This episode is made possible ad-free by the sponsorship of Hill’s Pet Nutrition!
Dr. Andy Roark has a 4yo FS Labrador that is 6-7/9 body condition score. He’s wondering why he struggles to motivate clients to make changes that will get this dog back to an ideal condition. Dr. Mike Robbins is in to discuss what vets get wrong in these conversations, how vets and technicians can make better recommendations to motivate these clients, and the missed opportunities we all have in doing nutritional assessments.
This episode has been sponsored by Hill’s Pet Nutrition.
LINKS
Hill’s Quick Reco Tool for personalized feeding fecommendations made easy:
quickreco.com/
Hill’s Veterinary Resources for Patient Weight Loss:
www.hillsvet.com/pet-solutions/we…agement-pet-food
American College of Veterinary Nutrition specialty website:
acvn.org/
WASAVA for Diet History Form:
Full Form:
wsava.org/wp-content/uploads/2…ssment-Checklist.pdf
Shortened Form: wsava.org/wp-content/uploads/2…iet-History-Form.pdf
Veterinary Technician Nutrition Specialty Program/Info:
nutritiontechs.com/
Veterinary Healthcare Team site: www.endpetobesity.com/vet
Pet Parent Friendly site: www.endpetobesity.com
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Michael T. Robbins, DVM, Dipl. ACVN received his veterinary medical degree in 2015 from the University of Tennessee and completed a rotating internship at the BluePearl Veterinary Hospital in Louisville, KY. This was followed by a residency in small animal clinical nutrition at North Carolina State University College of Veterinary Medicine. He then stayed on with the Clinical Nutrition Service for 7 months following his residency to further hone his skills prior to accepting the position of Scientific Communications Specialist with Hill’s Pet Nutrition. During
his time at NC State, Dr. Robbins was involved with developing specifically tailored assisted feeding tube diet blends, outlining feeding plans for all ICU patients, creating appropriate homemade diets for those patients with specific and complex nutritional needs (as well as extremely particular taste preferences), while also providing nutritional advice to referring veterinarians. He also assisted with teaching responsibilities of third and fourth year veterinary students as well as rotating interns. In 2021, Dr. Robbins received his diplomate status with the American College of Veterinary Nutrition which has recently been altered to American College of Veterinary Internal Medicine (Nutrition). His current responsibilities with Hill’s are to deliver education to veterinary staff, students, and those involved with Hill’s tours; provide technical support to Hill’s Veterinary Consultation Service; assist with review of technical documents; support the execution and development of digital education and social media strategy; and build relationships with Key Thought Leaders.
EPISODE TRANSCRIPT
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Gosh, I got a treat for you today. His name is Dr. Mike Robbins. I had a wonderful conversation with Dr. Robbins. He is a board of nutritionists and, generally, a delightful person. We do a how do you treat that episode. I talked to him, quite frankly and vulnerably, about the difficulty of getting pet owners to buy into doing something about their slightly overweight dog. And, some of it is just making time in the exam room to have the conversation, part of it is trying to keep things in proportion about what we’re recommending and how hard we push things and I needed his insight on how to think about these things. And then, also, what’s effective in getting people to say, “Oh, I know this isn’t obesity.”?
Dr. Andy Roark:
But we really need to get on this and make some changes. And I’ve always found that to be a hard conversational balance and, man, really good insight, a lot to think about here. This is a super practical, useful episode. Thank you to Hill’s Pet Nutrition for making this episode possible, ad free. I hope you guys love what we got for you. So, without further ado, let’s get into this episode.
Kelsey Beth Carpenter:
(singing) This is your show, we’re glad you’re here, we want to help you in your veteran veterinary career. Welcome to Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the show, Mike Robbins, I really appreciate you being here.
Dr. Mike Robbins:
Of course, Andy, this is amazing. I’ve heard of you, I’ve seen some of your clips on Facebook and stuff, this is like star struck.
Dr. Andy Roark:
Oh, well, thank you for saying that.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
Well, I appreciate that, you make my day. Well, listen, so you’re here, you are a boarded veterinary nutritionist, you are the manager of the US education for Hill’s Pet Nutrition and you’re a genuinely wonderful, nice, engaging, charismatic guy and I have a nutrition question.
