Obesity in all its Aspects: Causes, Consequences and Curative Treatment

Veterinarians' Perspective on Obesity Management

Word count: 14,065

Yvette Dalm Student number: 01202257

Supervisor: Prof. dr. Catherine Delesalle Supervisor: Prof. dr. Myriam Hesta

A dissertation submitted to Ghent University in partial fulfillment of the requirements for the degree of Master of Veterinary Medicine

Academic year: 2017 - 2018

Ghent University, its employees and/or students, give no warranty that the information provided in this thesis is accurate or exhaustive, nor that the content of this thesis will not constitute or result in any infringement of third-party rights. Ghent University, its employees and/or students do not accept any liability or responsibility for any use which may be made of the content or information given in the thesis, nor for any reliance which may be placed on any advice or information provided in this thesis.

Preface Iwouldliketoexpressmygra4tudetoallrespondentsthatcompletedthesurvey,forthisstudycouldnothavebeendonewithoutyou.Also,thankstoallveterinaryassocia4onpagesonsocialmediathatallowedthesurveytobedistributed.Finally,Iwouldliketoexpressmysinceregra4tudetomysupervisorsProf.dr.CatherineDelesalle,ms.DeMeeûsandProf.dr.MyriamHesta.Your4me,energyandguidancehasbeenofgreatinspira4ontoperseverewiththisstudy.

Tableofcontent PrefaceTableofcontent1. Abstract………………………………………………………………………………………………………………………………………..62. SamenvaLng………………………………………………………………………………………………………………………………..73. Introductoryliteraturestudy…………………………………………………………………………………………………………8

3.1. Introduc4on……………………………………………………………………………………………………………………………83.1.1. Causesofobesity…………………………………………………………………………………………………………..83.1.2. Consequencesofobesity……………………………………………………………………………………………….9

3.2. Addressingobesity……………………………………………………………………………………………………………..…103.2.1.Vetresponsibilityinanimalwelfare……………………………………………………………………………..103.2.2. Principlesofownereduca4on……………………………………………………………………………………..10

3.2.2.1. Theneedforownereduca4on……………………………………………………………………………103.2.2.2.Communica4vepaTerns……………….……………….……………….………………….………………103.2.2.3. Thetranstheore4calmodel……………….……………….………………………………………………11

3.3.Diagnosingpetobesity………………………………………………………………………………………………………….123.3.1.Qualita4vemethods…………………………………………………………………………………………………….123.3.2. Quan4ta4vemethods………………………………………………………………………………………………….13

3.4. Cura4vetreatment……………………………………………………………………………………………………………….153.4.1.Nutri4onalsupport………………………………………………………………………………………………………15

3.4.1.1.Weightlossdiets…………………………………………………………………………………………………153.4.1.2. Sa4ety………………………………………………………………………………………………………………..16

3.4.2.Exerciseregimes…………………………………………………………………………………………………………..163.4.2.1. Currentperspec4vesonexercise………………………………………………………………………..163.4.2.2. Posi4veeffects……………………………………………………………………………………………………163.4.2.3. Nega4veeffects………………………………………………………………………………………………….17

3.4.3.Psychologicalaspect…………………………………………………………………………………………………….173.5. Principlesoftherapycompliance………………………………………………………………………………………….18

3.5.1.Whatistherapycompliance?……………………………………………………………………………………….183.5.2. Causesforlowtherapycompliance……………………………………………………………………………..183.5.3.Howtoimprovetherapycompliance……………………………………………………………………………19

3.6. Evalua4on…………………………………………………………………………………………………………………………….203.7. Therapysuccess……………………………………………………………………………………………………………………20

4. Researchques4on………………………………………………………………………………………………………………………214.1. Researchques4on………………………………………………………………………………………………………………..214.2. Hypothesis……………………………………………………………………………………………………………………………21

5. Materialsandmethods……………………………………………………………………………………………………………….226. Results………………………………………………………………………………………………………………………………………..24

6.1. Therapysuccess……………………………………………………………………………………………………………………256.2. Causesanddiagnos4cs…………………………………………………………………………………………………………266.3. Therapeu4cregimes…………………………………………………………………………………………………………….286.4. Communica4on……………………………………………………………………………………………………………………30

7. Discussion…………………………………………………………………………………………………………………………………..347.1. Hypothesisandstudyexpecta4ons………………………………………………………………………………………347.2. Validityoftheresearch…………………………………………………………………………………………………………367.3. Limita4onsofthisresearch…………………………………………………………………………………………………..367.4. Sugges4onsforfollow-upresearch……………………………………………………………………………………….367.5. Theauthors’interpreta4on…………………………………………………………………………………………………..367.6. Answertothehypothesisbyotherstudies…………………………………………………………………………..377.7. Conclusion……………………………………………………………………………………………………………………………37

8. References………………………………………………………………………………………………………………………………….389. Appendix…………………………………………………………………………………………………………………………………….43

9.1. Dutchsurvey…………………………………………………………………………………………………………………………43

1. AbstractObesityisthemostimportantnutri4onaldiseaseinsmallanimalmedicineatthismoment(Mason,1970;Carciofietal.,2005;McGreevyetal.,2005;German,2006;Blandetal.,2009;FasceLetal.,2012).Thisstudypresentsanes4matedprevalenceofoverweight,BCS6-7/9,of41.4%(+/-19.8)onaverage.Clinicalprevalenceofobesity,BCS8-9/9,wases4matedat12.5%onaverage(+/-10.9). Thisdisserta4onisalimitedresearchstudyandaimstoinves4gatehowobesityismanagedwithinthe small animal clinics in Belgium and the Netherlands and which factors can be improved inordertodecreaseprevalenceandimprovetreatmentofthisseverecondi4onincatsanddogs.Itconcludedthatveterinariansexperiencemoretherapeu4csuccessincanineobesitymanagement,than in feline obesity management. Avoiding discussing obesity influences therapy successnega4vely,whileaddressingobesityinfluencestherapysuccessposi4vely.Calcula4ngtheindividualcaloric need to determine the amount of weight loss food should be preferred to using thedescribedamountonthepackaging.Elabora4ngonthetypeofexerciseneededtoinduceweightloss influencesmean therapy success posi4vely in cats.How followup appointments aremade,influencesmean therapy success significantly.Biweekly followupappointmentsarepreferred towai4ng for the client to contact the clinic. Assis4ng staff members influence therapy successposi4velywhenhandedtheresponsibilityofthefollowup. Incasesoftherapyfailure,veterinaryac4onalerwardscans4llinfluencemeantherapysuccessposi4vely.

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2. SamenvaLngObesitas is het meest belangrijke nutri4onele probleem binnen de geneeskunde van degezelschapsdieren(Mason,1970;Carciofietal.,2005;McGreevyetal.,2005;German,2006;Blandet al., 2009; FasceL et al., 2012). Deze studie geel een geschaTe prevalen4e weer vanovergewicht,BCS6-7/9,vangemiddeld41.4%(+/-19.8).Deprevalen4evanobesitas,BCS8-9/9,werdgemiddeld12.5%(+/-10.9)geschat. Deze masterproef is een beperkt onderzoek en heel als doel te onderzoeken hoe obesitasgemanagedwordtbinnendegezelschapsdierenprak4jkinBelgiëenNederland,enwelkefactorenverbeterdkunnenwordenomdeprevalen4ete latendalenendebehandelingvandezeerns4geaandoeningenbijkatenhondtekunnenverbeteren.Er kan geconcludeerd worden dat dierenartsen gemiddeld meer therapiesucces ervaren in debehandelingvanobesitasbijhondendanbijkaTen.Hetvermijdenvanhetonderwerp“obesitas”heel een nega4eve invloed op therapiesucces, terwijl het ac4ef benoemen van obesitas eenposi4eve invloed uitoefent op het gemiddeld therapiesucces.Qua diagnos4ek, is het berekenenvan de individuele calorische behoele is een betere methode dan de hoeveelheid voeding tebepalenaandehandvandevoederverpakking.BijkaTen,heelookuitleggenwelktypebewegingvan belang is voor gewichtsverlies, invloed op therapiesucces. Hoe opvolging aangepakt wordt,heel een significant invloed op therapiesucces. Opvolging iedere twee weken geel betertherapiesuccesdanafwachtentotdecliëntdeprak4jkcontacteert.Deassistentkanbest ingezetwordenomdeopvolgingvanobesitaspa4ëntenovertenemen.

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3. Introductoryliteraturestudy

3.1. Introduc4on Obesity is considered one of the most challenging issues in small animal medicine at thismoment. In general, it is considered the most important nutri4onal disease in companionanimalsworldwide(Mason,1970;Carciofietal.,2005;McGreevyetal.,2005;German,2006;Blandet al., 2009; FasceLet al., 2012). In the felinepopula4onobesity is the secondmostprevalentdiseasenexttodentaldisease(Lundetal.,1999;Robertson,1999;Allanetal.,2000;Colliardetal.,2009;Caveetal.,2012). Obesitycanbedefinedindifferentways.Someauthorsdefineobesityasbodyweight10-25%abovetheidealbodyweight(BurkholderandBauer,1998;Gossellinetal.,2007;Blandetal.,2009),whereasothersuseanincreaseinthebodycondi4onscoretodefineobesity(Gossellinetal.,2007;LinderandMueller,2014).Othersonlyconsiderdogsobese,whentheirexcessivebody weight causes adverse health effects (Na4onal Ins4tutes of Health, 1985; Kopelman,2000;Germanetal.,2010;FasceLandDelaney,2012).Inhumanmedicinescien4stshavelelthe idea of using “bodyweight” per se, as a golden standard to define “obesity”. It is wellknownthatthe“fatpercentage”ofthebodyplaysacrucialrole.Firsttherewastheconceptof“bodymassindex”,keepinginmindthebodyheightofaperson,relatedtohisorherweight.Nowadays, more aTen4on is directed towards where “fat accumula4ons” are located. Anincreasing loadofscien4ficstudiespointoutthat“abdominal fat”accumula4onneedstobeconsideredasmoreimportantwhenitcomestodiseasesassociatedwithobesity.Apparently,abdominal fat triggers more pro-inflammatory processes and together with that, morehormonal influences such as insulin resistance,when compared to fat accumula4on aroundthehipregion.Theseconsidera4onsarenotmadeinprac4cefordogsandcats,yet. Instead,thebodycondi4onscore,BCS,isusedtoquan4fyexcessbodymassandcangiveanes4ma4onoftheexcessbodyfatpercentagewhencombinedwiththebodyfatindex,BFI.Also, differen4a4on can bemade between overweight and obesity. Animals are consideredoverweightwhen their bodyweight exceeds ideal bodyweight by 10-19% and obesewhentheir bodyweight exceeds ideal bodyweightbymore than20% (Burkholder andToll, 2000;Courcieretal.,2010).WhenusingtheBCS,overweightcorrelatestoaBCSof6or7outof9,while obesity correlates to a BCS 8 out of 9 (Gossellin et al., 2007). This study uses thedefini4onforoverweightandobesityfromGosselinetal(2007). Just like inhumans,obesityseemstotakeonepidemicpropor4ons incatsanddogs.Recentprevalencestudiesareshownintable1andshowhighprevalenceofobesityindogsaswellascats,andalsoshowanincreaseinprevalenceintheUnitedStatesofAmerica(Donoghueetal.,1991; ScarleT et al., 1994; Lund et al., 2005; Lund et al, 2006). AlthoughUKprevalence forfeline obesity seemingly decreases, Tarkosova (2016) reported higher sensibility to error indatafromtheCourcier(2012)study,duetodifferentlevelofassessmentofthebodycondi4onscoreinthe2010studycomparedtothe2012study,aswellasasignificantagedifferenceinthefelinepa4entsassessed.Inparallel, humanobesity is also increasing,whichmight result in a further increaseofdogobesity,sinceobeseownersaremorelikelytoownanobesedog(Kienzle,2002;Bland,2009),whichisaquiteinteres4ngfinding.

3.1.1.CausesofobesityandtheirclinicalprevalenceObesity isamul4factorialdisease. It isprimarilycausedbyadisturbedbalancebetweenenergyintakeandenergyexpenditure.Howeverseveraldiseasesanddrugscanalsobetheprimary cause fordevelopingobesity (German,2006). Furthermore,predisposing factorsinclude gene4c predisposi4on (Edney and Smith, 1986; Bland et al., 2009; Raffan et al.,

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2016),spayingandneuteringandownermanagement(BurkholderandBauer,1998;Blandetal.,2009). A more recent study uncovered the veterinarian as possible contribu4ng factor to thecurrentprevalenceofobesity,duetoinsecurityabouttheirownknowledge,lackof4meorafearofupseLngclients(ChurchillandWard,2016).

3.1.2.ConsequencesofobesityObesity isanutri4onaldisorderwithanexcessofadipose4ssue that,asGerman (2010)put it, is no longer considered to be ‘a passive fuel depot’. Adipose 4ssue secretesadipokines that have a wide variety of effects all around the body, affec4ng ‘glucosehomeostasis, inflamma4on and immunity, hemostasis, fluid balance, vascular biology,hematopoiesis, cell prolifera4on, angiogenesis and neurotrophic func4ons’ (Radin et al.,2009; German et al., 2010). Therefore, we need to leave the view that fat is merely apassivefueldepot,readytobeusedincaseofincreasedenergydemands.Onthecontrary,itneedstobeviewedasthelargestendocrineorganinthebodyofanobeseorganism.In a more clinical perspec4ve, obesity in dogs has been iden4fied as a risk factor fordeveloping metabolic abnormali4es and endocrinopathies, renal pathology,cardiorespiratorydisease,dermatopathies,renalpathology,orthopedicdisorders,reducedreproduc4ve efficiency and a variety of func4onal abnormali4es, such as exerciseintolerance and dyspnea and increased risk when under anesthesia (Robertson, 2003;German, 2006; Becvarova, 2011; Pelosi et al., 2013). In feline pa4ents, obesity alsoincreasestheriskofdevelopingtypeIIdiabetesmellitus,hepa4clipidosisandfelinelowerurinarytractdisorderorFLUTD.(Robertson,1999;German,2006;Becvarova,2011;Raffan,E., 2013; Pérez-Sánchez et al., 2015). Of all these abnormali4es, exercise intolerance,orthopedic and cardiorespiratory disease, aswell as insulin resistance anddyslipidemiascanbereducedorresolvedwithweightloss(DiezandNgunyen,2006;Pelosietal.,2013).Withthatrespect,scien4ficstudiesperformedindogsandcatsmatchwithexpecta4ons,incomparisonwithwhatisalreadyknowinhumanmedicine.

