weight management clinics -the 30 minute consultation · what is obesity? the 30 minute...
TRANSCRIPT
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Weight Management Clinics - The 30 minute consultation
Caroline Burke BSc RVN Weight Management Specialist
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Agenda
What is Obesity? The 30 minute consultation - Stages 1 and 2Body condition scoringThe 30 minute consultation - Stages 3 and 4Measuring Food Follow upMaintenanceTreats and exercise
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Obesity in companion animals
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‘Excess accumulation of body fat’
What Is Obesity?
•overeating, under-exercising or a combination of both.
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What Is Obesity?
Overweight: When an animal is 10% above ideal weight(Body Condition Score of 6/7 out of 9)
Obese: When an animal is 30% above it’s ideal weight(Body Condition Score of 8/9 out of 9)
© Labat
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Obesity is
… a CHRONICINCURABLE
DISEASE
* PAW wellbeing report 2012: YouGov & PDSA
What Is Obesity?
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What can contribute to Obesity?
Pre-disposedIncorrect diet – feeding choicesFeeding ‘extras’Feeding behavioursExerciseStressNeutering
EDUCATION
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Owners perception
Media charactersDo not ‘see’ their pets as we see
themRecent studies show owners
underestimate body condition scores
97% of owners struggle to identify a healthy body shape for dogs
Not understand is health issue
PAW Report (2012)
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Consequences of obesity
Decreased lifespan in dogs and catsHealthDecreased quality of lifeWelfare
©ROYAL CANIN Weight Management Clinic
©ROYAL CANIN Weight Management Clinic
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Before After
PostureDepressionFight/FlightSadUnable to move efficientlyPainful?Unsocial
PostureHappyConfidentFight/FlightSociableComfortableImproved Quality of Life
Rocco’s Before Weight: 38.4Kg’s (June 2007)Rocco’s After Weight: 25.8Kg’s (December 2007)
Rocco achieved a 33% body weight loss!!!!!!
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The 30 minute consultation
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The Clinic Name
• Clinical• Weight Management Clinic, Obesity Clinic
• Positive• Healthy weight service, Healthy weight
club, Fit club• Descriptive
• Chub club, Slimmer's club
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The Clinic
Be PreparedSet date for clinic start Ensure everybody knows• Start date• When to book appointments and who with• What you will be discussing• How to refer to you
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How to recruit?
ReferralsAnytime and Everyone Involved• Discharges• Vaccinations• Consultations• Discussions with reception• Owners request
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Why 30 minutes?
Stage 1 (10 mins) – History Stage 2 (05 mins) - The Weigh-InStage 3 (10 mins) – Set PlanStage 4 (05 mins) – Give plan and diet
©ROYAL CANIN Weight Management Clinic
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Be prepared
Appointment pre-booked• Use questionnaire prior to appointment• Give owner BCS Chart
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All appointmentsHave pack prepared for client Flip chart (30 minute guide)Questionnaire Booklet for OwnerTool KitVet Follow UpFood
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Be prepared
Tool KitTape MeasurePuzzle feeders and toysBCS chartsAppointment CardKitchen scales Camera RosettesCertificates
© ROYAL CANIN®
© Shelley Holden
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Calibrating your scales
©Dr Alex German
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Stage 1History Gathering
(10 minutes)
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Stage 1 – Food Questionnaire
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Stage 1 - Exercise Questionnaire
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Further questioning
Need to understand the root of the issueHow and when did obesity first occur?Have there been changes in lifestyle/environment
that may have attributedCould there be an underlying medical condition
– may need to referSpend time understanding the situation
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Stage 2The Weigh-In
Weight, Photos, BCS, Measurements
(5 minutes)
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Stage 2
Weigh AnimalBody Condition ScoreTake Photographs
©ROYAL CANIN Weight Management Clinic
©ROYAL CANIN Weight Management Clinic
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Facilitate the taking of good before and after photosTake lots of different anglesNice photos too!!Use them for displays
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©Abbeycroft Vets Willows
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Before
Before 10.5kg
Before 10.5kg
After
After
After 6.5kg
After 6.5kg
Before
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Stage 2
Take morphometric measurements
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• Thoracic• Abdomen• Neck
© Shelley Holden
© Shelley Holden
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YES
NO
Do you currently use Body Condition Scoring in practice?
• 5 Point
• 9 Point
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1 cat and 5 dog shapes:• Chihuahua• Jack Russell• Pointer• GSD• Saint Bernard
5 breed morphologies: Variations in fat deposition Tailored measures for each individual Client-friendly: greater identification with
their pet
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9 Point Body Condition Score
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Practical 1
How good are your Body Condition Scoring Skills?
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-Palpate the pet by only applying light pressure
-Run your hands along the rib cage (following direction of fur)
-Run your hands on either side of the pets abdomen to see if you can feel a waist
© Shelley Holden
© Shelley Holden
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Look and feel from above to see if you can observe a waist
© Shelley Holden
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Run your hands from the back of the ribcage underneath the abdomen to see if an abdominal tuck
is present.
Using hands apply light pressure over the lumbar region, spine and hips.
© Shelley Holden
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Practical 1
How good are your Body Condition Scoring Skills?
What BCS is my dog?
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Stage 3Set Plan
Discuss diet and exercise (10 minutes)
© Shelley Holden © Shelley Holden
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Stage 3
Educate Owner• Seriousness of Obesity• Health Benefits• Welfare• Quality of Life ©ROYAL CANIN Weight Management Clinic
© Shelley Holden
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Stage 3
Set Plan• Estimate target weight• Decide on most appropriate diet• Calculate how much to feed• Provide diet• Weigh Food• Work out how long the diet will last
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Estimating target weight – How?