Dr. Mike Robbins:
Oh, my God. Well, thank you for flattering me on that, too. I do appreciate that. But yeah, [inaudible 00:02:22] your question, let’s go.
Dr. Andy Roark:
Let’s go. All right. So, we’re going to play how do you treat that and this is the thing where I tell you about problem that I have and you don’t resolve it.
Dr. Mike Robbins:
All right.
Dr. Andy Roark:
So, here’s what I got. I’m just going to be real vulnerable here because I know that everybody likes to flex and be like, “Oh, nutrition conversations, I got this. I do this all day long.” I also talk about nutrition all day long. It doesn’t mean I’m particularly great at it and it doesn’t mean that I don’t run into brick walls. And so, I’m wrestling a bit-
Dr. Mike Robbins:
Okay.
Dr. Andy Roark:
… and I’ll tell you this. In the exam room, I struggle with the BCS seven of nine dogs and the reason is because I do this math in my head. So, I’m in there and I need to talk to them about the weight of their pet. They are over ideal, I know that they’re in a place where this is having negative health consequences. I’m also doing all the other things I’m doing in the exam room and I struggle to have a productive conversation and they’ll go, “Well, is he obese?” And I’m like, “Well, no, he’s not obese but he’s also not really where he needs to be.”
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
And so, I want to talk to you about the BCS seven of nine dog and having good action-oriented conversations with pet owners that are actually going to get me somewhere because I feel like, and I’m sure I’m not the only one, who sees these dogs, let some slide a bit and then, ultimately, when they’re an eight of nine, that’s when I’m having the conversation. And, as someone who’s now squarely in the middle of his 40s, as I have gotten older, it’s a whole lot easier to try to fix things before they get out of hand in my body because it takes a lot more work later on.
Dr. Mike Robbins:
Yeah, I was going to say, the whole proactive before being reactive and, technically, if they’re a seven out of nine, we should have been having the conversation even prior.
Dr. Andy Roark:
Yeah, yeah.
Dr. Mike Robbins:
But I do realize it does get difficult when you’re in general practice or whatnot and you have what? A 20-minute appointment that you’re probably already maybe five minutes late to from the last appointment that ran over. Yeah, that’s a great, very real, realistic question, yeah.
Dr. Andy Roark:
Even six out of nine. I guess what I’m saying is, you’re running your hand over the pet, they don’t have the little tuck to their waist they used to, there’s a little bit of layer you have to press through to feel their ribs, you know what I mean?
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
So, here’s a specific case. Let me give you some specifics. Let’s look at this. So, I have a four-year-old, female, spayed Labrador Retriever named Sadie and Sadie is in love with life. She’s not laying around, she is super happy, that tail just swings around, reaping destruction on anything on the coffee table. She thumps against your knee as she wags halfway-
Dr. Mike Robbins:
Yeah, yeah, yeah, this common bruise on your knee. You’re like, “Where does this bruise keep coming from?”
Dr. Andy Roark:
Mm-hmm (affirmative).
Dr. Mike Robbins:
Oh, yeah, that’s my thought.
Dr. Andy Roark:
Exactly right. That’s where she positions herself and she just shares her love with you and so, that’s her. So, her owners are empty nesters, they’re probably about 60, late 50s, early 60s, the kids are gone to college, Sadie is their friend and companion. They’re not marathon runners, they’re just normal people, you get the idea they putter around the house a bit, laid back, enjoying coming up on retirement, that’s where they are. And so, whenever I bring up Sadie’s weight, I get this soft push back of, “But she’s so happy, but she needs her treats. It’s what we do,” and I feel like a jerk.
Dr. Mike Robbins:
[crosstalk 00:06:18]
Dr. Andy Roark:
It’d be like, “I know you love this and this makes you happy and her happy.” So, I need to gracefully crack this conversation open and I’m struggling a bit with that. So, let me just your hand it to you at this point. So, that’s what I got, that’s where I am. How do you treat that?
Dr. Mike Robbins:
Yeah, amongst all the other stuff, right?
Dr. Andy Roark:
Yeah.