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Country Prevalence Species Source

USA1994 25,0% Cat Scarlettetal.(1994)1991 22,9% Dog Donoghueetal.(1991)2005 35,1% Cat Lundetal.(2005)2006 34,1% Dog Lundetal.(2006)UK1998 52,0% Cat Russelletal.(2000)2010 59,3% Dog Courcieretal.(2010)(a)

52,0% Cat Courcieretal.(2010)(b)

2012 11,5% Cat Courcieretal.(2012)France

2006 38,8% Dog Colliardetal.(2006)

2009 26,8% Cat Colliardetal.(2009)

TheNetherlands

2013 19,7% Dog Corbee(2013)

2014 50,0% Cat Corbee(2014)

Table1:prevalenceofoverweightandobesecompanionanimals

3.2. Addressingobesity

3.2.1.VetresponsibilityinanimalwelfarePet obesity can be considered a sensi4ve subject to discuss with pet owners. Not onlyveterinarians,buttheen4reveterinaryteamtendstoavoidthetopicaltogetherinfearofupseLng,orevenlosing,clientstothistopic(ChurchillandWard,2016).Whenweightlossisnotachieved,veterinaryteammemberscanbecomelessmo4vatedtoconfrontclientswith their pets obesity (Churchill andWard, 2016). However, client ques4onnaires haveshownthatdogownerspreferablyreceiveadvicefromtheirveterinarianandexpectthemto inform and educate themon items related to their pet’swellbeing (Coe et al., 2008;Blandetal.,2010).Onecouldthusarguethatthis ‘professionalanxiety’,asChurchillandWard (2016) called it, is not only unfounded but also aids in failing to meet clientexpecta4ons, which may adversely affect client sa4sfac4on, client compliance andveterinarian sa4sfac4on, similar as in human medicine (Coe et al., 2008). Propercommunica4oncanbeatooltoimprovepa4entexpecta4onandresultinhigherstandardsofpa4entcare. Furthermore, the veterinary profession is required by law to protect animals and guardtheirwellbeing.This includesownereduca4ononphysiologicalandethologicalneedsofthepet,aspetownersareintheirturnobligedbylawtodoeverythingintheirpowertosuccumbtothesephysiologicalandethologicalneedsintermsofrecommendedhousing,nurturingandnutri4on(BurgelmanandDeVliegher,2016). Moral aswell as legal obliga4on add up to a professional responsibility that undeniablyresultinaddressingobesitytopetownersasmandatory.Waivingthismandatewillneitherbenefitthepa4ent,theclientnortheveterinarian(Coeetal.,2008).

3.2.2.Principlesofownereduca4on

3.2.2.1.Theneedforownereduca4on Everyclientandpetshouldbeassessedasanindividualcase,andownereduca4oncanhelpcreateasuccessful individualizedweight lossprogram(Roudebushetal.,2008).Forexample,byeduca4ngpetownerstoassesstheirpet’sBCS(Chauvetetal.,2011;Churchill and Ward, 2016). Chauvet et al. (2011) concluded that addi4onal clienteduca4on significantly leads to more weight loss, when combined with an exerciseregime. The influence of client educa4on only on weight loss was, however, notresearched in this study.Yaissleetal. (2004) found thatowners that receivedownereduca4onwithaweight lossplanhadnobeTerresultsalera24-monthweight lossprogram fordogs, compared to thecontrol group that receivednoaddi4onalownereduca4on.Regardlessof theneed for clienteduca4on, awarenessof certainprinciplesof clientcommunica4on can help the veterinarian when talking to clients about their pet’sweight.

3.2.2.2.Communica4vepaTerns Inhumanmedicine, paTernsof communica4onbetweenpa4ent andphysicianhavebeen iden4fied and used to create theore4cal models based on the authorita4vefigureduringaconsulta4on,theimportanceplacedonthepa4entsvalueandtheroleof thephysician (EmanuelandEmanuel,1992;Shawetal.,2006).ResearchdonebyShaw et al. (2006) shows that these theore4cal models can be extrapolated toveterinary-client communica4on. Three models have been formulated to describepa4ent-physician communica4on: thepaternalistmodel, the consumeristmodel andthe rela4onship centered model. In the paternalist model the physician is an

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authorita4vefigurethatprovidesthepa4entwithhealthcarebyusingmainlyhisskills.Thephysicianassumesthepa4entsharesthesamevaluesasheorshedoesandplansinterven4on accordingly. He or she takes on the role of “guardian” over the pa4ent(Emanuel and Emanuel, 1992; Shaw et al., 2006). In the consumerist model thephysician provides all informa4on needed for the pa4ent to choose an interven4onthatthepa4enthimselfseesmostfit.Thevaluesofthephysicianareofnoimportanceinthiscommunica4onpaTern,forheorsheonlyservesasasourceofinforma4onforthe pa4ent. The consumerist model was found to be of insignificance in veterinarymedicine(Shawetal.,2006).Therela>onshipcenteredmodel isbasedonabalanceofpower,inwhichboththevaluesofthephysicianandthepa4entareusedtocreatea‘joint venture’ as Shaw et al. (2006) called it. The physician takes on the role ofcounselor in this model. The use of a rela4onship centered model whencommunica4ngwithpa4entshasposi4veeffectsonpa4entandphysiciansa4sfac4on,pa4ent health, reduces malprac4ce complaints and increases therapy compliance(Gerrard, 2015; Shaw et al., 2006). Good use of the rela4onship-centered approachwould, for example, be teaching pet owners to correctly perform a body condi4onscoreontheirpet(ChurchillandWard,2016).In prac4ce, physician-pa4ent communica4on is based on the ra4o of ‘biomedicalcontent’, the content that purely focusses on the medical condi4on, and the‘psychosocial content’, related to lifestyleandmentalhealth. The ra4o isdecidedbythree components: the content of the ques4ons asked by the physician, theinforma4onthoseques4onsconveytothepa4entbythemselves,andtheen4retyofverbal and non-verbal communica4on used by the physician throughout theconsulta4on(Shawetal.,2006).Thisra4opresentsthreeprac4calmodelsthatparallelthethreetheore4calmodelsforphysician-pa4entcommunica4on.ApurelybiomedicalpaTern reflects a paternalist paTern of communica4on. A consumerist paTernsreflects the consumerism paTern of communica4on. And a biopsychosocial-psychosocialpaTernsreflectsarela4onship-centeredpaTernofcommunica4on.Itcanbe assumed that these models can be used to describe communica4on betweenveterinarianandclientaswell(Shawetal.,2006;CornellandKopcha,2007).Usingtheright model to convey the message will benefit owner educa4on and ownercompliance, and thus result in improved pa4ent care, owner sa4sfac4on andveterinariansa4sfac4on. Whichmodelismostlyusedisdependentonseveralfactors.Firstly,duringpreven4veappointments, such as rou4ne vaccina4ons, the veterinarian ismoreprone touse abiopsycho-psychosocialpaTern,whileduringamedicalproblemconsulta4on,suchasa case of epilepsy, they preferably resort to a biomedical paTern. Secondly, genderplays a role. When veterinarian and client are of the same sex, a biopsycho-psychosocialpaTernisusedmoreolen,whileifveterinarianandclientareofoppositesex, a biomedical paTern is used more frequently (Shaw et al., 2006; Cornell andKopcha, 2007). Although the rela4onship-centeredpaTern is op4mal inmany cases,clientsmight prefer, and specificmedical situa4onsmight need, amore biomedicalapproachandit isuptotheveterinariantodis4nguishineachindividualcase,whichpaTern can be used best (Cornell and Kopcha, 2007). But not only the veterinarianneeds to be aware of hismanner of communica4ngwith the clients. Efficient clientcommunica4on has been proven to be a “teameffort”when it comes to crea4ng aweight lossplan.Consistencyintheinforma4ongivenbyallstaffmembersandbasicknowledge on prescribed diets and the therapeu4c plan set by the veterinarian areimportant to communicate with clients about their pets individual weight loss plan(ChurchillandWard,2016). Besides the communica4ve style, using open ended ques4ons provides the

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veterinarian with more informa4on (Gerrard, 2015). However, research showsveterinariansdotheopposite(Coeetal.,2008;ChurchillandWard,2016).

3.2.2.3.Thetranstheore4calmodel ConsideringtherightmomenttodiscussaweightlossprogramwithaclientwillcreatebeTer adherence and therefore beTer chance of therapy success (Churchill, 2010;ChurchillandWard,2016). Assessing‘readinessforchange’,asChurchillandWard(2016)callsit,canbeexplainedby the transtheore4calmodel.Thismodelexplainsdifferentstages thatcandescribetheprocesofbehavioralchangesconcerninghealth,inpeople(ProchaskaandVelicer,1997). Thefirststageisprecontempla>on,whereclientsareconsiderednottotakeac4oninthecomingsixmonths.Frequentmonitoringandprovidinganopeningforfollow-upofany co-morbid disease can lead these clients into the next phase (Prochaska andVelicer,1997;ChurchillandWard,2016).Thesecondphaseiscontempla>oninwhichtheclientdebatesbetweentheposi4veandnega4veeffectsofstar4ngaweight lossprogram.Inthisphaseitisconsideredimportanttoprovideinforma4onontherisksofobesity (Prochaska and Velicer, 1997; Churchill and Ward, 2016). Thirdly, in theprepara>onphasetheclientplanstobegintheweightlossprogramwithinamonth.Inthisphaseitisadvisedtoprovideinforma4ononwhattheclientmayneedtochangehis behavior even further in the right direc4on and start the weight loss program(ProchaskaandVelicer,1997;ChurchillandWard,2016).Thefourthphaseistheac>onphase.Inthisphasetheclienthastakenac4ontochangeandisac4velyreducingtheweight forhisorherpet.Crea4ngan individualweight lossplan,suitedforboththepa4ent and the client, will help in achieving healthy and long las4ng weight loss(ProchaskaandVelicer,1997;ChurchillandWard,2016).Thefilhandfinal stage,asdiscussedbyChurchill andWard (2016) is themaintenancephase, inwhich therapyfailurebyrelapse isprevented.ProchaskaandVelicer (1997)discussasixthstage,asthetermina>onstage,inwhichthepa4entnolongerhasthetempta4ontoresorttopast, unhealthy, tempta4ons. Following this model, overweight or obesity is notignoredinanystage,butveterinaryac4ondiffers. Obese pets accompanied by obese clients can be especially difficult, for fear ofinsul4ng the client (Churchill and Ward., 2016). Obese dogs are more olenaccompaniedbyobeseowners, thannormalweightdogsare, so in lightof reducingobesity prevalence, these type of clients cannot be ignored (Kienzle et al., 1998).ChurchillandWard(2016)statethatplacingthefocusoftheconsulta4ononnega4vesideeffectsofobesity,ratherthanaspecificweightforthepet,mighthelpthecausewithoutbeingpromptaboutthepet’scondi4on.

3.3. DiagnosingpetobesityAcompletepa4entworkupshouldruleoutdiseasesthatcancontributetoweightgain,aswellasco-morbiddiseasealreadypresent(LinderandMueller,2014;LinderandParker,2016).Thisincludes a complete pa4ent history, including nutri4onal assessment, and will give theveterinarian further informa4on on how owners relate to both their pet and their feedingregimes,whichcanhelpinseLngupanindividualizedweightreduc4onstrategy(ChurchillandWard,2016).Es4ma4nganidealortargetweightiscrucialinseLngupaweightlossplan.Itisusedforcalcula4ngthecaloricintakeneededtoachieveweightloss,es4ma4ngthedura4onofthetreatmentandprovidingowneraswellasveterinarianwithagoal(Germanetal.,2009).

3.3.1.Qualita4vemethodsQualita4ve methods to diagnose obesity are X-ray and ultrasound. Ultrasound can, in

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combina4on withmorphometric measurements, help in predic4ng body fat percentage(Tolletal.,2002).However,less4meconsumingandlessexpensivemethodsareavailabletoquan4fy the excess of bodymass at the same4meas qualifying it. In light of ownereduca4on,thesediagnos4cmethodsshouldhowever,bekeptinmind(Tolletal.,2002).

