ArticlePDF AvailableLiterature Review

From Problem to Success: Feline weight loss programs that work

Authors:

Abstract

Practical relevance: Obesity is the most common unhealthy nutritional condition that is recognized in cats. Documented associated health risks include diabetes mellitus, lameness, non-allergic skin disease, feline lower urinary tract disease and idiopathic hepatic lipidosis. Clinical challenges: Simply recommending a diet designed for weight loss fails, in most cases, to result in successful weight loss in the obese or overweight cat. A more in-depth approach that centers on communication and commitment, alongside a program of feeding a predetermined amount of a specific diet plus exercise and enrichment of the cat's life, offers a chance for a healthy result. Patient group: It has been reported in some developed countries that as much as 40-50% of the feline population may be overweight or obese, with middle-aged cats, male cats, mixed-breed cats and neutered cats being at greatest risk. Audience: This review of what is currently known about the health risks, predisposing factors and treatment of excessive weight gain in cats is aimed at all veterinary health professionals. Evidence base: The information reported in the review is drawn from the current scientific literature as well as from the clinical experience of the authors.
JFMS CLINICAL PRACTICE 327
CLINICAL REVIEW
Journal of Feline Medicine and Surgery (2012) 14, 327–336
Kathryn Michel and Margie Scherk
FROM PROBLEM TO SUCCESS
Feline weight loss programs
that work
Practical relevance: Obesity is the
most common unhealthy nutritional
condition that is recognized in cats.
Documented associated health risks
include diabetes mellitus, lameness,
non-allergic skin disease, feline lower
urinary tract disease and idiopathic hepatic
lipidosis.
Clinical challenges: Simply recommending a diet
designed for weight loss fails, in most cases, to
result in successful weight loss in the obese or
overweight cat. A more in-depth approach that
centers on communication and commitment,
alongside a program of feeding a predetermined
amount of a specific diet plus exercise and
enrichment of the cat’s life, offers a chance for
a healthy result.
Patient group: It has been reported in some
developed countries that as much as 40–50% of the
feline population may be overweight or obese, with
middle-aged cats, male cats, mixed-breed cats and
neutered cats being at greatest risk.
Audience: This review of what is currently known
about the health risks, predisposing factors and
treatment of excessive weight gain in cats is aimed
at all veterinary health professionals.
Evidence base: The information reported in the
review is drawn from the current scientific literature
as well as from the clinical experience of the
authors.
Kathryn E Michel
DVM MS DACVN
University of Pennsylvania
School of Veterinary Medicine, USA
Email: michel@vet.upenn.edu
Margie A Scherk
DVM DABVP (feline practice)
catsINK, Vancouver, Canada
Email: hypurr@aol.com
Consumptionofkcal > energy expenditure=weight gain
By far the most common nutritional condition that is recognized in
pet cats is the problem of excessive weight gain. There have not been
any recent large scale investigations of the prevalence of this condition;
however, an investigation from the mid-1990s found that nearly 29% of
8159 cats over 1 year old and living throughout the United States were
classified as overweight, with a body condition score (BCS) of 4/5, and
another 6.4% were judged grossly obese (BCS = 5/5).1There is no rea-
son to think that the situation has improved in the past 15 years, nor is
this problem limited to the US, as a more recent investigation in France
attests.2The investigators in that
study evaluated 385 healthy cats
seen at a veterinary school vacci-
nation clinic and found that 27%
had a BCS of 4/5 or 5/5. These
figuresare concerning, but they
do not reveal the entire picture.
When the US data was analyzed
to look at the proportion of cats
with a BCS of 4/5 by age, the
percentage of overweight/obese
cats aged 5–12 years rose to
between 40 and 50%.3
Agenerally agreed upon definition of obesity is abody weight 20% or
more above ideal, with individualsweighing 1020% over ideal consid-
eredoverweight.4Weight maintenance is a matter of energy balance
weight gain will occurwhenacat consumescalories in excess of its
energy expenditure. Such ascenariocan happen alltoo easilygiven the
pampered lifestyle of many domesticated cats. Forexample, a4kg cat
consuming amere 10 kcal/dayin excess of its dailyenergy needs (the
equivalent of about 10 kibblesof a typical dry cat food) willgainnearly
0.5 kg of adipose tissue(the energycontent of adipose is estimated as
7920 kcal/kg) or 12% of its body weight over the course of just 1year.
So,given that excessive weightgaincan happen readily, appearsto be
a common phenomenon amongpetcats, and, regrettably, has anegative
impact on health, how do practitioners address this serious condition?
DOI: 10.1177/1098612X12444999
© ISFM and AAFP 2012
A 4 kg cat consuming a mere
10 kcal/day in excess of its
daily energy needs (the
equivalent of about 10 kibbles)
will gain 12% of its body weight
in just 1 year.
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328JFMS CLINICAL PRACTICE
Health risks of excessive
weight gain
While the hazards of obesity have not been as
extensively studied in cats as in some other
species, there is evidence that overweight cats
are at increased risk of a number of pathologic
conditions. Retrospective studies have found
excessive body weight to be a risk factor for
feline lower urinary tract disease and idio-
pathic hepatic lipidosis.5,6 In an epidemiologic
study of nearly 1500 cats living in the north-
eastern United States, an association was
found between overweight or obese BCS and
diabetes mellitus, lameness and non-allergic
skin disease.7
In recent years, the focus has shifted to
elucidatingwhat role excessive adiposity
plays in the pathogenesis of these conditions.
Increasingly, we are recognizing that white
adipose tissue (WAT) is not simply an energy
depot but rather a metabolically active secre-
tory organ.8Furthermore, progression from
a lean to an obese state leads to alterations in
the morphology and secretions of WAT that
may underlie the pathogenesis of some of the
conditions associated with obesity.
Ithas been recognized for several decades
that, with weight gain, cats develop glucose
intolerance and impaired insulin secretion.9,10
Those findings, coupled with the epidemio-
logic evidence that obese cats have a nearly
four-fold greater risk of becoming diabetic
compared with normal-weight cats,7have led
investigators to take a closer look at the
metabolism of WAT in lean and obese cats.