Dr. Mike Robbins:
Yeah, I can definitely empathize, that’s a difficult conversation. And the way I would start talking about it, let’s assume that the conversation has already come up, you’ve reached Sadie’s weight and then they’re giving, maybe, a little bit of pushback about the treats and whatnot. And where I really, really like to start, especially with people who have such a connection, this emotional bond with their animals is, I really like to go back to that longevity study that was done in Labs and that’s great that Sadie’s a Lab, too. So, you can look at this and you say, “You look at the study where, really, all they did was control the amount of food that these animals got and these animals that were on the four, four and a half,” I know you’re not really supposed to split the nine scale into halves and whatnot but we’ll just say four, I should practice what I preach. So, I should practice what I preach. [inaudible 00:07:34].
Dr. Andy Roark:
It doesn’t matter how many numbers we give to vets, they’re always going to split it.
Dr. Mike Robbins:
Absolutely.
Dr. Andy Roark:
If we had a-
Dr. Mike Robbins:
[crosstalk 00:07:41] so, right.
Dr. Andy Roark:
If we had an 18-point scale, you would still get nine and a half.
Dr. Mike Robbins:
Yeah, absolutely. Yeah, yeah. So, we have this four out of nine and they lived, on average, two years longer, nothing but controlling their weight. And that’s compared to not an eight out of nine, that is compared to those six, seven out of nine. So, that’s what that study showed. So, I’m not even going to call them necessarily obese because obese starts to hit at about the seven, eight out of nine, they’re just considered overweight. So, there is technically a definition of overweight versus obese and it really just depends on the amount of the extra body fat that the animal is carrying around with them, the extra weight that they’re carrying around with them.
Dr. Mike Robbins:
So, these six out of nines, seven out of nines, again, aren’t necessarily obese but they’re overweight but we know that, as we mentioned, they live longer if you keep them skinnier and they have less health problems that come along and you can offset that by years. I think it’s two years for comorbidities and then three years for succumbing to arthritis [crosstalk 00:08:49].
Dr. Andy Roark:
What do you mean when you say that?
Dr. Mike Robbins:
When I say the comorbidities, they tend to-
Dr. Andy Roark:
Yeah, yeah, in offsetting years, help me understand that.
Dr. Mike Robbins:
Yeah, so the heavier set animals, the ones that were free fed, ended up being diagnosed with comorbidities, I guess I shouldn’t say comorbidities because that’s to say that they necessarily had something first starting out, but they were diagnosed with long term conditions, potentially, osteoarthritis that started three years later in the lean dogs compared to the overweight dogs.
Dr. Andy Roark:
Got you.
Dr. Mike Robbins:
Other conditions like dermatological conditions, urinary tract problems, respiratory concerns, so just a lot of different health concerns started earlier on in the overweight animals compared.
Dr. Andy Roark:
Got you.
Dr. Mike Robbins:
So, it’s crazy that we can prevent a lot of health concerns and a lot of other conversations down the road if we start this conversation early. So, again, I guess I haven’t quite said exactly how to address these owners, but I still want to just highlight the importance of us needing to still have these conversations with them.
Dr. Andy Roark:
Yeah. Well, there’s two pieces, I guess, as to what you’re saying to me.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
One of them is, the case I gave you is we’re in a bit of a hole and I still want to do that but I also want to dig in with you a little bit of are the things we can do to not getting into this hole in the first place? And that’s the easiest solution.
Dr. Mike Robbins:
Yeah, yeah, not digging a hole and I think that goes back to us having conversations, us as veterinarians and technicians and nurses having conversations with owners when their pets are at ideal weight because I think we forget to coach them on that, too. We still need to coach them when they’re doing well, praise them when they’re doing well, still get information, making sure that they’re not increasing treats or whatnot and still asking about activity level. So, that’s still really important even if an animal comes in and is ideal weight, is not overweight or obese, we need to really solidify this with the owners and make them feel good about having a healthy weight pet. So, that’s how I would try and, I guess, avoid getting to this point in the first place is paying attention to a situation when we don’t have a problem, it’s not a problem yet, but that’s what we want to avoid.
