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Weight Management Clinics- The 30 minute consultationCaroline Burke BSc RVNWeight Management Specialist COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

AgendaWhat is Obesity?The 30 minute consultation - Stages 1 and 2Body condition scoringThe 30 minute consultation - Stages 3 and 4Measuring FoodFollow upMaintenanceTreats and exercise COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Obesity in companion animals COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY3

What Is Obesity?‘Excess accumulation of body fat’ overeating, under-exercising or a combination of both. COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY4

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 COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY5

WhatIs Obesity?Obesityis aCHRONICINCURABLEDISEASE* PAW wellbeing report 2012: YouGov & PDSA COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY6

What can contribute to Obesity?Pre-disposedIncorrect diet – feeding choicesFeeding ‘extras’Feeding behavioursExerciseEDUCATIONStressNeutering COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLYclosettraveler.com

Owners perceptionMedia charactersDo not ‘see’ their pets as we seethemRecent studies show ownersunderestimate body conditionscores97% of owners struggle to identifya healthy body shape for dogsNot understand is health issuePAW Report (2012) COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Consequences of obesityDecreased lifespan in dogs and catsHealthDecreased quality of lifeWelfare ROYAL CANIN Weight Management Clinic COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY ROYAL CANIN Weight Management Clinic

BeforeAfter Posture PostureRocco’s Before Weight: 38.4Kg’s Depression Happy(June 2007) Fight/Flight ConfidentRocco’s After Weight: 25.8Kg’s(December 2007) Sad Fight/FlightRoccoachieveda 33% bodyweight loss!!!!!! Unableto moveefficiently Sociable Painful? Comfortable Unsocial Improved Quality of Life COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

The 30 minute consultation11 COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

The Clinic Name Clinical Weight Management Clinic, Obesity Clinic Positive Healthy weight service, Healthy weightclub, Fit club Descriptive Chub club, Slimmer's club COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

The ClinicBe PreparedSet date for clinic startEnsure everybody knows Start dateWhen to book appointments and who withWhat you will be discussingHow to refer to you COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

How to recruit?ReferralsAnytime and Everyone Involved Discharges Vaccinations Consultations Discussions with reception Owners request COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Why 30 minutes?Stage 1 (10 mins) – HistoryStage 2 (05 mins) - The Weigh-InStage 3 (10 mins) – Set PlanStage 4 (05 mins) – Give plan and diet COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY ROYAL CANIN Weight Management Clinic

Be preparedAppointment pre-booked Use questionnaire prior to appointment Give owner BCS Chart COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

All appointmentsHave pack prepared for clientFlip chart (30 minute guide)QuestionnaireBooklet for OwnerTool KitVet Follow UpFood COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Be preparedTool KitTape MeasurePuzzle feeders and toysBCS chartsAppointment CardKitchen scalesCameraRosettesCertificates COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY ROYAL CANIN Shelley Holden

Calibrating your scales Dr Alex German COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Stage 1History Gathering(10 minutes) COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Stage 1 – Food Questionnaire COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Stage 1 - Exercise Questionnaire COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Further questioningNeed to understand the root of the issueHow and when did obesity first occur?Have there been changes in lifestyle/environmentthat may have attributedCould there be an underlying medical condition– may need to referSpend time understanding the situation COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Stage 2The Weigh-InWeight, Photos, BCS,Measurements(5 minutes) COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Stage 2Weigh AnimalBody Condition ScoreTake Photographs ROYAL CANIN Weight Management Clinic ROYAL CANIN Weight Management Clinic COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Facilitate the taking of good before and after photosTake lots of different anglesNice photos too!!Use them for displays Abbeycroft Vets Willows COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY26

AfterBeforeBefore 10.5kgAfter 6.5kgAfterBeforeBefore 10.5kg COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLYAfter 6.5kg

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Stage 2Take morphometric measurements Shelley Holden Thoracic Abdomen Neck COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY Shelley Holden29

