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A Step-by-Step Approach to the Obese Veterinary Patient | VetGirl Veterinary CE Blog

A big shout out to VetGirl's guest blogger Dr. Catherine Lenox, DVM, CVA, DACVN, for this great nutrition contribution!

In today's VetGirl blog, we're going to discuss a step-by-step basic approach to the obese veterinary patient. With obese patients, prevention is key. However, with pet obesity on the rise, we all need a plan for obese patients. This step-by-step guide is designed for management of the “basic” obese patient. By “basic,” I mean the dog or cat does not have any concurrent health issues that need to be addressed, and is not already consuming a low number of calories. Obese patients with systemic diseases (including things like adverse food reactions, diabetes, or renal disease) would be managed differently. Patients who are obese but are already consuming a low number of calories (I call them the “easy keepers”) are also more complicated and would require additional diagnostics such as thyroid testing, rechecking the diet history with the owner (maybe the “cup” is really 16 ounces instead of 8 ounces), evaluation of the activity plan, and a potential consult with a board-certified nutritionist (DACVN) to ensure adequate nutrient composition of the chosen diet and plan.

1. Take a thorough dietary history
This includes not only the type of food fed with amount and frequency, but also treats, table scraps, human foods, foods for medication administration, dietary supplements, food used for training purposes, anything the dog or cat could get into (other pets’ food, etc), and anything else the pet may be eating on a regular basis. Try to estimate calories consumed as best as possible. Calorie information on many diets can be found on the packaging, or in the company product guides, on the company’s website, or by calling the manufacturer.

2. Estimate body condition, muscle condition, and ideal weight
Body condition score and muscle condition score should be assessed on all patients. Body condition score is a subjective assessment of cutaneous fat mass, and is generally on a scale of 1-9, with 1 being emaciated and 9 being obese. 4-5/9 is ideal for most patients, with emphasis on making pets leaner if there is presence of joint disease or neurologic disease. Muscle condition score describes the lean muscle mass and can be assessed by palpating over the epaxial muscles, scapulae, hips, and hindlimbs.

Body condition and muscle condition charts can be found, along with other nutrition resources at: http://www.wsava.org/nutrition-toolkit

Ideal weight is best estimated in one of two ways. The first way is based off historical weight or by asking the owner if the pet looked normal at a specific weight. This does not always work, so I use the following method, keeping in mind that each point on the 9-point BCS scale is equivalent to approximately 10% of body weight.

Ideal Body Weight (IBW) = current weight / (100% + ([BCS-5] x 10)%)

Example: a 10 kg dog with BCS of 8/9:
IBW = 10 kg / (100% + (8-5)%) = 10 kg / (100% + 30%) = 10 kg / 1.3 = 7.7 kg

This is always an estimation and the patient should be monitored frequently (see step 6).

3. Calculate resting energy requirements for ideal body weight
Always use body weight in kilograms for the following formula:
RER = 70 x (BW)^0.75

This can be done on a regular calculator by using the following formula:
RER = BW x BW x BW =, √ √ =, x 70

Example:
Take our 10 kg dog who should weigh 7.7 kg as mentioned above. Resting energy requirements for IBW = 70 x (7.7)^0.75 = 324 kcal/day.

4. Compare current intake to estimated energy requirements
a. Complicated cases:
For dogs with RER [IBW] x 1.0 > current intake, check thyroid, recheck diet history, increase activity, and/or consult with a DACVN

For cats already consuming less than 0.8 x RER [IBW], recheck diet history, discuss environmental enrichment, and/or consult with a DACVN.

For these complicated cases, severe caloric restriction can result in nutritional inadequacy, so it’s best to consult with someone who can ensure there are no nutrient deficiencies in the final plan.

b. If RER [IBW] x 1.0 < current intake, continue with step 5

5. Select a diet and feeding plan and include treat options
Treat calories should be less than 10% of total kcal, and the remaining kcals should be fed as a therapeutic weight loss diet, if possible. The therapeutic weight loss diets are higher in protein in other nutrients and help avoid nutrient restriction despite caloric restriction.

It’s always best to ensure that there is adequate protein in the chosen diet. Dogs should receive approximately 1 gram protein per pound of current body weight and cats should receive approximately 2 grams of protein per pound of current body weight.

If the pet has concurrent health problems, there are other options – but if you need severe caloric restriction to allow for weight loss, it’s best to consult with a DACVN for these cases. I use homemade diets in a lot of patients that are obese but have other nutritional issues.

6. Reassess the patient
Patients should lose 0.5-2% of starting body weight per week. I try to give my clients a schedule (e.g. it will take up to x months to achieve ideal weight) so they know what to expect. I recommend checking patients’ weight every 2 weeks until they establish a weight loss trend – that is, they are not losing too quickly or too slowly. After the weight loss trend has been established, the weight can be checked every 2-4 weeks. If the plan needs to be adjusted, I usually decrease or increase in increments of 5-10% of total calories. Make sure you reduce treat calories if you do that, but never eliminate treats entirely. I have the best luck with compliance if I include controlled treat options in a weight loss plan.

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