Dr. Andy Roark:
What exactly do you say to those people? So, let’s take Sadie and let’s go back to she’s two years old in our time machine and she’s a BCS five of nine and she’s happy and she’s active.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
Yeah, so, in our time machine, what do I do with this dog that doesn’t have a weight problem that’s going to save me this effort later on? So, help me with the wording of that? What exactly do I say? What exactly do I do to positively reinforce where they are right now?
Dr. Mike Robbins:
Yeah, let’s pretend that this is the yearly appointment, lab work has come back fine, so there’s nothing else to have a conversation really about. This is a really positive yearly annual exam. At the very end, I know I’m nutrition focused so I might be a little biased, but as they’re going out the door thing or the last part of the appointment and I say, “Let’s talk about Sadie’s weight and how Sadie’s doing at home with eating.” And I feel like, usually, when you’ve reached that conversation, owner’s start to recoil because when you always start it with let’s talk about weight, they think they’re going to get something negative. And then you pop in with, “You’re doing an awesome job, Sadie is looking great.” You praise them for what they’re doing, you praise Sadie because they love Sadie and that helps build your relationship with Sadie regardless by just giving positive praise.
Dr. Andy Roark:
Mm-hmm (affirmative).
Dr. Mike Robbins:
You talk still about the food that they’re feeding, “Hey, what are you feeding? How much are you feeding? How are treats going with Sadie? You’re doing a great job now and we want to make sure that when I see Sadie once Sadie comes back at three years old that Sadie isn’t overweight because we know that being overweight can predispose to a lot of other health conditions down the road and can shorten their lifespan. I want to keep Sadie with you as long as possible and you guys are doing great now. So, let’s make sure that we continue to do great from now on.”
Dr. Andy Roark:
Yeah, you know what? When I do exam room training with doctors, there’s a couple things that are pretty scientifically proven, well researched and backed up that they help build trust in people and being complimentary of people builds trust. We all like to feel praised and feel that we’re being told that we’re doing a good job. If someone’s always telling you, “Oh, you should do this differently,” or, “You should really buy this,” or, “You should really let us do this service,” that doesn’t help trust. Saying things like, “Oh, this is perfect, you’re doing a wonderful job here,” it sounds simplistic but those are the building blocks that we build relationships on.
Dr. Andy Roark:
As you’re saying this, too, I was trying to be complimentary, it strikes me that this would be an ideal conversation for the nurses, the vet techs to be having as well. It’s something in their repertoire that they can do to help build relationships and just support recommendations. But yeah, talk to me about leveraging technicians in nutritional assessments like this.
Dr. Mike Robbins:
Sure, yeah. Well, what I will say is, by no means do, I think, we need to be diminishing our techs and our nurses, we need to be supporting them-
Dr. Andy Roark:
Oh, no.
Dr. Mike Robbins:
… and we need to be giving them, I guess, some level of autonomy to manage some use cases like this but I also don’t want to forget about the pet owner’s perception of a doctor praising them because I think-
Dr. Andy Roark:
Sure, okay.
Dr. Mike Robbins:
So, whether or not, the doctor doesn’t need to go through all the things, like the what are we feeding and whatnot, I think the doctor still needs to praise though, that needs to still happen because that relationship still needs to be built.
Dr. Andy Roark:
Oh, yeah.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
I completely agree with that. I think, also, in the modern media world that we live in where they’re getting messaging 24/7 from every different place, I really think that doctors and technicians delivering-
Dr. Mike Robbins:
Delivering it.
Dr. Andy Roark:
… the same message, I think, that’s super important. They need to hear a consistent message from us, from multiple people on our team, we’re all in lockstep, this is what we need to do or this is what we believe in or this is what is important. And so, not to take it away and say the doctor should do this, I think it’s more important than ever that the technicians deliver a message that the doctors reinforce.
Dr. Mike Robbins:
Yes, yeah, absolutely. I support you 100% on that. So, yeah. So, not forgetting, again, necessarily that the doctor needs to give praise, how do you leverage the rest of the veterinary team to help you out with that. And personally, the way I like to do it, because I think weight loss can be a little nuanced and just the weight conversations can be a little nuanced. And again, especially when you get into the heavier set animals, let’s not even talk about, necessarily, bringing an overweight person bringing an overweight pet in.
