By Ernie Ward, DVM
A common misperception exists among veterinary professionals that addressing a pet’s obesity will offend a pet owner with obesity. This falsehood prevents many veterinarians from initiating a vital medical conversation, resulting in the avoidable suffering of untold millions of pets and owners spending countless millions in preventable pet care costs. The fact is you can talk about pet obesity without upsetting clients.
Pet obesity communication skills for your team
Evaluating an owner’s feeding habits is where most weight-loss programs begin. Use inviting, open-ended questions such as, “Tell me how you feed your dog throughout the day” or “What does a typical day’s feeding and goodies look like at the Smith household?” instead of more clinical, closed-ended questions such as, “What brand of food do you feed?” or “How much do you feed your cat?” The stories clients tell us are often filled with the most valuable medical information.
Instead of asking “Do you give Buddy treats or table scraps?” try asking “Tell me about Buddy’s favorite human foods or snacks?” This type of nonjudgmental question implies the team understands and accepts the importance of treats in the client’s relationship with their pet. The best forecasters of adherence to a weight loss program are the interviewing skills and the details of the veterinary-client interaction. The conversations the veterinary team initiates concerning diet, lifestyle and attitudes help build trust and establish a client’s interest and willingness in a weight-loss program or nutritional counseling. It is critical to provide adequate staff training and allow ample time with clients to increase success.
“Fat” is an ugly word
It is important we avoid using words such as “fat,” “heavy,” “chubby,” “plump” or other derogatory terms. It is also critical that staff members do not passively diminish the significance of obesity by saying, “He’s not that fat. I’ve seen worse” or “Most pets need to lose a little weight.” Minimizing the potential severity of obesity undermines future weight loss counseling. The goal at this point in the communication process is to gather information, not make a diagnosis or pronounce judgment. Strive to create a clinic culture that understands and values preventive care, especially diet, lifestyle and body condition and seeks ways to enhance compassionate communication to support medical recommendations.
“Obese pets” versus “pets with obesity”
Another subtle, but significant, shift in communication involves using weight as a noun instead of an adjective. When we frame obesity as an adjective, “obese pet,” we potentially minimize the disease state. In human obesity treatment, the shift from “obese person” to “person with obesity” has been important and impactful. A physician wouldn’t dare say “cancer person”; stating “a person with cancer” signals a different relationship with the disease. We don’t say “kidney disease cat,” we say, “cat with CKD.” See the difference? Obesity is a disease defined by the American Medical Association.
Obesity also is a condition ripe with judgment, societal norms and misunderstanding. Many times, we see a person or pet with obesity and conclude poor lifestyle choices, laziness or gluttony are solely to blame. If only it were as easy as eating less and exercising more. Obesity is an incredibly complex disease with genetic, microbial, hormonal, environmental and neurophysiological causes in addition to overeating and inactivity. Watch your word order when communicating about obesity, and you’ll witness increased acceptance and adherence.
Communicating about pet nutrition and obesity with clients can be problematic without prior thought and practice. Few subjects are as emotionally loaded and full of personal opinions as what and how people feed their pets. Veterinarians may worry they will inadvertently offend a client, aren’t comfortable with their knowledge or feel they are too busy to engage in a “food debate.” These factors have contributed to the current pet obesity epidemic.
Despite the challenges associated with pet obesity, ignorance and obliqueness is infinitely worse. The best communication practices begin with honesty. If a pet is overweight, tell the owner. Skip the derogatory terms and focus on the pet’s quality of life. The battle against obesity isn’t about chasing a number on a scale; it’s about improving health and vitality and decreasing disease.
Guide the conversation toward daily activities such as feeding and treating, walks and play activities, climbing stairs and getting in and out of cars. Inquire about inappropriate elimination in cats, jumping onto counters, beds and chairs or withdrawal from contact. Focus on the relationship between pet and pet owner and how better nutrition can improve quality of life.
When the client has obesity
Many veterinarians avoid discussing a pet’s obesity with a client suffering from obesity because they fear inadvertently offending the client. While this certainly can occur, it is extremely rare. You can minimize the risks by adopting a nonthreatening communication methodology whenever discussing pet obesity.
