management Clinic, Obesity Clinic

• Positive• Healthy weight service, Healthy weight

club, Fit club• Descriptive

• Chub club, Slimmer's club


The Clinic

Be PreparedSet date for clinic start Ensure everybody knows• Start date• When to book appointments and who with• What you will be discussing• How to refer to you


How to recruit?

ReferralsAnytime and Everyone Involved• Discharges• Vaccinations• Consultations• Discussions with reception• Owners request


Why 30 minutes?

Stage 1 (10 mins) – History Stage 2 (05 mins) - The Weigh-InStage 3 (10 mins) – Set PlanStage 4 (05 mins) – Give plan and diet



Be prepared

Appointment pre-booked• Use questionnaire prior to appointment• Give owner BCS Chart


All appointmentsHave pack prepared for client Flip chart (30 minute guide)Questionnaire Booklet for OwnerTool KitVet Follow UpFood


Be prepared

Tool KitTape MeasurePuzzle feeders and toysBCS chartsAppointment CardKitchen scales Camera RosettesCertificates

© ROYAL CANIN®

© Shelley Holden


Calibrating your scales

©Dr Alex German


Stage 1History Gathering

(10 minutes)


Stage 1 – Food Questionnaire


Stage 1 - Exercise Questionnaire


Further questioning

Need to understand the root of the issueHow and when did obesity first occur?Have there been changes in lifestyle/environment

that may have attributedCould there be an underlying medical condition

– may need to referSpend time understanding the situation


Stage 2The Weigh-In

Weight, Photos, BCS, Measurements

(5 minutes)


Stage 2

Weigh AnimalBody Condition ScoreTake Photographs




Facilitate the taking of good before and after photosTake lots of different anglesNice photos too!!Use them for displays

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©Abbeycroft Vets Willows


Before

Before 10.5kg

Before 10.5kg

After

After

After 6.5kg

After 6.5kg

Before


Stage 2

Take morphometric measurements

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• Thoracic• Abdomen• Neck

© Shelley Holden

© Shelley Holden


YES

NO

Do you currently use Body Condition Scoring in practice?

• 5 Point

• 9 Point


1 cat and 5 dog shapes:• Chihuahua• Jack Russell• Pointer• GSD• Saint Bernard

5 breed morphologies: Variations in fat deposition Tailored measures for each individual Client-friendly: greater identification with

their pet

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9 Point Body Condition Score


Practical 1

How good are your Body Condition Scoring Skills?

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-Palpate the pet by only applying light pressure

-Run your hands along the rib cage (following direction of fur)

-Run your hands on either side of the pets abdomen to see if you can feel a waist

© Shelley Holden

© Shelley Holden


Look and feel from above to see if you can observe a waist

© Shelley Holden


Run your hands from the back of the ribcage underneath the abdomen to see if an abdominal tuck

is present.

Using hands apply light pressure over the lumbar region, spine and hips.

© Shelley Holden


Practical 1

How good are your Body Condition Scoring Skills?

What BCS is my dog?

36


Stage 3Set Plan

Discuss diet and exercise (10 minutes)

© Shelley Holden © Shelley Holden


Stage 3

Educate Owner• Seriousness of Obesity• Health Benefits• Welfare• Quality of Life ©ROYAL CANIN Weight Management Clinic

© Shelley Holden


Stage 3

Set Plan• Estimate target weight• Decide on most appropriate diet• Calculate how much to feed• Provide diet• Weigh Food• Work out how long the diet will last


Estimating target weight – How?

HOW?


Decide on appropriate diet


Owner to keep record

For feeding and exercise guidesWrite everything downGet owner to record using diaryAssess at every weigh-inWrite down adjustments

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Stage 4Send home with plan

Provide diet and written instructions(5 minutes)


Send home with written instructionsOwner booklet completedInformation on dietExercise planDiary

© Shelley Holden

http://www.digionline.co.uk/RoyalCaninResources/PetOwnerLeaflet/m/index.html#/page/2

http://www.digionline.co.uk/RoyalCaninResources/PetOwnerLeaflet/m/index.html#/page/2

http://www.digionline.co.uk/RoyalCaninResources/PetOwnerLeaflet/m/index.html


http://www.digionline.co.uk/RoyalCaninResources/PetOwnerLeaflet/m/index.html#/share

http://www.digionline.co.uk/RoyalCaninResources/PetOwnerLeaflet/m/index.html#/share

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Stage 4

Send home with:Diet (STOCK)Kitchen scales (advise on purchase)Toys (may discuss next appointment)Arrange next appointmentProvide contact details (phone/email)Arrange follow up call/email


How accurate are measuring cups?