Do you currently use Body ConditionScoring in practice?YES 5 PointNO 9 Point COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

9 Point Body Condition Score1 cat and 5 dog shapes: Chihuahua Jack Russell Pointer GSD Saint Bernard5 breed morphologies: Variations in fat deposition Tailored measures for each individual Client-friendly: greater identification withtheir pet COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY31

Practical 1How good are your Body ConditionScoring Skills?32 COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

-Palpate the pet by onlyapplying light pressure Shelley Holden-Run your hands along the ribcage (following direction of fur)-Run your hands on eitherside of the pets abdomen tosee if you can feel a waist Shelley Holden COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Shelley HoldenLook and feel from above to see ifyou can observe a waist COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Shelley HoldenRun your hands from the back of the ribcageunderneath the abdomen to see if an abdominal tuckis present.Using hands apply light pressure over the lumbarregion, spine and hips. COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Practical 1How good are your Body ConditionScoring Skills?What BCS is my dog?36 COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Shelley HoldenStage 3Set PlanDiscuss diet and exercise(10 minutes) COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY Shelley Holden

Stage 3Educate Owner Seriousness of Obesity Health Benefits Welfare Quality of Life ROYAL CANIN Weight Management Clinic Shelley Holden COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Stage 3Set 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 COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Estimating target weight – How?HOW? COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Decide on appropriate diet COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Owner to keep recordFor feeding and exercise guidesWrite everything downGet owner to record using diaryAssess at every weigh-inWrite down adjustments COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY42

Stage 4Send home with planProvide diet and writteninstructions(5 minutes) COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Send home with written instructionsOwner booklet completedInformation on dietExercise planDiary Shelley Holden COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Stage 4Send 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 COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

How accurate aremeasuring cups? COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Practical 2Using the measuring cup measure .Tip amount measured onto scalesRecord amount Shelley Holden Shelley Holden COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY47

How accurate are measuring cups?Methods 12 different studies Various cup sizesVarious dietsVarious portion sizesResults Accuracy Ranged from 18% under to 80% over Usually an over-estimatePrecision Intra-operator CV: 2% to 15%Inter-operator CV: 2% to 28%Worse for small portionsScales printed on cups were also inaccurate COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Shelley Holden Shelley Holden COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

AfterBehaviourDiscuss changes that will occurMore activeLivelierMore attentionFeeding habitsImproved mobilityImproved groomingImproved QUALITY OF LIFE COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY Shelley Holden

Owner Requirements:CommitmentTime:to monitor feedto complete diariesto attend clinicto weigh foodincrease exerciseincrease play timeto buy products COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLYHave you triedyour own advice?

The follow-up (Repeat Appointment)How often to review?Weight/Measurements/BCSUpdate booklet/filesImplement new ideas, new suggestions Shelley Holden COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLYclosettraveler.com

Feeding plan - AdviceHow 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 mealDon’t suggest everything at once!! Shelley Holden COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Encouragement – even if small lossExplain lossWhat is a safe loss? COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

Safe Weight LossOptimal 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) COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

How to calculate safe weight lossPrevious weight 3 weeks ago was 32kgTodays weight 30.9kgTherefore 32kg -30.9kg 1.1kg1.1/32kg (previous weight) x 100 3.4%3.4/3 (number of weeks since last visit) 1.1% per weekIs that good/bad?What would you do if the dog had lost 0.4% per week? COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY

SupportMonthly competitions – prizesCertificates / awarded at different stagesDisplays to show enrolled petsMembership cards for clients/benefitsMOTIVATION Vetfollowup COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY Shelley Holden

Maintenance Post Weight LossWhich diet to feed?Recent Study shows:Nearly half of dogs who lost weight regained weight post loss14 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 wasoriginally 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 COPYRIGHT MARS INCORPORATED – CONFIDENTIAL – INTERNAL USE ONLY