On 20th May 2021, Canine Arthritis Management hosted a Facebook Live with two big names in pet weight management and obesity.
Who was involved?
Hannah Capon MA Vet MB MRCVS (Host): Winner of the 2020 Royal College of Veterinary Surgeons Impact Award, the 2019 Ceva Vet of the Year and finalist in the 2019 Petplan Vet of the Year, Hannah is a first opinion veterinary surgeon in the UK. She is recognised for her tireless work on Canine Arthritis Management (CAM) - an online education and support service for owners of arthritic dogs and professionals that care for them.
Prof Alex German BVSc (Hons), PhD, CertSAM, DipECVIM-CA, SFHEA, FRCVS: Alex German holds the position of Royal Canin Professor of Small Animal Medicine at the University of Liverpool. He is a Diplomat of the European College of Veterinary Internal Medicine, a Royal College of Veterinary Surgeons Recognised Specialist in Internal Medicine, and a Senior Fellow of the Higher Education Academy. His main clinical and research interest is management of obesity in pets. For 15 years, he has run the Royal Canin Weight Management Clinic at the University of Liverpool. This specialist clinic aims to improve the quality of life of all overweight pets through clinical excellence, research and education.
Dr Ernie Ward, DVM, CVFT: Ernie Ward represents the Association for Pet Obesity Prevention. He has spent his entire career practicing, writing about, teaching, and encouraging better care for animals to earn the title as “America’s Pet Advocate.” Whether he’s discussing the dangers of obesity, how to perform a physical examination, dealing with behavioural issues, answering pet owner’s questions about nutrition or surgery, or innovating better care for ageing pets, Dr. Ward’s unifying theme is: Do what is in the pet’s best interest.
The event was sponsored by PitPat who produce activity monitors for dogs.
What's the extent of the problem?
A shocking 56% of US dogs and 60% of US cats are overweight or obese, equating to almost 100 millions dogs and cats in the USA alone.
UK based prevalence surveys suggest a similar magnitude, with at around half of all UK pets being overweight. Perhaps most worryingly, we are seeing an increasing number of dogs and cat (around one quarter to one third) still in their growth phase, that are above their ideal weight. This is worrying as not only predicts a lifelong battle with weight issues for the individuals concerned, but means we can expect the pet obesity epidemic to get even bigger (no pun intended) over time.
Why should we be worried?
Obesity is a very serious issue. Just like kidney disease, heart disease or cancer, it can affect every aspect of a pet's life. It can negatively impact not only quantity (i.e. life expectancy) but quality too. Research shows that just a 6% reduction in bodyweight can result in owner reporting that the dog is happier. There is also a wealth of evidence that - as in people - obesity increases the likelihood of pet illnesses such as high blood pressure, heart disease, some cancers and, of course, osteoarthritis.
To highlight the impacts of obesity on quality and quantity of life, Prof German talked about the "the Labrador study" (Kealey et al. 2002). The study was carried out over a 15 year period and followed 48 Labradors from 8 weeks old until death. The dogs were split into two groups: one group were given ad libitum access to food (i.e. they could eat as much as they wanted), whereas the second group were fed 75% of this.
The findings of the study were profound. The restricted group were not only an ideal weight but lived 2 years longer on average. There was also a significant delay in how long it was before they suffered a chronic health condition such as osteoarthritis. The study was not perfect in that it was a colony study i.e. not pet population, and looked at only one breed of dog. However, more recent studies looking at pet dogs of other breeds have also made similar findings.
How is weight management related to osteoarthritis?
Given that the webinar was being hosted by Canine Arthritis Management, the panel delved a little more specifically into the effects of obesity on osteoarthritis. They grouped the effects into:
Biomechanical weight bearing effects. This is the mechanism most people would think of as to why obesity increases the risk of obesity. Obesity increases the load placed on the joints, and although this can cause increased wear and damage over time - it is most often associated with acute injury such as cruciate tears etc. Underpinning this injury though, is often a longer history of destruction of the ligaments and joint structures over time. These can be due to:
Direct effects on the joint: This is probably the less well known, but very significant mechanism by which obesity causes osteoarthritis. Excess fat in the body causes pro-inflammatory chemicals to be released and these cause joint inflammation and destruction. It explains why people that are overweight are more prone than others to osteoarthritis even in their non-weight bearing joints such as their hands and wrists.
Weight loss has been proven to be the single most effective treatment for osteoarthritis, with just 6-9% reduction in bodyweight being enough to have a positive effect on the dog's mobility and quality of life. Most drugs, on the other hand, largely manage or the symptoms associated with this chronic and incurable condition. The only other treatment which you might argue is more successful is surgical joint replacement, but these procedures as salvage procedures and a major undertaking, and often not a feasible option for many owners and pets.
Is obesity a disease?
Obesity in humans is recognised as a disease - most of the World's medical associations have declared it as such. Most of the largest veterinary medical associations are also in agreement.
