Dr. Taryn Pestalozzi, DVM, residency-trained in Nutrition, joins the podcast to talk about how she approaches difficult pet weight-loss conversations. Dr. Pestalozzi and Dr. Roark discuss the case of an obese Labrador Retriever named Greta, and how best to handle her care. As a veterinarian who practiced in GP for 7 years before running the Healthy Weight Clinic during her internship at Kansas State University’s Veterinary Health Center, Dr. Pestalozzi has fantastic and practical insight on how to motivate pet owners to make real changes for the sake of their best friends.
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LINKS
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ABOUT OUR GUEST
Dr. Taryn Pestalozzi received her bachelor’s degree from Smith College in 2008, before graduating with her DVM from Oregon State University in 2013. Dr. Pestalozzi was a general practitioner in the Portland, OR metropolitan area for 7 years before completing a clinical nutrition internship at Kansas State University’s Veterinary Health Center, where she managed the Healthy Weight Clinic. Dr. Pestalozzi recently completed her clinical nutrition residency at UC Davis Veterinary Medical Teaching Hospital.
EPISODE TRANSCRIPT
Dr. Andy Roark (00:07):
Hello and welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one for you. Today is on mastering weight Management. This is super mega practical, what to say and how to say it. Podcast, I have got Dr. Taryn Pestalozzi here. She is residency trained in nutrition. She’s a joy to talk to. She is super practical and pragmatic, which I really love. She’s got great advice for setting up these weight management conversations in a way that actually get results and help us convince pet owners to make the steps they need to make to take care of their pets. Anyway, you are going to probably get some affirmation for things that you do out of this, you are also going to get some tips and tricks for things that you don’t do or ways to have these conversations that you haven’t had.
(00:55):
I am really big on this. I love it when we get insights on things that we do a lot of because little tweaks in those behaviors make a huge difference because we do ’em all the time. And so anyway, this episode is really good and it’s really useful. I think you guys are going to really, really like it. I have to say thanks to my friends at Hill’s Pet Nutrition for making this episode possible ad free. And I also have to say thanks to ’em for their Hill’s Veterinary Academy. Guys, if you have not checked out the Hill’s Veterinary Academy, it is a fantastic learning platform that Hill’s is putting out and they are steadily growing and expanding and it is packed full of good stuff for training your team. It’s got free RACE CE in there. There’s so much that’s going on and they’re really putting a lot of effort into it. So anyway, if you are not familiar with the Hill’s Veterinary Academy, I’m going to put a link down in the show notes. You can give it a Google if you want to go that way, but check it out. Go see what they’re doing. This is really just a neat little gift through our profession. So anyway guys, that’s enough of that. Let’s get into this episode.
Kelsey Beth Carpenter (01:55):
(singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark (02:12):
Welcome to the podcast, Dr. Taryn Pestalozzi. How are you?
Dr. Taryn Pestalozzi (02:16):
Good. Thanks for having me.
Dr. Andy Roark (02:17):
Oh, I am so glad that you’re here. I am looking forward to this. So, what I wanted to talk to you about today, so when you did your internship, you did your internship at Kansas State and you ran the healthy weight clinic there and I see a lot of very heavy pets. I saw a cat that was rapidly gaining weight last week and it bothers and this is a passion of yours. It’s something you have a lot of experience in. I just want to run through a healthy weight campaign with you today and just be like, alright, tighten. Let’s tighten the bolts down here and I want to make sure that I’m running a program and then I can carry this out and I want to get weight off of pets and so are you okay to run through a case with me and just start to finish and get me set for success?
Dr. Taryn Pestalozzi (03:22):
That sounds great. Let’s do it.
