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Ken Lambrecht DVM
Medical Director West Towne Veterinary Center
Presented at University of Wisconsin School of Veterinary
MedicineFebruary 24, 2014
[email protected] www.Slideshare.net/KenLambrecht
www.facebook.com/AmazingAdventuresofLittleBug
Weight Management in Pets How we can help them feel better & live longer.
1.Up to 59% of pets are overweight Lund et al Intern J Applied Pract 2010 & Courcier EA et al Scotland J Feline Med 2010
2.Excess weight can reduce longevity and quality of life Kealy et al JAVMA 2002
3.Hormones & inflammation caused by fat lead to a state of chronic inflammation Wakschlag et al Br J Nutr 2011
4.Excess weight leads to skin, respiratory, renal disease, diabetes, orthopedic disease and some types of cancer LaFlamme J Anim Science 2012
The problem:
1. Veterinarians need to become comprehensively “Nutri fluent” with the recent flood of evidence based articles
2. Food manufacturers need to become more accountable and transparent
3. Organized veterinary medical groups need to continue to cooperate (AVMA, AAHA, etc)
The Solution:
Increasing rates of obesity Increasing rates of obesity related disease
90% of cats get arthritis 58% of cats overweight Relationship??
The urgency:
Catalystcouncil.org
The veterinary team is the preferred source of nutritional information and has a key role in advising clients about the quality and safety of food and supplements, especially with recurrent food safety issues and misinformation about canine diets.
Discussions about nutrition are appropriate at every visit to strengthen theveterinarian’s role and provide sound nutritional advice includingall of the items in Table 2.
AAHA and the World Small Animal Veterinary Association Nutritional Assessment Guidelines provide excellent discussions of comprehensive nutritional plans that can be individualized for each dog.13,17,48
AAHA Canine Life Stage Nutrition Guidelines Jan 2012
With more than 40% of dogs in the United States considered overweight or obese, the primary care veterinary team is in a pivotal position to detect abnormal body condition scores and provide toolsfor clients to routinely make appropriate adjustments beginning at the dog’s first visit. 13,17,49–53
Dogs kept at their ideal weight from puppyhoodthrough the senior life stages live an average of 15% longer. 54
Guidelines Continued…
Advocate evidence-based nutrition.13,17
An emerging body of evidence infers that certain nutrients may turn gene expression on and off and help prevent disease.55
Monitor the emerging body of knowledge with regard to supplements, implementing those if and when peer-reviewed evidence-based studies support these potential benefits (e.g., probiotic support of the immune system, the role of Eicosapentaenoic acid in inflammation).13,17
Additionally, use and refer to veterinarians who are board-certified through theAmerican College of Veterinary Nutrition to answer questionsand provide nutritional consultations (Table 4).
Obesity may occur at any age, but is most commonly encountered in middle age.32,36 The risk of obesity may be reduced by environmental enrichment, increasing opportunities for activity, and individualizing food intake. The energy density of cat foods varies widely, based on the moisture and fat content of the diet. This information should be helpful in determining a guideline of how much to feed.
Slowly (<10% increments and decrements) adjust calorie intake to life stage and conditions (eg, sterilization, indoor housing).
Provide environmental enrichment to increase activity.35
Switch to a diet with lower energy density (reduced fat, increased air, fiber and/or moisture).
Change the feeding strategy. Switch to meal feeding, with portion control. Introduce foraging devices (see above). Introduce barriers to food access (eg, baby gates, elevated feeding stations).
AAHA/AAFP Feline Life stage Guidelines 2010
Standard Physical Exam 5 Vital signs
1. Temperature2. Pulse3. Respiration4. Pain Assessment5. Nutritional Assessment
2011 WSAVA Nutritional Assessment Guidelines
Up to 59% of dogs and cats are overweight, making this the most common nutritional disorder identified in veterinary practice
Weight management, including obesity prevention and treatment, remains a challenge for veterinarians and clients alike.
AAHA Weight Management Guidelines January 2014
Client challenges Data challenges (calories per cup, grams
protein/1000 kcal etc) Time challenges
The Challenges are many:
In December 2010 the AVMA added “prevention of disease” to the veterinary oath.