The peptides and hormones secreted by
WAT are collectively known as adipokines
and include leptin, adiponectin and various
REVIEW/Feline weight loss programs
cytokines, in particular tumor necrosis factor
alpha (TNF-α). Findings in companion ani-
mals are preliminary to date; howeve r, inves-
tigations have found thatoverweight cats
have increased circulating levels of leptin and
TNF-αand decreased circulating levels of
adiponectin.11–13 Leptin and TNF-αhave
been shown to decrease insulin sensitivity in
many tissues while adiponectin improves
insulin sensitivity.14 Hence, the alterations in
circulatinglevels of theseadipokines that
occur with weight gain could, in part, be
mediating the changes in glucose tolerance
that are observed clinically in overweight cats.
Hopefully, further investigations along these
lines will help to elucidate the role of obesity
in the pathogenesis of feline diabetes mellitus
and other associated diseases.
Increasing awareness of
overweight and obesity
Fundamentalto combatting the problem of
excessive weight gain in the feline population
is for veterinary professionals to takethis issue
seriously. In one investigation of computerized
medical records data from 52 veterinary prac-
tices located throughout theUS, 28.7% of feline
patients were classified as being overweight by
BCS, yet only 1.4% were reported as being
overweightby diagnosticcode.1While this
investigation was not able to document
whether any concernsabout the patients’ body
condition wereexpressed to theirowners, it
does suggestthat, at least in some instances,
veterinarians are neglectingto address the
health implications of excess weight and obesi-
ty in their feline patients. So while most veteri-
narians and veterinarytechnicians recognize
Each excess 0.5 kg on a cat is equal to approximately 6.8 kg on the
average 5'4"adult woman and 7.7 kg on the average 5'9"adult man.
While most
veterinarians
recognize that
conditions of
overweight and
obesity are
not merely
aesthetic
issues, we can
do more to
impress on
owners the
benefits of
maintaining
cats in optimal
body condition.
Cat’s
weight
(kg)
Percentage
overweight
Equivalent
weight for
a 5'4" adult
woman (kg)
Equivalent
kg over-
weight for
adult woman
Equivalent
weight for
a 5'9" adult
man (kg)
Equivalent
kg over-
weight for
adult man
4.5 0% 65.8 0 76.7 0
4.9 10% 72.6 6.8 84.4 7.7
5.9 30% 85.7 20.0 99.8 23.1
6.8 50% 98.9 33.1 115.2 38.6
9.0 100% 131.5 65.8 153.3 76.7
9.5 110% 138.3 72.6 161.0 84.4
10.4 130% 151.5 85.7 176.4 99.8
11.3 150% 164.7 98.9 191.9 115.2
Adapted from the Association for Pet Obesity Prevention
Equivalent weight for adult cats and humans
Tab le 1
Figure 1 Obese cat weighing 8.6 kg (ideal weight 4.5 kg).
Courtesy of the Association for Pet Obesity Prevention
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JFMS CLINICAL PRACTICE 329
REVIEW /Feline weight loss programs
that conditions of overweightandobesity are
not merelyaesthetic issuesfortheir patients,
it is likelythat we can do more to impress the
benefits of maintaining cats in optimal body
condition upon theirowners.
The first step is to teach people how to
assess their cat’s body condition. Once a cat
owner learns how to recognize what is, and is
not, optimal, they can be taught how to adjust
their feeding practices to address undesirable
weight gain or loss. Teaching the cat owner
what constitutes an optimal body condition
for their pet is a step that absolutely cannot be
overlooked. Two investigations examined the
ability of cat owners to assess their pet’s body
condition and found significant differences
between the assessments of a trained observer
and the cat owners.2,15 In both studies, owners
of overweight or obese cats underestimated
their cats’ BCS in comparison with the
expert’s findings. Again in both studies, the
investigators, using multiple logistic regres-
sion, found owners’ underestimation of their
cats’ body condition to be a risk factor for
Figure 2Nine-point body condition scoring system validated for use in cats.
Courtesy of Dorothy Laflamme/Nestlé Purina
Instruct the
owner to
palpate for the
abdominal fat
pad in the cat’s
inguinal region
in addition
to palpating
for body fat
over the cranial
rib cage.
being overweight, with similar odds ratios
(19.12 vs 20.7).2,15 Therefore, simply demon-
strating a body condition scoring technique to
a cat owner without giving clear criteria for
what constitutes optimal body condition will
not be sufficient training to ensure proper
feeding practices going forward, especially if
the patient is already overweight.
Targeting optimal weight
Compared with dogs, the range of variation in
optimal adult body weight of cats is minimal.
The differencebetween beingconsidered
ideal or obese could be as little as 0·9 kg of
excess weight for a typical domestic shorthair
thatideally should weigh around 4.5 kg
(Figure 1 and Table 1). Most people do not
have access to an accurate scale, and so using
routine monitoring of a cat’s body weight as a
basis for making adjustments to its diet would
not be practical. Body condition scoring, by
contrast, requires no special equipment, is
easy to learn and so can be used to assess and
modify feeding practices in the home setting.
A number of different body condition scor-
ing systems have been proposed for compan-
ion animals including a system with a five-
point scale that was referred to earlier. Figure
2 shows a nine-point system that has been
validated for use with cats, both in terms of
reproducibility between trained observers
and body composition using dual energy
x-ray absorptiometry (DEXA).16 The system
uses a combination of evaluation of body
silhouette and palpation for assessment of
adiposity. The owner should be instructed to
palpate for the abdominal fat pad in the cat’s
inguinal region in addition to palpating for
body fat over the cranial rib cage. Some cats
may have a large abdominal fat pad and yet
only a minimal fat covering over their ribs.
Any palpable fat pad denotes an excess of
body fat, regardless of the amount of fat cov-
ering over the rib cage.16 For cats, a BCS of 5/9
is considered optimal. Based on DEXA, this
score reflects 25–30% body fat; each increment
in BCS above or below approximates to an
increaseordecrease of 10–15% in body
weight.16 (It is important to realize that this
guide fails at 9/9, as patients that are morbid-
ly obese can far exceed this scale.)