Dr. Andy Roark (03:24):
Let’s do it. I have got a 100 pound female spayed chocolate Labrador named Greta. So Greta is eight years old and those hips ain’t what they used to be. Sure not. And I can see it. I can see that the muscle mass in her back legs is not what it used to be. And owners are not reporting mobility issues. She’s not, her gait doesn’t appear to be, you don’t see her walking going, oh boy, but she’s eight and I can see that when I look into my future scope where I look ahead a year or two. And so this dog is probably 20 pounds overweight. I think she should be, honestly, if I’m really serious, she should probably be a 75 pound lab, but she’s a hundred. I could be okay. I think if she’s 80, I have to see it. You know what I mean? And you go,
(04:23):
I think 80 is about right. I have to see it, but I need some help in this. And I think that I can get the owners motivated, they love this dog. I think I can make a solid pitch for the lack of mobility that’s coming down the pipes and I want to really push and so I have not gone into this room yet, but I want you to help me. That’s how the table is set. Taryn, how do you treat this case? Where’s your head at when you’re standing outside this door to the exam room getting ready to go in?
Dr. Taryn Pestalozzi (04:55):
So I think the first thing is maybe keeping in mind maybe these owners haven’t come to see you for this problem. They’ve brought Greta in for her annual exam. Yeah, she’s in needs. So it can sometimes take people off guard when you bring up a topic and you get really fixated on that that they weren’t really coming to talk about. So first thing I think is to not forget your primary reason for the appointment. And if you need to schedule a follow-up to actually spend more time talking about the weight loss, do that. But then also consider asking permission to talk about her weight. Be thoughtful with your language. Don’t use fat humor. There was a consensus statement that came out of the UK between medical professionals and the human medical side and patients from obesity programs that talked about what kind of conversations and language are useful. So some of those tips are coming from that consensus statement sort of extrapolated that to our veterinary friends. So just be mindful that as you go into have this conversation.
Dr. Andy Roark (05:53):
Okay, talk to me a little bit about asking permission, right? Give me some language. I know we’ve had a lot of doctors who, and there’s a lot of technicians that are coming in and taking a history and they know that I’m going to come in and talk about the weight and it would be helpful to me if they could open this conversation up. So give me an example of what that, asking permission, I get the concept, what does that sound like?
Dr. Taryn Pestalozzi (06:12):
Yeah, I would start with an open-ended question probably. So asking the client how do they feel Greta’s doing overall? Do they have an idea of where they think she is in terms of weight? Do they think she’s a healthy weight? Do they have any concerns that she might be over or underweight? And that lets you also assess maybe where they’re at with that topic and then ask them, do you mind if we spend some more time talking about this today? I think I have some concerns.
Dr. Andy Roark (06:40):
I really like that question of do you have any concerns about her being over or underweight? It feels like a standard sort of form question and it’s not a judgment question. It feels like I’m taking a history or I’m filling out my form and it helps me know really quickly do they see it or are they blind to it? And we’ve seen, I mean I literally had a case just like this one chocolate lab a hundred pounds and the owners just could not see it. And I was showing them the body condition out and they didn’t get, that was rare. Definitely happened. I still remember it. They were just like, Nope, she looks like a five of nine to us and I’m just going, we’re not looking at the same things.
Dr. Taryn Pestalozzi (07:19):
Yup.
Dr. Andy Roark (07:19):
Anyway, a great question. Alright, I love it, Taryn. That’s super helpful. Alright, great. So I get get this conversation, get permission to talk to them about it. I like it. Let’s say that they’re like, sure we’re here for our annual exam, wellness, yup, we’ll totally talk about it. Where do you start to go from there?
Dr. Taryn Pestalozzi (07:39):
Yeah. Next would, as part of my exam I do a body condition score assessment on Greta and I think most of us are familiar with the body condition score concept. There’s a couple of different scale systems out there, so there’s a five point scale, there’s a nine point scale in the nutrition world, we tend to go with that nine point scale and if you need a resource in your clinic, the world’s mono, that association has some nice non-branded charts that you can use, but there’s lots of them available and I keep a copy in my exam room laminated and I actually pull it out and I look at it while I do my body condition score because the more you actually read through the definitions of what each of the points on the scale mean, the more consistent you will get. And also if you have your support staff and the other clinicians in your hospital all using that same tool and actually looking at it, you’re going to be more consistent across your whole clinic so that you start building a more reliable history as you’re seeing patients.