Start with an open body posture. Being seated is ideal, situating yourself at a 45-degree angle to the client without any table or other barrier between you and the client. Studies show people are most comfortable talking to a medical professional at a two- to three-foot distance from your closest body part. Don’t cross your legs or arms, and avoid holding a medical record or computer between your body and the client. Maintain good eye contact and speak in a normal, warm tone. Think to yourself that this conversation is about the pet’s health, not the client’s weight issues. Assume the client may know that their pet is overweight but doesn’t understand the negative health effects of obesity. If you preload your thoughts with ideas about the client’s weight, your nonverbal communication will convey your discomfort and nervousness. If a client perceives the veterinarian is uncomfortable or unconfident, they will disregard their advice.
Open the pet obesity conversation with a statement acknowledging the relationship between the pet and owner:
“Mrs. Guild, I know how much you care for Skippy and that’s why I want to discuss his weight. As a veterinarian, it’s my job to keep updated on advances in medicine and how to keep Skippy as healthy and happy as possible. Numerous studies conclude if a pet is overweight their risk of developing diabetes, arthritis and high blood pressure, and even many types of cancer is increased. What do you think about Skippy’s current weight?”
“I suppose he’s a little heavy like the rest of us.”
“You’re right, Skippy’s not alone in his battle against obesity. Veterinarians are often trained to focus on getting our patients to a certain weight, no matter what. I think we should take a slightly different approach with Skippy. I want us to focus our efforts on improving Skippy’s overall health and well-being so that he can be around for a long time. How does that sound?”
“Oh, anything I can do to help Skippy. He’s my baby.”
By directing the conversation away from a specific weight and number and toward quality of life and health, we can subtly shift the discussion in our favor with little risk of offending anyone, regardless of how sensitive they may be. You can now begin to discuss diet, treats, exercise, recommended diagnostic tests, goals and quality of life in a more collaborative setting. If you approach the issue directly and say, “Skippy’s getting a little full around the middle. His ideal weight should be about 10 pounds less. We need to get him on a diet to get those pounds off,” you will likely be met with defensiveness and reluctance to follow your recommendations.
What if the veterinarian has obesity?
Veterinarians with obesity may be reticent to discuss weight loss with their clients because they may be uncomfortable with their own body condition. If you’re struggling with your own weight and diet, be honest and proactive. By stating the obvious and discussing personal weightloss challenges, a veterinarian with obesity can transform a potentially anxious exchange into a calm and meaningful conversation. Of course, a veterinarian using this approach must be sincerely seeking help and actively pursuing lifestyle and dietary changes.
“Mrs. Howe, I’d like to take a few minutes to discuss Rover’s weight gain. I know how much he means to your family and that you want him to be as healthy and lively for as long as possible. As you can plainly see, I’m like most Americans who share Rover’s weight problem and the potential medical problems that accompany obesity. And, like Rover, I want to be around a long time and see my kids grow up and kiss my future grandkids. For me to do that and to be able to do things I want to do with them, I’m working on getting healthier. As you probably know, this is not easy for pets or people, but I’d like to share with you some strategies that I have found successful for both my own pets and my patients.”
By reframing the discussion in personal terms and immediately transferring the focus to the pet’s condition, you will be viewed as more truthful, caring and concerned. These are attributes every veterinarian should strive for with any client interaction and ultimately leads to increased adherence to our recommendations, regardless of the topic.
When the client doesn’t care
Not every pet owner is ready or willing to discuss their pet’s weight. While we don’t want to force the issue or appear overzealous, we still must address the problem and allow for future visitation.
“As we’ve mentioned, I’m concerned about Freddie’s weight gain.”
“Yeah, well he’s a house cat and he’s going to be fat.”
“You’re absolutely right. Indoor cats have a higher incidence of weight problems and associated diseases such as diabetes than outdoor cats. The great news is if Freddie sheds as few as two or three pounds, it can reduce his risk of those diseases significantly. I’m also glad Freddie lives inside your safe home; I don’t advocate cats living outdoors in our area—it’s simply too dangerous.
“I’m going to send you home with some information on food choices for indoor cats that I’d like you to look over when you have some time. You may be surprised at how easy some of the steps we can take to help Freddie lose weight and be happier and pain free. Since he’s gained more weight over this past year, I think we should follow up in three months instead of waiting a year before we see him again.”
Make your point politely, review the major health risks associated with excess weight and keep the emphasis on health and quality of life. The key is to continue discussing obesity in the face of adversity and not shut down or dismiss the client as “difficult.” Many clients will take action eventually, and if the veterinary team has remained helpful, positive and proactive, the client will return. If the pet owner feels vilified, judged or uncomfortable, they will likely seek help from a pet store or other nonprofessional.