3.3.2.Quan4ta4vemethods Quan4ta4vemethodsgiveanes4ma4onoftheextendtowhichthepa4entisoverweight.Dual-energyX-rayabsorp4ometry,DEXA, isanon-invasivetechniquethatmeasuresbodycomposi4onwithgreatprecisionbydifferen4a4ngbetweendifferent typesof4ssue thebodyismadeupofbyuseofX-ray.Thedeuteriumoxide,D2O,dilu4ontechniquegivesanaccurate calcula4onof the fat-freemassof apa4entbymeasuringhis totalbodywater.However,theuseofthesemethodsinclinicalcircumstancesis imprac4cal(Mawbyetal.,2004;Witzeletal.,2014). In a clinical seLng, quan4fying the excess of bodymass can either be done by weightscaling,theuseofabodycondi4onscore,musclecondi4onscoreandbodyfatindex,andmorphometricalmeasurements. Theuseof aweighing scale for determining ideal bodyweight is a simple method in which the target or ideal body weight is set a certainpercentage lower than the weight at the start of the weight loss program. However,underes4ma4on of the weight loss needed to get back to a healthy weight leads tooveres4ma4ng the caloric intake needed forweight loss and therapy failure (BuTerwickandMarkwell,1996;Germanetal.,2009).Theweightatonsetofadulthoodcanalsobeusedasanes4ma4onofidealbodyweightincatsanddogs,ifthiswasconsidered tobeop4malbodyweight(Tolletal.,2002).Theidealweightcanalsobedeterminedusingsetstandardsforop4malweightwithinacertainbreed.However,publishedstandardsdonottakeindividualvaria4onsinaccount,andmaythereforbefaultyindeterminingidealbodyweight(Tolletal.,2002). Morphometricalmethodsaremeasurementsofthepa4entsform,inrela4ontoitsbodycomposi4on (German, 2006).Morphometricalmethods include tapemeasurements andthebodycondi4onscore.Thetapemeasurementmethodgivesanes4ma4onofbodyfatpercentage bymaking a calcula4on taking into account the height of the animal at theshoulderandthepelviccircumference.Tapemeasurementscanbeusedtocalculate thebody fat percentage via gender specific formulas or via the BodyMass Index, BMI. ThebodyfatpercentageobtainedalerBMIcalcula4onsshowedlowercorrela4ontothebodyfatpercentageobtainedwithDEXA,thanthegender-specificformulasdid(Mawbyetal.,2004).Thepi{allsofmorphometricmethodsare incorrect interpreta4onofvaria4ons inbody types and unaccountability of interspecies varia4on on fat deposi4on or variablessuchascoatthickness,operatorvariabilityandpa4entrestraint(Tolletal.,2002;Witzeletal.,2014). A body condi>on score, BCS, can be used to assess the animal’s body fat (Linder andMueller,2014;Tolletal.,2002).Itisasubjec4vescoringsystemrangingfrom1to9ideally,asthisrangecorrelatesmostcloselytoweightcalculatedbytheDEXAmethod(Mawbyetal.,2004).TheBCSfordogsandcatsareshowninfigure1and2respec4vely.AnidealBCSof4or5,representsabodyfatpercentageof11%.EachincreaseordecreaseoftheBCSwithone,correlateswithan increaseordecrease inbodyfatpercentageof8,7%to15%(Mawbyetal.,2004;Germanetal,2009;LinderandMueller,2014).TheBCSisconsideredto be the most applicable method to diagnose obesity in a clinical seLng (Linder andMueller,2014),andshouldbeperformedduringeveryvisittotheveterinaryclinicaspartof thefilhvitalassessmentasdraledby theWSAVA .Togetherwith theBCS,amuscle1

hTp://petnutri4onalliance.org/site/pnatool/pa4ent-assessment/(May3rd,2018)1

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condi>on score,MCS, shouldbeassessed, forweight loss is supposed tooriginate fromlossoffatmass,andminimallossofmusclemass(LinderandMueller,2014). Although theBCScanbe sufficient inquan4fying theexcessbodymassand thereby theideal weight in overweight pa4ents, it will not suffice in pa4ents with a body fatpercentagethatexceeds40%(Tolletal.,2002;Witzeletal.,2014).Addi4onaltodefiningaBCSandMCS,assigningthepa4entabodyfatindex,BFI,canhelpquan4fytheexcessfat

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Figure1:BodyCondi4onScoreDogFrom:hTp://www.wsava.org/sites/default/files/Body%20condi4on%20score%20chart%20dogs.pdf(May3rd,2018)

Figure2:BodyCondi4onScoreCatFrom:hTp://www.wsava.org/sites/default/files/Body%20condi4on%20score%20chart%20cats.pdf(May3rd,2018)

Figure3:BodyFatIndexDogFrom:hTps://albertnorthvetclinic.wordpress.com/2013/06/12/body-fat-index-what-does-that-mean/(May3rd,2018)

Figure4:BodyFatIndexCatFrom:hTps://albertnorthvetclinic.wordpress.com/2013/06/12/body-fat-index-what-does-that-mean/(May3rd,2018)

massmoreaccuratelyinpa4entswithbodyfatpercentagesupto65%,leadingtoamoreaccuratemaximum caloric intake needed forweight loss (Toll et al., 2002;Witzel et al.,2014).TheBFIcanbeassessedbyvisualassessmentandpalpa4on,ascanbedonewiththeBCSandisshowninfigure3and4(Witzeletal.,2014).

3.4. Cura4vetreatmentThegoalofanytherapeu4cregimeforcombaLngpetobesityislongtermweightlossthatisobtained in a healthymanner. The success of the implemented treatment is dependent onseveral factors. Firstly, an individualizedweight lossprogram, that focusseson restric4ononenergyintakeandincreasedenergyoutlet, isessen4al(Gosselinetal.,2007;Wakshlagetal.,2012;ChurchillandWard,2016).Secondly,ownercommitmenttotheproposedtherapyisvitalforthesurvivalofanytherapeu4cplan.Ownersaremorewillingtoperformdietarychanges,than change exercise regime or treat-giving (Bland et al., 2013). Nutri4onal guidance canthereforbe consideredas a star4ngpoint for increasingowner compliance toanyproposedtherapy,fromwhereontheplancanbecomplementedwithnecessary,butachievable,op4ons.Andthirdly,regularcontactwiththesupervisingveterinarianincreasesthesuccessofaweightlossplan(Wakshlagetal.,2012;ChurchillandWard,2016).Furthermore,authorsreporttheuseofpharmaceu4caldrugsasanop4onwhen installingaweight lossprogram(Germanenet.,2009).

3.4.1.Nutri4onalsupport Athoroughdietaryhistoryincludesthetype(dry,semi-moist,moist),brand,amount,andfrequency of maintenance food, treats given, food used to give medica4on and foodsupplements (Linder and Parker, 2016). GeLng a full dietary history also provides theveterinarianwith,asLinderandParker(2016)callthem,the‘Non-nego4ables’.Thisisthefoodthattheownerisreluctanttoleaveoutofanyproposedplan.Clientcompliancewillimprove when working with the owner and incorpora4ng these ‘Non-nego4ables’ intoyourplan(LinderandParker,2016).Thiscanbedonebydecreasingthecaloric intakeofmaintenance food to balance the caloric intake generated by the feeding of snacks.However, the caloric percentage of snack feeding should not lead to a decrease ofmaintenance food in suchquan44es, that essen4al nutrients are indangerof becomingdeficient. Snack feeding can best be limited to 10% of caloric intake (Becvarova, 2011;Laflamme,2012).

3.4.1.1.Weightlossdiets Mostownersarereluctanttousespeciallydesignedweightlossdiets.However,usinga commercialmaintenance pet food for weight loss programs entails risks. In caseswhere5-10%weight loss is indicated,veterinarianscanturntonon-therapeu4cdietsto achieve caloric restric4ons, without expec4ng problems (Becvarova, 2011). Butwhenmoreweight loss is indicated, energy restric4onwith amaintenance dietwillleadtodeficienciesinotheressen4alnutri4onalcompounds(Diezetal.,2002;Tolletal.,2002).Besidestheamountofweightloss,species,genderandlevelofac4vitymustbeconsidered,beforeaneffec4vediet is chosen.Moreac4vedogsareable tohavehighercaloricintakeswhiles4llachievingweightloss,incomparisontolessac4vedogs(Vitgeretal.,2016). Energyrestric4oncanbeachievedbydecreasingthefatcontentofafood(Borneetal.,1996; Laflamme, 2006). Fat contributes themost tometabolizing energy of a food.Decreasingfatcontent,thereforhasthemosteffectontheenergydensityofafood.Especiallyfoods lowinfatandhighinfibreseemtohavesignificanteffectonweightlossindogs(Laflamme,2006).LinderandParker(2016)warnaboutcommercialweightlossfoods,thatcansome4mesbeconsideredlow-fatwhenexpressedingramsoffat

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per calorie,butprovidemore caloriesper kg food than isneeded toachieveweightloss.Reduc4onoffatcontentindogsallowsup4ll9%fatonadrymaTerbasis.Incats10% fat content on a dry maTer basis is recommended as maximum, when notconsideringanAtkins’diets(Tolletal.,2002). Insteadoffeedingenergyintheformoffat,veterinarianscanexerttoafoodhigherinprotein,whichispreferabletopreserveleanbodymass(Diezetal.,2002;Vitgeretal.,2016).Byslowingdowntheweightlossprocessoveralongerperiod,preserva4onofleanbodymassandlossoffatmasscanalsobeachieved(Diezetal.,2002).

3.4.1.2.Sa4etyWeight loss is accompaniedby the decrease in lep4n concentra4ons,which adds tothefeelingofbeinghungry(Bas4enetal.,2015;Tarkosovaetal.2016).Thiscanleadtofood-seeking behavior (Toll et al., 2002).Owners get less compliantwhen their petsexerttothesebehaviors,suchasbegging(Becvarova,2011).Thiscanbecounteredbyincreasingthesa4ety,whichcanbedoneindifferentways.Firstly,airandwatercanbeused, indry andmoist foods respec4vely. This however, only increases sa4etywhilethe food passes through the gastro-intes4nal system (Toll et al., 2002). Secondly,increasedfibrefrac4oncanhelptoincreasesa4etyduringweightloss(Tolletal.,2002;Becvarova, 2011). Increased fibre content increases the bulk which aids in gastricdisten4on. Gastric disten4on s4mulates the secre4on of cholecystokinin, whichdecreasesthesensa4onof‘hunger’(Chengetal.,1993;Tolletal.,2002).Fibrecanalsointerferewiththeuptakeofothernutrientsandtherebydecreasethecaloricuptakeofthe food (Toll et al., 2002). Other studies, are in doubt about fibre contribu4ng tosa4etylevels,andseektheircontribu4oninweightlossdietsmoreinmetaboliceffectsonly (Gossellin et al., 2007). However, the combina4on of high fibre diets and highprotein levels has been proven to increase sa4ety during weight loss and is usedsuccessfullyusedinmanyweightlossstudies(Weberetal.,2007;Germanetal.,2015;Flanagan et al., 2017). Forweight loss diets fibre content is advised to be between12-25%onadrymaTerbasisfordogsand15-20%onadrymaTerbasisforcats(Tolletal.,2002).Besidestheinfluenceonsa4ety,fibrealsooffersothernutri4onalbenefits.Itaidsindilu4ngtheenergydensityofthefoodanddecreasesinsulinsecre4on(Borneet al., 1996).When prescribing a diet high in fibre, the owner should be informedabouttheincreaseinstoolvolumethatcanbeexpectedandisanega4vesideeffectofthiskindofdiet(Tolletal.,2002;Gosselinetal.,2007).

3.4.2.Exerciseregimes

3.4.2.1.Currentperspec4vesonexerciseExercise has long been a beneficial rou4ne component in weight loss programs inhumans.Recently,researchhasshownthatexerciseisaverybeneficialcomponentincanineweight loss programs aswell (Roudebush et al., 2008;Morrison et al., 2013;Vitgeretal.,2016).Moreintensiveexerciseregimescanleadtomoreweightlossthancaloricrestric4onalone,eveniftheexerciseregimeconsistsofamildfitnessprogram.However, owners have the tendency to overes4mate their exercise regime, whichmakes it harder to convince them to undertake more rigorous ac4on in order toachieveproperweightloss(Fryeetal.,2016). Exerciseincatsmaybelessconven4onalthanitisindogs.However,alsocatsthatarelessexercisedbytheirownerareathigherriskofdevelopingobesity(Roudebushetal.,2008).Studiesontherapeu4cexerciseforfelineobesityhavenotbeendoneyet.

3.4.2.2.Posi4veeffectsExercise increases theenergyexpenditureof theanimal,whilepreserving leanbody

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mass.Thisbenefitsweight loss,becausepreserva4onof leanbodymassenables theanimal torestoreto fullmuscle func4on.Also,preserva4onofmusclerequiresmoreenergythanpreserva4onoffatdoes,whichmakesiteasiertomaintaintheachievedweightloss(Wakshlagetal.,2012;Vitgeretal.,2016).Furthermore,exercisehasbeenproventoincreaseinsulinsensi4vityandpar4allyreverselep4nresistance(Roudebushet al., 2008). Therefor it canhelp reverse comorbiddisease,while at the same4medecrease the sensa4on of hunger for the animal. Exercise also helps to reduce thestatusofchroniclowgradeinflamma4on,thatobesitycauses(Vitgeretal.,2017).Allthese improvements can already be no4cedwhen exercise is implemented into theregime of the pet, without it having lost weight yet (Roudebush et al., 2008). Thusexercise,inanyobesepetwithoutorthopedicco-morbidi4es,isbeneficialtoincludeintherapeu4c regimes, even if there is a slim chance of actual weight loss. Lastly,controlledexercise,suchasregulartreadmillsessions,canincreasetherateofweightloss(Chauvetetal.,2011).Althoughcrash-die4ngshouldbeavoided,mildincreaseintherateofweightloss,bymeansofregularexercise,canbeanincen4vefortheownertocomplywiththetherapy,asresultsaremoreprominentmorequickly.Furthermore,exercisecanaidinthepreven4onofobesityandcanbeconsideredforpreven4onofrelapsandlongtermtherapysuccess(Robertson,2003;Roudebushetal.,2008;Fryeetal.,2016). Exercisecanbebeneficialifdonemoderatelyandregularly.However,thedefini4onofmoderate,regularexercise isnotdefinedbyRoudebushetal. (2008)and isopenforpersonal interpreta4on and dependent on the pa4ent. Studies done by Diez et al.(2002) implemented at least 20minutes of exercise per day to prevent loss of leanmass during their weight loss program. The exact dura4on of exercise needed toachieve weight loss is unknown (Vitger et al., 2016). Besides the dura4on, also theintensity of exercise needed for healthy weight loss is unknown. Robertson (2003)found that the intensity of exercise had no significant influence on a dog becomingobese.Ifthiscanbeextrapolatedtocura4veweightlossinanobesepethasyettobeinves4gated.