Dr. Andy Roark (08:35):
I tend to run into not opposition to this conversation, but just a level of passiveness that they don’t argue with you. They’re not like, no, we’re not going to do a weight loss program. But non-committal I think is how I would
Dr. Taryn Pestalozzi (08:57):
Yeah
Dr. Andy Roark (08:57):
And again, I’m going to lean into the hips in this case and try to make a real quality of life point here, but as I try to motivate for action and try to push through that non-committal place to get them on board with taking action, how can you support me there?
Dr. Taryn Pestalozzi (09:18):
Yeah
Dr. Andy Roark (09:18):
How do you do that?
Dr. Taryn Pestalozzi (09:20):
I think it’s common for a lot of us to maybe focus on those negative outcomes that we are sort of foreseeing in the future. And there’s certainly clients that might need that, right? They maybe need you to really kind of hone in on those negative potential outcomes because they might not budge without it. But going back to that consensus statement in human medicine, it’s actually more effective a lot of times to focus on positive outcomes of weight loss rather than the negative potential consequences of being overweight or obese. So I hear from clients all the time, even with minimal, it’s pretty small amounts of weight loss. They’re acting so much younger, I can see they look thinner. I’m getting compliments on how they look. I’ve had to make their harness smaller. And so really focusing on what the benefits are and what they might see as that progress happens, I think is often more motivating.
Dr. Andy Roark (10:14):
I like that. So what your counsel here would be in the case of a dog that’s overweight and a senior pet is maybe don’t, ooh, she’s getting older, but instead talk about what we could accomplish and she could have the best years of her life. I mean there’s quite possible we could turn back the wheel of time a couple of years and you would see her
Dr. Taryn Pestalozzi (10:35):
Sure, let’s give her the best quality of life where we can as long as possible. And to do that, let’s really focus on getting her down to a lean ideal body condition so that she can be mobile as long as possible and do the things that she loves.
Dr. Andy Roark (10:47):
I’d much rather have the positive conversation than the negative one. No one wants to go tell someone, I’m really worried your dog is going to get worse and have hard time getting up. And that’s not a fun conversation.
Dr. Taryn Pestalozzi (11:00):
No, it’s not at all.
Dr. Andy Roark (11:00):
Appreciate this perspective. I like this so motivating from here to hear to action. I do like that. Any other advice for trying to get buy-in and build momentum?
Dr. Taryn Pestalozzi (11:11):
I think it’s important to try to get all of the humans in the household on the same page. There’s always going to be that person who maybe causes lack of compliance, sneaking treats or they don’t see the importance of the plan. So trying to get everybody involved in that conversation and on the same page is always a good idea if you can, it’s not always possible, but I think that’s going to be helpful for your success.
Dr. Andy Roark (11:40):
What does that look like when you go into the exam room? Because it’s always like my husband does and he’s not there.
Dr. Taryn Pestalozzi (11:50):
They throw each other under the bus. Right?
Dr. Andy Roark (11:52):
Business. That’s totally true. It could a hundred percent not just because they say it’s the person who’s not there. That doesn’t mean that really is.
Dr. Taryn Pestalozzi (12:00):
Sure. I’ve had clients pull me aside, tell me to kind of tell on their spouse or their partner. So I think if you can have ’em both in the same room, maybe you do have schedule a follow-up appointment and ask if they can both be there or I’ll be there. But otherwise, I mean I’ve had clients ask me to write letters to their significant others on letterhead to tell them they need to stop feeding the pet. I haven’t had that as much since I came to nutrition, but I was a GP for seven years before I did nutrition, so I definitely got that apps that several times
Dr. Andy Roark (12:31):
Oh that’s so funny. Alright.
