Monitoring and maintenance
Effective follow-up and regular monitoring by the entire veterinary team are critical components of a successful weight loss program. Consider some of the following points:
- Train the veterinary team to provide consistent information about diet and feeding for each life stage.
- Implement multimodal client reminder systems (e.g., postcards, phone calls, e-mails).
- Designate specific team members for client support and followup encouragement.
- Provide or recommend that clients participate in group programs (e.g., dog walking groups, agility clubs).
Once a program has been initiated, contact the client after the first week as many get discouraged with concerns such as food refusal and begging behaviors that are best addressed early on. Provide clinical support from team members via frequent phone calls between weight checks. Identify and address obstacles and client concerns, satisfaction, or frustrations with the program.
Follow up with the client either by telephone or an office visit q 2 wk until the desired rate of weight loss is established. Monitor the patient monthly until the ideal weight has been reached and has stabilized on a long-term maintenance program.
Suggested follow-up procedure
Consider some of the following suggestions when following up with the patient and clients:
- Ask open-ended questions to solicit client observations and concerns. Provide positive reinforcement.
- Record BW, MCS, and BCS. It may be useful to show the client measurements of either girth or abdominal circumference to emphasize losses.
- Take a picture of the patient. Create a chart to monitor and show progress.
- Calculate the rate of weight loss using the calculation:
- %weight loss/wk = (amount of loss since last visit/weight at last visit x 100/number of wk since last weight measurement)
- The desired rate of weight loss in dogs is 1–2%/wk, and in cats is 0.5–2%/wk.
- Modify the rate of weight loss in growing pets < 1 yr of age (see previous comments about feeding for growth). Depending on patient age, the focus may be to slow weight gain rather than to cause weight loss.
- Anticipate a possible slower rate of weight loss in patients with a comorbid condition (such as hyperadrenocorticism or hypothyroidism) either until or unless the primary disease is addressed.
- If MCS decreases, confirm adequate protein intake and evaluate the patient for either too-rapid weight loss or a comorbid condition that intensifies catabolism (e.g., diabetes, renal disease, hyperthyroidism), and adjust intake to reduce the rate of weight loss.
- If the desired weight loss is achieved, congratulate the client and identify the next target weight.
- If weight loss is greater than the above-described desired rates, increase calories by 10% and monitor response.
Reassess if weight loss is insufficient
If the desired weight loss is less than the above-described desired rates, consider the following:
- Evaluate either adherence or other influences that may have tempered results and suggest alternatives.
- If adherence is verified and there is no evidence of risk, reduce calories by 10–20% and/or change activity recommendations and identify the next benchmark.
- In the authors’ experience, to achieve weight loss, most patients can tolerate caloric restriction as low as 60% of RER of ideal BW without adverse clinical signs.64,65 Warn clients that that approach will likely differ from feeding instructions on the label.
- More aggressive caloric restriction (< 60% RER) increases the risk of nutritional deficiencies and undesirable pet behavior that will test the client’s commitment and adherence. Both commercial and therapeutic diets may lack adequate levels of essential nutrients at that level of caloric restriction. Cats may also have increased risk of hepatic lipidosis.
- Consult with or refer to a board-certified veterinary nutritionist for clients with pets requiring < 60% RER to achieve weight loss.
- Schedule the next weight check or telephone follow-up.
Maintain weight loss once goals are achieved
Once the pet has reached its ideal BW, careful monitoring is essential to avoid weight regain. Some pets may have a propensity to quickly regain excess BW after a period of weight loss if healthy lifestyle habits are not continued.
Selection of a diet for BW maintenance is based on the pet’s metabolic needs and client preferences, but during maintenance many pets still require relatively low caloric intake.40 When faced with caloric restriction, some pets’ metabolism may reset at a lower rate and, thus, they may require greater caloric restriction than expected after the ideal BW has been achieved.66 Some pets may plateau at an ideal BW and require no change in intake from that used during the weight loss program for weight maintenance going forward.
If the patient is still losing weight once the ideal BW is achieved, increase caloric intake by 10% to change from weight loss to weight maintenance. Monitor q 2 wk until stable BW is achieved then monitor monthly to make sure ideal BW is being maintained, making adjustments if necessary. It may take several monthly recheck exams to determine appropriate maintenance energy requirements.