3.4.2.3.Nega4veeffectsAlthoughmany benefits can be stated for exercise, the owner should be guided toimplementthisintotherou4neinahealthymanner.Safetyandanimalwelfareshouldalways be guarded andoverhea4ng due to exercise is a risk that should be avoided(Fryeetal.,2016).

3.4.3.PsychologicalaspectObesityisolenfoundtobeadifficultproblemtotackle,forifolenincludestheneedforserious change in the owners behavior towards their pet (Churchill and Ward, 2016).Communica4on is key to beTer compliance rates and the increase in health care thatcomeswithit(BonviciniandAbood,2006;Lueetal.,2008;Gerrard,2015).Theprinciplesofownereduca4on(see§3.2.2)areessen4altoachievethis.Thefirst ‘stage’ofaclientswillingnesstochangecanbeconsidered‘acceptance’oftheproblemathand.ChurchillandWard (2016) foundthatacceptancecanbestbetoldby theveterinary interviewingskillsand the quality of veterinarian-client interac4on. The ‘stages of change’ model (see§3.2.2.3) can help by determining if the owner is ready to start the process of weightmanagement.Onemustbare inmind thatdogandcatownershavedifferent life styles,whichasks foradifferentapproach tocombaLngpetobesity.Dogownersaregenerallymoreawareoftheirpetsweightproblemthancatownersare.Especiallycatownerswithoverweight cats have difficulty acknowledging their pets health issues (Kienzle and

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Berglery,2006).The owner can be educated on different aspects of weight management. For instancedeterminingcorrectBCSforthepa4ent,whichownersolenhavedifficultydoing(Tolletal., 2002; Colliard et al., 2006; Kienzle and Berglery, 2006). Also posi4ve side effects ofweight loss can be discussed, such as improvement in insulin resistance in dogs, anddecreaseinclinicallamenessindogswithosteoarthri4s(Impellizerietal.,2000;Germanetal,2009).Itisalsoworthmen4oningthatdietaryrestric4oncanincreasemedianlifespan(Kealyetal.,2002).Besidesmajorhealthbenefits,behavioralaltera4ons thathavebeenstudiedincats,includingincreasedpurringandsiLngontheownerslapmoreolenalerweightloss,canaidinownerpersuasion(Levineetal.,2016).Besidesmen4oningposi4veeffectsweightlosscanprovide,theownershouldbeinformedofnega4veeffectscertaintherapeu4cmeasures can give, such as increased volumeof faeces and increasedflatus(Tolletal.,2002;Gosselinetal.,2007).Seriousadjustmentsontheownersaccountcouldincludeusingplayasatreatinsteadoffood(KienzleandBerglery,2006).

3.5. Principlesoftherapycompliance

3.5.1.Whatistherapycompliance? Therapycompliance isanessen4alpartof the therapy implementedbyveterinarians,astherapy success is determined by thewillingness of the pet owner to follow veterinaryrecommenda4ons. Compliance is described by the 2009 American Animal HospitalAssocia4on,AAHA,reportas ‘thepercentageofpetsreceivingatreatment,screening,orprocedureinaccordancewithacceptedveterinaryhealth-carerecommenda4ons’,whereasadherenceisdescribedas‘theextendtowhichclientsadministermedica4onsprescribedand comple4ng the prescribed course’. As this disserta4on covers the completemanagementofobesity,thetermcompliancewillbeused.Ownersaregenerallymorecompliantwhentheyhaveastrongrela4onshipwiththeirpets.Compliancealso increaseswhen the vet-client rela4onship is stronger (Lueet al., 2008).Thisrela4onshipissubjecttocommunica4on,pethandlingandownereduca4on(Gerrard,2015,ChurchillandWard,2016).Resultsfromthe‘AAHAcompliancereport’(2009)pointout that non-compliancemoreolen stems from lack of advise or lack of conveying theimportanceofacertaintherapy,thanitisaresultofhighcosts.

3.5.2.CausesforlowtherapycomplianceVeterinary teams olen see compliance as a given when recommending certainprocedures, and olen place the responsibility for non-compliance with the client.However,clientsexpress theneed formoreelaborateexplana4onaboutproceduresandtheirimportance,andrequiremoreintensivefollowup,herebyexpressingthatitismoretheveterinaryteam’sresponsibilitytomakethemmorecompliant(AAHApress,2003). Although veterinary studieson the causesof lowor non-compliance are absent, humanstudiesgivetheprimalreasonsforlackincompliance:

- pa4entpsychologicalfactors

- lackofpa4entunderstandingoftheimportanceoffollowingtherapy

- lengthoftherapyandcosts

- dysfunc4onalcommunica4onbetweenphysicianandpa4ent.

Directextrapola4ontoveterinarymedicine isnotpossible,asourpa4entsarecontrolledbytheirowners.However,manysimilari4escanbedrawnbetweenthewayveterinaryand

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humanmedicineareprac4ced.Inhumanmedicine,increaseincomplianceisaTemptedindifferentways:

- Technical: simplifying the therapeu4c regimen, so pa4ents have to do as liTle aspossiblebythemselves.

- Behavioral:providingarewardfordesiredbehavior.

- Educa>onal:usinghandouts.

3.5.3.Howtoimprovetherapycompliance? Table 6 shows different factors associated with compliance. Improving compliance inaspectsof obesitymanagementwhere veterinarians losemostof the compliance in thefirstplace,canproveefficient. Ingeneral,gooduseofcommunica4oncanincreaseclient

complianceby40%(BonviciniandAbood,2006;Lueetal.,2008;Gerrard,2015).Besidesthe principles for proper owner educa4on, as discussed in §3.2.2, other communica4onskills can be used to increase client compliance. ‘Reflec>ve listening’ can be done byprovidingashortsummaryoftheclientsstorytotheclient,bygivinganinterpreta4onofwhat the clienthas told the veterinarianorby tes4ngahypothesis the veterinarianhasformulated by means of the clients informa4on (Bonvicini and Abood, 2006; Gerrard,2015).Expressingempathy andcorrectuseofbody language supports themessage theveterinarian is trying to convey (Bonvicini and Abood, 2006; Gerrard, 2015). Clienteduca4onshouldbeclearandbond,foroverwhelmingtheclientwithinforma4onhastheoppositeeffect.Makinganefforttoincreaseclientunderstandingoftheproblemandwhatcanbedoneaboutit,forexamplebyprovidingwriGeninforma>onfortheclienttotakehomecanincreasecompliancealso(BonviciniandAbood,2006).Forweightlossprogramsinpar4cular,veterinarypublica4onsrecommendthefollowing:

- Providetheclientwithmeasuringinstrumentsfortheprescribeddiet,andaddi4onallyaBCSchart,aswellaswriTen informa4on(BonviciniandAbood,2006;AAHAreport,2009)

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Figure6:‘FactorsCorrelatedwithAdherence’from:AAHAreport,2009

- Maketheclinicscaleavailablebetweenrechecks(Becvarova,2011)

- Provide financial rewards for success: installing discounts on procedures for healthy-weighingpets.

- Followuponthepa4ent:eitherbyappointmentsintheclinicorbyphone(Levyetal.,2007).

- Setrealis4cgoals:weightlossof0,5-2%/weekisdesirable(Becvarova,2011)

- Take‘before’and‘aler’photographs

When a team effort ismade to increase overall client compliance, itwill lead to higherqualityofcare,thatdoesnotnecessarilyinvolvehighcosts(AAHAreport,2009).Furthermore,petownersrecommendconsulta4onsthattakelongerthan10minutesandcon4nuitywiththeveterinarianwitheveryvisittoincreaseclientcompliance(AHAAreport2009;Gerrard,2015).

3.6.Evalua4on Properevalua4on isessen4al toanysuccessfulweight lossplan (Laflamme,2006;Laflamme,2012; German, 2016). This ensures the implemented weight loss regime is healthy for theindividualpet,andcanallowfortherapytoberedirectedifitisnotgivingthedesiredresults,decreasing the risk for client dissa4sfac4on (Churchill and Ward, 2016). In the beginning,supervisionforahealthyweight losstrendshouldbedonebyfollow-upvisitsevery2weeks(Becvarova,2011;Churchill andWard,2016).Preferablyweight loss is followedupusing thesamescale. In-clinicweight checkare thuspreferred toathome followup in thebeginning.Herealer,monthlyfollowupvisitsshouldsufficetocon4nuehealthyweight loss(Becvarova,2011).

3.7. TherapysuccessThesuccessofan implemented therapycanbe rela4veaccording topersonalopinionaboutwhatsuccessentails.Successfulweightlosscanbedefinedbythenumericlossofkilograms,ora percentage of weekly weight loss that should be achieved (Becvarova, 2011). However,accordingtosomeauthors,success isbeTermeasuredbythedecrease inco-morbiddiseaseprevalenceandahealthypet(Churchilletal.,2016).Alsoreducingtheriskaloneofco-morbiddisease, or improvement in clinical symptoms of co-morbid disease can be considered asuccess (Germanetal., 2009). Therefor, therapy success is considered tobea verypersonalconcept,fortheveterinarianaswellastheowner.

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4. Researchques4on

4.1.Researchques4on The general aim of this surveywas to inves4gate how obesity ismanagedwithin the smallanimalclinics inBelgiumandtheNetherlandsandwhichfactorscanbeimprovedinordertodecreaseprevalenceandimprovetreatmentofthisseverecondi4onincatsanddogs.Therapysuccess rates were compared to other survey ques4ons to inves4gate if certain behavioralpaTernshadmoreorlesseffectontherapysuccess.

4.2.Hypothesis The hypothesis of this study is that an ac4ve aLtude in combaLng obesity in companionanimals is expected to lead to greater therapy success. An ac4ve aLtudes includesacknowledging personal responsibility within obesity management, following the currentconsensusondiagnos4csandtherapyandapplyingcommunica4onguidelinesasdescribedintheaboveintroductoryliteraturestudy.

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5. Materialsandmethod For thisdisserta4on,a format for limitedresearchwaschosen.Asurveywaschosenas researchmethod, to inves4gate thepaTern small animal veterinarians usewhenmanagingpa4entswithobesity and their owners. The aim was to get a broad view of the current prac4ce of obesitymanagementbyques4oningthefollowingaspects:

- Introductoryques4onsonspecificcharacteris4csoftherespondent

- Presumedcausesofobesity

- Diagnos4cmethodsandes4matedprevalence

- Cura4vetherapyforobesity

- Communica4onwiththeownerbothwhenaddressingobesityaswellascommunica4onwhenfollowinguponacertainpa4ent.

- Therapysuccessandfailure

The survey was made up of 53 ques4ons, of which 7 introductory ques4ons, 6 team-relatedques4ons, 10 ques4ons on presumed causes and diagnos4cs, 12 ques4ons on implemen4ng atreatmentplan,8ques4onsoncommunica4onand10ques4onsontherapysuccessandfollowup.As an incen4ve, one free consulta4on about small animal nutri4on, was raffled amongst thepar4cipa4ngveterinarians. Adutchversionwasmadebytheauthorandtranslated intoaFrenchversionbyHomeOffice.Acopyofthesurveywasincludedasappendix1. The survey was made in SurveyMonkey and distributed via Facebook pages of veterinaryassocia4ons (Vlaams Dierenartsen Vereniging, Intérêts des vétérinaires Dierenartsen Belangen,IVDB, Small Animal Veterinary Associa4on Belgium, Het Dierenartsengilde, Caring Vets,NeoAnimalia VeTube and Union Proffesionnelle Vétérinaire). Distribu4on via social media waschosen to keep the costs as low as possible, while gaining high responses at the same 4me.Addi4onally,thesurveywasdistributedviaawebsite(IVDB)andamailinglist(‘DierenartsenKringDenHaag’,anarrangementforveterinaryemergencyservicesinTheHague,theNetherlands).TheDutchsurveyairedonfacebookonDecember13th2017andwassendbymailondecember15th. The French survey aired on facebook on december 14th. The surveywas online for threeweeks,alerwhichareminderwassend.Theapplica4onwasthenopenforanotherthreeweeksandclosedaleratotalofsixweeks.Inordertogetfairresults,theop4on‘mul4pleresponses’,thatenablepeopletorespondmul4ple4mesfromthesamedevice,wasturnedoff,aswastheop4on‘responseedi4ng’,whichenablesresponderstoaltertheiranswersalerleavingthesurveypage.Inordertoavoidrespondersinthesameclinictoalteranswersinorderforacertainoutcometoresult,theop4on‘instantresult’wasalsoturnedoff.Instead,responderscouldentertheire-mailaddressandno4fytheauthoroftheirinterestintheresults.Surveyresponseswereexcludedfromthestudywhen:

1. <25%ofthesurveyques4onsanswered

2. Therewasnoresponstotheques4onsontherapysuccess.

Alerexclusioncriteriawereset,adescrip4onofthesurveyrespondentswasmade.Respondentswere classified according to their gender, gradua4on year, current working posi4on and theircon4nuingeduca4oninthefieldofnutri4onandcommunica4on. Thedataanalysisresumedwithdescrip4onoftherapeu4csuccessrangesaccordingtosurveydata.Specificperspec4vesontherapysuccess,orlackofit,andits’causesweredescribedaccordingly.Subsequently,therestofthedatawasfirstdescribed,beforelinksbetweenthedifferentpartsof

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the survey were made. Correla4ons were made using IBM SPSS Sta4s4cs 25. P-values werecalculatedwithatwo-tailedtest,withsignificancebeingatthe0.05level.Aone-wayANOVAtestwasusedtocomparecon4nuouswithnon-con4nuousdata.