(12:33):
Got it.
Dr. Taryn Pestalozzi (12:34):
I mean you kind of have to play it by ear, but I think trying to get buy-in from everybody is useful.
Dr. Andy Roark (12:39):
Oh, I love it. I just wondered if you had some special tool like I video myself and text it to them. I don’t know. I don’t know. I was just curious if you had any tools for wrangling people in.
Dr. Taryn Pestalozzi (12:48):
Yeah, we do the best we can.
Dr. Andy Roark (12:49):
I love it. This feels so daunting. 25 pounds is a lot. I mean 20 pounds, it’s a lot. 20 pounds per person is a lot and a person weighs more than a hundred pounds. Generally it’s a lot to lose. We’re talking 25%, 20, 25% of this pet’s entire body weight. How do set, it’s not going to be done in a week. This is going to be a process. How do I set expectations so that the clients are not like we’re going to try hard for five days and then I don’t see any changes I’m giving up, help me set us up for success in this and what’s going to be a marathon?
Dr. Taryn Pestalozzi (13:33):
Yeah, I think that’s a really good question, a thing to consider. So there’s a few things. First, the Association for Pet Obesity Prevention puts out annual reports that do surveys of both veterinary clinics and pet owners. And on the most recent data from 2022, they reported on average maybe 30 to 40% of pet owners who had tried a weight loss plan either reported their pet was not successful or they even gained weight. So trying to mitigate that is going to be helpful for long-term compliance. So the first thing is being specific in your recommendations so that you are setting them up for hopefully success right away and not sort of initial lack of weight loss, ribbon weight gain. We can’t always prevent that. So I do warn owners this is a process, it’s going to take us a while. We might backslide occasionally, but we will hopefully be moving forward the majority of the time. I think the second thing is coming up with a timeline. If Greta is a hundred pounds, let’s say that she is, I don’t know, 20% overweight, so she’d be a seven out of nine. For example, if our goal’s a five, so she’s actually 20 to 30% overweight as a seven out of nine. So then we can say, okay, well she’s 20 to 30% overweight and she loses on average 1% per week, which would be the bottom of our target range, then it’s going to take us at least 20 to 30 weeks to get her down to ideal weight. And that’s on an ideal sort of situation. It often takes longer. So giving them a timeline of what to expect I think is helpful.
(15:12):
Then the last thing is just really monitoring so that you can be making adjustments to the plan. I normally see these patients ideally every two to three weeks, or if I’m not seeing ’em in person, I’m at least doing a virtual check-in appointment. I’ll have them weigh them on their own and send me the wait before the appointment and then we can spend maybe five to 10 minutes on the phone or on a video call having that conversation of what’s next, what adjustments do we do or not need to do, what do we need to troubleshoot? And that way we’re keeping progress moving forward hopefully and not running into plateaus that just continue on and on and on.
Dr. Andy Roark (15:48):
Yeah. Okay. I got a couple of questions, so I really like this. So tell me what a specific recommendation sounds like when you say that. How far down the rabbit hole are you going as far as the specificity of what you’re giving to?
Dr. Taryn Pestalozzi (16:03):
Yeah, well, I mean as a GP was totally guilty of this, and I know lots of other practitioners do this too, of they’re overweight to say, oh, just drop their food a quarter of a cup, right? Yeah.
(16:14):
And we go, okay, great. We’ll see you in six months for your net set of vaccines, have a good life, whatever. And instead, what really we should be doing is giving a specific feeding amount. So the first thing is, as much as we can getting an accurate assessment of how much the pet is currently eating, so all the food they’re getting, any treats, any foods they’re going to use to give medications, which often clients forget to include in that history when you ask. And from there, I normally would drop their intake probably 20% initially if, I don’t know if they’re the kind of client who says, oh, well I feed the green bag, it’s really expensive so I know it’s good quality and I just fill the bowl up every two days. Well then I would start for a dog with their resting energy requirement and if they’re a cat, I’d start at 80% of the resting energy requirement.