As veterinarians ...we need to do all we can to PREVENT disease
● Periodontitis 80% of dogs 2 yrs of age ● Obesity 59% of pets are overweight● Arthritis 20% of dogs, 90% of cats over 10 yrs● Infectious disease (Distemper, Rabies, etc)● Vector borne Heartworm● Internal parasites Roundworms, hookworms
etc
What common diseases can we prevent?
Feline Life Stage Guidelines 2010 AAHA Nutritional Guidelines 2010 Canine Life Stage Guidelines 2012 WSAVA Nutritional Guidelines Guidelines 2011 AAHA Weight Management Guidelines 2014
https://www.aahanet.org/Library/Guidelines.aspx
Recent Guidelines & Support
Clients would visit their veterinarian IF:
1. They thought a visit could prevent expensive treatment later
2. They believed their pet needs more frequent exams (30% missed heartworm meds, had oral disease, or lameness identified by an online survey)
3. They were convinced it would help their pet live longer
AAHA Health Risk Assessments 2014
Organized Veterinary Medical Groups● AAHA American Animal Hospital Association● AVMA American Veterinary Medical Association● WSAVA World Small Animal Association● CVMA Canadian Veterinary Medical Association● NAVTA National Association of Veterinary Technicians
Association● AAVN American Academy of Veterinary Nutrition● ASVE_______________
What is the PET NUTRITION ALLIANCE (PNA)?
American College of Veterinary Nutrition
● Purina● Hills● Iams
Funded by 3 of the “Big 4” pet food companies
www.PetNutritionAlliance.org
Questions & Answers & Myths for Pet Owners Non branded Tools for Veterinarians Effective branded tools Evidence based & practical
Just launched in July 2013 …Needs your input!
The Website:
Other great resources
http://www.petobesityprevention.com/ http://catalystcouncil.org/
4 Board Certified Nutritionists 1 ABVP Feline Certified DVM2 DVM Practitioners3 CVTs (2 in practice & 1 certified in nutrition)1 Nutrition resident
PNA Non Branded Tools Committee
Board Certified Veterinary Nutritionists Only 87 in the world
Who are the experts?
American College of Veterinary Nutrition
Lectures from ACVN diplomats PNA Pet Nutrition Alliance AAVN American Academy of Veterinary Nutrition
ACVN American College of Veterinary Nutrition
My resources
Prevention Nutrition Dentistry Cats
My current areas of interest after 30 years of preventive/wellness veterinary practice
Are our own pets their ideal weight?
1. How to PREVENT2. How to ASSESS3. How to CHOOSE an appropriate diet 4. How to CALCULATE what a pet needs5. What EXERCISE & ACTIVITY
What we need to know to be able to manage weight in pets:
PREVENTION
This is an 100% preventable problem! Prevention begins with puppies & kittens (Effect of neutering, how much to feed etc) Continues at middle age Communication issue
Prevention:
Good communications skills (e.g Franke program) Effective Tools (available on PNA website) Educated Support staff (Hills, Purina, Iams, Royal
Canin, PNA Continuing education programs) Support from software providers (Impromed,
Patterson etc)
What do we need in the exam room?
Effective
Branded & Non branded tools!
Effective Visual aids (Static BCS & % over) Ability to track progress (trending tools for BW,
BCS etc) Non branded tools
Tools we need
Calculating % over ideal Conversion of Body Condition Score (BCS) to a
% Muscle Condition Score (MCS) Weight Trends
More tools
Visual trending (BCS and weight) use graph Easily accessible Calorie and protein source Easily calculated RER (chart vs calculation)
What tools are most effective for veterinarians?
Food Recommendation Written Calories and Cups to feed Measuring cup Food intake & exercise diary
What are the best tools for pet owners?
