3 Steps to Client Compliance
Step 1: Clear plan
Just saying “Your dog needs to lose weight, you should cut back on the amount you feed” is not going to do the trick. Clients need a plan that is Clear, Customized, and Realistic.
The plan must include a diet recommendation. There has never been a more confusing time to be a veterinarian making recommendations for food. Between human nutritional trends, client pressures, marketing tactics, and food recalls, it can truly be hard to have a discussion around food. But results from the Association of Pet Obesity Prevention Pet Obesity Survey (2017) found that dog owners want us to make a diet recommendation.
What should we recommend?
Virtually all of the studies on weight loss and nutritional requirements for dogs have been done using kibble products produced by one of the “big” manufacturers such as Royal Canin, Hills or Purina.
We are very fortunate to have the data that has come out of these studies. However, a lack of research does not equate to lack of efficacy. So, would a home cooked or commercially available cooked, freeze-dried, or raw diet also provide nutrition and achieve weight loss? The data is not in yet.
Boy, do I hope that one day we will get it because I can honestly see the benefit of incorporating fresh food over highly processed food (it would be like us eating cereal or meal replacement bars for every single meal). We all probably agree that the nutrition education we received in vet school has some room for improvement.
I think it is imperative that we continue to learn about this field, do our own research into companies, and use our own ethics to guide us in diet recommendations. I do not believe there is a single right or best food out there and work with clients to find the right food that fits their budget and lifestyle.
The guidelines I suggest when making a diet recommendation are:
First, figure out where all of the calories the dog is getting are coming from and the dog’s current daily caloric intake. Some owners and well-meaning vets may have no idea how many calories are things like marrow bones or bully sticks (See this case study for more details).
Second, figure out the dog’s daily caloric requirement or caloric deficit required. Use this tool to help calculate the caloric requirements (link in forms box on the right)
Then, figure out how many calories are in the food that is being fed. If it is very calorie dense (typically high in fat), then the dog will need a smaller volume, and this runs into the problem of “I only feed my dog ½ a cup and they still look starving.”
- Seek out higher protein foods with lower fat content.
- Give an allowance for treats! Treats are going to happen, so you might as well give the client guidelines for which treats to feed and how many.
- The Plan must include Clear instructions on how much to feed. This is an ideal role for a technician nutrition advocate! Use our Feeding Tool to help (link in forms box on the right)
Calculate the recommended daily caloric intake based on ideal body weight
- Figure out ideal body weight by finding % overweight using BCS:
- Each point above 5 on 1-9 scale = 10% overweight
- Using the IDEAL BW, figure out the Resting Energy Requirement:
- BW(in kg)0.75 x 70 = RER
- For weight loss, multiply RER by 0.8 (feed 80% of RER)
- Once the target weight is achieved, then the dog can be fed full RER.
Alternative calculation: daily caloric deficit
- Figure out how many pounds the dog needs to lose to reach Ideal BW (using the BCS method described above)
- Figure out how many weeks it should take to reach Ideal BW (goal of 1% weight loss per week)
- One pound = 3,500 calories; so if the goal is to lose 1 pound per month or 0.25 pounds per week, you would need to reduce the daily calories by 125.
- These numbers are just estimates and a place to start. It is critical to keep track of weight loss and make adjustments based on the speed of weight loss and BCS.
- Allow for 10% of calories to come from treats
- Find the number of calories per cup/ can/ oz of the diet that you recommend
- Indicate how many cups/cans/oz of food and how many treats the dog gets per day
- The plan must have realistic expectations for the amount of weight loss per week and overall time period to reach the target goal.
- Safe weight loss should be 0.5-1% BW loss per week. Anything more than 2% will result in loss of muscle.
- Identify the ideal body weight and figure out how many weeks it will take to reach this based on 1% weight loss per week (use our tool to help you)
- Educate clients that this is a long term plan; weight loss is the first step, then maintaining the weight is equally important.
- While caloric restriction accounts for 80% of the weight loss plan (the old 80/20 rule), we have learned that exercise helps with preserving muscle mass and calorie burning. Give your client recommendations for an exercise plan.