(17:02):
There’s two methods, so a lot of nutritionists will use an estimated ideal weight to do those calculations and that’s great. That’s how I did it when I ran the Healthy Weight Clinic at K State for that year, and it’s definitely a successful method. That’s also what AHA has in their weight management guidelines. At Davis, we do things a little bit different. We use their current weight, not an estimated ideal weight. We want to use a true number and not an estimate to make all of our calculations. Both methods work really, you’re just picking a starting point and you’re adjusting from that starting point. The other thing we do is we recommend they weigh their food in grams, or if it’s canned food, then at least an easy fraction of a can because we want to be as accurate as we can so that we can make small adjustments as we go.
Dr. Andy Roark (17:46):
Okay. Yeah, that totally makes sense to me. I like the timeline idea as well. I think that’s part of the recommendation. It’s funny when you say 1% per week, I go, okay, well that’s six months, which feels very different. And just saying out loud, this is minimum of six months, just so you know,.
Dr. Taryn Pestalozzi (18:05):
That’s like best case scenario. If there is six out of nine, I can probably get them down to ideal and figure out what it takes to keep them there in about six months. If they’re seven or above, realistically you’re talking more like nine to 12 months or more.
Dr. Andy Roark (18:19):
Yeah.
Dr. Taryn Pestalozzi (18:20):
They’re that 11 out of nine, maybe you’re talking 18 months. So it’s not a short process. It does take a dedicated owner and that’s why you have to be their cheerleader and positive reinforcement of the owner. You’re doing a great job. I’m seeing improvement. Let’s keep going. We give prizes. When they reach their target weight.
Dr. Andy Roark (18:38):
What kind of prizes do you give?
Dr. Taryn Pestalozzi (18:40):
Well, at Kansas we took a photo of them and we were going to make, this was right as I was leaving, we were going to make a wall of fame. So I dunno if that or wall of success kind of oncology departments like to do with their pets finished chemo and then I would give them slow feed bowls or leashes or frisbees, that kind of stuff. If we had plants who are really hesitant to weigh their pet’s, weigh their food, we actually had some gram scales and we would just give them one
Dr. Andy Roark (19:07):
Wow.
Dr. Taryn Pestalozzi (19:07):
Say, can you please just do it? I didn’t do that for everybody, but it was like I was getting a lot of pushback. Yeah.
Dr. Andy Roark (19:13):
Well it shows how serious you are about it, for sure.
Dr. Taryn Pestalozzi (19:16):
Yeah.
Dr. Andy Roark (19:17):
Talk to me a little bit about what these, so I really like sort of the monitoring part. Talk to me a little bit about what these monitoring recheck appointments look like. So you’re like, yeah, we see ’em back two to three weeks. First let’s talk in person. But I think the virtual is, there’s a lot of opportunity there, but just if you have them sort come back into the clinic, what does that recheck look like? I know everybody’s busy, you know what I mean?
Dr. Taryn Pestalozzi (19:37):
Sure, yeah.
Dr. Andy Roark (19:37):
So we’re trying squeeze it in. What does that experience for the clients look like?
Dr. Taryn Pestalozzi (19:42):
So it can be a quick appointment. So my sort of rule of thumb is if I’ve made any changes to their plan, I try to see them back in two to three weeks. If we haven’t made any changes, I push it out like a three to four weeks. So on average every three weeks or so, and it could be probably at the most a 15 minute appointment if you are sort of efficient in how you’re running it, if you’re leveraging your support staff so you could have your support staff go in and body condition that animal if you’ve gotten everybody well trained and on the same book in that regard, get a weight and take a little bit of a diet history. How have things been going? Are you feeding them out? We talked about last time, have you run into challenges? What sort of troubleshooting?