At each clinic visit every patient should
have its BCS assessed and recorded, along
with an accurately obtained body weight.
Weight change can easily be calculated and
thus can help to detect trends before they
become dramatic.
(Current weight − Previous weight)
Previous weight
% Weight change = x 100
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330JFMS CLINICAL PRACTICE
Accurate accounting of
caloric intake
A complete diet history is essential for devel-
oping an effective weight loss program for
your patients. Not only will it give an accurate
account of all foods fed to a pet on a typical
day, it will be an opportunity to evaluate all
the ways that food is involved in interactions
between the pet and the other members of its
household, including other pets. The discus-
sion of the patient’s diet is also a good time for
the caregiver(s) to be given the opportunity to
offer their viewpoints regarding the proposi-
tion of modifying their feedingpractices.
Particularly in cases where a weight reduction
program may be indicated, it is absolutely
necessary to assess the readiness of the care-
giver to embark on such a project. If the care-
giver does not recognize that a problem exists
and does not see the necessity to address it,
you will first need to try to bring their point of
view into alignment with yours. If they are
unwilling to address the problem at the pres-
REVIEW/Feline weight loss programs
ent time, perhaps they will be more open to
necessary changes at a future time.
The household
Begin by asking about who lives with the
patient. How many adults and children are in
the household? Are any of them at home all
day with the cat? Inquire about whether there
are other pets in the home and whether they
are, or can be, fed separately from the cat.
Can the cat access other pets’ food? Find out
if it is confined indoors or not; if it does go
out of doors, is it supervised when outside?
Ask if the cat has the opportunity to steal
food, get into garbage, scavengeor hunt
(see diet history box, page 331).
The principal diet, feeding routines
and eating behaviors
Obtain the precise names (including variety, if
appropriate) and brands of any commercial
cat foods that the patient is receiving and the
specific amounts fed. Often the caregiver will
not be able to provide this information accu-
The factors that put cats at risk of excessive weight gain fall into three categories: those with respect to the patient’s caregiver, those
with respect to the patient itself, and those with respect to the patient’s environment.
The caregiver
A major factor related to the caregiver, as discussed earlier, has
to do with inability to accurately assess apet’s body condition.
Undoubtedly, the nature of the human–animal bond is such that
the relationship between cat and owner plays arole as well.
Researchers in Germany interviewed cat owners and found that,
among other things, individuals owning overweight cats had a
closer relationship with their cats and were more likely to view
their cats as a substitute for human companionship than owners
of normal-weight cats.17 More work needs to be done in this area;
however, taking the time to solicit the client’s point of view with
regard to starting the pet on aweight reduction program may help
you craft amore successful plan for that patient. While the subject
of communication is beyond the scope of this review, there are
some excellent resources for helping practitioners enhance their
communication skills;18 clearly, developing arapport and eliciting
the client’s understanding and concerns about a proposed plan
of action can only be beneficial.
The patient
The patient factors that have been found through multivariate
analysis to be associated with overweight or obese body condi-
tion include age, gender, breed and whether the cat is intact or
neutered.1,2,19 In general, middle-aged cats, male cats, mixed-
breed cats and cats that are neutered are at greater risk of being
overweight or obese.
The last risk factor, neutering, has been extensively studied
and investigators consistently report both an increased food
intake as well as decreased caloric requirement for weight main-
tenance shortly after spaying or castration.2024 In other words,
if aclient has not been educated as to how to make adjustments
in feeding management based on body condition assessment
before their pet is gonadectomized, and not warned to be pre-
pared for changes in feeding behavior and calorie requirement
post-neutering, the patient will be at significant risk of inappro-
priate weight gain. An opportune time to review both the client’s
feeding management and proficiency in body condition scoring,
and to advise them of what to expect, is when the patient is
examined for aspay or castration. Ideally, arecheck weigh-in
within amonth postoperatively would serve to ensure that appro-
priate monitoring and adjustment of feeding is taking place. This
intervention should be relatively simple to implement in practice
and could have amajor impact on feline health.
The environment
Some environment-related factors that might contribute to weight
gain in pet cats include those that influence physical activity
(eg, indoor confinement and lack of environmental stimulation)
and those that affect caloric intake (eg, feeding of calorically
dense cat foods or free-choice feeding). The epidemiologic stud-
ies that have examined risk factors for weight gain in cats have not
uniformly found these environmental features to be significantly
associated with overweight or obese body condition, although
most studies did find that feeding calorically dense commercial
foods was acontributing factor for weight gain in cats.1,2,15,19
Regardless, for the individual patient, anything that predisposes to
astate of positive energy balance by either decreasing energy
expenditure or increasing energy intake should be examined and,
if possible, addressed. In particular, aportion control rather than a
free-choice feeding method may be necessary for many patients.
Risk factors for weight gain
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JFMS CLINICAL PRACTICE 331
REVIEW /Feline weight loss programs
rately by recall alone, and will need to check
labels and measure feeding portions. Specify
that, if at all possible, dry pet foods be meas-
ured with a gram scale. A recent investigation
found measuring cups to be a very imprecise
means of portioning dry dog foods and it is
highly likely that the same would be true for
dry cat foods.25 If using a scale to measure the
food is not an option, ensure that the client is
using a standard 250 ml/8 oz measuring cup.
Often people don’t recognize that the ‘cup’ or
scoop they are using is in excess of this. If the
patient is eating a canned diet ask what size
can. Sometimes a specific variety of cat food is
sold in different sized cans (eg, 85 and 170 g/
3 and 6 oz) so be certain to inquire about what
size is used by the client. Don’t forget to ask
Diet history
What specific amounts and type of food (all,including treats) are fed?
Does the cat drink milk?
Is the cat fed ‘people’ food?
Who feeds the cat’s regular meals?
Do family members routinely feed treats and table scraps?
How often is the cat fed? Is the food measured?
Does the cat nibble or gorge?
Where is the cat fed?
Is the cat indoor or outdoor? If outdoor, does it routinely hunt?
What other pets are in the household?
Do other pets have access to the cat’s food?
Does the cat have access to the other pets’ food?
What is the activity level of the cat?
Are there any known stress factors in the home environment?
