Nov
14
2018

Most canine weight loss interventions involve a change in diet, but the authors of a new literature review wanted to know whether interventions that used behavior change techniques (BCTs) to modify pet owners’ behavior could be effective, too.

The authors’ conclusion, based on the findings of the 14 studies they analyzed: Um, probably.

Which BCTs were most effective? Hard to say . . . needs more research.

Thomas Webb, PhD, MSc, a professor of psychology at the University of Sheffield in Sheffield, England, and lead author of the paper, concedes that the paper provides no clear answers, and told NEWStat that while the findings point to the potential of BCTs in canine obesity interventions, “There’s currently too little research in this area to draw any firm conclusions about the most effective strategies and techniques to include in an intervention."

NEWStat reached out to Ernie Ward, DVM, CVFT, founder of the Association for Pet Obesity Prevention (APOP), an expert on pet obesity, and a coauthor of the 2014 AAHA Weight Management Guidelines for Dogs and Cats, for help in parsing the review’s findings.

Ward said Webb, who has done a lot of research into the effectiveness of BCTs in human obesity studies, was trying to see if there was any overlap between veterinary research and human research—which puts the review in a context most readers would be unaware of.

Ward says that any overlap could have important implications for both humans and pets: “The general consensus in weight loss for humans, and I’d argue that this trend relates to pets, is that behavioral intervention is very limited in sustained efficacy.” Human weight loss research suggests that based on behavioral changes alone, maybe 10% of subjects will achieve sustainable weight loss for longer than five years. “We know that behavior changes alone aren’t likely to make lasting changes [in humans].”

Ward says that the relative ineffectiveness of BCTs in human weight loss is the reason the success stories in human weight loss literature tend to focus on medical and surgical interventions: “Those are the only things that have been demonstrated to provide lasting, sustainable benefits.”

The trouble is, veterinary medicine currently has no approved medical or surgical interventions as treatment options; the only optional intervention outside of dietary is behavioral. Hence Webb’s interest in its efficacy.

Still, Ward says the findings offer “glimpses of hope” that BCTs can help reduce canine obesity: “The studies are very clear that measuring and weighing food probably has the most dramatic impact; that seems to be the thing that really moves the needle.” So does the use of tracking devices to monitor physical activity.

But as with successful human obesity management, successful canine obesity management is unlikely to hinge on human interventions. Most likely, Ward says, it will hinge on medical ones.

Ward defines medical intervention as administering medication designed to influence metabolism to enhance weight loss or maintain lean muscle mass, a common treatment option for humans. “Currently there are more than 13 FDA-approved weight loss medications for humans,” Ward says. There are none for companion animals. “The fact that those treatment options exist [for humans] is really important, not only in the treatment, but in the raising of awareness,” Ward says. “Many veterinarians are frustrated that the only advice they can offer [pet owners] is ‘feed less, exercise more.’”

“Until we actually have medical intervention, we’re still going to be frustrated by how [little] impact behavioral changes alone can have,” says Ward

Ward believes the answer to the problem of companion animal obesity lies in changing the way we talk about it—and that starts by taking our cue from human medicine and defining obesity as a disease.

Ward points out that when obesity was declared a disease in human medicine in the US in 2013, awareness of the condition ramped up exponentially; once people stopped seeing obesity as a character flaw or a lack of willpower and started viewing it as a disease, attitudes about treating it changed: “You started seeing more extreme options—whether they were surgical or medical.” As attitudes changed, those treatment options that once seemed extreme became mainstream.

Ward compares obesity in dogs today to osteoarthritis in dogs 30 years ago. “There were probably a very similar number of dogs who had it [then as have it now],” he says, “but we didn’t have great treatments, so diagnostic rates were pretty low. A lot of times [veterinarians would] say, ‘Well, you know, old Sam is slowing down, his hips are probably starting to bother him.’” But veterinarians wouldn’t necessarily make a diagnosis of osteoarthritis “because we didn’t have good treatment options.” Back then, treatment for osteoarthritis was mostly limited to NSAIDs like aspirin, which were prone to cause side effects. “So, suddenly fast forward to the late nineties, and we have [Rimadyl], the first NSAID for dogs that was safe and effective.”

That was a game changer.

Once we had effective treatments for osteoarthritis, Ward says, “veterinarians were far more likely to diagnose the condition. I think you’ll see the same thing happen as we move forward [with] declaring obesity as a disease.”

That could happen as early as next year.

Ward was lead author of “The Global Pet Obesity Initiative Position Statement,” which essentially calls for classifying pet obesity as a disease. The APOP position statement was endorsed last July by the American Veterinary Medical Association Board of Directors and Future Leaders Group. The AAHA Board of Directors endorsed it last April.

“Right now, as long as all I tell vets to do is feed less, exercise more, we’re probably not going to see the research or the changes we need. That’s why [Webb’s] paper is also significant. Even in cases and studies where we saw [BCTs implemented], we still didn’t see the majority of the subjects have significant or profound changes. We’re still looking at very minor shifts, and we have to do better.”

Ward says the the APOP statement is scheduled for publication in Journal of the American Veterinary Medical Association in January 2019.

“It’s the first step in saying, ‘Let’s standardize the definitions; let’s standardize the measurement, and let’s declare it a disease,” says Ward.

The second step?

“We have to let the profession fill in the blanks and find the solution,” Ward says.

He’s confident it will, if what happened when obesity was declared a disease in humans is any indication. “This really [will] encourage people to do additional research.”

Photo credit: © iStock/alkir

 

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