Dr. Mike Robbins:
I think having a dedicated team member, one or two dedicated team members, in my personal opinion, I think it’s great to have a dedicated doctor and a dedicated nurse or technician so you have both in case the conversations get a little difficult. So, maybe, if the nurse needs to say, “Hey, I need a little bit of help here,” they can tag in a doctor who can come in who’s good with that.
Dr. Mike Robbins:
So, I think having dedicated team members is probably the first and foremost step because that shows to clients, A, that you have this specialized person, you, as the clinic, as the doctor, as this business know that this is important and putting someone aside who is especially dedicated to this. So, I think that’s positive, that’s a positive look in pet owner’s eyes.
Dr. Andy Roark:
Yeah.
Dr. Mike Robbins:
And then, it also just, I think, makes it a lot easier to delegate who is expected to do what in the vet clinic. So, if appointments are getting really busy or something, you know who you need to go to and try and prioritize to get into the room to talk to the owners positively or constructively, whatever that means.
Dr. Andy Roark:
We know that one of the keys in retaining staff is them seeing themselves in the future and feeling like they’re being developed and they’re getting to do new things and flex new muscles and build new skills. And so, yeah, these are the types of positions that, honestly, are very attractive and that let people do new things and they should be compensated for their knowledge and for what they bring to the practice. And so, I really like those types of investment in the staff and I’ve seen that work really well in hospitals.
Dr. Mike Robbins:
Yeah, I think that’s a fabulous idea that, I will admit, I didn’t necessarily even think about. So-
Dr. Andy Roark:
Oh, yeah.
Dr. Mike Robbins:
… new doctor here learning things on the podcast, too. I love that.
Dr. Andy Roark:
Yeah. No, it’s true. It feels good as a technician to have an area of expertise and people are like, “Yeah, this is what he does,” or, “This is what he’s really strong in.” And, especially you back them up with resources, you have ongoing training, you get them continuing education that fits into this area of expertise and specialty and then you leverage them and you figure out how to charge effectively for their time to pet owners and everybody benefits. We all want to practice at an appropriate skill and challenge level, you know what I mean? We want to do hard things, I really think that most of us enjoy that, we just want to be prepared for them and feel like we’re set up for success. So, this is a program that I saw years ago when that practice started doing nutrition advocates and nutrition experts in the paraprofessionals and it has always made a ton of sense to me.
Dr. Mike Robbins:
Yeah, definitely. And I’ll even plug a resource on here or not necessarily Yeah, I guess the resource. So, if you have technicians or nurses who want to know more of the, I guess, technical aspects of it or what to potentially do in rooms, excuse me. Just as with specialist doctors, there are specialty nurses and veterinary technician programs and there is one for nutrition. So, they could definitely reach out to that specialty program and I’m blanking now what website that is to get onto that, especially now that the ACVN has changed. So, our-
Dr. Andy Roark:
Yeah, yeah.
Dr. Mike Robbins:
That’s also added. I’ll get you that resource if you need [crosstalk 00:19:12].
Dr. Andy Roark:
Yeah, yeah. We’ll link to it in the show notes, yeah.
Dr. Mike Robbins:
Yeah, let’s do that because I’m not sure what’s changed with that. So, yeah, as you mentioned, leveraging your team and getting someone who’s dedicated is really, really helpful. Again, they’re going to know where the resources are to utilize and have effective conversations and I think that also, A, makes conversations more efficient. Efficiency is really, that’s the name of the game in general practice, right?
Dr. Andy Roark:
Yeah.
Dr. Mike Robbins:
So-
Dr. Andy Roark:
Oh, absolutely. Yeah, having this conversation set up and the doctor can come through, it’s a whole lot easier to reinforce than it is to introduce a new idea and a new concept.
Dr. Mike Robbins:
Yes, definitely.