HOW?
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Decide on appropriate diet
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Owner to keep record
For feeding and exercise guidesWrite everything downGet owner to record using diaryAssess at every weigh-inWrite down adjustments
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Stage 4Send home with plan
Provide diet and written instructions(5 minutes)
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Send home with written instructionsOwner booklet completedInformation on dietExercise planDiary
© Shelley Holden
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Stage 4
Send home with:Diet (STOCK)Kitchen scales (advise on purchase)Toys (may discuss next appointment)Arrange next appointmentProvide contact details (phone/email)Arrange follow up call/email
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How accurate are measuring cups?
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Practical 2
Using the measuring cup measure……….
Tip amount measured onto scales
Record amount
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© Shelley Holden
© Shelley Holden
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How accurate are measuring cups?Methods
• 12 different studies• Various cup sizes• Various diets• Various portion sizes
Results• Accuracy
• Ranged from 18% under to 80% over
• Usually an over-estimate• Precision
• Intra-operator CV: 2% to 15%• Inter-operator CV: 2% to 28%
• Worse for small portions• Scales printed on cups were also inaccurate
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©Shelley Holden
©Shelley Holden
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Behaviour
Discuss changes that will occurMore activeLivelierMore attentionFeeding habitsImproved mobilityImproved groomingImproved QUALITY OF LIFE
After
© Shelley Holden
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Owner Requirements: CommitmentTime:
to monitor feedto complete diariesto attend clinicto weigh food increase exerciseincrease play timeto buy products
Have you tried your own advice?
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The follow-up (Repeat Appointment)
How often to review?Weight/Measurements/BCSUpdate booklet/filesImplement new ideas, new suggestions
© Shelley Holden
closettraveler.com
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Feeding plan - Advice
How often, when to feed?Change feeding times aroundFeed a combination of wet and dryFeed more meals when owners presentUse feed ball/play time for a meal
Don’t suggest everything at once!!
© Shelley Holden
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Encouragement – even if small lossExplain lossWhat is a safe loss?
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Safe Weight Loss
Optimal Weight Loss per week?
Dog - 1-3% per week• (Average 0.9% a week)
Cat - 0.5-2% per week• (Average 0.8% a week)
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How to calculate safe weight loss
Previous weight 3 weeks ago was 32kgTodays weight 30.9kg
Therefore 32kg -30.9kg = 1.1kg
1.1/32kg (previous weight) x 100 = 3.4%3.4/3 (number of weeks since last visit) = 1.1% per week
Is that good/bad? What would you do if the dog had lost 0.4% per week?
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Support
Monthly competitions – prizes Certificates / awarded at different stagesDisplays to show enrolled petsMembership cards for clients/benefits
MOTIVATION © Shelley Holden
©Vetfollowup
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Maintenance Post Weight Loss
Which diet to feed?Recent Study shows:Nearly half of dogs who lost weight regained weight post loss
14 dogs (42%) maintained3 dogs (9%) lost more than 5%
16 dogs (48%) gained more than 5%
Most dogs gained just under half the weight of what was originally lost!
German, A.J., et al. Long-term follow-up after weight management in obese dogs: The role of diet in preventing regain.The Veterinary Journal (2011), doi:10.1016/j.tvjl.2011.04.001
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Monitoring Post Weight Loss
Maintain on current dietGradually increase in stages• 0-10kg - Increase by 5g• 10-25kg - Increase by 10g• 25kg + – Increase by 20g
Maintain plan – reweigh every 2 weeksOnce maintaining 4 weeks/8 weeks/12 weeks
© Shelley Holden
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To Treat or Not?© Shelley Holden
© Shelley Holden
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= 53 kcals (small)= 20gms K9 Satiety = 45 kcals (100g)
= 16gms K9 Satiety= 191 kcals= 71gms K9 Satiety And 62gms F9 Satiety
= 85 kcals
= 31gms K9 Satiety100g of Ham= 164 kcals= 61gms K9 Satiety
Bonio= 75kcals= 28gms K9 Satiety
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This is more fun!!
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© Shelley Holden
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© Louise Brennan
Piping & Freezing
Using ROYAL CANIN
Satiety Wet
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© John Bowen
©Nina Ottoson
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© Shelley Holden
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Treat or Not?
It will depend on the individual patient!
© Shelley Holden
© Shelley Holden
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Exercise
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Exercise
Realistically consider the owners capabilitiesTailor the plan for the individual Consistent PlanComplete diary
© Shelley Holden
closettraveler.com
What do you advise?
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Cats
Start with small sessions 2 x 2 minutes daily and gradually increase
Alternate toys/Find what interests themSpread food/move bowls – think of natural behavioursHide and SeekKeep the owner interested!!!
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TIME TO PLAY
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Dogs
Set Exercise PlanHow Overweight?Injury/IllnessWeatherLifestyle of owner Anybody to help?
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Hydrotherapy
© Shelley Holden
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The 30 minute consultation
Be preparedBe organisedTool kit• Stage 1 – History• Stage 2 – The weigh-in• Stage 3 – Set Plan• Stage 4 – Send home with plan and diet
Follow up consultationsPrioritiseSupport
© Shelley Holden
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BeforeAfter
THINK OF ROCCO!!!!!
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With many thanks:
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Any Questions?
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Thank you!