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Increase the success of weight loss programs by creating an environment for change

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Abstract

Veterinary professionals frequently recommend weight loss programs for pets, but success is often elusive. By learning techniques to assess clients' readiness for change, the veterinary team can apply communication tools and strategies to help clients overcome obstacles and barriers to sustainable change. With a better assessment of a client's ability to change, a weight loss plan can be implemented at the right time in the right way to achieve better adherence to the agreed-upon plan and improve patient health.
Vetlearn.com | December 2010 | Compendium: Continuing Education for Veterinarians® E1
Abstract: Veterinary professionals frequently recommend weight loss programs for pets, but success is often elusive.
By learning techniques to assess clients’ readiness for change, the veterinary team can apply communication tools
and strategies to help clients overcome obstacles and barriers to sustainable change. With a better assessment of a
client’s ability to change, a weight loss plan can be implemented at the right time in the right way to achieve better
adherence to the agreed-upon plan and improve patient health.
Increase the Success of Weight
Loss Programs by Creating an
Environment for Change
Julie Churchill, DVM, PhDa, DACVN
University of Minnesota
ll too often in small animal practice, the discussion
about weight loss and obesity is a frustrating one.
The topic can be sensitive, and recommendations
frequently go unheeded. Before lack of success in help-
ing pets achieve and maintain a healthy weight leads you
to ignore obesity in your patients, consider trying another
way of communicating with your clients about helping their
pets.
Obesity continues to be the most prevalent disease of
dogs and cats: it is estimated that between 24% and 40%
of pets in the United States are overweight or obese.1,2
Although it is well established that obesity negatively influ-
ences health, well-being, and even life span,3,4 veterinary
professionals still struggle to influence clients to begin or
adhere to a weight loss program for their pets. One diffi-
culty may be that veterinary team members lack concrete
tools to assess their clients’ readiness for change. By using
carefully worded questions when taking a medical and diet
history, veterinary professionals—both veterinarians and
technicians—can identify a client’s receptiveness to and
readiness for change. With this knowledge, they can bet-
ter identify the appropriate time to implement a nutritional
plan. If a client is not yet ready, they can instead help him
or her explore obstacles and overcome barriers to sustain-
able change.
Essential Elements of a Weight Loss Program
In veterinary practice, there are three essential elements
of a successful weight loss program. Ensuring that each
of these components is present greatly contributes to suc-
cessful patient weight loss as well as client and veterinarian
satisfaction.
1. Establish owner commitment: Assess the client’s
readiness for change, as outlined below. If the client is ready
to act, proceed with your nutritional plan. If not, use state-
ments and questions such as the examples in TABLE 1 to
encourage the client to move from thinking (contemplation)
to doing (action).
2. Customize the weight loss plan: Partner with the
client to create an individualized plan that works for him or
her and meets the nutritional needs of the pet. A careful and
complete diet history (e.g., food and treat types, amounts,
schedule)5 can reveal important information about how the
family relates to the pet through food and often provides
insight about potential challenges for the client. The diet his-
tory can also reveal information about the pet’s nutritional
status, which is often imbalanced from excess treats and
human foods being added to commercial pet foods. Because
pets’ energy needs can vary significantly, it is important to
know an individual pet’s current caloric intake. The diet his-
tory can provide this information, which can then serve as
a much more accurate starting point for calculating the pet’s
specific food dose (start at 75% to 80% of current intake6).
©Copyright 2010 MediMedia Animal Health. This document is for internal purposes only. Reprinting or posting on an external website without written permission from MMAH is a violation of copyright laws.
A
aDr. Churchill discloses that she has received financial support from
Nestlé Purina PetCare Company and serves on its advisory board.
E2 Compendium: Continuing Education for Veterinarians® | December 2010 | Vetlearn.com
3. Reassess: Initially, biweekly follow-up helps to sup-
port clients, ensure a healthy rate of loss (0.5% to 1.5%
body weight/week), and detect potential relapses early so
that the weight loss plan can be adjusted or the client redi-
rected before additional weight gain occurs and frustration
becomes another barrier to success.
Keys to Communication
Great communication skills are as essential as clinical (phys-
ical examination and technical) skills to achieving success
in helping clients with weight loss programs for their pets.