The panel discussed some of the benefits of obesity being recognised as a disease including the fact that it allows it to be taken more seriously and helps to reduce some of the stigma and owner blame attached. It also allows the complexity of the underlying cause(s) of obesity to be recognised.
What causes obesity?
Of course, the basic foundation and underpinning main principle of why obesity occurs is that calorie intake exceeds calorie expenditure. Prof German reminded us of the first law of thermodynamics - that energy cannot be created or destroyed, merely changed from one to another. So indeed, in many instances, simply eating less and exercising more would be enough to tackle the issue.
But in some cases, it is more complex than just lifestyle factors (i.e. exercise and diet). There are many other factors that might influence the rate at which weight is gained or lost including e.g. changes in the gut microbiome and genetics. In humans, for example, we know that between 40-70% of an individual's risk of obesity can be attributed to their genes. Many of these genes code for the parts of the brain that control appetite. We know comparatively little in pets than humans, but an example is the POM-C gene which has been identified as giving labradors a genetically "hungry brain".
Again this brings us back to the discussion about the benefits of recognising obesity as a disease, as it gives us therapeutic targets - i.e. the chance to treat obesity using medications that change the brain neurochemistry and not focus only on the mantra of "eat less, exercise more".
Prevention is better than cure
Preventing obesity can prevent chronic conditions such as osteoarthritis too. And obesity itself, is a classic example of a disease that is much better prevented than cured. Treatment is much harder to do, and is far less successful.
Prof German talked about how this needs to start from a young age, and introduced us to the Waltham puppy growth charts. Although these are free to access, they are best used alongside guidance from a veterinary professional. They work similarly to the WHO growth charts for children in that they plot the growth trajectory and help to identify problems and make adjustments early on. There are different charts based on their predicted adult size (not breed).
Early life obesity is a massive predictor for obesity in adulthood. In people, for example, we know that if a child has developed obesity by the time they are 7 years old, they are highly likely to have obesity for the rest of their lives. Studies show similar patterns in dogs too.
Use of the puppy growth charts also encourages regular weighing (at least every 6 months) which is also a good idea to carry on throughout adulthood. It has been shown in people to be one of the best ways to manage bodyweight in that it prevents "the ostrich effect" and allows small changes to be noted and adjustments to be made early on.
Dr Ward agreed with this point and reiterated that a lack of awareness often plays a big part of obesity in our pets. He said he thought many owners were not aware of:
What their pet current weight is (going back to the importance of regular weighing)
What weight the pet should be for their breed
How much they should be fed (bearing in mind that many bag recommendations are based on all life stages, activity levels, neutered or not etc.)
These factors are likely to play an important role in the pet obesity epidemic.
So what about if that ship has already sailed, and the opportunity to prevent obesity has been missed? Many people who watched the webinar or are reading this summary, will be pet professionals who are well aware of the harmful effects of obesity but struggle to convince owners of the issue.
How to have THE conversation with owners
1. Use an ice breaker to broach the subject and gauge the owner's reaction; try to work out if they are ready to have the conversation. If not, park it for another day. Some suggestions they made were:
Talk to the pet - "oh you have gained a bit of weight here Freddie" - you can look at the owner's reaction out of the corner of your eye!
Use body condition scores (the animal equivalent of BMI) to put a number on it and talk body shape, helping you to avoid the use of the "F word" and "O word". It can also be a good conversation starter to ask owners where THEY think their pet is on the scale, and compare their assessment to yours.
Play a guessing game about the pet's weight before weighing them. If the owner hasn’t a clue or guesses way off you know they don’t weigh often or it is not a priority for them.
2. Ask permission: "Do you mind if we talk about Freddie's weight today?" - this gives them a degree of ownership over the conversation and makes them more receptive.
3. Have a clear tactic or strategy on what to do next. Be ready to talk about the consequences of obesity for the pet and highlight that obesity is not just an aesthetic issue. Explain the importance of weight management in terms of the impact the potential for obesity to limit life expectancy, cause suffering etc. Use facts and figures to demonstrate the seriousness of the issue (e.g. the Labrador study above). Knowing the consequences is more likely to motivate the owner to make an issue. Be aware that "now" might not be the right time to go into this depth of conversation - the action you take might in fact be to book them in for a separate conversation with about it another time.
What about neutering and bodyweight?
The situation regarding the timing of neutering is never clear cut and requires an in depth discussion between vet and owner taking into consideration the risk of other diseases, behavioural factors, population control etc. But for the purpose of this discussion, the focus was on the relationship between neutering and bodyweight.
Neutering (that is castration or spaying/speying) has been shown to increase dogs' and cats' likelihood of becoming overweight. There are links between the sex hormones and various metabolic pathways and so from a physiological point of view, the more we delay neutering the better.
Hannah Capon reminded us that science is always changing, and that recommendations to delay neutering have only been evidenced in recent years. She also suggested that specialists in other fields might in fact disagree, again, reiterating the need to consider all variables in decision making and therefore for a case-by-case discussion between vet and owner.