- Walking is the foundation of exercise for weight loss (and rehabilitation). Ideally, dogs should walk for 60 minutes/ day. But, when first starting a walking program for a dog with OA, shorter, more frequent walks are recommended.
- Calories out: The number of calories burned = 0.5 cal/ lb/km when walking at a 10 min/km pace (about 1 mile in 16 minutes, or just under 4 miles/ hour),
- For example, a 65-pound dog walking 5k (3.1 miles) would burn 160 calories.
Step 2: Accountability
There is a reason why Weight Watchers and other human diets have meetings and support groups—going on a diet is hard and everyone needs help and accountability! Make sure your clients know that you and your team are supporting them.
The best way to do this is to schedule FREE weekly weigh-ins. This should take no DVM or tech time, simply have the client stop by your clinic and weigh their dog on your lobby scale once a week. They can then report the weight to your receptionist, who then enters the weight in the patient’s record.
Part of the accountability should be that if they miss a week of weighing-in, a team member calls to check in to make sure that the client is staying compliant.
We also recommend that the client use a weight loss tracking form, where they can monitor their dog’s progress. CARE has provided a form to help with this, as well as a Complete Care Journal for tracking activity, medications, veterinary appointments, and other health-related events.
Use challenges
Consider having a weight loss challenge for your clients and patients to promote compliance, build community, and encourage loyalty to your practice. Select a period of 3-6 months over which you will be holding the challenge.
In addition to weekly weigh-ins, use social media to acknowledge success, and hold weekly free educational seminars on any aspect of pet health care. At the end of the challenge, hopefully, everyone wins and should celebrate, but be sure that the grand prize is a good one!
Building habits takes time
Remind clients that it takes 3 weeks (21 days) to build a habit. Have them commit to the first 3 weeks of the diet and new exercise plan; check in with them regularly throughout this initial 3 weeks and celebrate the small successes that should come in this period.
In addition to weekly weigh-ins and first-3-week check-ins, be sure to schedule recheck examinations every 4 weeks to be sure that the recommended calories and diet are working. Remember, the goal is 0.5- 1% weight loss per week.
If this is not happening, you need to figure out why! Interview the owner about how things are going (without being judgmental), recalculate calories and adjust the plan, potentially considering a different food.
Consider recommending fitness trackers such as FitBark. While these wearables for dogs are currently not counting calories in, they can keep clients accountable for their exercise program, which should be part of their new habit for helping their dog lose weight.
Step 3: Celebrate success
Weight loss is not meant to happen quickly (in order to be safe and lasting), which means that clients can become frustrated by not seeing immediate results. Be sure to celebrate each week of weight loss. This is where weekly weigh-ins and the weight loss tracking form can really help everyone see the big picture.
When the end goal is met, this is a huge (pun not intended) deal! Be sure to let your client know how proud of them you are and that you recognize how hard they (and their dog) worked to get here. This is the time for the entire hospital to show their support for the client and dog. Be creative—have a party, post on social media, make this client feel extra special!
The yo-yo diet is a real thing. For pets too. The plan does not stop once the target weight/ BCS is reached, you must provide a plan for maintaining the dog’s new body condition. Should they stay on the same food? Can the calories be increased?
In theory, the calories can be increased to a maintenance level once the caloric deficit is no longer needed. But this is a time that weekly weigh-ins must continue! If the dog can maintain their ideal weight with the increased amount of food for 4 weeks, then you can start backing off the frequency of weigh-ins. But make sure that the client understands how to monitor their dog’s body condition and adjust the amount they feed each day based on the dog’s activity level.
In summary, weight loss is THE most important aspect of managing OA and keeping dogs healthy throughout their life. We will continue to provide resources and information to help you make recommendations for diets as new data becomes available.
Use our tools to help you calculate your patient’s daily caloric requirement, figure out how many calories are in common foods and treats, and track weight loss and activity.
References
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Glanagan J, Bissot T, Hours MA, et al. Success of a weight loss plan for overweight dogs: The results of an international weight loss study. PLOS One 2017 https://doi.org/10.1371/journal.pone.0184199