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6. Results The survey got a total of 101 responses. 72 responses were gained from the Dutch survey. 29responsesweregainedfromtheFrenchsurvey.13responseswereexcludedbecauselessthan25%of the surveywas completed. 23 responseswereexcludedbecauseques4ons regarding therapysuccesswerenotanswered.Thislelatotalofn=65tobeusedinthestudy.The survey was completed by 12male veterinarians and 52 female veterinarians. Respondentsgraduated between the years 1985 and 2017, with an average of 2010 as gradua4on year.Gradua4on year showed weak nega4ve correla4on to therapy succes (r=-0.08), that was notsignificant(p=0.50).Genderdidnotsignificantlyinfluencetherapysuccesseither(F=0.01,p=0.94),nor did current occupa4on (F=0.27, p=0.77). Of the Francophone veterinarians all graduated inBelgium,ofwhich4ares4llworkinginBelgium,7inFranceand6didnotanswer.Thecurrentworkingposi4onsarepresentedintable2anddonotinfluencemeantherapysuccess

significantly. Table 3 shows the amount of staff present in the clinic respondents are currentlyworking in. The number of veterinarians showed nega4ve correla4on tomean therapy success(r=-0.21, p=0.09), as did the number of assis4ng staff (r=-0.10, p=0.43), though neither weresignificant.Withintheobesitymanagementprotocol,assistantshavebeengiventhetaskoftakingadetailedanamnesisin39.8%(+/-24.6)ofthecasesonaverage,whichisposi4velycorrelatedtotherapysuccess(r=0.042),butwithoutsignificance(p=0.79).Weighingthepa4entisdelegatedtoassis4ng staff in 81.3% (+/- 24.2) of the cases on average,which is also posi4vely correlated totherapysuccess(r=0.11),withoutsignificance(p=0.50).AssistantsmakeuptheBCS in40.9%(+/-38.4),withr=0.04andp=0.81,ofthecasesonaverageandcreatetheweightlossplan, includingtypeofdietandamounttobegivenofaspecificdietin39.9%(+/-32.0)ofthecasesonaverage,withr=0.16andp=0.33.Explainingthetherapyisdelegatedtoassis4ngstaffin58.4%(+/-37.4)ofthe casesonaverage,with r=0.03andp=0.83. Followup isdonebyassis4ng staff in48.9% (+/-33.6)ofthecasesonaverage,andshowsaposi4vecorrela4ontotherapysuccess(r=0.31)thatissignificant(p=0.05). Respondents were also asked about their current and future con4nuing educa4on, regardingcommunica4on and veterinary nutri4on.Data are shown in figure 2.An analysis of variance forboth the effect of con4nuing educa4on about communica4on and nutri4on on therapy successshowednosignificance,F=0.56,p=0.65andF=0.27,p=0.85respec4vely.

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0 1 2 3 4 5-10 >10

Veterinarians N/A 18,5% 26,2% 13,9% 10,8% 18,5% 12,3%

Assis4ngstaffmembers

32,3% 4,6% 18,5% 9,2% 9,2% 15,4% 10,8%

Table3:availableclinicalstaffinveterinaryclinics

Occupation Respondents (%) Mean therapy success (%)

Owner 32,3% 29.6%(+/-17.6)

Associate 6,2% 36.6%(+/-11,5)

Employee 60,0% 31.6%(+/-18.9)

Table2:currentworkingposi4onofveterinarians

6.1.TherapysuccessMean therapy success rate, es4matedby veterinarianswason average31.4% (+/- 17.8) butslightly differed according to the different categories. For overweight dogs, therapy successes4ma4onsonaveragewere39.1%(+/-20.2).Forobesedogs,therapysuccessonaveragewas35.2%(+/-22.8).Foroverweightcats,veterinarianses4mateasuccessrateof28.2%(+/-18.0).Veterinarians es4mated their therapeu4c success in feline obesity on 22.9% (+/- 17.1) on

average. Presumed causes for therapy failure are shown in table 4, the effect thereof ontherapy success showed no significance (F=1.57, p=0.22). Personal defini4ons on therapysuccessandfailureareshownintable5and6.Ananalysisofvarianceshowedthattheeffectof veterinary ac4on taken aler therapy failure (table 6) on therapy success was significant(F(2.71),withp=0.04).Thiswasnotthecasefordatafromtable5(F=0.96,p=0,44).Vetswerealso asked if rebound aler therapy success, could s4ll fall under their defini4on of therapysuccess,whichonaverage62.6%(+/-32.0)disagreedwith.For65.8%(+/-34.0)onlylongterm

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Figure2:currentopinionondoingcon4nuingeduca4ononcommunica4onandnutri4onalsupport.TheX-axisshowstheop4onsrespondentscouldchoosefrom.TheY-axisshowsthepercentageofrespondentschoosingthatop4on.

0%

25%

50%

75%

100%

Neverdonethis,

mightinthefuture

Neverdonethis,

neverwill

Havedonethis

Yes,regularly

N/A

Communica4on Nutri4onalsupport

Maincausefortherapyfailure Respondents(%) Meantherapysuccess(%)

Ownerrelatedcauses 87,7% 30.2%(+/-17.7)

Animalrelatedcauses 3,1% 51.4%(+/-15.0)

ToliGlepreven>veac>on 6,2% 36.9%(+/-22.1)

N/A 3,1%

Table4:“Whatdoyouconsidertobethemaincausefortherapyfailure?”

weightlosswasconsideredtherapysuccess.Respondentswouldnotdiscusstheweightofananimalanymore,alertherapyfailurein19.6%(+/-25.9)ofthecasesonaverage.

6.2.Causesanddiagnos4cs The presumed primary causes for canine and feline obesity according to respondents areshown in table7andshowednosignificanteffectonmeantherapysuccess indogs (F=0.05,p=0.82) or cats (F=0.09, p=0.92). Es4mated prevalence of overweight, BCS 6-7/9, inrespondents’ clinics was on average 41.4% (+/- 19.8), with a minimum value of 5% and amaximumvalueof85%.Clinicalprevalenceofobesity,BCS8-9/9,wases4matedtobe12.5%onaverage(+/-10.9),withaminimumof2%andamaximumof70%.Weight isdiscussedin48.2%(+/-40.1)ofpa4entswithaBCS5/9.WhenBCS increases to7/9,overweightpa4ents,78.4%(+/-27.9)oftherespondentsdiscusstheweight.Ifthepa4enthasaBCSof8-9/9,obesepa4ents,90.0%(+/-23.7)ofrespondentsdiscusstheweight.Overweightisdiscussedin100%of the pa4ents by 27 respondents and obesity is discussed in 100% of the pa4ents by 40respondents. Addressing overweight shows a posi4ve correla4on, though not significant, to

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“Icans4llviewlimitedweightloss,astherapysuccess” Respondents(%) Meantherapysuccess(%)

Yes,Icanseeweightlossofanyrangeasasuccess. 30,8% 26.0%(+/-16.8)

Yes,butonlyiftheweightlossislonglas>ng.(norebound). 41,5% 31.5%(+/-16.6)

Yes,butonlyiftheweightlosscomeswithadecreaseofcomorbiddiseaseoritsintensity.

15,4% 34.9%(+/-24.1)

No,therapysuccesisonlyachievedwhenthetargetweightisreached(whenthisisdifferentfromidealweight).

7,7% 37.7%(+/-14.7)

No,therapysuccesisonlyachievedwhentheidealweighthasbeenreached.

3,1% 44.3%(+/-20.2)

N/A 1,5%

Table5:Isthefollowingstatementapplicabletopa4entsyouhavetreatedforoverweightorobesity?:“Ifweightlossislimited,Icans4llthinkofthetherapyassuccessful.”

Table6:Whenreachingforidealweightdoesnotseemachievable…:

Whenreachingforidealweightdoesnotseemachievable…: Respondents(%)

Meantherapysuccess(%)

Icanseetheweightlossthathasbeenachievedasasuccesfortheimplementedtreatment.

38,5% 30.2%(+/-17.2)

Thetherapyhasfailedandwewilltryagainlater. 7,7% 40.9%(+/-11.7)

Thetherapyhasfailedandwewilltryagainwithadifferentapproach. 41,5% 35.4%(+/-18.6)

Thetherapyhasfailed,andIwon’tdiscussthepa>entsweightinthefuture. 7,7% 11.6%(+/-10.5)

ThetherapyhasfailedandIwillreferthepa>ent,iftheclientisopentothis. 3,1% 19.5%(+/-8.8)

N/A 1,5%

mean therapy success (r=0.16), with p=0.21. Addressing obesity shows stronger, andsignificant,correla4ontomeantherapysuccess(r=0.27,p=0.03).Addressingweightinpa4entswithaBCS5/9showsaweaknega4vecorrela4on(r=-0.07)tomeantherapysuccess,withnosta4s4csignificance(p=0.6).Table8showstheaveragefrequenciesthatrespondentsdiscussthe overweight of a pa4ent. It had no significant effect on mean therapy success (F=0.87,

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Presumed primary cause

Dogs Mean therapy success in dogs (%)

Cats Mean therapy success in cats (%)

Owner related causes

96,9% 36.8%(+/-20.1) 83,1% 24.9%(+/-15.8)

Animal related causes

0,0% 3,1% 23.8%(+/-6.0)

To little preventive action

1,5% 50%(+/-.) 9,2% 29.2%(+/-22.7)

N/A 3,1% 4,6%

Table7:presumedcausesofobesityaccordingtoveterinarians(%)

“How many times do you address the overweight of a patient?” Respondents (%)

Mean therapy success (%)

Ifneeded,duringeveryconsulta>on 61,5% 33.3%(+/-15.6)

Inanumberofsubsequentconsulta>ons.Iftheownerdoesnotrespond,Ileaveresponsibilityforthepetsweightwiththeowner

29,2% 27.7%(+/-20.6)

Duringoneconsulta>onandnomoreiftheownerdoesnotcomply.

6,2% 26.3%(+/-14.5)

N/A 3,1%

Table8:addressingobesity

Placement of the scale

Dogs Mean therapy success in dogs (%)

Cats Mean therapy success in cats (%)

Scaleinthewai>ngareaonly

44,6% 36.4% (+/-21.2) 15,4% 31.3% (+/-22.1)

Scaleintheconsulta>onroomonly

26,2% 36.7% (+/-18.6) 64,6% 24.8% (+/-14.7)

Scaleintheconsulta>onroomandthewai>ngroom

24,6% 38.7% (+/-21.1) 16,9% 21.9% (+/-14.8)

Noscale 1,5% 0% (+/-.) 0,0%

N/A 3,1% 3,1%

Table9:facili4esforweightscaling(%)

p=0.43).Respondentsaretemptedtoignoreobesity in14.5%(+/-15.0)ofthecases,whichisnega4velycorrelatedtomeantherapysuccess(r=-0.27withap=0.03).Themerepresenceofoverweight and obesity is nega4vely correlatedwithmean therapy success thoughwithoutsta4s4csignificance,r=-0.14(p=0.28)andr=-0.06(p=0.64)respec4vely. The in-clinicpossibili4esofweight scaling, including theplacementof the scale for catsanddogsisshownintable9andshowednosignificantinfluenceonmeantherapysuccess(F=0.96,p=0.39andF=0.11,p=0.95).Thedifferentmethodsusedtodiagnosepetweightareshowninfigure 3 and do not influencemean therapy success significantly (F=1.04, p=0.42).Methodsused for diagnosing pet obesity are shown in figure 4, and do not influencemean therapysuccesssignificantly(F=0.87,p=0.54).

6.3.Therapeu4cregimesOnaverage59.9%(+/-29.7)oftherespondentsdecreasetheamountofcommercialpetfoodthat thepetwasea4ngbefore the start of aweight lossprogram,whilst 58.2% (+/-29.4) ofrespondents on averageprescribe a diet specifically indicated forweight loss.Home cookeddietscreatedforweightlosswereonlyrecommendedby7.9%(+/-17.6)oftherespondentsonaverage. The type of diets prescribed in obesity management all showed weak posi4vecorrela4ontomeantherapysuccess,ofwhichnoneweresignificant.Commercialweightloss

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Figure3:themakeupofadiagnosisconcerningpetweightingeneral.TheY-axisshowsthenumberofresponsesaboutdiagnos4cmethods(totaln=65).TheX-axisshowsthedifferentcombina4onsofdiagnos4cmethodsusedbyrespondents.Thebarsshowthemakeupofadiagnosis.eg.Thesecondbar:19respondentsuseweightscalingcombinedwithBCS5-systemtoevaluateapetsweight.

Methodsusedfordiagnosingpetweight

Num

berofdiagnosesm

ade

0

3

6

9

12

15

18

21

24

27

30

Methodsused

Weightscaling BCS5 BCS9 BFI Tapemeasures

dietshowsstrongercorrela4on(r=0,10withP=0,46)thanreduc4onofthepetsmaintenancefood(r=0.04withp=0.76)did.Prescribingahomecookeddietisposi4velycorrelatedtomeantherapysucces(r=0.07),butwasalsofoundtobenotsignificant(p=0.62). Thedailyquan4tyoffoodcanbederivedfromthepackagingofcommercialpetfoods,whichis

�29

Figure4:themakeupofadiagnosisconcerningpetobesity.TheY-axisshowsthenumberofresponsesaboutdiagnos4cmethods(totaln=67).TheX-axisshowsthedifferentcombina4onsofdiagnos4cmethodsusedbyrespondents.Thebarsshowthemakeupofadiagnosis.eg.Thesecondbar:20respondentsuseweightscalingcombinedwithBCS5-systemtodiagnosepetobesity.