Practical 2

Using the measuring cup measure……….

Tip amount measured onto scales

Record amount

47

© Shelley Holden

© Shelley Holden


How accurate are measuring cups?Methods

• 12 different studies• Various cup sizes• Various diets• Various portion sizes

Results• Accuracy

• Ranged from 18% under to 80% over

• Usually an over-estimate• Precision

• Intra-operator CV: 2% to 15%• Inter-operator CV: 2% to 28%

• Worse for small portions• Scales printed on cups were also inaccurate


©Shelley Holden

©Shelley Holden


Behaviour

Discuss changes that will occurMore activeLivelierMore attentionFeeding habitsImproved mobilityImproved groomingImproved QUALITY OF LIFE

After

© Shelley Holden


Owner Requirements: CommitmentTime:

to monitor feedto complete diariesto attend clinicto weigh food increase exerciseincrease play timeto buy products

Have you tried your own advice?


The follow-up (Repeat Appointment)

How often to review?Weight/Measurements/BCSUpdate booklet/filesImplement new ideas, new suggestions

© Shelley Holden

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Feeding plan - Advice

How often, when to feed?Change feeding times aroundFeed a combination of wet and dryFeed more meals when owners presentUse feed ball/play time for a meal

Don’t suggest everything at once!!

© Shelley Holden


Encouragement – even if small lossExplain lossWhat is a safe loss?


Safe Weight Loss

Optimal Weight Loss per week?

Dog - 1-3% per week• (Average 0.9% a week)

Cat - 0.5-2% per week• (Average 0.8% a week)


How to calculate safe weight loss

Previous weight 3 weeks ago was 32kgTodays weight 30.9kg

Therefore 32kg -30.9kg = 1.1kg

1.1/32kg (previous weight) x 100 = 3.4%3.4/3 (number of weeks since last visit) = 1.1% per week

Is that good/bad? What would you do if the dog had lost 0.4% per week?


Support

Monthly competitions – prizes Certificates / awarded at different stagesDisplays to show enrolled petsMembership cards for clients/benefits

MOTIVATION © Shelley Holden

©Vetfollowup


Maintenance Post Weight Loss

Which diet to feed?Recent Study shows:Nearly half of dogs who lost weight regained weight post loss

14 dogs (42%) maintained3 dogs (9%) lost more than 5%

16 dogs (48%) gained more than 5%

Most dogs gained just under half the weight of what was originally lost!

German, A.J., et al. Long-term follow-up after weight management in obese dogs: The role of diet in preventing regain.The Veterinary Journal (2011), doi:10.1016/j.tvjl.2011.04.001


Monitoring Post Weight Loss

Maintain on current dietGradually increase in stages• 0-10kg - Increase by 5g• 10-25kg - Increase by 10g• 25kg + – Increase by 20g

Maintain plan – reweigh every 2 weeksOnce maintaining 4 weeks/8 weeks/12 weeks

© Shelley Holden


= 53 kcals (small)= 20gms K9 Satiety = 45 kcals (100g)

= 16gms K9 Satiety= 191 kcals= 71gms K9 Satiety And 62gms F9 Satiety

= 85 kcals

= 31gms K9 Satiety100g of Ham= 164 kcals= 61gms K9 Satiety

Bonio= 75kcals= 28gms K9 Satiety


This is more fun!!


Exercise


Exercise

Realistically consider the owners capabilitiesTailor the plan for the individual Consistent PlanComplete diary

© Shelley Holden

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What do you advise?


Cats

Start with small sessions 2 x 2 minutes daily and gradually increase

Alternate toys/Find what interests themSpread food/move bowls – think of natural behavioursHide and SeekKeep the owner interested!!!

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TIME TO PLAY


Dogs

Set Exercise PlanHow Overweight?Injury/IllnessWeatherLifestyle of owner Anybody to help?


The 30 minute consultation

Be preparedBe organisedTool kit• Stage 1 – History• Stage 2 – The weigh-in• Stage 3 – Set Plan• Stage 4 – Send home with plan and diet

Follow up consultationsPrioritiseSupport

© Shelley Holden


BeforeAfter

THINK OF ROCCO!!!!!


With many thanks:


Any Questions?


Thank you!

Weight Management Clinics -The 30 minute consultation · What is Obesity? The 30 minute...

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