When inquiring about treats, pose the question several times in different ways:
Ask which specific commercial treats are used (name, flavor,
brand and size).
Ask whether human foods and table scraps are given as treats.
Ask specifically about products that are used to promote
dental hygiene (often people do not consider these things
treats). Some such products can contribute significant
amounts of calories to a cat’s diet.
Ask whether the patient routinely receives any medications
and, if so, whether the medication is given with food or
treats.
Treatsandsupplements
Treat/dental product kcal
Typical commercial cat treats 2–4/piece
Dental treats for cats 1–2/piece
‘Cat milk’ drink 2/tsp
2% milk 9/tbsp
Cheddar cheese 113/28 g
Chicken breast(skinless, roasted) 51/28 g
28 g=1oz
Hidden calories
This is equivalent to a
double hamburger (540
kcal) for someone on a
2000 calorie/day diet
A 5 kg cat needs 250
kcal/day. 1 cubic inch of
cheddar ≈ 28% of daily
requirements
Arecent study found measuring cups to be very
imprecise for portioning dry dog foods and it is
likely that the same would be true for dry cat foods.
whether the food the cat is currently eating is
its usual diet and, if not, inquire when the diet
change was implemented.
If the patient is eating a commercial cat food
find out whether thediet is being supplement-
ed with any human foods. If thisis thecase,
or if the patient is being fed ahome-prepared
diet, it is important to get accuratedetails,
including measured amounts, of all foods rou-
tinely given.Be certainto inquire whether the
patient is receiving any dietary supplements.
It is useful to have the cat owner bring in the
supplements or at leastthe label information
so you can see exactly whatnutrients are being
supplementedand in what quantities.
Ask whether the patient is fed at certain
times during the day or whether food is given
free choice. If the patient is fed with other cats
or dogs, are the meals supervised? Does one
person assume responsibility for feeding the
patient or can it vary day to day? This is
important to know when you are instituting a
weight loss program because you may not be
speaking with the person who will be imple-
menting the new plan.
Inquire about the patient’s normal feeding
behavior. Is this cat a picky eater? Does it eat
the food as soon as it is offered or is it content
to graze throughout the day? Does the cat
usually eat all the food that is offered? Does it
beg for food in between meal times?
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332JFMS CLINICAL PRACTICE
REVIEW/Feline weight loss programs
Formulation of the weight loss
plan
For a weight loss plan to be successful, the
veterinarian needs to consider four key
elements: what is fed, exercise, environmental
enrichment and recheck visits. The first two
determine the necessary negative energy bal-
ance; the second two support the psychologic
needs and behavioral aspects of cat and
owner, to improve ongoing compliance.
Counsel the client to produce a 1–2 week
feeding journal into which everyone in the
householdwhogives the cat anything
ingestible enters information. The amount
and exact type (brand) of food should be
recorded. The client can be asked to generate
this diet diary before the appointment and
bring it along. While it may not be completely
accurate, it provides a starting point for deter-
mining the caloric intake that the cat has been
receiving and gaining weight on. This should
be compared with the caloric allowance being
recommended. If the diaryis erroneous,
it will become readily apparent as the cat fails
to lose weight when fed the calculated,
recommended quantities,and adjust-
ments can be made.
Asarule ofthumb,in order to lose
weightacat needs 6070% of the calo-
ries required to maintainits ideal
weight. In other words, the veterinar-
ianneeds to:
Determine/approximate the cat’s
ideal weight (see right);
Calculate the calories needed for
its ideal weight (wt [kg] x40–50
kcal/kg/day);
Multiply this number by 60–70%.
Some pet food companies provide software
to help with the calculation that are specific to
their weight loss diets.
The client shouldbe informed of the cat’s
current weight,aswell as the goal weight. In
some cases, the goal weight may be higher than
the ideal’ weight; the goalis ahealthy weight.
For example,in extremely obese pets (BCS 9/9),
even thoughthe weight loss plan willbe based on
the patient’s ideal weight, the client needsto
appreciate that a loss of 20–30% body weight
(which may represent a BCS of 6/9 or 7/9) will
still provide health benefits. While this maynot
be sufficient weight loss to achieve the ideal
weight, interim targets for the client to aim for
provide motivation, and the cat’s quality of life
will be dramatically bettereven if still overweight.
Discuss with the client the lengthof time this
may take. Asafe rate of weight loss is 0.5–2.0%
body weight a week.This will help them stay
the course.
What to feed
In general, it is not enough simplyto feed acat
less of its normal diet. Not only will the
patient be unhappy and feel hungry, but
all nutrient quantities will be decreased,
not just the calories, because commer-
cial diets are balanced accordingto
energy content. Therefore, a cat on a
weight loss plan should be fed a
diet formulated for caloric restric-
tion that is fortified with all essen-
tial nutrients,so that when it eats
the appropriate amount of calories,
it still meets its protein, vitamin and
mineral needs. Apossibleexception
to this might be a cat thatis only
moderately overweight, in which case
Estimating ideal weight
Ideal weight may be estimated in a number of
ways:
Use the body weight recorded at a visit at which the
cat was at an optimal BCS.
If this is unavailable, body weight at 12–18 months
of age may be used.
Least favoured, but possibly all that is available,
is clinical judgement (ie, a guesstimate).
Bear in mind that each score above or
below 5/9 on the nine-point BCSsystem is
approximately equivalent to an
increaseor decrease of 1015%
in body weight.16
As a rule of
thumb, in order
to lose weight,
a cat needs
60–70% of
the calories
required to
maintain its
ideal weight.
Example weight loss program
Fluffy weighs 8.4 kg and has a BCS of 9/9. She is currently being fed 375 kcal/day.
Her ideal weight is 5.4 kg, with a BCS of 5/9.
Estimated calories for maintenance at ideal weight
5.4 kg x 50 kcal = 270 kcal
How much to feed
60–70% x 270 kcal = 162–189 kcal/day
(In order to achieve this lower number of calories, it helps both the cat and the client if the
food reduction is made gradually, over a period of 2 weeks)
How long weight loss will take
Weight loss of 3 kg will take at least 12 months. A 10–15% loss (0.8–1.3 kg) or a goal weight
of 7.1–7.6 kg will take approximately 5–6 months
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REVIEW /Feline weight loss programs
restrictionor elimination of treats along with a
modest reduction in thenormal diet may be
sufficient to permit weight loss. If treats are
being eliminated, another non-caloric
‘treat’ (eg, interaction through play,
combing or catnip) can be substituted.
