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Compendium December 2010 (Vol 32, No 12)

Focus On Nutrition — Increase the Success of Weight Loss Programs by Creating an Environment for Change

by Julie Churchill, DVM, PhD, DACVN

    Abstract

    Veterinary professionals frequently recommend weight loss programs for pets, but success is often elusive. By learning techniques to assess clients’ readiness for change, the veterinary team can apply communication tools and strategies to help clients overcome obstacles and barriers to sustainable change. With a better assessment of a client’s ability to change, a weight loss plan can be implemented at the right time in the right way to achieve better adherence to the agreed-upon plan and improve patient health.

    All too often in small animal practice, the discussion about weight loss and obesity is a frustrating one. The topic can be sensitive, and recommendations frequently go unheeded. Before lack of success in helping pets achieve and maintain a healthy weight leads you to ignore obesity in your patients, consider trying another way of communicating with your clients about helping their pets.

    Obesity continues to be the most prevalent disease of dogs and cats: it is estimated that between 24% and 40% of pets in the United States are overweight or obese.1,2 Although it is well established that obesity negatively influences health, well-being, and even life span,3,4 veterinary professionals still struggle to influence clients to begin or adhere to a weight loss program for their pets. One difficulty may be that veterinary team members lack concrete tools to assess their clients’ readiness for change. By using carefully worded questions when taking a medical and diet history, veterinary professionals—both veterinarians and technicians—can identify a client’s receptiveness to and readiness for change. With this knowledge, they can better identify the appropriate time to implement a nutritional plan. If a client is not yet ready, they can instead help him or her explore obstacles and overcome barriers to sustainable change.

    Essential Elements of a Weight Loss Program

    In veterinary practice, there are three essential elements of a successful weight loss program. Ensuring that each of these components is present greatly contributes to successful patient weight loss as well as client and veterinarian satisfaction.

    1. Establish owner commitment: Assess the client’s readiness for change, as outlined below. If the client is ready to act, proceed with your nutritional plan. If not, use statements and questions such as the examples in TABLE 1 to encourage the client to move from thinking (contemplation) to doing (action).

    2. Customize the weight loss plan: Partner with the client to create an individualized plan that works for him or her and meets the nutritional needs of the pet. A careful and complete diet history (e.g., food and treat types, amounts, schedule)5 can reveal important information about how the family relates to the pet through food and often provides insight about potential challenges for the client. The diet history can also reveal information about the pet’s nutritional status, which is often imbalanced from excess treats and human foods being added to commercial pet foods. Because pets’ energy needs can vary significantly, it is important to know an individual pet’s current caloric intake. The diet history can provide this information, which can then serve as a much more accurate starting point for calculating the pet’s specific food dose (start at 75% to 80% of current intake6).

    3. Reassess: Initially, biweekly follow-up helps to support clients, ensure a healthy rate of loss (0.5% to 1.5% body weight/week), and detect potential relapses early so that the weight loss plan can be adjusted or the client redirected before additional weight gain occurs and frustration becomes another barrier to success.

    Keys to Communication

    Great communication skills are as essential as clinical (physical examination and technical) skills to achieving success in helping clients with weight loss programs for their pets. Often, the most frustrating cases are those in which the client’s and the veterinary professional’s expectations are mismatched. An appreciation of the client’s level of motivation for weight loss allows us to tailor our interventions and can help reduce our frustration with clients who do not adhere to the weight loss program we have designed.

    Using collaborative communication skills encourages clients to actively participate in their pets’ care. This communication style, known as relationship-centered care,7 uses techniques that engage the client, allowing for shared decision-making between the client and the veterinarian. Shared decisions are especially important in developing a successful weight loss plan. To begin this process, first ask permission to discuss the pet’s weight. This helps include the client in the direction of the visit, and the answer will give you insight into the client’s perspective. To help elicit pertinent information, especially when collecting a diet history, use open-ended questions, such as those beginning with “when,” “what,” and “where.” When the client answers, summarize and clarify the information in a supportive, nonjudgmental way. These techniques, called reflective listening and empathetic statements, communicate to the client that his or her perspective is recognized and valued. TABLE 1 provides some specific examples of these communication techniques, as well as common client statements that can help identify the client’s stage of change.

    Moving Clients from Thinking to Doing

    The best predictors of adherence to a weight loss program are the veterinary professional’s interviewing skills and the qualities of the veterinary–client interaction.8 To improve adherence, it is essential to establish an atmosphere of trust and demonstrate concern for both the patient’s and the client’s well-being.9 It is also important to understand how behavior change takes place.

    Psychologists have developed several models to help guide understanding of how humans make changes in behavior to improve health. The “stages of change” model developed by Prochaska and colleagues,10 also known as the transtheoretical model, can be used to assess a client’s readiness to change his or her behavior.11 It can help veterinary professionals better understand the change process, better partner with clients and patients, and customize recommendations that best suit their clients’ needs—in other words, to use the “right” approach for the “right” client at the “right” time. Implementing a weight loss plan when the client is ready to act on your advice will improve your success and be a more efficient use of your time.

    Step 1. Identify the Stage of Change

    The transtheoretical model identifies five stages of change and their characteristic attributes10,11:

    1. Precontemplation. The person has no intention of taking action in the next 6 months. These clients might commonly be referred to as resistant, unmotivated, or unaware, but clearly, they are not ready to change. In reality, our intervention programs are often not ready for them.