Of course obesity post-neutering can be prevented with careful lifestyle and dietary management. Prof German again highlighted the power of regular weighing and plotting bodyweight on the growth charts, since this can quickly tell us if there has been a change in trajectory post-neutering, and for changes to be put in place.
So how much food SHOULD a dog get?
Food packaging will advise you how much to feed your dog in grams. Many owners "guestimate" or use scoops or cups. However, research has shown that food cups can be very inaccurate and inconsistent, and weighing out the food is a much better way to go. And of course, weighing the pet regularly will tell you if you need to fine tune the amount you are feeding.
What about treats?
There are so many products out there for our pets - even doggy champagne - enough to make us feel like we are "bad owners" if we do not buy them to our pets from time to time. Surely the specialists would tell us that all treats like this are bad?!
Believe it or not, neither Prof German or Dr Ward are 100% anti-treat. In fact they talked about the importance of being able to treat our pets in terms of the human-animal bond. They did say though, that like with us - it must be done in moderation, and as part of a balanced diet and active lifestyle.
Prof German told us that provided a dog is on a complete and balanced diet, there is a safety factor built in. You can feed up to 10% of their diet as treats, and everything will stay in balance (i.e. they will still get all their required nutrients).
Where possible, and especially in pets that are overweight, treats should be substituted for something lower in fat/calories, such as courgette, carrot, broccoli or watermelon! And don't forget that other rewards like playtime, grooming and walking can not only be positive for us and them, but be better for their bodyweight and health.
HOW should I feed my dog?
As well as wanting to "ban the cup", Prof German talked about his wish to "ban the bowl". He explained that pets are contra-freeloaders which means they would prefer to work for food even if it is freely available to them. There was a bit of chat, therefore, about the benefits of taking the pet's daily diet allowance and presenting it in novel ways including e.g. puzzle feeders, snuffle mats, food parcels etc.
WHAT should I feed my dog?
There are lots of very strong opinions on what we should/shouldn't feed our pets, so this can always be sketchy ground for any webinar to cover but the team did a good job.
Dr Ward's opinion is that the pet food industry is by no means perfect, but feels that (on the whole) they are mostly balanced and serving a definite need, and are safer and healthier now than ever before. However, he did warn us that the caloric density of pet foods has increased over the years, largely to enhance palatability (after all, we all know the unhealthy food tastes the best right?).
Prof German takes the stance that it is a personal decision, but that he has three rules:
Make sure it’s safe - i.e. it isn't going to cause harm to your pet (if feeding raw, for example, bare in mind the potential for the ingredients carrying infectious agents and follow hygiene recommendations)
Make sure it’s complete and balanced. A diet needs to provide energy and the essential nutrients. With a balanced diet, provided you are feeding enough food, you can be certain the pet is getting everything they need.
Don't feed too much!
There isn't any evidence to suggest one way of feeding e.g. raw vs cooked etc., is beneficial over the other in terms of weight management. Prof German did, however, report that in one study comparing dogs on dry, wet or dry/wet combined diets, those on the dry diets were more likely to reach their target weight. The reason for this is not known although it might be that the diet for these dogs was easier to weigh out and fine tune, but this does go against the argument that it is the carb content of dry food that is largely to blame.
In terms of pets that need to lose weight, those diets that are high in protein and fibre can help with satiety (feeling full), and there is evidence too that diets containing substances such as L-carnitine can help.
How to lose weight without losing muscle
There is inevitably some muscle loss, more so the more weight the dog loses. The main ways to offset muscle loss are:
To make sure the weight loss is gradual
Feed a higher protein diet (30-35%+)
What about exercise and activity?
Whilst energy expenditure must of course play a role, getting the diet sorted is the prime aim of any weight management plan.
Surprisingly, there is not much evidence to suggest that increased activity speeds up weight loss in pets. It does, however, preserve lean (muscle) mass and is important for their wellbeing.
Some tips are:
Set small, achievable goals. This will make the new regime easier to follow and maintain, and will be more rewarding and therefore motivating for the pet and owner.
Decide what "success" will look like. This will be different for each pet and owner, and doesn't necessarily mean huge amounts of weight loss. Keep the focus on improving the animal's quality of life - remember this can be achieved with just 6-9% weight loss for many pets.
Take a look at how much exercise the pet already gets and then increase this slightly (by about a quarter to a third). This can be achieved by increasing the number or duration of their walks, or perhaps adding in a play session.
Don't increase the intensity of the exercise they get too quickly or dramatically - this could be detrimental, especially in animals with joint disease such as osteoarthritis.
Don't over do it. Always work within the animal's capabilities, discussing any existing health issues with their vet before making any big changes.
For animals with joint disease, look into alternatives to running/walking etc. such as hydrotherapy - this can be much friendlier on the joints.
Work with other pet professionals too - hydrotherapists, physiotherapists and pet rehab specialists can really help.
Look at alternatives to running/walking
For anyone wanting more pet weight management resources, check out the Association for Pet Obesity Prevention website.