(20:21):
I mean, I think the classic example I give to students is they come in and they haven’t lost any weight and it’s December and you find out that, oh, the in-laws are in town visiting for the holidays and they’ve been feeding the dog a ton of milk bones, so maybe we don’t need to make a change that visit. Maybe we just need to send the in-laws home and get back on track. But if they have kind of lost in that one to two-ish percent percent of body weight per week, then great, we don’t make any changes. We see you again in a few weeks, reassess. If they have not lost as quickly as we’d like or they’ve gained weight, then I’d probably drop them about 10% of their daily caloric intake.
Dr. Andy Roark (21:03):
Okay.
Dr. Taryn Pestalozzi (21:03):
They’re losing too fast, then I’d up ’em 10% and I’d see ’em again in two to three weeks and we’d reassess at that point. And I keep in mind treats. So we plan for treats in our plans. Yeah,
Dr. Andy Roark (21:14):
Gotcha. Talk to me about what losing too fast looks like. So that’s what I was going to start to poke you about a little bit was like when they come back in two to three weeks, what are we looking for? And definitely, I like the idea that we’re going to put ’em on a scale. We’re going to put ’em on the same scale they used last time, so we get some consistency and then if we’re not seeing any weight loss at all, we’re going to start to adjust. And that all tracks to me, when do I have to start worrying like, oh, we’re falling like a stone? Because I suspect that pet owners are probably pretty psyched. They’re like, this is great. We’re making real headway. Greta’s not really thrilled, but the pet owners, I could see them being on board. What am I looking out for there?
Dr. Taryn Pestalozzi (21:56):
Yeah, I mean I’ve had that happen. It’s less common than you might think, but I mean, I’ve had dogs that got boarded when they were sort of starting their plan and they lost like five, 6% in a short period of time, like 10 days. And so our concern there is two things for both species we’re concerned about lack of muscle, muscle losing lean muscle. You mentioned Greta, you were concerned about the muscle in her hind end. So that’s great. I would encourage everybody to actually record a muscle condition score every visit. It doesn’t have to have a number. The world’s Monolo Bed Association actually doesn’t use a numerical scale. It’s just normal or mild, moderate or severe atrophy. And then I’d also be concerned maybe in our cat patients about something like hepatic lipidosis, but that takes a lot. It takes very dramatic sort of extended in tants or hypoxia to get hepatic. So I don’t get too worried about it. But certainly for our cat patients, if I’m starting a new plan, I am really conscious of how I tell owners to transition ’em onto a new food and give them criteria for when they would need to call us. If they’re not eating the new food or they’re not doing well,
Dr. Andy Roark (23:04):
How does the virtual check-in visit work? Because if they’re not there and you don’t have your scale, what is that experience like for the pet owner?
Dr. Taryn Pestalozzi (23:11):
Yeah, I mean it’s a pretty similar, I think outline to how the appointment runs. But what I do is I made a little handout for my owners that shows them some specific photos. I want them to take the photo from the side, a photo from above, and then one of their face if you want to use the body fat index tool from Hill’s and University of Tennessee, I’d also take a picture from behind them staring at their butt. And that lets me just assess roughly their body condition or their body fat index. And then I have the owners weigh them and I just tell ’em, find a consistent way to weigh them, whatever that is. They’re coming to your clinic just for a quick swing by the lobby scale. Or if they have a scale at home, they can get an infant scale or even a floor scale for a big dog relatively inexpensively online. And so they just email me in advance their weight, they send me their photos. I can do the math that I need to do right before the appointment, and then it takes 10 minutes or less to have that conversation about do we need to troubleshoot anything? How fast or how slow were you losing weight? And what adjustments do we need to make?