There are a number of dietary
approaches to feline weight loss:
High protein protects (minimizes
loss of) lean mass, stimulates protein
turnover, and may enhance
satiety.26,27
High moisture can reduce caloric
density, which promotes short-term
weight loss. It can take a few weeks to a
few months for a cat to compensate for the
lower caloric density (as fed) in canned foods
versus dry foods by increasing their volume
of food intake; however, not all cats respond
in this way.28
High fiber can reduce caloric density and
induce satiety. Some cats will self-restrict
calorie intake when fed a dry, high-fiber,
low-calorie diet.
Low fat will reduce caloric densit y. High-
fat diets are a risk factor for inducing obesity
and are generally not considered optimum
for a weight loss diet. That said, some cats
will lose weight on a high-protein, high-fat,
low-carbohydrate diet.
Ultimately,it is caloriesingested versus
expended that is critical for weight loss. Given
the benefits of achieving lean body mass by
feeding a high-protein diet, a goal of at least
45% protein, on an energy basis, is a healthy
approach to take.
Exercise
Caloric restriction alone is, in most cases,
inadequate. Incorporating other modalities
that increasecalorie use and metabolic rate
will help to achieve the goalof losing weight.
Exercising cats might wellbe considered an
oxymoron, but any exercise will help(Figure
3). Some dedicated clients
have even designed agility
obstacle courses for their
cats. The Association for
Pet Obesity Prevention
offers some practicalsug-
gestionsforclients(see
resourcesbox, page 335).
It is in a cat’s nature to
hunt by aprocessof slow,
patient stalking and then,
when opportune, leaping or
running involving a short
burst of effortand speed.
Thismakes chasing alaser
pointeror playingwith a
‘cat dancer’ (a hand-held
flexible wire with a toy on
the end) a very suitable form of activity.
(Notethat when discontinuing play with
a laser pointer, the spot should alight
on a toy and be turned off when the
cat has pouncedon it so that the
hunt can be ‘successful’.)It is help-
ful for owners to coincide the
times they choose to exercise their
cat with when thecatisnaturally
inclined to be most active. This
tends to be early in themorning or
later at night (their ‘crazy’ times!).
One can also capitalize on the ener-
gy burst that some cats showafter
using the litterbox.
While the more prolonged and con-
sistent energy required forrunning on, for
example, atreadmillor exercise wheel
may seem unreasonableto expect
from a cat, some do seem per-
fectly happy to run on these
exercisedevices for sever-
al minutes at a time.
Others readilytaketo
leash walks. A search
on YouTube will
reveal numerous
entertaining, butalso
informative, videosof
cats exercising. It can
be useful to show these
to the clinic team andto
clients as ideas to consid-
er with theircat.
Clients should be encour-
aged to move the food bowl
every few days so that the cat has
to look for it on different levels and in differ-
ent rooms of the house. Placing tiny portions
of the calculated daily ration onto small plates
or in muffin liners allows for a ‘treasure hunt’
throughout the day. In addition to a modest
challenge and a bit of exercise, eating smaller
amounts throughout the day increases the
energy utilized to
digest and absorb the
food (the so-called
thermiceffect of
food). It is important
in a multi-cat house-
hold to ensure there
is enough distance
between bowls, to
reduce any threat of
proximity andcom-
petition. Other con-
siderations for the
multi-cat household,
in which there may be
conflicting nutritional
needs, arediscussed
on page 335.
What about treats?
As long as 90%of thedietary intake comesfrom a
completeand balanced food, treats maybe fine. In other
words, owners shouldn’t overdo it. A tablespoon of 2%
milk or acouple of cat treats (see Hidden calories table on
page331) may make a cat very happy. In fact,thesepro-
vide good positive reinforcement when given after taking
medication or havingnails trimmed. Alternatively, dry
kibble can be used as treats for play and exercise.
However, these calories must be factored into the
total allowance fordaily intake, otherwise
thesefew little treats can sabotage a
weight loss program.
Using a standard treadmill
It is very important that the client ensures the catisnot
discouraged by making the treadmill go faster than a
walking pace. Start by placing the cat on the rear of the
stationary treadmill and offeringatreat at the front of the
machine. Over several days, thecat learns to associate
walking forward on the treadmill with a positive reward
through successful repetition. Turn the treadmillon to the
lowest possible speed. Continue to reward the behavior,
gradually increasing the speed to acomfortablewalking
pace for the individual cat. If the cattakes to this
readily, the frequency of rewards can be reduced
to one at the beginning and at the end of the
session. The aim is to havethe cat
walk on the treadmill for 5–10
minutes.
Figure 3 Exercise, in any shape or form, willhelp. Courtesy of (a) Sarah Ellis and (b) Deb Givin
a b
JFMS CLINICAL PRACTICE 333
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334JFMS CLINICAL PRACTICE
Environmental enrichment
We must also consider why the cat is eating
more. Is it bored and sleeping most of the
day? Is it not receiving enjoyable stimuli from
other, more healthy sources and, therefore,
eating? What other aspects of normal behav-
iour are not available for the cat to participate
in? How is the cat meeting its emotional needs
(‘hedonic budget’)? Chronicstress (which
may be present in the indoor-confined cat)
results in neuroendocrine changes that predis-
pose to obesity.29
Environmental enrichment has been exten-
sively studied as it pertains to animal
welfare.30–37 It has also been looked at briefly
in the context of how it affects weightloss.38
In astudy of 19 two-cat indoor households,
where one cat was overweight andthe other of
normalweight, nine households wererandom-
ly selected to be the control group. Their
weightlossprogram consistedof counseling
anddirections to feedthe twocats separately in
two or more meals perday,closelymonitoring
the obese cat’s food intake. The goal weight
was 90% of the cat’s initial weight, which
allowedcats to lose 1–1.5% of their
initial weightper week. The 10 treatment
households receivedthesamecounseling and
feeding recommendations but, in addition,
REVIEW/Feline weight loss programs
underwent environmentalenrichment. The
enrichments consisted of additional food dish-
es, water bowls and litter boxes,as well as
climbing trees, window perches, scratching
posts, grooming supplies and toys. All cats (38)
were weighed weekly andall wore activity
monitors. Cats in theenvironmentally enriched
group had increased activity counts and their
caregivers weremore positive about the weight
lossprogram.While only a trend towards
improved weight loss was noted,environmen-
tal enrichment (Figure 4) may be important not
only in terms of a cat’smental wellbeing, but
also in improving commitmentby the client.38
Recheck visits
Weight loss requirescommitment on thepart
of the client.It also requirescommitment on
thepart of the clinicteam because the client
needs support and a motivator outside of
themselves in order to perseverewith the
program. Successin losing weight often
requiresbehaviorchanges in the client and
thepeoplewho interact with the cat (see What
drives the client?’). Thus, recheck visits (initial-
ly every coupleofweeks) areanessential part
of asuccessful program. Createabargraph to
maintain in the clinic computer and cat’s
medical record. Send an updated graph home
with the client at every visitas a good
reminderof their success. Positive reinforce-
ment is apowerful motivator.
