Obesity: Is there anything we can do about the epidemic? (Proceedings)

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Obesity: Is there anything we can do about the epidemic? (Proceedings)


Obesity is the most common nutritional problem encountered in daily practice. Studies suggest that obesity may affect as many as 40% of dogs and 30% of cats in some practices. Obesity, like cancer and infection, is a plural noun, as the list of causes below demonstrates:

Causes
     1. Animal
          a. Breed
          b. Age
          c. Neuter status
     2. Nutritional
          a. Diet
               i. Highly palatable diets
               ii. High fat diets
          b. Feeding
               i. Early feeding practices (?)
               ii. Progressive hyperphagic obesity
               iii. Frequency of eating
               iv. Overeating
     3. Environmental factors
          a. Activity
          b. Stress
               i. Owners
               ii. Housing
               iii. Other animals
          c. Seasonal
     4. Genetic factors
          a. Autosomal recessive traits
          b. Autosomal dominant traits
          c. X-linked traits
          d. Chromosomal abnormalities
     5. Intrauterine, perinatal influences
          a. Intrauterine malnutrition
          b. Intrauterine hormonal influences
          c. Early life dietary influences
     6. Drug-related
          a. Phenothiazines
          b. TCAs (amitriptyline)
          c. Cyproheptadine
          d. Glucocorticoids
          e. Megestrol acetate
          f. Valproate
          g. Lithium
          h. Insulin
          i. Sulfonylureas
     7. Seasonal
     8. Neuroendocrine
          a. Hypothalamic syndrome
          b. Cushing's syndrome
          c. Hypothyroidism
          d. Hypogonadism
          e. Growth hormone deficiency
               i. Genetic
               ii. Acquired (?)
          f. Insulinoma and hyperinsulinism
     9. Viral - ?
     10. Idiopathic

In 2004, we published our experience with an obesity therapy program for dogs that included dietary changes, monthly weight checks, and a structured maintenance portion. We found that clients achieve an average percent weight loss of 15% and a decrease in body condition score (BCS) of an average of 2/9 during 6 months of weight reduction, and maintain the reduced weight in their pets for the following 18 months.1 To our knowledge, this is the most successful documented approach to obesity therapy. Despite this positive overall result, individual results varied widely, and nearly 50% of clients dropped out during the course of the study.

Although understanding the causes of obesity in companion animals remains a daunting challenge for veterinary nutritional scientists, veterinary hospitals that provide clients a structured obesity therapy program offer a valuable service for their clients. After the veterinarian and client identify the problem(s), the client and patient are "referred" to a trained technician, who usually has more time to focus on the complex issues raised during obesity therapy. An outline of our approach follows:

Approach
     1. History
          a. Clinical – onset - age (young, mature), rate - (slow, fast), co-morbid conditions (drug therapy?), disease risks factors (endocrinopathy, musculoskeletal)
          b. Diet – satisfactory?
          c. Feeding – ad lib? Meal? Intake? –high (>maintenance), intermediate (<maintenance>basal), low (<basal)
          d. Environmental – opportunities for activity, other animals, other humans (alternative food sources, saboteurs, allies)
     2. PE – Body Condition Score, Muscle Condition Score, fat distribution, other abnormalities (skin, other)
     3. Labs – as indicated by index of suspicion from Hx & PE (thyroid, adrenal, etc.)
     4. DDX
     5. Simple – young, healthy, high intake, positive history and environment
          a. Intermediate –older, predisposed breed, ± disease, intermediate intake, questionable history (e.g., orphan) or environment,
          b. Complicated – aged, + other disease, low intake, unstable environment
     6. Options for Management
          a. Animal
               i. Simple – healthy animal
               ii. Intermediate – begin treating other conditions before weight loss to assess/gain adherence.
               iii. Complicated – question need for weight loss
          b. Diet
               i. Simple – reduce intake of satisfactory diet
               ii. Intermediate - ± change to reduced energy density food
               iii. Complicated – change to reduced energy, increased protein content diet
          c. Feeding
               i. Simple – meal feed, try to eliminate other sources of food, replacement vs. supplementation of kcal
               ii. Intermediate – Simple + treat bags, recruit other family members as allies,
               iii. Complicated – collaborate with owner on a plan
          d. Owner/environment
               i. Simple – education, find alternative forms of interaction (obedience training, teach tricks to cats, more activity)
               ii. Intermediate – identify hidden sources of food, saboteurs
               iii. Complicated - collaborate with owner on a long-term plan