Often, the most frustrating cases are those in which the cli-
ent’s and the veterinary professional’s expectations are mis-
matched. An appreciation of the client’s level of motivation
for weight loss allows us to tailor our interventions and can
help reduce our frustration with clients who do not adhere
to the weight loss program we have designed.
Using collaborative communication skills encourages
clients to actively participate in their pets’ care. This com-
munication style, known as relationship-centered care,7 uses
techniques that engage the client, allowing for shared deci-
sion-making between the client and the veterinarian. Shared
decisions are especially important in developing a successful
weight loss plan. To begin this process, first ask permission
to discuss the pet’s weight. This helps include the client in the
direction of the visit, and the answer will give you insight into
the client’s perspective. To help elicit pertinent information,
especially when collecting a diet history, use open-ended
questions, such as those beginning with “when,” “what,” and
“where.” When the client answers, summarize and clarify the
information in a supportive, nonjudgmental way. These tech-
niques, called reflective listening and empathetic statements,
communicate to the client that his or her perspective is recog-
nized and valued. TABLE 1 provides some specific examples
of t hese commu n icat ion t echniq ues, as well as commo n clie nt
statements that can help identify the client’s stage of change.
Moving Clients From Thinking to Doing
The best predictors of adherence to a weight loss program
are the veterinary professional’s interviewing skills and the
qualities of the veterinary–client interaction.8 To improve
adherence, it is essential to establish an atmosphere of trust
and demonstrate concern for both the patient’s and the cli-
ent’s well-being.9 It is also important to understand how
behavior change takes place.
Psychologists have developed several models to help
guide understanding of how humans make changes in
behavior to improve health. The “stages of change” model
developed by Prochaska and colleagues,10 also known as
the transtheoretical model, can be used to assess a client’s
readiness to change his or her behavior.11 It can help vet-
erinary professionals better understand the change process,
better partner with clients and patients, and customize rec-
ommendations that best suit their clients’ needs—in other
words, to use the “right” approach for the “right” client at the
“right” time. Implementing a weight loss plan when the client
is ready to act on your advice will improve your success and
be a more efficient use of your time.
Step 1. Identify the Stage of Change
The transtheoretical model identifies five stages of change
and their characteristic attributes10,11:
1. Precontemplation. The person has no intention of
taking action in the next 6 months. These clients might com-
monly be referred to as resistant, unmotivated, or unaware,
but clearly, they are not ready to change. In reality, our inter-
vention programs are often not ready for them.
2. Contemplation. The person is aware of the pros
and cons of changing and intends to change in the next
6 months. These clients may be stuck “thinking about it,”
intending to change “soon.”
3. Preparation. The person plans to take action in the
next month. Clients may have recognized the problem of
their pet’s weight and already sought advice from books,
online sources, or a pet store employee, trainer, or veteri-
nary professional.
4. Action. The person has taken action that is significant
enough to reduce the risks for disease. For example, the cli-
ent may have reduced the number of treats fed or selected
a different pet food. However, a change is not considered a
significant action unless it has reduced calories by at least
10% and provided complete and balanced nutrition.
Contributed by
ThE AmEricAn coLLEgE of
VETErinAry nuTriTion
About ACVN
Founded in 1988, the primary objective of the American College of Veterinary
Nutrition (ACVN) is to advance the specialty area of veterinary nutrition and
increase the competence of those who practice in this field by establishing
requirements for certification in veterinary nutrition, encouraging continuing
professional education, promoting research, and enhancing the dissemination of
new knowledge of veterinary nutrition through didactic teaching and postgraduate
programs.
For more information, contact:
American College of Veterinary Nutrition
c/o Dawn Cauthen, Administrative Assistant
School of Veterinary Medicine:
Dept. of Molecular Biosciences
One Shields Avenue
Davis, California 95616-8741
Telephone: 530-752-1059 | Fax: 530-752-4698
Email: dawncauthen@yahoo.com | Web: acvn.org
Vetlearn.com | December 2010 | Compendium: Continuing Education for Veterinarians® E3
TABLE 1 Assessing Readiness for Changea
Stage of Change Tasks for Veterinarians Common Client Comments Options for Veterinarians
Precontemplation—
the client is unaware
of the problem or
has no intention of
making changes at
the present time.
Seek permission to talk
more about the problem.
Provide general
information.
Establish a supportive
relationship.