Figure 5A selection of commercially available and home-made feeding devices. For weight control, the food must be measured as part of the daily ration.
Courtesy of (a) Deb Givin, (b) Sarah Ellis and (c) Vicky Halls
There are avariety of commercial products available to enhance
the feeding experience by requiring interaction with the device to
gain the food (Figure 5a,b). Home-made gadgets can be
constructed relatively simply as well. For example, kibble can be
added to aseries of empty plastic water bottles or other small
drinks containers with holes that are gradually made smaller. The
bottle with the largest holes is introduced first; once the cat has
learned how to roll the bottle to spill the kibble out of the holes, the
bottle is replaced by the next in the series. Another DIY option is
to construct apyramid of cardboard tubes (eg, from paper towel
rolls) laid horizontally and glued together (Figure 5c). This requires
the cat to reach into the tubes to pull kibble out. Not only does
this result in engaged behavior and areduction in boredom, but it
also slows down eating behavior so that the satiety centre may
register ‘full’ before the cat has overeaten.29 Interestingly, an
automated pet feeder may have an undesirable effect, as some
cats have been observed to become obsessed with the device,
apparently waiting for it to open.
Devices to enrich f eeding
abc
Figure 4 Environmental
enrichment contributes to
weight loss programs by
promoting increased activity
and, it appears, improving
client commitment.
Courtesy of Kate Hurley
at AAFP on November 17, 2016jfm.sagepub.comDownloaded from
JFMS CLINICAL PRACTICE 335
REVIEW /Feline weight loss programs
What drives the client?
A fascinating study by Kienzle and Bergler
found that the emotional rewards/reinforce-
ment that aclientgetsfrom interacting with
theircat (the ‘positive strokes’), and the behav-
iors of clientstowards their cats, differ with the
cat’s weight.17 Theseinvestigators found that
more people living withoverweight cats
(versus cats of normal weight) had adopted
theircat for emotional support andconcluded
that theseindividuals tended to humanize
theircat companions. They underestimated
their overweight cat’sBCS and enjoyed
watching theircat eating. Peoplewith cats of
normal weight played more with their cats.
Surprisingly, the number of meals, snacks and
typesoffood did not differ between the house-
holds; however, overweight cats received
more treats, while normal-weight cats received
agreaterproportion of canned food.
So, in a cat’s weight, there is an element of
meeting the hedonic budget for the person liv-
ing with the cat. Hence, it is essential that we
address the behavior of the people living with
and feeding the cat! The value of encouraging
alternative ‘strokes’ – things that make the
person feel good about their interactions with
the cat, such as play and a sense of pride in
achieving weight loss goals – is not to be
underestimated. Positive feedback, both from
the veterinary team (the outside environment)
as well as self-generated by the client, is vital
to the success of a weight loss program.
The behavior modification requiredto make
aweight lossprogram successful needs all key
familymembersto play a role. Are there other
forms of interaction that the client can have
with the cat besides feeding? Treats are the
downfallof many a weight controlprogram;
when used, their calories must be taken into
consideration anddeducted fromthe food
calories fed.In orderto decrease the risk of too
manycaloriesbeing fed, it is simpler if one
Weight loss i n the m ulti-cat household
Multi-cat households present aspecial challenge in terms of
behavioral concerns as well as for nutritional planning in health
(age and stage) and illness. The goals within amulti-cat household
are to:
Achieve a feeding strategy that puts no one cat at risk
nutritionally through having the base diet available to all; and
Meet the individual nutritional needs of each member of the
household as closely as possible twice aday behind closed doors.
This requires analysis and consideration of the clowder’s needs
as well as the individual cats’ physical, personality and nutritional
profiles.
An overweight cat can be prevented from getting to any food
other than that designed for weight loss (the base diet) by putting
a latch on a door so that only the thinner cats can get through the
narrower space. Should the client be so motivated and have the
space, asilhouette box can be constructed that allows the thinner
cats through the narrow opening. Note, however, that if a thinner
cat is likely to fall prey to aggression from the heavier cat, this
situation would allow bullying to develop. Another solution might
be to consider using elevations if the heavier cat is unable or
unwilling to jump, allowing the thinner cat (if that individual is able)
to eat on a perch or another raised and stable location.
KEY POINTS
The first step towards a healthy weight for an overweight or obese
cat is recognizing excess body condition. Thereafter, success in
achieving weight loss requires:
A cooperative approach between the cat’s family and the
clinic team.
Understanding what quantity and type of food and treats
are to be fed.
Encouraging some form of exercise.
Enriching the home environment and providing
supportive follow-up.
