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Compendium January 2009 (Vol 31, No 1)

Focus on Nutrition — Using a Diet History to Improve Adherence to Dietary Recommendations

by Kathryn Michel, DVM, MS, DACVN

    Abstract

    Proper dietary management is essential to pet health, yet changing pet owners' feeding practices is often difficult. Taking a diet history provides an opportunity to open a dialogue about animals' dietary needs as well as invaluable information that will aid in tailoring specific dietary interventions to the needs and preferences of patients and their caregivers.

    Communicating effectively with people about the nutrition and dietary management of their pets can be difficult, particularly when the goal is to persuade them to alter their feeding practices. However, circumstances frequently arise in which a change in feeding management may be in the best interests of a pet. Obtaining a complete diet history is the essential first step in the process of altering feeding practices to suit a pet's needs. The diet history provides information about what the pet is being fed and whether this food is complete, balanced, and appropriate to the pet's life stage and health status. Just as important, the history provides information about how food is used in interactions between the pet and the other members of the household. Understanding this relationship is a key element when designing dietary interventions that meet the health and nutritional needs of the patient and are acceptable to the pet's caregivers.

    Elements of the Diet History

    A complete diet history gives an accurate account of all foods fed to a pet on a typical day. It is an opportunity to evaluate all the ways that food is involved in interactions between the pet and the other members of its household. It should also be an opportunity for the pet's caregivers to offer their viewpoints regarding the proposition of modifying their feeding practices.

    The Household

    Begin by asking about who lives with the pet. How many adults and children are in the household? Do any of them spend all day with the pet? Inquire whether there are other pets in the home and whether they are—or can be—fed separately from the patient. Can the patient get into the other pets' food? Ask whether the pet is confined indoors or is allowed outside. If the pet is allowed out, is it supervised while it is outside? Does it have the opportunity to steal food, get into garbage, scavenge, or hunt?

    The Principal Diet, Feeding Routines, and Eating Behaviors

    Obtain the precise names (including flavor, if appropriate) and brands of all commercial pet foods that the patient is receiving and the specific amounts fed. Often, caregivers cannot provide this information accurately by recall alone and need to check labels and measure feeding portions. Also, pet owners who use a scoop to measure dry food often do not realize the true size of their measuring device. If the pet is eating a canned diet, ask what size can the owner buys. Some varieties of pet food are sold in multiple can sizes (e.g., 5.5 and 12 oz), so the size used by the client is important information. Make sure to ask whether the food the pet is currently eating is its usual diet and, if not, when the diet change was implemented.

    If the pet is eating a commercial pet food, ask if the diet is being supplemented with any human foods. If this is the case, it is important to get accurate details, including measured amounts of all foods routinely given to the pet. If the pet is being fed a home-prepared diet, ask for the recipe, including measured amounts of all the ingredients. Some owners do not use a standard recipe when making a home-prepared diet. It is useful to ask these owners to keep a diary of all food fed to the pet for 5 to 7 days. Be certain to inquire whether the pet is receiving any dietary supplements. If possible, have the client bring in the supplements—or at least the label information—so you can see exactly which nutrients are being supplemented and in what quantities.

    Ask about the daily routine of feeding the pet. Is the pet fed at certain times of the day, or is food always available? If the pet is fed with other pets, are the meals supervised? Does one person assume responsibility for feeding the pet, or can it vary day-to-day? This is important information, especially when you are making dietary recommendations, because the person who brings the pet to the office may not be the person who will be implementing the new plan. Ask about how and where the food is stored (e.g., in a sealed container, in the refrigerator). If the pet is fed a dry food, is the food bought in large quantities, and how long does it take to use up a bag of food? Food can lose its freshness over time, especially if it is not stored under optimal conditions.

    Inquire about the pet's normal feeding behavior. Is the pet an "easy keeper" or a picky eater? Does the pet eat the food as soon as it is offered, or is it content to graze throughout the day? Does the pet usually eat all the food that is offered? Does the pet beg for food between meals? If the pet is not eating as it normally does, find out what has changed and for how long the behavior has been altered.

    Treats, Supplements, and Exercise

    When inquiring about treats, ask the question several times in different ways. Ask specifically about which commercial treats are used—not just the brand name but also the flavor, variety, and size. Ask about human foods and table scraps. Ask about products or foods that are used to promote chewing and dental hygiene or to alleviate boredom. Also inquire about different ways food may be used as a reward, such as for performing tricks or for good behavior during walks. Owners do not always consider such items treats, and many of the products and foods used for these purposes are high in calories.