Assessment
History BW, BCS, MC Clients pet food education/orientation Must touch the pet! Baseline Bloodwork r/o hypothyroidism,
Cushing's etc
ASSESSMENT
little or no fat covering ribs defined body waist minimal abdominal fat (ideal = 20%) often correlates to 1 yr of age weight
Definition of Ideal Weight
Purina’s BCS for Cats
Purina’s BCS for Dogs
Hill’s BCS for Dogs & Cats
Purina’s Large Breed Puppy BCS
your
Muscle Condition Score (MCS)
Fist/knuckles (Dr Katherine Michel) One year body weight When your friends tell you your pet looks too
thin…..you’re almost there! (Dr Julie Churchill)
My favorite “rules of thumb”
Up to 20% over ideal (BCS up to 3.5/5 or 6/9) = OTC food if no other problems)
If 20%-30% over their ideal (BCS 4/5 or 7/9) = Prescription food or high protein OTC food
Over 30% over their ideal = Rx food only
Food will depend upon BCS
Protein level Satiety Wet vs dry L Carnitine & Isoflavones Rx & OTC
Food Choice Challenges
CALCULATIONS
RER calculation/chart Protein calculations
CALCULATIONS
CHOOSING A FOOD
Send a measuring cup home with every client or describe in detail!
When: when over 20% of their ideal weight (BCS 7/9 and 4/5)
Why: to insure adequate protein Low number of Cals/Cup (Lisa Freeman study) Insure micronutrients and vitamins Higher fiber, lower fat Satiety factors
When & Why use an RX weight loss diet
Our recommendation box
Association for Prevention of Pet Obesity Internet PNA app someday ??
CALORIES IN TREATS
Dogs 1-2% per week 60 lb dog 0.6 to 1.2 lbs/week
Cats 0.05 to 2.0% per week 15 lb cat (240 ounces) 1.2 to 4.8 ounces/week
How Fast is safe?
1) Overweight Dog 10Kg ideal weight
2) Food has 21% crude protein and 3,490 kcal/kg (on label)
3) RER = 80% (70 x 10 kg 0.75) = 315 kcal/day
4) Grams Protein in food = (% crude protein/kcal/kg of food) X 10,000=g/1000 kcal 21/3,490 x10,000 = 60 g/1000 kcal
Minimum daily protein requirement = 5g/kg for cats 2.5g/kg for dogs = 25 g for 10 kg dogThis food 315 kcal has 315/1000 or 31% of 60 g =18 gm NOT ADEQUATE
Protein level calculations
1) Assume Overweight Cat of 5 kg ideal weight (11 lbs)Food with 31% crude protein and 3490 Cal/kg60% (70 X 5KG 0.75) = 150 kcal/day2. G of protein in food(% crude protein/kcal/kg food) X 10,000 = g/1000 kcal 31/3490 X 10,000 = 90 g/10003) Cats daily protein requirement 5g/kg 5kg cat = 25 grams4) Food sufficiency 150 Kcal/ day X 90 kcal food only has 13.5 grams NOT SUFFICIENT!
How about Cats?
Wouldn’t it be nice?
Exercise & Fitness
preserve lean muscle mass increase caloric expenditure (1 kcal/kg/km)
at brisk walk 45 kg dog will burn about 250 kcal in 5K
“promote behaviors that aid in sustainable weight loss”
Activity & exercise
Client communication skills Make sure it is evidence based Constant reassessment Keep it fun
How will we succeed?
Environmental enrichment Strict Calorie control Protein is a huge issue!
What about cats?
Clover
Sat April 5th 12:30 to 2 PM 8 week Contest Kickoff Preventive Pet Care Fair Raised over $2500 for local rescues in its 5
year history
5th Annual Pets Reducing for Rescues
Biggest Loser category (Dogs & Cats more than 20% over ideal)
Iron Dogs & Iron Cats (between 5 and 20% over ideal)
Dog Packs & Cat Prides (3 or more in a team challenge)
Over $1000 in pet food prizes $5 for each pound lost to any rescue chosen
Details
SatietyBehaviorData/toolsClient communication skills
MAJOR CHALLENGES
We need to make this a priority for our own pets and the pets we care for
to help them feel their best and live their longest possible life!
Getting owner buy in Respect their relationship with pet Emotional nature Difficulty in choosing food
Client Challenges:
What is a pet owner to do?
Are our own pets their ideal weight?
Slideshare.net/KenLambrecht
Thank you for your attention!
