Is obesity a disease?
The American Medical Association officially recognized human obesity as such in 2013. In veterinary medicine, the answer is “no”—for now.
Ernie Ward, DVM, founder of the Association for Pet Obesity Prevention, is working with veterinary nutritionists, surgeons and other experts on a proposal that may be presented to the American Veterinary Medical Association as early as this summer. If the AVMA House of Delegates signs off on the idea that pet obesity is a disease, the impact could be similar to what is happening in human medicine: greater awareness and acceptance of the need to diagnose and treat obesity.
Dr. Ward was among more than 100 professionals from the human and veterinary medicine communities who met in Atlanta in November at the inaugural Obesity Conference. The two-day event, organized by the World Small Animal Veterinary Association’s One Health Committee, aimed to address ways to prevent obesity in people and pets.
Stephen Cook, M.D., MPH, a pediatrician and associate professor at the University of Rochester Medical Center in New York, told attendees that obesity is not a choice.
“Obesity is a complex disease that is poorly defined,” said Dr. Cook, whose talk focused on obesity’s link to human cardiovascular disease.
“There are biologic drivers, there are environmental factors, there are … neuroendocrine pathways in terms of how you respond to food,” he said. “There’s genetics and susceptibilities as well as specific single-gene mutations.”
Ward, whose surveys have found that more than half of U.S. cats and dogs are overweight or obese, at one time didn’t think of obesity as a disease.
“Slowly, over the past decade, as the research came in, you realized there was a genetic component to this, you realized that there are underlying changes to the microbiome, for example,” he said. “It really does fall under the definition of disease.”
What Is Obesity?
Ward and other members of his association have crafted a consensus definition of obesity, but the description is only part of the proposal. The second step, now underway, is to define obesity from a clinical point of view.
“Is it 20 percent above ideal weight?” he said. “Is it a BCS [body condition score] of 5, 6, 7, 9, depending on which scale you’re using?”
A standardized BCS scale is the third step. Some charts run from 1 (very thin) to 5 (obese), while others go from 1 to 9, with 5 being ideal. Ward’s group supports a nine-point scale.
The last thing to do is generate best practices for treating obese patients and counseling pet owners.
“Maybe we revise AAHA guidelines, maybe we have a different set of guidelines, but regardless we want to see obesity treated as a disease with better science,” Ward said.
Obesity is a One Health matter, he said.
“Since this is the most commonly diagnosed condition in veterinary medicine and human medicine, I feel strongly that we need to be aligned [with the AMA],” Ward said.
He hopes all pet health insurers one day will cover obesity.
“It will be very important as pet insurance matures,” he said. “One thing we don’t want to happen is owners not pursue some very simple treatments—either medications or therapeutic diets or services that veterinarians could offer. We would not want cost to be a barrier.”
The 25 conference speakers ranged from Heidi Blanck, MS, Ph.D., the obesity chief in the Division of Nutrition at the U.S. Centers for Disease Control and Prevention, to Alex German, BVSc, Ph.D., Dipl. ECVIM, a senior lecturer at the University of Liverpool Institute of Veterinary Science in England.
More than 1-in-3 American adults and about 9 percent of toddlers are obese, Dr. Blanck said.
“Obesity is a complex issue,” she said. “We know that it’s behavior, we know there’s genetics [and] society. There’s a lot of interplay.”
Dr. German called obesity “a family issue.”
“We know that parents who are overweight tend to have overweight children, and there are veterinary studies that show overweight owners tend to have overweight pets,” he said.
Pet owners who indulge cats and dogs with food and treats have a hard time complying with weight-loss plans, German said.
“Studies that we look at … suggest that early weight loss is very quick—1 percent per week in the first few months—but then it rapidly slows down,” he said.
Two ways that veterinarians can help prevent obesity is by identifying at-risk pets and by educating new dog owners who show up with a puppy, German said. Evidence-based growth charts that would help a veterinarian spot an at-risk patient are on their way, he said.
Among other speakers:
- Elizabeth Lund, DVM, MPH, Ph.D., the senior director of research at Banfield Pet Hospital, pointed to a link between obesity and the composition of pet food.
“High-fat diets have been found to be positively associated with overweight or obesity,” she said. “The cheaper the source of the food, the higher the risk for overweight or obesity."
- Gregg Takashima, DVM, a Lake Oswego, Ore., practice owner and One Health Committee member, said the human-animal bond plays a role in creating obese pets.
“When you feed your pet, you bring that pet closer to you,” he said. “When you look at that pet … neurotransmitters make you feel good. … So if feeling good means feeding our pets, we’re going to feed our pets more.”
- Jacqueline Neilson, DVM, Dipl. ACVB, a consultant at Elanco Animal Health, suggested that the veterinary profession has equated a strong appetite with a healthy animal. When a pet’s history is being documented and the owner reports the pet has a good appetite, she said, the reaction often is “Oh, good!”
- University of Georgia Professor Joe Bartges, DVM, Ph.D., Dipl. ACVIM, Dipl. ACVN, said some veterinarians have difficulty broaching the subject of obesity, especially when the pet owners are overweight.
“When you say, ‘You have a fat dog’ … it pigeonholes you immediately into all sorts of judgmental perceptions,” Dr. Bartges said.
The proper approach: “Your pet has obesity,” which “takes it out of the realm of being personalized,” he said.
- Several presenters noted the proven benefits of exercise for both people and pets. University of Missouri Professor Rebecca Johnson, Ph.D., RN, FAAN, FNAP, participated in a program that encouraged volunteers to walk shelter dogs.
“We had increased numbers of animals adopted because the dogs were not bouncing off the walls,” she said. “Those dogs had been exercised; they were calmer.”
Originally published in the December 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!