    It is important to remember to inquire whether the pet routinely receives any supplements or medications that are disguised with food. Human foods that are typically used to pill a dog or cat, such as cheese, lunch meats, or peanut butter, are often high in sodium, fat, and calories. For example, one study evaluating dogs with cardiac disease showed that 62% of the owners used human or pet food for pill administration and that many of these foods were high-sodium table foods such as cheese or lunch meats.1

    One further point to ask about is the pet's level of activity and opportunity to exercise. Is the pet walked regularly? How often, and how far? Find out whether the pet goes outside, has a fenced-in yard—and if so, how large—or participates in regular activities that involve exercise, such as going to a dog park or an agility class. See if you can gauge whether increasing the opportunity to exercise would be feasible in the household. This information is especially valuable when you are designing a weight reduction program for a patient.

    Gathering the Information

    This may seem like a great deal of information to gather in a routine office visit, but the process can be expedited by having a  diet history form available for clients to fill out while they are in the waiting room. As previously mentioned, the client may not be able to recall all of the information in the office and may need to take the form home. If your practice has a Web site, you can have a link to a downloadable version of the form so that clients can fill it out before the office visit. To help expedite the process, a veterinary technician familiar with taking diet histories can either gather the pertinent information directly from a client during the visit or review the diet history form for completeness and accuracy once the client has filled it out.

    Negotiating a Diet Change

    The information obtained in the diet history will be invaluable for making appropriate and, hopefully, acceptable dietary recommendations for your patients. Knowing a pet's current diet and any recent changes to it will inform your decision about what kind of dietary modification may be necessary to address the pet's health condition and what kind of diet the pet may find most acceptable. Being aware of owner preferences and potential obstacles to change will help you tailor your recommendations not only to the pet but also to the entire household to ensure the greatest probability of success and adherence. Understanding the client's attitude toward, and concerns about, the dietary management of pet dogs and cats will present you with the opportunity to open a dialogue with the client about pet nutrition and educate him or her about the reasons for your recommendations.

    Investigations in human medicine have found that when physicians make an effort to talk with patients about their knowledge, beliefs, concerns, and expectations about their condition, the result is better adherence to treatment regimens.2 Exploration of all of these issues from a patient's perspective on his or her illness permits the attending health professional to address deficiencies in knowledge or understanding of the condition and its treatment and the patient's ability and willingness to pursue a particular course of therapy. In veterinary medicine, the owner speaks for the patient, but the same principle applies.

    With regard to dietary practices, despite a basic uniformity in nutritional requirements and physiologic needs, there is considerable variation in what humans eat. In the case of pet dogs and cats, their owners largely determine what they eat on a daily basis. Yet in many, if not most, cases, client education alone will not succeed in changing habits and behaviors relating to how a pet is fed. Just as a person's social and cultural context will influence his or her own dietary habits, it will also have an impact on how and what that person feeds a pet. Therefore, it is important to consider the social and cultural aspects of owners' food consumption in order to communicate effectively with them about their pets' nutritional needs and appropriate dietary management, particularly if you are attempting to change current feeding practices.3

    Conclusion

    The information that can be obtained from a diet history can greatly facilitate the process of implementing dietary therapy for a patient. It can help not only in making an appropriate diet selection and accurate feeding recommendations but also in understanding the pet owner's rationale for current feeding practices and assessing any concerns that may arise from a diet change. By anticipating problems, you should be able to craft the dietary intervention in a way that will be acceptable to the pet's household or, at the very least, to communicate more effectively with the pet owner about the rationale for the changes in feeding management. You will be in a better position to explain why you feel the changes you are proposing are in the pet's best interest and to look for compromise when your recommendations and the pet owner's preferences are in conflict.

    Downloadable PDF

    Dr. Michel discloses that she has received financial support from Nestlé Purina PetCare Company and Royal Canin.

    1. Freeman LM, Rush JE, Markwell PJ. Dietary patterns of dogs with cardiac disease. J Nutr 2002;132:1632S-1633S.

    2. The "why": a rationale for communication skills teaching and learning. In: Kurtz S, Silverman J, Draper J. Teaching and Learning Communication Skills in Medicine. 2nd ed. San Francisco: Radcliffe Publishing; 2005:13-27.

    3. Michel KE. Unconventional diets for dogs and cats. Vet Clin North Am Small Anim Pract 2006;36:1269-1281.

    References »

    NEXT: Immunosuppressive Therapy for Canine Immune-Mediated Hemolytic Anemia

    didyouknow

    Did you know... More than half (54%) of US pet owners would buy a supplement for their pet over themselves. Read More

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