Resources for clinic and clients
Indoor pet initiative – for advice on enrichment of the life of the indoor cat:
http://indoorpet.osu.edu/
Association for Pet Obesity Prevention (APOP):
www.petobesityprevention.com
APOP pet weight translator (to convert a cat’s weight to an approximate
equivalent human weight):
www.petobesityprevention.com/pet-weight-translator
The Cat Wheel Company – distributor of a cat exercise wheel:
www.catwheelcompany.com
Blog about cat wheels – different varieties and building your own:
http://jillyotz.blogspot.com/2011/01/how-to-build-cat-exercise-wheel-part-1.html
personhandles all of the feedingandothers
bond through other means (catnip,combing,
playing).As described earlier, feeding multiple
small meals as a treasure hunt is beneficial.
Developing a routine involving several periods
of play a day will add interest and exerciseto
the cat’s life. The cost of the program mightjust
then include a bag of catnip and a cat dancer!
Acknowledgements
With grateful thanks to those who have supplied
images for this article: Tony Buffington (title picture
of cat on scales), Sarah Ellis, Deb Givin, Vicky Halls
and Kate Hurley.
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336JFMS CLINICAL PRACTICE
REVIEW/Feline weight loss programs
Available online at jfms.com
Reprints and permission: sagepub.co.uk/journalsPermissions.nav
Funding
The authors received no specific grant from any funding agency in
the public, commercial or not-for-profit sectors for the preparation
of this review article.
Conflict of interest
Kathryn Michel is a member of the Purina ScientificAdvisory Council.
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Urban cats live in cities like humans and humans affect their life intentionally or unintentionally. Waste production is only one of the human effects on the urban cat ecosystem. The waste produced by human supply some of the food needed by urban cats. This descriptive - estimation research is the first study in the world to measure the cats’ weight to investigate the effect of the increase or decrease in urban wastes on physical status of cats. In the first phase of the research (Spring 2016-Winter 2017) in Tehran, we found that the average volume of the collected wastes had increased by 14% and the average weight of cats in the mentioned period had increased 1%. The 9.5% decrease in the waste volume in Autumn 2016 had led to the decrease in the average weight of cats in Winter 2017. The male cats were more affected by the decrease in waste volume.
Preprint
Full-text available
Some animals live in cities like humans. So, humans affect their life intentionally or unintentionally. Waste production is only one of the human effects on the urban ecosystem. The waste produced by human supply some of the food needed by urban cats. This research is the first study in the world to measure the cats’ weight to investigate the effect of the increase or decrease in urban wastes on physical status of cats. In the first phase of the research (Spring 2016-Winter 2017) in Tehran, we found that the average volume of the collected wastes had increased by 14% and it had led to a 1% increase in the average weight of cats in the mentioned period. The 9.5% decrease in the waste volume in Autumn 2016 had led to the decrease in the average weight of cats in Winter 2017. The male cats were more affected by the decrease in waste volume.
Conference Paper
Phosphorus and renal health – what we currently know Dr. Britta Dobenecker, Ludwig-Maximilians-Universität Munich, Germany Abstract In the body, phosphorus (P) occurs mainly in the bones but is also known for its central role in energy metabolism and storage with considerable amounts in soft tissues. Major dietary sources of P are proteins, bones, cartilages as well as inorganic sources added mainly for technical purposes. But the organism must also be protected against excessive intake or storage of minerals and different strategies exist to eliminate certain elements. With the help of PTH and other messengers, excessively ingested P is efficiently excreted via urine and therefore usually not considered as health risk. Common knowledge in human as well as veterinary medicine is, however, that P is a progressive factor in chronic renal insufficiency (CRI) wherefore typically a P restricted diet is prescribed for affected patients. To date, the total amount of P in a diet is used to assess the P supply. Moreover, excessive P consumption has been shown to have adverse effects on renal, cardio-vascular and/or skeletal metabolism and health in various species. Therefore, P excess is suspected to play a role also in the development of CRI. In 1995, Pastoor demonstrated that a P excess (~890mg P/MJ ME; Ca/P 0.4/1, 28d) reduces the endogenous creatinine clearance in healthy cats. Own studies about effects of P excess on renal function in cats were performed aiming at verification of these initial findings and at identification of factors such as the Ca/P ratio or the source of P (inorganic phosphate salts vs. ‘organic’ phosphates, e.g. originating from meat and bones) influencing the effect of P excess. Key words: cat dog phosphorus/phosphate renal health metabolism Abbreviations aD: apparent digestibility; BW: body weight; Ca: calcium, CRI: Chronic Renal Insufficiency; DM: dry matter; FGF23: fibroblast growth factor 23; P: phosphorus / phosphate; Pi: inorganic phosphate (P salts not from tissues such as meat and bone); ppr: postprandial; PTH: Parathyroid hormone Phosphorus metabolism Major player in the P homeostasis are linked to Ca regulation. Briefly, calcium-sensing receptors in the parathyroid gland detect changes in serum Ca concentration, then influencing PTH secretion. PTH increases the Ca blood concentration through bone resorption, by increasing tubular reabsorption of Ca in the kidneys and also by increasing vitamin D3 production. Increased bone resorption increases also the serum P concentration, while PTH downregulates tubular reabsorption of P. Further modulators of serum P concentrations with phosphaturic effects are fibroblast growth factor 23 (FGF23) and its co-factor αKlotho. There is possible cross-talk to systems regulating energy metabolism, blood pressure and possibly even sex hormones. However, species specific differences are probably existing and a simple extrapolation of findings from man to pets is not advisable. However, there is a consensus that the prevention of hyperphosphatemia is crucial especially in renal patients to prevent adverse effects on the body, mainly by aiming at limiting the P load per nephron. For example, there is evidence that hyperphosphatemia in transforming cells from