    2. Contemplation. The person is aware of the pros and cons of changing and intends to change in the next 6 months. These clients may be stuck “thinking about it,” intending to change “soon.”

    3. Preparation. The person plans to take action in the next month. Clients may have recognized the problem of their pet’s weight and already sought advice from books, online sources, or a pet store employee, trainer, or veterinary professional.

    4. Action. The person has taken action that is significant enough to reduce the risks for disease. For example, the client may have reduced the number of treats fed or selected a different pet food. However, a change is not considered a significant action unless it has reduced calories by at least 10% and provided complete and balanced nutrition.

    5. Maintenance. The person continues action to prevent relapse.

    Step 2. Select a Stage-Appropriate Intervention

    Many weight loss programs fail because the type of intervention chosen is not matched to the client’s readiness to change. Many traditional programs are action-oriented, but most clients do not start in the action stage. By understanding the stages of change, veterinary health professionals can adapt their communication tactics to better meet a client’s readiness and support the client to become ready for change (TABLE 1). It may take time and several visits to establish rapport and build the trust necessary to move clients along to the next stage. These visits may require patience, but we can better serve the patient’s health needs and build great loyalty when we partner with these clients.

    1. Precontemplation. If a client is in this stage, it is not yet time to try implementing a weight loss plan for the pet. However, it is equally important not to ignore the patient’s obesity until the next annual examination. A frequent monitoring plan should be implemented for these patients. Express your concern about the pet’s health and recommend monthly follow-ups to monitor for any adverse effects of being overweight. Depending on the patient’s health, these can be brief weight checks performed by a technician. By conveying care and concern for the patient rather than judgment, you can follow both the patient and the client so that you are ready with a weight loss plan when the client is more receptive.

    2. Contemplation. If a client seems to be “stuck” in this stage, he or she may need to learn more about the issues involved. Providing resources such as handouts or links to reliable Web sites may give them necessary information and reinforce the message that you care about their pet’s health and that obesity is a real health concern.

    3. Preparation. Recruit these clients for action-oriented programs. Ask them if they are ready to begin.

    4. Action. Work with clients to design an individual weight loss plan that accounts for their pet’s needs and their own schedule and lifestyle. Provide feedback and compliments on the patient’s progress to encourage the client to stay with the plan.

    5. Maintenance. Refine the plan as necessary to achieve or continue healthy weight loss. Give clients information and permission for a possible relapse. This removes judgment if a relapse should happen and encourages them to seek your help if it does.

    Conclusion

    When you form a partnership with a client, you create an environment that supports change. By understanding the stages of change, you can help move your clients from thinking to doing, bring them closer to implementing a weight loss program for their pets, and, ultimately, improve their pets’ health. Selecting the right intervention at the right time for the right client can tremendously improve the clinical outcome. Successfully managing obesity can change a frustrating problem to a rewarding one. The pet’s health and quality of life improve, and the pet owner becomes a loyal client because he or she has been an active partner in the health care plan.

    Related Reading

    Using a Diet History to Improve Adherence to Dietary Recommendations, January 2009.

    Downloadable PDF

    Dr. Churchill discloses that she has received financial support from Nestlé Purina PetCare Company and serves on its advisory board.

    1. Lund EM, Armstrong PJ, Kirk CA, Klausner JS. Prevalence and risk factors for obesity in adult dogs from private US veterinary practices. Intern J Appl Res Vet Med 2006;4:177-186.

    2. Lund EM, Armstrong PJ, Kirk CA, Klausner JS. Prevalence and risk factors for obesity in adult cats from private US veterinary practices. Intern J Appl Res Vet Med 2005;3:88-96.

    3. Kealy RD, Lawler DF, Ballam JM, et al. Effect of diet restriction on life span and age related changes in dogs. JAVMA 2002;220:1315-1320.

    4. Obesity: epidemiology, pathophysiology and management of the obese dog. In: Pibot P, Biourge V, Elliot D, eds. Encyclopedia of Canine Clinical Nutrition. Royal Canin; 2006:11-16.

    5. Michel KE. Using a diet history to improve adherence to dietary recommendations. Compend Contin Educ Pract Vet 2009;31:22-24.

    6. Perea S. What’s the take-home? Nutrition. Clin Brief 2010;8:63-65.

    7. Cornell KK, Kopcha M. Client-veterinarian communication: skills for client centered dialogue and shared decision making. Vet Clin North Am Small Anim Pract 2007;37:37-47.

    8. Morrisey JK, Voiland B. Difficult interactions with veterinary clients: working in the challenge zone. Vet Clin North Am Small Anim Pract 2007;37:65-77.

    9. Abood SK. Increasing adherence in practice: making your clients partners in care. Vet Clin North Am Small Anim Pract 2007;37:151-164.

    10. Prochaska JO, Johnson S, Lee P. The transtheoretical model of behavior change. In: Shumaker SA, Ockene JK, Riekert KA, eds. The Handbook of Health Behavior Change. 3rd ed. New York: Springer; 2009:59-84.

    11. Contemporary issues in clinical nutrition. In: Buffington CA, Holloway C, Abood SK. Manual of Veterinary Dietetics. St Louis: Saunders; 2004:143-162.

    References »

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