Leave the door open for
future discussion.
“Toby looks just ne to
me. She’s kind of cute that
way.”
“We tried that special
diet last year and she just
won’t eat it.”
“I can’t get my kids to
stop feeding her from the
table.”
AP: “I am wondering if we could talk about Toby’s
weight.”
OQ: “What are your thoughts about Toby’s weight?”
OQ: “I am concerned that Toby’s weight may be
contributing to her health problems. What do you
think?”
RL: “It seems like you are comfortable with Toby’s
weight right now.”
ES: “I can see that you love Toby very much.”
Contemplation—the
client is aware of a
problem, but not yet
necessarily ready to
change behavior.
Look at pros/cons of
change and identify
supports and barriers.
Talk about ambivalence.
• “Yes, but….”
“I might be able to t
another walk into my
already busy day.”
“We could try reducing the
amount of table scraps.
She has come to expect a
treat at every meal.”
RL: “It seems like you are concerned about Toby’s
weight and are not quite sure how to make the change.”
OQ: “What will be most difcult for you?”
OQ: “What will be the easiest piece to put into place?”
OQ: “Tell me what is most important to you in caring
for Toby.”
OQ: “Who in your family is on board and will help you
with Toby?”
ES: “I know it’s hard to do this when you are already
busy.”
Decision making—
the client commits
to making a change,
and plans are set to
do the best the client
can.
Help determine the best
course of action and aid
in setting small, specific,
achievable goals.
“What can I do to address
Toby’s weight?”
“What was the name of
that weight-reducing diet
we might try?”
OQ: “What are your goals concerning Toby’s weight?”
OQ: “What small change might you make to start with?”
OQ: “How might we work together to develop a weight
loss plan for Toby?”
RL: “I hear you saying that you would like to discuss a
plan to address Toby’s weight.”
ES: “You seem motivated to address Toby’s weight.”
Action—the client is
ready and is making
changes.
Provide active support and
encouragement.
• Praise the client’s efforts.
“I am walking Toby twice a
day now.”
“She seems to like the
weight reduction diet and
eats it readily.”
C: “It sounds like you are doing a great job of
increasing Toby’s activity.”
OQ: “What changes have you noticed in Toby?”
RL: “It sounds like your plan is working well for you
and Toby.”
Maintenance—the
client is progressing
with the changes.
Provide active support to
maintain and practice new
behaviors.
Praise the client’s efforts
and recognize progress.
“I am starting to look
forward to the monthly
weigh-ins, as I am anxious
to see how much she has
lost.”
C: “Due to your hard work, Toby lost one pound in the
past month.”
OQ: “What has been the most challenging for both of
you?”
OQ: “How have you overcome these challenges?”
RL: “You are pleased with the progress you are making
with Toby’s weight.”
Lapses—the client
lapses into old
habits.
Identify changes that have
worked and use these
as strategies for moving
forward.
Understand that
motivation comes and
goes as a normal part of
life.
• Plan ahead for lapses.
“We did not make any
progress in Toby’s weight
this month. With the
holidays, I did not have
time to walk her like I had
been.”
“We were doing well until
I had the baby. I just don’t
have any time for Toby
these days.”
ES: “It’s hard to be consistent with any health plan. At
times we will do better than others.”
• OQ: “What has been working well for you and Toby?”
• OQ: “How might we capitalize on these successes?”
• OQ: “How do you feel we should proceed from here?”
AP = ask permission, C = compliment, ES = empathy statement, OQ = open-ended question, RL = reflective listening
aAdapted from material by Jane Shaw, DVM, PhD, Argus Institute Director, Colorado State University. Used with permission.
E4 Compendium: Continuing Education for Veterinarians® | December 2010 | Vetlearn.com
©Copyright 2010 MediMedia Animal Health. This document is for internal purposes only. Reprinting or posting on an external website without written permission from MMAH is a violation of copyright laws.
5. Maintenance. The person continues action to prevent
relapse.
Step 2. Select a Stage-Appropriate Intervention
Many weight loss programs fail because the type of inter-
vention chosen is not matched to the client’s readiness to
change. Many traditional programs are action-oriented, but
most clients do not start in the action stage. By understand-
ing the stages of change, veterinary health professionals can
adapt their communication tactics to better meet a client’s
readiness and support the client to become ready for change
(TABLE 1). It may take time and several visits to establish rap-
port and build the trust necessary to move clients along to
the next stage. These visits may require patience, but we
can better serve the patient’s health needs and build great
loyalty when we partner with these clients.
