Words by Nicky Jarvis
Government statistics show that nearly 62% of people in the UK are overweight with 27% considered to be clinically obese (body mass index of 30 or higher) compared to just 15% in 1993. With rising obesity levels questions have been raised over how to tackle patient issues and how best to achieve effective weight loss. Studies also show that between 29-39% of dogs and 19-29% of cats are thought to be overweight and many small animal practices have invested time in weight management clinics. But how much success do our human and small animal counterparts have and what lessons can we take forward to the equine world?
In companion animal practice only a few studies exist on the success of weight loss programmes and many are focused on short-term results rather than return of the animal to optimal weight. In one study, which included client education, only 53% of the dogs enrolled completed a six month weight loss programme. Owner related issues such as lack of compliance and illness were cited as reasons for not completing the course and interestingly the more obese animals were most likely to be lost to follow up. One factor for lack of compliance may be that diets aim to achieve a safe weight loss of 1% bodyweight per week and for the first 6 to 7 weeks this is meaningful to the owner. However, without regularly reducing the feed ration further, weight loss quickly falls to 0.3% BW per week. Whilst still a significant percentage for a cat or a dog, this can prove frustratingly slow to the owner.
Like humans, cats and dogs also show the ‘rebound effect’ when it comes to weight loss. One study showed 48% of dogs and 46% of cats began to gain weight at the end of a weight loss programme. So is finding ways to support and motivate horse owners long-term just as important as that initial short term success?
Weight gain is often insidious and in small animals many risk factors have been identified. Breeds such as the Labrador, Pug and Golden Retriever have a higher prevalence of obesity thought to be linked to early life rapid weight gain seen in the growing phase of these breeds. Certainly in humans, rapid weight gain in growing children has now been linked to an increased likelihood of obesity in adulthood. The existence of a ‘thrifty gene’ is often discussed and debated in native ponies and cobs. And with recent studies demonstrating specific genetic markers in horses which result in elevated insulin levels, increased obesity and laminitis could we soon be soon be able to identify ‘at risk’ horses before they become obese?
And what becomes of those animals that never even enroll on a weight management programme. Two small animal studies from 2008 and 2014 suggested that vets discussed the weight and body condition of overweight dogs in less than 2% of consultations. So do some of us struggle to raise the subject of an overweight horse?
Guidelines for human doctors recommend regular screening of patient weights and active encouragement to join commercial weight loss programmes that have been found to be far more effective than ‘going it alone’. In fact a doctor can now refer a patient to Slimming World and similar organisations on the NHS. However doctors find that lack of time and knowledge, fear of causing offence and a belief that intervention would be ineffective hold them back from raising the subject with patients during routine consultations.
A study led by Professor Paul Aveyard and published in the Lancet looked at the efficacy of a scripted ‘brief’ opportunistic intervention by GP’s in terms of encouraging patients to lose weight without the advice being deemed ‘inappropriate’. Patients attending a routine consultation were invited by the practice receptionists to weigh themselves on arrival at the surgery and then at the end of the consultation the GP was asked to spend just 30 seconds advising those patients deemed to be overweight:
GP: “While you’re here I just wanted to talk about your weight. You know the best way to lose weight is to go to (Slimming World or Rosemary Conley) and that’s available free on the NHS.”
GP: “Yes and I can refer you now if you are willing to give it a try?”
Patient: “Yes, OK.”
GP: “Ok, what you need to do is to take this envelope to reception…….. And I’d like to see you again in 4 weeks time please if that is OK?”
The study found that 77% of patients offered the service agreed to take part and over 40% went on to successfully attend the weight management programme. This success was also replicated in Hugh Fearnley-Whittingstall’s experiment featured in BBC One’s ‘Britain’s Fat Fight’ where a group of Bristol based GP’s were trained in the brief intervention technique. And 4 out of 5 patients reported they found the conversation both helpful and appropriate.
So perhaps this is something we can learn from the human world. If one of our biggest struggles is getting horse owners to recognise that their horse is overweight and motivate them to address the problem perhaps we need to start with that opportunistic conversation, our own ‘brief’ intervention at the end of a routine consultation. And as most weight gain is insidious perhaps by automatically producing a weight tape or body condition chart at every vaccination or dental check we can show owners with how much their horse has gained (or lost) in a few months rather than waiting until the situation harder to manage.