Dr. Andy Roark:
To say, “Hey, I know that Kayla talked to you about this and I just wanted to follow up with you on it because this is really important and you’re doing an excellent job.” I really like the idea, positive reinforcement. People are simple animals. I don’t care how many degrees you have, positive reinforcement works, it works on you and it works on me. And yeah, catching people when they’re doing a great job and leaning into that and creating a picture in their own mind that, “Oh, yeah, this is what my pet is and this is something that I’m good at that,” that helps later on.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
All right. So, when we get behind the eight ball, we’re not badly behind the eight ball, but you can see where this is going.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
So, Sadie is four years old, her metabolism is not going to speed up, I have a pretty good guess that there are some detrimental habits at home that could easily slide further. Once we start treating from the table and from the kitchen cutting board, that’s a slippery slope from what I’ve seen. People like it and Sadie, of course, responds very positively.
Dr. Mike Robbins:
Of course.
Dr. Andy Roark:
She’s super happy about this. Let’s be honest, they’re getting positive reinforcement from Sadie for slipping treats. I love it when I give my dog a treat and he just celebrates and bounces around in a circle like a goofus, it makes me very happy. That’s what we’re up against and so, we have to figure out how do I reverse course before this gets out of hand?
Dr. Mike Robbins:
Yeah. So, getting back to Sadie with this. So, I believe, if I’m recalling correctly, we’ve reached the topic, they push back a little bit. Correct [inaudible 00:21:30]?
Dr. Andy Roark:
Yeah. Well, they like making Sadie happy and she’s super happy. If it’s a problem, then let me know, that [inaudible 00:21:38] and you go, “Oh, we’re getting there.”
Dr. Mike Robbins:
Yeah, yeah, and that’s where I also like to talk. I think they can tell that Sadie really wants to please them, wants to make them happy, likes to be happy around them and all that stuff. And animals push through pain so much, but, us, humans, were babies, the vast majority of us are babies. But animals want to push through pain and Sadie might be starting some arthritis with this extra weight that’s coming on. And, even if Sadie is not, we can tell them that this is going to be predisposing to arthritis, not even just the physics of the abnormal weight, there are cytokines, there are molecules that are being pumped out at higher amounts from this adipose tissue that are actually encouraging the cartilage to be broken down, so that’s a problem. So, we can talk to that and then, again, as I mentioned, this narrative that they’re fat and happy and they’re happy for us and these animals push through pain for us and we don’t want them to do that. We don’t want them to pretend to be happy for us or try and force themselves to be happy.
Dr. Mike Robbins:
So, what I like to talk about is treats. Yes, absolutely, treats are loved. Especially for a Lab, they definitely take that as something positive, you’re paying attention to them but I think a lot of it, too, is paying attention, that’s part of it too. These animals want our attention, doesn’t necessarily have to be treats. So, I think let’s shift how we show attention to Sadie. Does Sadie really like to get praises? A pat on the head? Throwing something? If Sadie’s a Lab, she’s going to want to retrieve something, I’m sure. So, just different ways of showing love and what we need to do is figure out what ways Sadie feels loved or the way that the owners perceive Sadie feels love.
Dr. Andy Roark:
Yeah.
Dr. Mike Robbins:
So, currently, they’re perceiving that she feels love with treats. I’m sure that they would-
Dr. Andy Roark:
[crosstalk 00:23:31]
Dr. Mike Robbins:
I’m sure that they would agree that they sit down on the couch, Sadie loves to come up to them and pet them or, sorry, loves when they pet her or when they’re outside. So, we just need to fix the type of love that we’re giving Sadie.
Dr. Andy Roark:
Yeah.
Dr. Mike Robbins:
And that’s-
Dr. Andy Roark:
No, I like it.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
That totally makes sense to me. What is Sadie’s love language? What is her language of appreciation and how do we engage with that? I like that. I think that makes a ton of sense.
Dr. Mike Robbins:
Yeah. You said love language, I think that’s a perfect [inaudible 00:24:07] about love languages then-
Dr. Andy Roark:
That’s the thing it reminds me of.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
So, I was talking about my wife, there’s this book of the five love languages, I have not read it. There’s a business version called the five languages of appreciation which, from what I can tell, is the same book with a different cover on it.
Dr. Mike Robbins:
Probably.