Dr. Andy Roark (24:14):
Got it. Perfect. That totally makes sense. Good deal. I like this. This seems good. Are there, so we’ve got a plan, we’ve got some good motivators, we’ve got specific recommendations. We’ve got a follow-up plan. I really like the ongoing monitoring. That makes a ton of sense. I a hundred percent see how I can lean on my technicians to help me with this and to run this program. That’s a big deal to me. I really like nutrition for technicians and they can make my job really easy and we can make a real impact together. But anyway, so I like all this. Is there any final pearls pieces that I want to make sure that I’m not forgetting
Dr. Taryn Pestalozzi (24:54):
And I maybe skipped over it? So in our specific recommendations,
Dr. Andy Roark (24:58):
mm-hmm
Dr. Taryn Pestalozzi (24:58):
the majority of these patients should be on a therapeutic, a prescription weight loss diet because if we start restricting their calories, especially if they get below RER or even 1.2 times RER, if we’re talking about dogs, we can cause nutritional deficiencies if we feed a non-therapeutic diet for a long time because those therapeutic diets are fortified with extra protein and vitamins and minerals to account for the lower calorie intake that those pets are having. They also help them with stain full, so satiety, if they’re canned diets, they have a lot of moisture. If they’re kibble, they might be what they call air puffed, so bigger kibbles to take up more volume. And then they also often are high in fiber to help them feel full. So you really should be using a diet like that if you’re going to institute a weight loss plan unless you’re doing small amounts of weight loss and you’re being very conservative with how fast you push them.
Dr. Andy Roark (25:50):
Okay. Define RER for me real quick.
Dr. Taryn Pestalozzi (25:53):
Resting Energy Requirements, and there’s a couple ways you can calculate it. I’m going to give some resources I think at the end that we’ll show you how to do all the calculations and walk you through how to do a plan like this.
Dr. Andy Roark (26:05):
Cool. I love it. And then I want to dig into this a little bit. I think that’s a great point about moving to therapeutic D because one of the pushbacks I always get is, well, I can just, there’s a light version of what they eat. Can I just use the light food? And I want to be supportive of pet owners and kind meet ’em where they are. And at the same time, I do feel like I’m only going to get one good shot. Often it’s one good shot, they’re going to make an attempt and if it doesn’t go anywhere, they’re going to kind of say, well, I guess she’s just a big girl and that’s what she’s going to be. And that’s that. So break that down for me a little bit as far as where your lines are when you’re like, no, it’s time to go to the therapeutic diet. I want to be confident when I make that recommendation to switch to a therapeutic diet and say, yes, this is the play we need to make. Where are your lines? Can you solidify that for me a little bit?
Dr. Taryn Pestalozzi (27:04):
It’s never wrong to pick a therapeutic diet for weight loss unless they have comorbidities that require other nutritional strategies. And there is not a commercially available combination diet. So there are combination joint support and weight loss diets. They’re a combination hydrolyzed and weight loss diets, et cetera. So it’s not wrong if you can find an option to do that other than it’s more expensive, I think that’s always the safe way to go. If I had a patient that did have other comorbidities, that’s the time to talk to a nutritionist or at least call the vet consult line for one of the therapeutic companies to talk to them about the case because maybe that pet really needs a homecooked diet to be able to accomplish weight loss and safely manage their other disease. But if I was going to go with a light or weight management diet over the counter, I’d be looking at patients that are maybe a six out of nine,
(28:02):
Or they have a calorie intake that’s already quite high. So if they’re eating 1.6, I’m talking about a dog right now, 1.6, 1.8 times their resting energy requirement, then I can probably reduce them at least for a while on their normal food and be safe. If they’re starting below that, which often these obese pets are, they have slow metabolisms, most of them. So if they’re starting at 1.2 or one times their resting energy requirement, then it’s not safe because I’m going to have to be cutting them back over this six to nine to 12 month process. We’re going to be making gradual reductions most likely. So we’re going to reach a point where it’s not safe for them to eat a regular diet over the counter. And I think that’s another takeaway is to talk to owners about the fact that this diet is not as short-term diet. Most of these pets have a low metabolic requirement, even once they’re at ideal body condition, so they really should be on a weight loss diet long term. I own one of these dogs, she’s on a weight loss diet for life unless I have to make a switch for another reason.
