Nutritional conversations, front and center

Dr. Julie Churchill knows that food is intertwined with the way people show care and love for each other and their animals.

“Nutrition and nutrition are linked,” said Dr. Churchill, a professor of clinical veterinary nutrition at the University of Minnesota College of Veterinary Medicine and a board-certified nutrition expert. This may be why more than half of dogs and cats in the United States are overweight, according to data from the Association for Pet Obesity Prevention. Nearly 70% of pet owners said they would like veterinarians to recommend a diet for their pets, according to survey results from APOP from 2018.

Dr. Churchill with a client
Dr. Julie Churchill is reviewing nutritional recommendations with a client whose cat has hypertrophic cardiomyopathy and was previously overweight. (Images provided by Dr. Churchill).

Sales of pet food and treats totaled $42 billion in the United States in 2020, according to data from the American Pet Products Association.

Nutrition is an integral part of proactive veterinary care. Sometimes it can be a simple topic to discuss with clients, other times conversations about nutrition and diet can be challenging. Veterinarians can navigate them by making use of tools such as sending a nutritional assessment before tests, teaching pet owners about body condition scores, and implementing empathic communication techniques.

Dr. Churchill said pet owners want these conversations, and veterinary teams should have them.

“We (communally) lose sight of what health looks like. “We (as veterinary teams) are not accustomed to what a healthy pet looks or feels like,” said Dr. Churchill, a board member of the Pet Obesity Prevention Society and the Pet Nutrition Alliance. We should be the antidote to that.”

Top view of Sasha overweight
Sasha, a 2-year-old Chihuahua, was brought to the University of Minnesota for nutrition services and weight management assistance. Her starting weight was 25 lbs.
Top view of Selim Sasha
Sasha, after about two years of weight management and nutritional services, has lost about half her body weight and is at a healthy weight of 12.5 pounds.

start the conversation

Kara Burns, a licensed veterinary technician who specializes in nutrition, said veterinary teams should start a discussion with open-ended questions.

Selim Sasha looks at the camera

“I ask what is being fed and why,” Burns said. Pet owners usually have a reason for their choice of food. To fully understand a pet owner and his or her decision, we have to ask, “Why?”

For example, pet owners may be vegetarians and feed their pets a plant-based diet as well, which is important information the veterinary team should have when discussing nutrition. The team should educate pet owners about the nutrients that animals may need in their diet.

Burns is president of the Pet Nutrition Alliance, an organization dedicated to raising awareness about integrating nutritional assessment into veterinary care and strengthening veterinary teams as sources of pet nutrition information. The PNA has calorie calculators, tools for making feeding plans, and resources for understanding pet food. The Palestinian National Authority provides a source of contact with the client (PDF).

Dr. Sarah Abboud, founder of the consultancy Sit, Stay, Speak Nutrition, speaks with members of the veterinary team who are uncomfortable discussing nutrition and diet because they are multifaceted topics.

Dr. Abboud suggests finding out the origin of this concern. It could be fear of not having enough time during the scan, concern about the owner complying with diet suggestions, or feeling unwilling to fight with a client who may have already done research on diets and does not want advice from the veterinary team.

Dr. Abboud said the lack of belief in science and evidence also presents an additional worrisome layer in the nutrition conversation. However, in trying it out, many pet owners would like to talk about nutrition with their veterinary team.

Dr. Churchill said nutrition would usually show up during the scan because clients wanted advice. You prepare clients for conversation before an appointment by sending a note before the visit.

“It defines how we think we’re a nutrition-focused practice,” she said. “If you ask them beforehand, they will be able to take pictures beforehand, and it will be easier so that they do not have to remember the name of ‘pet food and candy.

Dr. Jackie Barr, associate clinical professor of nutrition at the University of Georgia College of Veterinary Medicine, says her service won’t see food service clients until they submit a sample diet history.

Dr. Barr, a board-certified veterinary nutritionist, said veterinary teams have been talking about nutrition for decades. Questions about vomiting, skin or coat problems, and bowel habits are all related to nutrition.

She also suggests that telemedicine appointments can make nutrition conversations easier.

“There is a lot of important information that can be captured,” she said. “Two partners can join a video call during their lunch break. More family members can be together. Through telemedicine, we can recreate a plan for the whole family.”

WSAVA . Score Chart
World Veterinary Society Small Animal Body Score Chart for Cats (enlarge)

on board

Dr. Churchill said that training pet owners how to determine body condition score could also be helpful. It can keep them engaged and aware of their pet’s health. The body condition score is an estimate of the percentage of body fat and is used in conjunction with the body weight and muscle condition score. The most common body condition scoring systems use a nine-point scale.

Dr. Churchill tells clients to have an evaluation once a month.

Joseph Bartjes, professor of medicine and nutrition at the College of Veterinary Medicine of Georgia and a board-certified veterinary nutrition expert, said the degree of body condition is critical.

“It’s easy to say a cat looks skinny, but the body condition score provides a real number,” said Dr. Bartjes. “If you quantify the information, you can notice trends and avoid them.”

There is also a difference in weight within the breeds. For example, a male Labrador might weigh between 80 and 100 pounds, he said. What is her healthy weight? A body condition score can help determine this.

University of Minnesota Examination Card
University of Minnesota Check Card for Nutritional Risk Factors Adapted from American Animal Hospital Association Nutritional Assessment Guidelines for Dogs and Cats

Speak through challenges

Dr. Churchill said there are always difficult conversations.

“Sometimes it’s not the right time in a family’s life,” she said. They have other things to do, especially during a pandemic. There are a lot of other problems. Sow the seeds of anxiety, give them permission not to act now, but tell them when they are ready, you will be there.”

Dr. Abboud agrees. She said veterinary teams would have less anxiety and frustration about nutrition-related conversations if they assumed that not every client was ready to make a change.

“Think of it as an ongoing conversation,” Dr. Abboud said. “They are not always ready to make a commitment. They need motivation and support. If you have a philosophy that you think represents ongoing support, it will be easier to stay engaged.”

Dr. added. Bartges says that despite the potential challenges, there is no excuse not to talk about nutrition.

“As a priority, it should be high,” he said. “All dogs and cats should eat. It’s 100%.”

Veterinary nutritionists suggest the following tips for talking about nutrition:

  • Do not enter a conversation with preconceived notions.
  • Use the entire veterinary team to promote nutrition and share information.
  • Consider adding a nutrition section on the clinic’s website.
  • Include communication about nutrition in each examination.
  • Ask open-ended questions.
  • Don’t suggest just one diet or brand.
  • Educate yourself on different foods and diets.
  • Be open to hearing about a diet you may not know about, and be willing to learn.
  • Send a note before the appointment to ask about nutrition and diet.
  • Use the tools and resources for nutritional assessments and body condition score charts.

Dr. Churchill said non-judgment and empathy are also key.

“Remove the sentence from the conversation,” she said. “Most of the obese pets I meet, they are all cuddly.”

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