vascular phenotype to osteogenic phenotype, creating a predisposition for calcification additionally to the hypothesized direct injury to heart, vessel and kidney cells. Phosphorus excess – studies performed in cats Starting a decade ago, own research has been performed firstly in cats. For each trial, 12 adult, healthy cats were available. After a control period of 28d feeding a complete and balanced diet with Ca/P of 1.3/1, the cats were randomly allocated to a control and a test group in a cross-over design. Parallel to a control, cats received a surplus of P from different ‘organic’ and inorganic sources (total ~880mg/MJ ME) and a Ca/P ratio of either 0.4/1, 0.9/1 or 1.3/1 determining water and mineral balance, endogenous creatinine clearance, blood chemistry, urine analysis etc.. We were able to show that P excess might cause a decrease in endogenous creatinine clearance, glucosuria, hematuria, an increase of renally excreted P and therefore the P load per nephron, modulated by factors such as source of P and the Ca/P ratio already after short term exposure to added Pi. Phosphorus excess – studies performed in dogs Aiming at insight about P kinetics after oral supply with different amounts and sources of P in dogs, additional trials in dogs were started in 2012. In 8 adult Beagles, the apparent digestibility (aD) of P and Ca was determined after feeding a control diet (0.5% P/DM). This was repeated aiming at 2.2% P/DM by adding different P sources (CaHPO4, NaH2PO4, poultrymeal, Na5P3O10, Ca(H2PO4)2, bonemeal, KH2PO4, K4P2O7) aiming at a Ca/P of ~1.3/1. Serum P, Ca and PTH was measured at 18d pre- and 2h postprandially. Postprandial serum P concentrations increased significantly with levels above reference range using certain Pi but not organic P sources. Postprandial PTH levels clearly increased especially in diets with Na and K phosphates. The trial was repeated to study the effects in more detail. The design was kept identical, but on d 18 blood was sampled 1 h pre- as well as 0.5, 1, 1.5, 2, 3, 5 and 7h postprandially (ppr). Serum was analysed amongst others for minerals and PTH. We were able to verify former findings of higher aD and stronger effects of Pi sources on ppr serum P and PTH concentrations than organic P from bony material. The serum Ca x P product exceeded the recommended threshold of 55mg2/dl2 up to 2.1fold in dogs fed Pi. Feeding Pi sources in excess changed the kinetics of serum P and PTH with a prolonged increase of both parameters, possibly disrupting the Ca and P balance. The aD of Pi sources, which are highly water soluble (Lineva et al. 2017), correlates with serum P and PTH concentrations. Conclusion Because of the relevance of the P load in CRI patients and obviously also in clinically healthy animals due to the potentially adverse effects of elevated serum P and PTH levels on skeleton, cardio-vascular system and kidneys, the intake of highly soluble Pi compounds such as Na and K phosphates have to be assessed separately: knowledge of the total amount of P in a diet does not suffice to decide about adequacy or potential adverse effects. Further work on factors influencing the effects of Pi on the body, such as other minerals in the diet, Ca/P ratio, cation-anion-balance, urine volume, species specific effects etc. are clearly warranted. References NRC, National Research Council. The Nutrient Requirements of Dogs and Cats. 2006; Block (2000). Prevalence and clinical consequences of elevated Ca x P product in hemodialysis patients. Clinical nephrology, 54(4), 318-324; Böswald, Kienzle & Dobenecker (2018). Observation about phosphorus and protein supply in cats and dogs prior to the diagnosis of chronic kidney disease. Journal of animal physiology and animal nutrition, 102, 31-36; Calvo & Uribarri (2013). Public health impact of dietary phosphorus excess on bone and cardiovascular health in the general population. Am J clin Nutr, 98(1), 6-15; Cortadellas, Fernandez del Palacio, Talavera & Bayón (2010). Calcium and phosphorus homeostasis in dogs with spontaneous chronic kidney disease at different stages of severity. J vet int med, 24(1), 73-79; DEMMEL (2011). Der Einfluss der alimentären Phosphorversorgung auf ausgewählte Nierenfunktionsparameter bei Katzen. Dissertation, LMU; Dobenecker, Webel, Reese, Kienzle (2017) Effect of a high phosphorus diet on indicators of renal health in cats. J Fel Med Surg 1–5; FEDIAF The European Pet Food Industry Federation. Nutritional guidelines for dogs and cats. 2012; Hardcastle, Dittmer (2015). Fibroblast Growth Factor 23: A new dimension to diseases of calcium-phosphorus metabolism. Vet Pathol 52(5)770-784; Hertel-Böhnke (2018). Einfluss der Phosphorquelle und des Calcium-Phosphor-Verhältnisses bei Phosphorüberversorgung auf Parameter der Nierengesundheit bei der Katze (Doctoral dissertation, LMU); Kiefer‐Hecker, Bauer & Dobenecker (2018). Effects of low phosphorus intake on serum calcium, phosphorus, alkaline phosphatase activity and parathyroid hormone in growing dogs. JAPAN, 102(6), 1749-1758; Kiefer‐Hecker, Kienzle & Dobenecker (2018). Effects of low phosphorus supply on the availability of calcium and phosphorus, and musculoskeletal development of growing dogs of two different breeds. JAPAN, 102(3), 789-798; Kienzle, Thielen, Pessinger (1998). Investigations on Phosphorus Requirements of Adult Cats. J Nutr. 128: 2598S-2600S; Lineva, Kirchner Kienzle, Kamphues,Dobenecker (2018). A pilot study on in vitro solubility of phosphorus from mineral sources, feed ingredients and compound feed for pigs, poultry, dogs and cats. JAPAN, Pastoor, van'T Klooster, Mathot, Beynen (1995). Increasing phosphorus intake reduces urinary concentrations of magnesium and calcium in adult ovariectomized cats fed purified diets. J Nutr, 125(5), 1334-1341; Ritz, Hahn, Ketteler, Kuhlmann & Mann (2012). Phosphate additives in food—a health risk. Deutsches Ärzteblatt International, 109(4), 49; Schneider, Pappritz, Mullerpeddinghaus et al. (1980). potassium hydrogen phosphate induced nephropathy in the dog. 1. pathogenesis of tubular atrophy. Vet Path, 17(6), 699-719; Siedler, Dobenecker (2016). The source of phosphorus influences serum PTH, apparent digestibility and blood levels of calcium and phosphorus in dogs fed high phosphorus diets with balanced Ca/P ratio. Proc. WINNS; Siedler (2018). Der Einfluss verschiedener Phosphorquellen bei alimentärer Phosphorüberversorgung auf die Phosphorverdaulichkeit und auf ausgewählte Blutparameter beim Hund (Doctoral dissertation, LMU); Wolf (2010). Forging forward with 10 burning questions on FGF23 in kidney disease. J Am Soc Neph, 21(9), 1427-1435.
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