Methodsusedfordiagnosingpetoverweight

Num

berofdiagnosesm

ade

0

3

6

9

12

15

18

21

24

27

30

Methodsused

Weightscaling BCS5 BCS9 BMI Ultrasound X-ray

Respondents(%)

Meantherapysuccess(%)

areabsolutelyprohibitedduringtheweightlossprogram.Iamveryfirmonthissubject.

10,8% 35.9%(+/-15.6)

arebestleVoutofthera>onduringweightloss.However,Idorealizemanyownerswon’tcomplytothis.

12,3% 29.0%(+/-15.7)

arebestreplacedwithacaloric-poorsnack,suchasbeans 23,1% 33.1%(+/-12.3)

areallowedtoasetpercentageofthedailycaloricintake 7,7% 20.5%(+/-7.3)

areallowedaslongasthegivencaloriesareretractedfromthedailyquan>tyofmaintenancefood.

41,5% 32.0%(+/-22.0)

areallowed,becauseitisextremelydifficulttoforbid 1,5% 0.0%(+/-.)

N/A 3,1%

Table10:Recommenda4onsregardingsnacks

Snacks…

done bij 65.8% (+/-37.5) respondents on average, or by calcula4ng individual caloric need,doneby30.7%(+/-38.2)oftherespondentsonaverage.Usingcaloriccalcula4onstodeterminetheamountof food indicated forweight losswas significantly,posi4vely correlated tomeantherapy success (r=0.30, p=0.02). Using the prescribed amount of food described on thepackagingisnega4velycorrelatedwiththerapysuccess(r=-0.17),withoutsignificance(p=0.19). Recommenda4onsregardingsnacksareshownintable10anddonotinfluencemeantherapysuccess significantly (F=1.14, p=0.35). Next to nutri4onal support, 70.4% (+/-29.8) ofrespondentsonaveragerecommendexerciseaspartofthetherapyindogs,whilstincatsthisis57.0%(+/-32.4).However,inonly45.1%(+/-40.1)ofcaninepa4entsonaveragethetypeofexerciseisexplained,andin37.3(+/-36.0)thedura4onandintensityofexerciseareexplained.In cats the type of exercise is explained in 39.68% (+/-39.83) of the cases on average.Recommenda4onsaboutexerciseingeneralhaveposi4ve,thoughnosignificant,correla4ontotherapy success for dogs, r=0.16 with p= 0.22, as well as for cats, r=0.13 with p=0.30.Elabora4ngonthetypeofexercise isposi4velycorrelatedtotherapysuccess indogs,r=0.19with p=0.15, as well as cats, r=0.28 with p=0.03. This observa4on was only found to besignificant in cats. Elabora4ng on intensity and dura4on of exercise in dogs is posi4velycorrelatedwiththerapysuccessaswell,r=0.22,butwithoutsignificance(p=0.09).

6.4.Communica4on Figure 5 shows the communica4on style that respondents feel describes themselves. Themodelusedbyrespondentsdidnotshowsignificantinfluenceontheirmeantherapysuccess(F=0.16,p=0.69). Theirmo4vesforusingthisstyle,areshownintable11.Thisdidnotinfluencemeantherapysuccesssignificantly(F=1.82,p=0.15).Onaverage,respondentsspend22(+/-12.5)minutesonaconsulta4onaboutpetobesity,withamin/maxof4and60minutes.Respondentsusingapaternalistcommunica4onstyleforreasonsof4meefficiency,mostlydidspend less4meon

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Figure5:Useofdifferentcommunica4onmodelsandrelatedmeantherapysuccess.TheX-axisshowsthedifferentcommunica4onmodels,respondentscouldchoosefrom,withtheircorrespondingmeantherapysuccess.TheY-axisshowsthe%ofrespondentschoosingthe

Useofdifferentcommunica4onmodels

Respon

dents(%

)

0,0%

15,0%

30,0%

45,0%

60,0%

Paternalistmodel Consumeristmodel Rela4onship-centeredmodel

RespondentsusingthemodelMeantherapysuccess

anobesityconsulta4on,onaverage17minutes.Timespentonanini4alobesityappointmentis posi4vely correlated with therapy success (r=0.12), though without significance (p=0.36).Gradua4onyearhadnoeffectontheuseofaspecificcommunica4onpaTern.Conveyingthenecessary informa4on to clients is done as shown in table 12 and showed no significant

influence on mean therapy success (F=1.14, p=0.35). Providing the client with wriTeninforma4on showed higher mean therapy success (33,7% +/-17,11) than providing verbalinforma4on alone (27,8% +/-18,7), though not significant (F=1.72, p=0.20). The informa4on

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Table11:Mo4vesofrespondentsforusingtheircommunica4onstyle.

Mo4veforusingacommunica4vepaTern Respondents(%)

Meantherapysuccess(%)

Thistakestheleastofmy>me 7,7% 39.3%(+/-20.3)

ThisishowIgainthemostvaluableinforma>on 38,5% 36.3%(+/-20.8)

ThisiswhatIammostcomfortablewith/ThisiswhatIamusedto 32,3% 27.4%(+/-14.4)

Thereisnospecificreason 21,5% 25.8%(+/-14.1)

Theownerissendhomewith… Respondents(%) Meantherapysuccess(%)

anextensiveverbaladvise 29,2% 30.2%(+/-19.8)

anextensivewriGenadvise 3,1% 38.5%(+/-18.0)

ashortverbaladvise 10,8% 20.0%(+/-12.3)

ashortwriGenadvise 4,6% 31.4%(+/-25.3)

verbalaswellasashortwriGenadvise 43,1% 31.5%(+/-16.3)

verbalaswellasextensivewriGenadvise 9,2% 43.5%(+/-17.9)

Table12:typeofinforma4ontheownerissendhomewith

Table13:informa4onincludedinwriTeninforma4ononoverweightandobesityindogsandcats.

Informa4onincludedinwriTenadvise Respondents(%)

Meantherapysuccess(%)

Whichtypeoffoodisindicatedforweightlossandtheamountneeded 61,5% 31.3%(+/-17.6)

Informa>onconcerningoverweightandobesityindogsandcats 9,2% 28.1%(+/-21.9)

Informa>onconcerningoverweightandobesityindogsandcats,includingtheprocessofweightloss.

24,6% 32.3%(+/-19.3)

N/A 4,6%

included is shown in table 13, and does not influence mean therapy success significantly(F=0.11,p=0.89).Howfrequentlyandhowfollowupappointmentsaredone,inaccordancetomeantherapysuccess,isshowninfigure6andtable14respec4velyandbothinfluencemeantherapy success significantly. The frequency of follow-up is a significant influence on mean

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Figure6:frequencyoffollowupasreportedbyrespondents.TheX-axisshowsthefrequencyofobesepa4entsbeingfollowedupbytherespondents,inaccordancetotheirmeantherapysuccess.TheY-axisshowsthepercentageofrespondentschoosingthespecificallyfollow-upop4on.

Frequencyoffollowupappointments

0,0%

17,5%

35,0%

52,5%

70,0%

Everyweek

Everytwoweeks

Everym

onth

Every3months

Every6months

Un4ltheclient

contactstheclinic

Respondents(%)Meantherapysuccess(%)

Table14:methodoffollowup

Waystofollowuponapa4ent Respondents(%)

Meantherapysuccess(%)

Iwaitfortheclienttocontacttheclinic 47,7% 25.2%(+/-15.5)

IcalltheowneraVeroneortwoweekstoaskhowthingsaregoing 9,2% 43.5%(+/-16.2)

IcalltheowneraVeramonthtoaskhowthingsaregoing 6,2% 16.1%(+/-1.1)

Isendreminderswhenit’s>metostartthenextstageofthetherapy 9,2% 44.8%(+/-16.2)

Imakesurethepetandclientarehelpedbythesamevet/assistentwitheachvisit

27,7% 36.9%(+/-18.6)

therapysuccess(F=2.76withp=0,04).Apost-hocmul4plecomparisonsshowedthatbiweeklyfollowupappointmentssignificantlyimprovemeantherapysuccesscomparedtorespondentswai4ng for the client to contact the clinic (p=0.02). How follow up is done significantlyinfluencesmeantherapysuccesswithF=4.41andp=0.003.Themethodsusedduringafollowupappointment,areshowninfigure7anddonotinfluencemeantherapysuccesssignificantly(F=0.52,p=0.84).

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Figure7:themethodsusedwhenfollowinguponanobesepa4ent.TheX-axisshowsthecombina4onofmethodsusedtofollowuponanobesepa4ent.TheY-axisshowsthepor4onofrespondentschoosingthisop4on.

Methodsusedforfollowup

Num

beroffo

llowupdiagno

ses

0

5

10

15

20

25

Methodsused

Clinicscale Homescale BCS5 BCS9 BFI Tapemeasures

7. Discussion

7.1.Hypothesisandstudyexpecta4ons Expecta4onsabouttheresultsofthisstudywerethatanac4veaLtudeincombaLngobesityin companionanimals leads tobeTer results in termsof therapy success.Anac4veaLtudeincludes inves4ng 4me in following con4nuing educa4on about either communica4on ornutri4onandconsulta4onsaboutobesity,asensa4onofresponsibilityintermsofthecausesofobesity,con4nuesaddressingofunhealthypetweighttoclients,useofproperdiagnos4cs,therapeu4c regimes and communica4on as described in the above introductory literaturestudy,andconsequentfollowuponpa4ents.Respondentdescrip>onandassis>ngstaff Theamountofstaffmembersdidnotinfluencemeantherapysuccess.Ofalltasksdelegatedtoassis4ng staff, delega4ng follow up shows a posi4ve correla4on to therapy success (r=0.31)thatissignificant(p=0.05).ThusleLngassis4ngstaffdothefollowupofobesitymanagementinfluences therapy success posi4vely. Neither gender, gradua4on year or current workingposi4on of responding veterinarians influenced therapy success significantly. Unexpectedly,con4nuing educa4on about communica4on and nutri4on did not influence therapy successsignificantly,F=0.56,p=0.65andF=0.27,p=0.85respec4vely. Therapysuccess Personaldefini4onsontherapysuccessdonot influencetherapysuccesssignificantly,butdoshow a trend: the more demanding the defini4on of therapy success is, the higher meantherapysuccessisachieved,whichisanunexpectedoutcome.Veterinariansseeowner-relatedcauses as a primary source for overweight and therapy failure. Presumed causes foroverweight, obesity or therapy failure showed no significant influence on mean therapysuccess. However, veterinary ac4on taken aler therapy failure influences mean therapysuccesssignificantlyF(2.709),withp=0.039). AddressingObesityThehigherdeBCS,themorerespondentsaddressobesity.However,overweightisdiscussedin100%ofthepa4entsby27respondentsandobesityisdiscussedin100%ofthepa4entsby40respondents,whichshowspar4alignoranceofoverweighttoobesepa4ents,inatleastsomecases. Inpa4entswithobesity, addressing the issuewill influence therapy successposi4vely(r=0.27 with p=0.03). As expected, temp4ng to ignore the overweight of a pa4ent showsnega4vecorrela4onwiththerapysuccess(r=-0.27withaP=0.03)andshouldthusbeavoided.Surprisingly, how olen respondents address overweight had no significant effect on meantherapysuccess. Diagnosis Themajorityofveterinariansusethecombina4onofweightscalingandBCSsystemofascaleof 9. Although the BCS on a scale of 5 combined with weight scaling provides a beTeres4mated targetweight thanweight scalingalone, theBCSona scaleof9 ismoreaccuratethanonascaleof5,andthusshouldbepreferred.Interes4nglyenough,ultrasoundwasusedbynoneoftherespondents.X-rayandultrasoundarethequalita4vemethodsinthisques4on,which should be accompanied by some form of qualita4ve method to come to a properdiagnosis and therefor proper target weight. All respondents that use X-ray as a diagnos4cmethod,haveitcombinedwithweightscalingaswellastheBCSsystemof9,whichisagoodoutcome.Whichmethodormethodsareusedfordiagnosingpetweightoroverweightdidnotinfluencemeantherapysuccesssignificantly,whichissurprisingsincethisdictatesthecorrecttarget weight, essen4al to achieve weight loss and was thus expected to influence mean