1. Precontemplation. If a client is in this stage, it is not
yet time to try implementing a weight loss plan for the pet.
However, it is equally important not to ignore the patient’s
obesity until the next annual examination. A frequent
monitoring plan should be implemented for these patients.
Express your concern about the pet’s health and recom-
mend monthly follow-ups to monitor for any adverse effects
of being overweight. Depending on the patient’s health,
these can be brief weight checks performed by a technician.
By conveying care and concern for the patient rather than
judgment, you can follow both the patient and the client so
that you are ready with a weight loss plan when the client is
more receptive.
2. Contemplation. If a client seems to be “stuck” in this
stage, he or she may need to learn more about the issues
involved. Providing resources such as handouts or links to
reliable Web sites may give them necessary information and
reinforce the message that you care about their pet’s health
and that obesity is a real health concern.
3. Preparation. Recruit these clients for action-oriented
programs. Ask them if they are ready to begin.
4. Action. Work with clients to design an individual
weight loss plan that accounts for their pet’s needs and their
own schedule and lifestyle. Provide feedback and compli-
ments on the patient’s progress to encourage the client to
stay with the plan.
5. Maintenance. Refine the plan as necessary to achieve
or continue healthy weight loss. Give clients information
and permission for a possible relapse. This removes judg-
ment if a relapse should happen and encourages them to
seek your help if it does.
Conclusion
When you form a partnership with a client, you create an
environment that supports change. By understanding the
stages of change, you can help move your clients from
thinking to doing, bring them closer to implementing a
weight loss program for their pets, and, ultimately, improve
their pets’ health. Selecting the right intervention at the right
time for the right client can tremendously improve the clini-
cal outcome. Successfully managing obesity can change a
frustrating problem to a rewarding one. The pet’s health and
quality of life improve, and the pet owner becomes a loyal
client because he or she has been an active partner in the
health care plan.
References
1. Lund EM, Armstrong PJ, Kirk CA, Klausner JS. Prevalence and risk factors for
obesity in adult dogs from private US veterinary practices. Intern J Appl Res Vet Med
2006;4:177-186.
2. Lund EM, Armstrong PJ, Kirk CA, Klausner JS. Prevalence and risk factors for
obesity in adult cats from private US veterinary practices. Intern J Appl Res Vet Med
2005;3:88-96.
3. Kealy RD, Lawler DF, Ballam JM, et al. Effect of diet restriction on life span and age
related changes in dogs. JAVMA 2002;220:1315-1320.
4. Obesity: epidemiology, pathophysiology and management of the obese dog. In:
Pibot P, Biourge V, Elliot D, eds. Encyclopedia of Canine Clinical Nutrition. Royal Canin;
2006:11-16.
5. Michel KE. Using a diet history to improve adherence to dietary recommendations.
Compend Contin Educ Pract Vet 2009;31:22-24.
6. Perea S. What’s the take-home? Nutrition. Clin Brief 2010;8:63-65.
7. Cornell KK, Kopcha M. Client-veterinarian communication: skills for client cen-
tered dialogue and shared decision making. Vet Clin North Am Small Anim Pract
2007;37:37-47.
8. Morrisey JK, Voiland B. Difcult interactions with veterinary clients: working in the
challenge zone. Vet Clin North Am Small Anim Pract 2007;37:65-77.
9. Abood SK. Increasing adherence in practice: making your clients partners in care.
Vet Clin North Am Small Anim Pract 2007;37:151-164.
10. Prochaska JO, Johnson S, Lee P. The transtheoretical model of behavior change.
In: Shumaker SA, Ockene JK, Riekert KA, eds. The Handbook of Health Behavior
Change. 3rd ed. New York: Springer; 2009:59-84.
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Manual of Veterinary Dietetics. St Louis: Saunders; 2004:143-162.
Using a Diet History to Improve Adherence to •
Dietary Recommendations, January 2009
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Clinic Resources—Diet History Form
[http://www.vetlearn.com/Portals/0/Media/
PublicationsArticle/PV0109_DietHistoryForm.pdf]
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