Dr. Andy Roark (29:05):
Gotcha. That makes sense. Yeah, that’s wonderful. Any other pearls I should pick up here at the very end?
Dr. Taryn Pestalozzi (29:12):
I mean, I think we’ve talked about a lot of them. It’s really about pick a starting point, monitor,
Dr. Andy Roark (29:17):
Yeah.
Dr. Taryn Pestalozzi (29:18):
Make adjustments, be a cheerleader. Those are the keys that people miss and that are what actually result in success. And I mean, we had roughly a 75 to 80% success rate and healthy weight clinic at Kansas when I was there. And most of the cases that weren’t successful, we had lack of compliance or we lost a follow-up. So I think if you work the plan so to speak, you can help a lot of these pets. And there’s like 60% of both dogs and cats that are overweight or obese currently. So this is the case you see every day.
Dr. Andy Roark (29:49):
Oh, I mean, yeah, the overweight Labrador people were like, oh, that’s really a novel case. Sandy, you haven’t seen that before. Yeah. That’s awesome. You’ve given me a number of resources. I’m going to be linking like crazy in the show notes, which I always love. People love having a list of resources. Any other that you would recommend if somebody’s just like, I love this, I love what you’re talking about. Where do you refer people who are nutrition geeks? They’re just like, yeah,
Dr. Taryn Pestalozzi (30:16):
Anymore. I’ve got a few. So the first one that will really walk you through this step-by-step is that 2014 aha weight management guidelines. There is a later like an updated version, but the 2014 as well. The meat and potatoes of this topic is the world’s model of that association has a nutrition toolkit. So that’s where you can get your body condition, your muscle condition, other resources for your support staff. Pet Nutrition Alliance does have a little online calculator you can use. I think they may have updated the website recently, so I’m not sure how they’ve changed it. And then Hill has the Bed Academy with some cece type videos about weight loss. They also have the quick reco tool that can help you initially make a plan. And then if you want more about the stats from that recent annual survey, the Association for Pet Obesity Prevention website has the results of all of the surveys, but the most recent being 2022 and they’ve got good infographics and stuff.
Dr. Andy Roark (31:12):
That’s amazing. I’ll link up to all that stuff. Dr. Taryn Peal, thank you so much for being here. I so enjoy you.
Dr. Taryn Pestalozzi (31:19):
Great, thanks. It was so nice talking about it. This was a topic that I really like.
Dr. Andy Roark (31:23):
Well, yeah, it’s obvious. That’s why I had to have you. Anyway, guys, thanks for tuning in. Everybody take care of yourselves. And that’s it, guys. That’s what I got for you. I hope you enjoyed it. I hope you got something out of it. Thanks so much to Taryn for being here. I really enjoy her. I really enjoy talking with her about weight management. It’s a thing that we talk about a lot, but man, when you find someone who is really passionate about this subject and who has had a job, just having these conversations, these are important, and just because we have ’em a lot doesn’t mean that we shouldn’t take them seriously and really think about how we get better. In fact, it’s the conversations we have a lot that we should really focus on because that’s where we can make a real difference for the clients and the pets that we see.
(32:09):
I mean, I dunno. I think a lot of times in education there’s this push to find these unique things that rarely happen and to be aware of them, and that’s okay. I really think that finding the things that happen commonly and deciding that we’re going to be amazing at them, I think that’s how we really make an impact on the world through veterinary care. Anyway, that’s just how I feel. Guys, if you have not checked at the Hill’s Veterinary Academy, you should take a look. Go and check it out. It is their learning library, it’s their Learning academy. There’s so many resources there. It is a great, great, great source of knowledge on all things nutrition. I’ll put links down in the show notes, go and check it out. Thanks to Hill’s for making this episode possible, guys. Take care of yourselves. I’ll talk to you later.