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therapy success at some level. The in-clinic possibili4es of weight scaling, including theplacementofthescalealsoshowednosignificantinfluenceontherapysuccess.TreatmentThe typeofdietsprescribed inobesitymanagementall showedweakposi4vecorrela4on totherapysuccess,ofwhichnoneweresignificant.Prescribingcommercialweightlossdietshowsstronger correla4on (r=0.10 with p=0.46) than prescribing home cooked diets (r=0.07 withp=0.62)orreducingthepet’smaintenancefood(r=0.04withp=0.76)did.Thiswasexpected,asmaintenance food does not serve weight loss as good as commercial weight loss diets do.Using caloric calcula4ons to determine the amount of food indicated for weight loss wasposi4vely correlatedwithmean therapy success (r=0.30), significantly (p=0.02). Surprisingly,usingtheprescribedamountoffooddescribedonthepackagingisnega4velycorrelatedwithmean therapy success (r=-0.17), though without significance (p=0.19). Using caloriccalcula4ons to determine the quan4ty of food needed for weight loss should thus bepreferred. Surprisingly, recommenda4ons regarding snacks do not influence mean therapysuccesssignificantly(F=1.14,p=0.35). Recommenda4onsaboutexerciseingeneralaremadeinthemajorityofweightlossprograms,whileclarifyingtheserecommenda4onsbyelabora4ngontypeofexercise,aremadeonly intheminority ofweight loss regimes. This is a pity, since elabora4ngon the type of exerciseneededtoinduceweightlossincats,helpsincreasetherapysuccess.Communica>on Noneof the respondents recognized themselves in the consumerist-styleof communica4on,which is inaccordancetofindingsbyShawetal., (2006).Mostoftherespondentsdescribedthemselvesbythepaternalistmodel(n=35)insteadoftherela4onship-centeredmodel(n=30),whentherela4onshipcenteredmodelhasbeenproventobemoreeffec4ve inveterinarian-clientcommunica4on.Neitherthemodelusedbyrespondents,northeirmo4veforusingthisstyleshowedsignificant influenceontheirmeantherapysuccess. Itwasexpectedthatmorerecently graduated veterinarians would make more use of the rela4onship-centered modelinstead of the paternalist model. However, gradua4on year had no effect on the use of aspecificcommunica4onpaTern.Mo4vesforusingthechosenstyleshowthatthesevaryquiteseverelybetweenrespondents.Fromthisdata,onecouldconcludethatcommunica4onstyleisnot something that isbeingdone consciously, asmost respondentseitherdowhat theyareusedto(n=21),orevenhavenospecificreasonforcommunica4ngthewaytheydo(n=14).Ofthe respondents mo4va4ng their communica4on style with ‘4me efficiency’ (n=5), themajorityhaveanpaternalistcommunica4onstyle(n=4).Researchhasshownthatveterinariansrelate the paternalist communica4on paTern with saving 4me during consulta4ons, whenactualdatapointsouttheexactopposite:therela4onship-centeredcommunica4onmodel ismost 4me efficient (Shaw et al., 2006). Time spent on an ini4al obesity appointment wasexpectedtobesignificantlycorrelatedtotherapysuccess.Itwasposi4velycorrelated(r=0.12),thoughwithoutsignificance(p=0.36). Conveying the necessary informa4on to clients showed no significant influence on meantherapy success. Providing the clientwithwriTen informa4on showed highermean therapysuccessthanprovidingverbal informa4onalone,thoughnotsignificant(F=1.72,p=0.20).ThecontentofthewriTeninforma4onhadnosignificantinfluenceofmeantherapysuccess.FollowupMost veterinarians follow up on obese pa4ents once a month (n=41). And besides therespondents relying on the client for follow up frequency (n=6), respondents follow up onobese pa4ents at least once every three months. If these follow-up recommenda4ons arecorrect inclinicalcasescanbedoubted,asrespondentsprimarilyplaceresponsibility for the

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followupappointmentwiththeclient(n=31),whichissurprising.Only14.92%ofrespondents(n=10) call the owner within a months 4me to follow up on the implemented therapy.Predominantly follow up is done by weighing the pa4ent at the clinic. This is a goodobserva4on, as weight can best be monitored on the same calibrated scale. However, themethodusedforfollowupshowednosignificantinfluenceonmeantherapysuccess.How frequently andhow followup appointments are done, in accordance tomean therapysuccess,both influencemeantherapysuccesssignificantly.Biweekly followupappointmentssignificantly improvemeantherapysuccesscomparedtowai4ngfortheclienttocontacttheclinic.

7.2.Validityoftheresearch Theinternalvalidityofthisresearchcanbeconsideredsomewhatques4onable.Theuseofasurveyfordatacollec4onissensi4vetosubjec4vityfromresponders.Answersarenotverifiedandthusthegaineddatamightbeanunderoroverglorifiedimageoftheactualsitua4oninprac4ce.As responsdecreasesas surveysget longer, the survey shouldbe limited in length.This makes is difficult to gain a broad perspec4ve on disease management. Furthermore,distribu4ngthestudyviasocialmediacanmakethisresearchlessvalid,foroldergenera4ons,that use socialmedia less,might be under represented,while themore recently graduatedveterinariansmightbeoverrepresented.Theexternalvalidityofthisresearchhowevercanbeconsidered good. Results of this study can be used to create awareness amongst the en4reveterinarian popula4on. The external validity would have been greater if the response ratewerehigher.Theauthoraimedformorethan100responses,but65responseswerelelalertheexclusioncriteriawereimplemented.

7.3. Limita4onsofthisresearch Thisresearchhasseveral limita4onsto it.Firstly,themost importantques4onsofthesurveywere on the last page. Therefore, incomplete ques4onnaires were olen useless (n=23).Secondly,oneques4onwaslostintransla4onbetweenDutchandFrench,andcouldtherefornot be used. Thirdly, some ques4ons’ formula4on lel room for interpreta4on. Also, someques4ons might have lead to more unambiguous answers when they would have beencombined,whichwouldalsohaveshortenedthesurvey.It is important to realize that the results of the survey only reflect veterinarians’recommenda4ons,andnotnecessarilywhattheownerwascomplianttointheend.Therefor,somecau4onmustbetakenwhendrawingconclusionsastorela4ngtheserecommenda4onsto therapy success. Lastly, the research does not answer to veterinary perspec4ve on theircontribu4ontotherapysuccessandfailure,whichwouldhavebeeninteres4ng.

7.4.Sugges4onsforfollowupresearch Followupresearchcouldbedonebydoingmoredetailedstudiesoneachseparateaspectofobesity management. This might lead to more detailed informa4on about mo4ves behindveterinary ac4on when managing obesity, which will make improving obesity managementeasierandmoreeffec4ve.

7.5.Theauthor’sinterpreta4on In general, the results show that obesitymanagement in small animal prac4ce is olen notdone by the most recent scien4fic standards. Although no strong correla4ons were foundbetweenveterinaryac4onandtherapysuccess,theveterinarian’sresponsibilitywithinobesitymanagementcannotbedenied.Assistantscantakeoverpartofthisresponsibility.However,intheauthor’sperspec4vecrea4ngatreatmentplans4llbelongstotheroleoftheveterinarian.Surprisingly,veterinariansdelegatecrea4ngatreatmentplantoassistantsaswell. Although significance lacked in some data, addressing weight, in both normal weight andabnormalweightpa4ents, is s4ll something that is very important.Andalthoughaddressing

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overweight is not significantly correlated to therapy success,men4oning it to owners is s4llimportant.Only19.6%(+/-25.9)ofvetsonaveragestopdiscussingweightalertherapyfailure,which,althoughlowerpercentagesshouldbeaimedfor,isposi4ve.Assistantscantakeovermanypartsofobesitymanagement.

7.6.AnswertothehypothesisbyotherstudiesInanotherstudyaswell,ownersareviewedastheprimalcauseofpetobesitybyveterinarians(Cairns-HaylorandFordyce,2017).Addressingoverweightandobesitywasdonein84percentof the cases. In this study 82,9% (+/-25,4) of the pa4ents with a BCS 6/9 or higher wereaddressed. Interes4ngly enough, respondents could alsomo4vate not addressing the issue.Time constraints, presumed lack of owner compliance, concerns of causing offense andowner’s obesitywere reasonsnot to address the issue as also foundbyChurchill andWard(2016) (Cairns-Haylor and Fordyce, 2017). They found that two-thirds of the respondingveterinarians used the BCS to diagnose overweight. This study found that 81,5% of therespondentsusetheBCS,amongstothermethods,todiagnoseoverweight.

7.7.Conclusion Veterinariansexperiencemoretherapeu4csuccess incanineobesitymanagement,thantheydo in felineobesitymanagement.Temp4ngtoavoiddiscussingobesity inpa4entsshouldbeavoided, as this influences therapy success nega4vely, while addressing obesity influencestherapy success posi4vely. In determining the quan4ty of food needed for weight loss,calcula4ngthe individualcaloricneedshouldbepreferredtousingthedescribedamountonthepackaging.Incats,veterinariansshouldelaborateonthetypeofexerciseneededtoinduceweightloss.Mostinfluenceontherapysuccessiscreatedbycorrectfollowup.Bothfrequencyand how follow up appointments are made, influence mean therapy success significantly.Biweekly followupappointmentsarepreferredtowai4ngfortheclienttocontacttheclinic.Assis4ng staff members can influence therapy success posi4vely when handed theresponsibilityofthefollowup.Incasesoftherapyfailure,veterinaryac4onalerwardscans4llinfluencemean therapy successposi4vely. In conclusion, it is clear thatanac4veaLtude incombaLng obesity in companion animals par4ally does lead to beTer results in terms oftherapysuccess.

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70. Robertson,I.D.,2003.Theassocia4onofexercise,dietandotherfactorswithowner-perceivedobesityinprivatelyowneddogsfrommetropolitanPerth,WA.Preven4veVeterinaryMedicine,58,75-83.

71. Roudebush,P.,Schoenherr,W.D.,Delaney,S.J.,2008.Anevidence-basedreviewoftheuseofnutraceu4calsanddietarysupplementa4onforthemanagementofobeseandoverweightpets.JournaloftheAmericanVeterinaryMedicalAssocia4on,232,1646-1655.

72. Russell,K.,Sabin,R.,Holt,S.,Bradley,R.,Harper,E.J.,2000.Influenceoffeedingregimenonbodvcondi4oninthecat.JournalofSmallAnimalPrac4ce41,12-17.

73. Shaw,J.R.,BonneT,B.N.,Adams,C.L.,Roter,D.L.,2006.Veterinarian-client-pa4entcommunica4onpaTernsusedduringclinicalappointmentsincompanionanimalprac4ce.JournaloftheAmericanVeterinaryMedicalAssocia4on228,714-721.

74. Tarkosova,D.,Story,M.M.,Rand,J.S.,Svoboda,M.,2016.Felineobesity-prevalence,riskfactors,pathogenesis,associatedcondi4onsandassessment:areview61,295-307.

75. Toll,P.W.,Yamka,R.M.,Schoenherr,W.D.,Hand,M.S.2002.In:ObesitySmallAnimalClinicalNutri4on

76. Vitger,A.D.,Stallknecht,B.M.,Nielsen,D.H.,Bjornvad,C.R.,2016.Integra4onofaphysicaltrainingprograminaweightlossplanforoverweightpetdogs.JournaloftheAmericanVeterinaryMedicalAssocia4on,248,174-182.

77. Vitger,A.D.,Stallknecht,B.M.,Miles,J.E.,Hansen,S.L.,Vegge,A.,Bjørnvad,C.R.,2017.Immunometabolicparametersinoverweightdogsduringweightlosswithorwithoutanexerciseprogram.Domes4cAnimalEndocrinology,59,58-66.

78. Wakshlag,J.J.,Struble,A.M.,Warren,B.S.,Maley,M.,Panasevich,M.R.,Cummings,K.J.,Long,G.M.,Laflamme,D.P.,2012.Evalua4onofdietaryenergyintakeandphysicalac4vityindogsundergoingacontrolledweight-lossprogram.JournaloftheAmericanVeterinaryMedicalAssocia4on,240,413-19.

79. Weber,M.,Bissot,T.,Servet,E.,Sergheraert,R.,Biourge,V.,German,A.J.,2007.Ahigh-protein,high-fiberdietdesignedforweightlossimprovessa4etyindogs.JournalofVeterinaryInternalMedicine,21,1203-1208.

80. Witzel,A.L.,Kirk,C.A.,Henry,G.A.,Toll,P.W.,Brejda,J.J.,Paetau-Robinson,I.,2014.Useofamorphometricmethodandbodyfatindexsystemfores4ma4onofbodycomposi4oninoverweightandobesedogs.JournaloftheAmericanVeterinaryMedicalAssocia4on,244,1285-1290.

81. Yaissle,J.E.,Holloway,C.,Buffington,C.A.T.,2004.Evalua4onofownereduca4onasacomponentofobesitytreatmentprogramsfordogs.JournaloftheAmericanVeterinary

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MedicalAssocia4on,224,1932–1935.

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9. Appendix

9.1.SurveyDutchversion

1. Introducerendevragen Devolgendevragengaanoverdeprak4jkwaaruwerkzaambentalsdierenartsenoverenkelevanuweigenschappenalsdierenartszijnde1. Indeprak4jkwaarikwerkzaamben,werken…dierenartsen.(vulin)

1. 12. 23. 34. 45. 5-106. meerdan10

2. Indeprak4jkwaarikwerkzaamben,benik1. Eigenaar2. Geassocieerd3. Medewerker

3. Ikbeneen:1. Man2. Vrouw

4. Ikbenafgestudeerdin…(Vulin)5. Volgtubijscholingomtrentcommunica4emeteigenaren?

1. Nognooitgedaanenooknietvanplan2. Nognooitgedaan,mogelijkwelindetoekomst3. Weleensgedaan4. Metenigeregelmaat

6. Volgtubijscholingomtrentnutri4oneleondersteuningvanpa4ënten?1. Nognooitgedaanenooknietvanplan2. Nognooitgedaan,mogelijkwelindetoekomst3. Weleensgedaan4. Metenigeregelmaat

7. Indeprak4jkwaarikwerkzaamben,werken…assistenten.(vulin)1. 12. 23. 34. 45. 5-106. meerdan10

2. Hoeveelvandeobesitastherapielaatuaandedierenartsassistentenover?Beantwoorddezevragenalleenindienuwerkzaambentineenprak4jkofkliniekmetdierenartsassistenten.1. Eengedetailleerdevoedingsanamnese(…%)2. Hetwegenvandepa4ënt(…%)3. HetbepalenvandeBCS(…%)4. Hetopstellenvanhetbehandelplan,inclusiefkeuzedieetenhoeveelheidervan(…%)5. Uitleggenvanhetbehandelplan(…%)6. Deopvolging(…%)

3. Oorzakenendiagnos4ek1. Watzijndefaciliteitendieuwprak4jkbiedt,voordegewichtsinschaLngvandehond?

1. Weegschaalindewachtruimte

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2. Weegschaalindeconsulta4eruimte3. Weegschaalinzowelwachtruimtealsconsulta4eruimte4. Geenweegschaal

2. Watzijndefaciliteitendieuwprak4jkbiedt,voordegewichtsinschaLngvandekat?1. Weegschaalindewachtruimte2. Weegschaalindeconsulta4eruimte3. Weegschaalinzowelwachtruimtealsconsulta4eruimte4. Geenweegschaal

3. Waarligtvolgensudegrootsteoorzaakvanobesitasbijdehond?1. Diergerelateerdeoorzaken(ras,leelijd,onderliggendeaandoening)2. Eigenaargerelateerdeoorzaken(tevaak/teveelvoederen,teweinigbeweging)3. Teweinigpreven4evemaatregelen(vb.teweiniginforma4everstrekking,telate

diagnose)4. Waarligtvolgensudegrootsteoorzaakvanobesitasbijdekat?

1. Diergerelateerdeoorzaken(ras,leelijd,onderliggendeaandoening)2. Eigenaargerelateerdeoorzaken(tevaak/teveelvoederen,teweinigbeweging)3. Teweinigpreven4evemaatregelen(vb.teweiniginforma4everstrekking,telate

diagnose)5. Hoevaakkaartuhetovergewichtvaneenpa4ëntaan?

1. Indiennodig,bijiedereconsulta4e2. Bijenkeleopeenvolgendeconsulta4es,maaralsdeeigenaarerweinigtotnietop

ingaat,laatikdeverantwoordelijkheidvoorhetgewichtvooralbijdeeigenaarliggen.

3. Gedurendeéénconsulta4eennietverderalsdeeigenaarhiernietgoedopreageer/nietinmeegaat.

6. Hoevaakbentugeneigdhetovergewichtvaneenpa4ënttenegeren?(…%vandepa4ënten)

7. Indeprak4jkwaarikwerkzaamben,schatikdat…%vanmijnpa4ëntenindegewichtscategorievalt,diehierzichtbaaris:(BCS6-7/9)

8. Indeprak4jkwaarikwerkzaamben,schatikdat…%vanmijnpa4ëntenindegewichtscategorievalt,diehierzichtbaaris:(BCS8-9/9)

9. Eenevalua4evanhetgewichtmaakikmet:(meerdereantwoordenmogelijk)1. Weegschaal2. BCS53. BCS9

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4. BFI5. Me4ngenvandeomtrekkenvanverschillendelichaamsdelenmeteenmeetlint

10. Overgewichtaantonendoeikmet:(meerdereantwoordenmogelijk)1. Weegschaal2. BCS53. BCS94. BMI5. Echografie6. Radiografie

4. Bijwelkvandeonderstaandecategorieënkaartuhetgewichtvaneenpa4ëntaan?1. Nooit(0%)total4jd(100%)

2. Nooit(0%)total4jd(100%)

3. Nooit(0%)total4jd(100%)

5. Hetinstellenvaneenbehandeling1. Inhoeveel%vandegevallenligtdefocusvooralophetverminderenvande

hoeveelheidvanhethuidigevoeder,bijhetinstellenvannutri4oneleondersteuningvandeobesepa4ënt(BCS8/9of9/9)

2. Inhoeveel%vandegevallenschrijlu,bijhetinstellenvannutri4oneleondersteuningvandeobesepa4ënt,eencommercieelvermageringsdieetvoordatspecifiekgerichtisopgewichtsreduc4e?

3. Inhoeveel%vandegevallenschrijlu,bijhetinstellenvannutri4oneleondersteuningvandeobesepa4ënt,eenzelfbereidvermageringsdieetvoordatspecifiekgerichtisopgewichtsreduc4e?

4. Inhoeveel%vandegevallendoetuhetbepalenvandehoeveelheidvoeder,dievaneenvermageringsdieetgegevendientteworden,opbasisvanberekeningenvandeenergie-behoelevanhetindividueledier?

5. Inhoeveel%vandegevallenbepaaltudehoeveelheidvoeder,dievaneenvermageringsdieetgegevendientteworden,opbasisvandeaangegevenhoeveelheid

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voederopdeverpakkingvanhetvermageringsdieetopbasisvanhetideaalgewichtvanhetdier?

6. Bijhetinstellenvannutri4oneleondersteuningvandeobesepa4ent,bespreekikookdemaniervanvoeden,vooralindevormvan:1. Normaleeetbak2. Eetbakmeteen4mer3. Voedingspuzzels4. Ikbespreekdemaniervanvoedennietindetail

7. Snacks1. Mogenabsoluutnietgegevenworden4jdensdeperiodevangewichtsverlies.Ik

benhierzeerstriktin.2. Wordenbestnietgegeven4jdensdeperiodevangewichtsverlies,maarikbesef

datveleeigenaarsdietochgaandoen.3. Wordenbestvervangendooreencaloriearmesnack,zoalssperziebonen.4. Mogengegevenworden,maarslechtseenbeperktpercentagevandedagelijkse

calorischeinname.5. Mogengegevenworden,zolangdehoeveelheidcalorieënindesnacksafgetrokken

wordtvandehoeveelheidonderhoudsvoedingdiegegevenmagworden.6. Mogengegevenwordenwanthetisheelmoeilijkomditteverbieden

8. Inhoeveel%vandegevallenschrijlu,naastnutri4oneleondersteuning,ookbewegingvooralsonderdeelvanuwtherapiebijdehond?

9. Inhoeveel%vandegevallengaatdevolgendestellingopvoorpa4ëntendieubehandeldvoorofwelovergewichtofwelobesitas?:‘Inhetvoorschrijvenvanbeweging,differen4eerikbijdehondoverhettypebeweging(wandelen,rennenmetdebal,fietsen,fysiotherapie).’

10. Inhoeveel%vandegevallengaatdevolgendestellingopvoorpa4ëntendieubehandeldvoorofwelovergewichtofwelobesitas?:‘Inhetvoorschrijvenvanbeweging,wordtookovereenbepaaldeduurenintensiteitvanbeweginggesproken.’

11. Inhoeveel%vandegevallenschrijlunaastnutri4oneleondersteuningookbewegingvooralsonderdeelvanuwtherapiebijdekat?

12. Inhoeveelgevallen(...%)gaatdevolgendestellingopvoorpa4ënten,dieubehandeltvoorofwelovergewichtofwelobesitas?:‘Inhetvoorschrijvenvanbeweging,differen4eerikbijdekatoverhettypebeweging(spelenmeteenhengeltje,wandelenaandelijn,fysiotherapie).’

6. Communica4emetdeeigenaar1. Tijdenseengesprekmetdeeigenaaroverhetgewichtvandepa4ëntisdevolgende

op4ekenmerkendvoormijns4jl:1. Alsdierenartszijnde,zetikvooraldetoonvoorhetgesprek.Ikhaalhierbijzekerde

mogelijkerisico’svanobesitasaan.Hierbijneemikvooralderolvanbeschermheerinvoorzowelcliëntalspa4ënt.

2. Alsdierenartszijndelaatikvooraldecliëntzijnofhaarverhaalvertellen.Hetisvooraldecliëntdiebepaaltwathijofzijwiltbespreken4jdensdeconsulta4e.Mijnmeningofkennisomtrenthetonderwerp‘obesitas’blijleerderopdeachtergrond.

3. Alsdierenartszijndedeelikmijnkenniszekermetdeklant,maarinhetgesprekzijndecliëntenikgelijkaardigindematevancontrole.

2. Waaromwerktjuistdezes4jlgoedvooru?1. Ditkosthetminste4jd2. Zobekomikdemeestwaardevolleinforma4e3. Daarvoelikmehetbestebij/Ditbenikgewend4. Erisgeenspecifiekereden

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3. Hoeveel4jdneemtuvooreeneersteconsulta4eomtrenthetovergewicht/obesitasvaneenpa4ënt?(5-90minuten)

4. Opwelkemanierinformeertudeeigenaaroverhetvoorgeschrevendieet?1. deeigenaarwordtvooralvoorzienvaneenbondigmondelingadvies2. deeigenaarwordtvooralvoorzienvaneenuitgebreidmondelingadvies3. deeigenaarwordtvooralvoorzienvaneenbondiggeschrevenadvies4. deeigenaarwordtvooralvoorzienvaneenuitgebreidgeschrevenadvies5. deeigenaarwordt,naastmondeling,ookvoorzienvaneenbondiggeschreven

advies6. deeigenaarwordt,naastmondeling,ookvoorzienvaneenuitgebreidgeschreven

advies5. Bijhetmeenaarhuisgevenvangeschrevenadviezen,informeerikdeeigenaarover:

1. Welkvoedergegevendienttewordenendehoeveelhedenvoederdiegegevenmoetenworden

2. Informa4ebetreffendeovergewichtenobesitasbijhondenkat3. Informa4ebetreffendeovergewichtenobesitasbijhondenkat,inclusiefhoehet

corrigerenvanhetgewichtinzijnwerkgaat.6. Opvolgingvanhetgewichtdoeikmet:(meerdereantwoordenmogelijk)

1. Weegschaalopdeprak4jk2. Weegschaalthuis,deeigenaarhoudthetgewichtzelfbij3. BCS54. BCS95. BFI6. Me4ngenvandeomtrekkenvanverschillendelichaamsdelenmeteenmeetlint

7. Opvolgingindeprak4jkofkliniekgebeurt1. Iedereweek2. Iedere2weken3. Iederemaand4. Iedere3maanden5. Iedere6maanden6. Totdecliënthierovercontactmetonsopneemt

8. Hoevervolgtuhetcontactmetdeeigenaarvaneenpa4ëntmetovergewicht?1. Ikbeldeeigenaarnaéénoftweewekenomtevragenhoehettotnutoegaat2. Ikbeldeeigenaarnaeenmaandomtevragenhoehettotnutoegaat3. Ikstuurremindersalshet4jdisdetherapievoorttezeTennaareenvolgend

stadium4. Bijiederbezoekzorgikdatdeeigenaarmetdezelfdedierenarts/assistenttemaken

heel5. Ikwachtaftotdecliëntdeprak4jkcontacteert.

7. Therapiesuccesentherapiefalen1. Hoeveelprocentvandehondenmetovergewichtbehalenuiteindelijkhetbeoogde

resultaat?(GeefeenschaLngin%)2. Hoeveelprocentvandehondenmetobesitasbehalenuiteindelijkhetbeoogde

resultaat?(GeefeenschaLngin%)3. HoeveelprocentvandekaTenmetovergewichtbehalenuiteindelijkhetbeoogde

resultaat?(GeefeenschaLngin%)4. HoeveelprocentvandekaTenmetobesitasbehalenuiteindelijkhetbeoogde

resultaat?(GeefeenschaLngin%)5. Gaatdevolgendestellingopvoorpa4ëntendieubehandeldvoorofwelovergewicht

ofwelobesitas?:“Bijbeperktgewichtsverlies,beschouwikdetherapienogsteedsalseensucces”

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1. Nee,therapiesucceswordtenkelbereiktindienhetidealegewichtbereiktis.2. Nee,therapiesucceswordtenkelbereiktindienhetstreefgewichtbereiktis(indien

ditafwijktvanhetidealegewicht).3. Ja,gewichtsverliesvanelkeaardkanikalseensuccesbeschouwen4. Ja,maaralleenalshetgewichtsverliesgepaardgaatmetafnamevaneventueel

aanwezigeco-morbiditeitenofdiensintensiteit.5. Ja,maaralleenindienhetgewichtsverliesgedurendelangere4jdaanhoudt(geen

rebound).6. Inhoeveel%vandegevallengaatdevolgendestellingopvoorpa4ëntendieu

behandeldvoorofwelovergewichtofwelobesitas?:“Hervallenvaneenpa4ëntnatherapiesucces,beschouwiknietlangeralstherapiesucces”

7. Inhoeveel%vandegevallengaatdevolgendestellingopvoorpa4ëntendieubehandeldvoorofwelovergewichtofwelobesitas?:‘Hetopnieuwaankomeningewichtvandepa4ëntoplangeretermijnbeschouwikalstherapiefalen.’

8. Watbeschouwtualsdemeestvoorkomendeoorzaakvantherapiefalen?1. Diergerelateerdeoorzaken(ras,leelijd,onderliggendeaandoening)2. Eigenaargerelateerdeoorzaken(tevaak/teveelvoederen,teweinigbeweging)3. Teweinigpreven4evemaatregelen

9. Inhoeveel%vandegevallengaatdevolgendestellingopvoorpa4ëntendieubehandeldvoorofwelovergewichtofwelobesitas?:‘Therapiefalenisvoormijeenredenomindetoekomstnietmeeroverafvallentepraten.’

10. Wanneerhetstrevennaarideaalgewichtniethaalbaarblijkt,…:1. Kanikhetgewichtsverliesdatwélbereiktkanworden,beschouwenalseensucces

voordeingesteldetherapie.2. Beschouwikdetherapiealsnietsuccesvolenproberenwehetlaternogmaals.3. Beschouwikdetherapiealsnietsuccesvolenzullenweeenanderestrategie

proberen.4. Beschouwikdetherapiealsnietsuccesvolenlaatikhetgewichtvandepa4ënt

ongemoeid.5. Beschouwikdetherapiealsnietsuccesvolenstuurikdepa4ëntdoor,indiende

cliënthiervooropenstaat.8. Bedanktvooruw4jd!

1. Vulhieruwe-mailadresinalsukanswiltmakenopeengra4svoedingsadviesvanhetLaboDiervoeding,voedinggezelschapsdierenvandeVakgroepVoeding,Gene4caenEthologie,UniversiteitGent:

2. MogenweuopnieuwcontacterenomdeeltenemenaanonderzoekenrondvoedingvangezelschapsdierenvanhetLaboDiervoeding,voedinggezelschapsdierenvandeVakgroepVoeding,Gene4caenEthologie,UniversiteitGent?1. Ja2. Nee

3. Zouuderesultatenvandestudiewillenontvangen?1. Ja2. Nee

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