Dr. Andy Roark:
But just change the examples to be work appropriate. Definitely, that’s what it is. But it’s things like service, I do things for people that I care about. Or, spending time, I spend time with people I care about. Or, verbal appreciation is you’re telling people that they’re appreciated and giving them verbal praise. And physical touch and those sorts of things and it’s like there’s these different things that resonate with different people. I think it’s hard to argue with people that food is love and, what I was saying, I can hear the pet owner saying to me when I say, “We need to find Sadie’s love language.” They’re like, “I know what her love language is, it’s food.” And I was like, “Okay, she’s got a secondary love language too and we need to find that and lean heavily into that.”
Dr. Mike Robbins:
Pun intended.
Dr. Andy Roark:
And so, that makes sense to me.
Dr. Mike Robbins:
Yeah, yeah. So, I think that’s the first bit that we start with and just trying to retrain humans brains. Because as you said too, they’re getting positive reinforcement from their pet too.
Dr. Andy Roark:
Yeah, yeah.
Dr. Mike Robbins:
So, we have to train. This is training both the humans and the pets as well. And what I’ll say is, even if I chat with owners and we try and figure out the secondary love language for the dog, if they’re super reluctant to that, usually, I like to try and figure out what are … And we’re not even talking about getting into calories right now.
Dr. Andy Roark:
Yeah.
Dr. Mike Robbins:
This is just trying to just fix a habit. If Sadie really likes the kibble that Sadie’s being fed, let’s take some of the kibble and Sadie’s daily kibble amount, put it in a bag that the owners get to carry around and that’s how they treat. If Sadie doesn’t care the difference between a kibble and a piece of cold cut or something that’s coming off of the table, why does it matter to you? We need to fix the human brain. Is it the human brain that’s like, “Well, the kibble is the same thing she gets every day.” Sadie doesn’t care, Sadie just wants your attention. [inaudible 00:26:23].
Dr. Andy Roark:
Yeah, I think that’s a great point. I think it’s a fantastic point. The truth is, we’re not talking about calories at all. But the truth is, if we don’t fix the behavior, we’re never going to win on calories. We’ve got to talk to these people about what this means to them because, if we can’t get through to them in that way, we’re never going to be able to wrestle the calorie count down when their behaviors are just undermining us at every step.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
I think it’s great. It’s like, what is the line to achieve a celebration for Sadie?
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
And we want the lowest calories that get us over that line. I think that’s great. I still recommend vegetables, things like that and people could really and say, “Hey, look, if she loves her vegetables, then why would you not feed her vegetables?”
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
I think the kibble is a great idea. It’s funny, we can pull a fast one on Sadie. Just put it in a different bag and she’ll be so thrilled.
Dr. Mike Robbins:
Right. She’s going to be like, “This is the best thing ever. Look, it came out of a purple bag instead of the tub that mom and dad”-
Dr. Andy Roark:
Exactly right.
Dr. Mike Robbins:
Yeah, yeah.
Dr. Andy Roark:
This is a special one.
Dr. Mike Robbins:
Yeah, yeah. So, that’s just treating their psyche, basically. And then, once we get past the treats or the habits, I should say, then we need to start talking about calories like kcals and stuff. I’d be remiss if I didn’t mention any of that.
Dr. Andy Roark:
Yeah, sure.
Dr. Mike Robbins:
So, especially when they’re starting to gain weight and if you’ve been able to look back at previous history, patient history and showing that Sadie was ideal weight a year ago or two years ago, that’s when we need to start having this conversation especially. So, let’s talk about what are your feeding, and this is, again, where your veterinary technician or your veterinary nurse can come in and finish this conversation.
Dr. Andy Roark:
Yeah.
Dr. Mike Robbins:
You can say, “We need to address Sadie’s weight. You guys were doing a great job before, Sadie was looking great, we’re getting a little heavy now. Let’s try and figure out how we can just get Sadie a little bit back on track and I’m going to have my Joe so and so who’s our special nutrition veterinary nurse and they’re going to come in and we’re just going to get a little more information and talk about maybe what Sadie is being fed now and how we can look at the calories that Sadie’s bringing brought in and maybe switch some calories out with different things that are either no calories or less calories and that are still going to provide that really positive reinforcement with you and your relationship with Sadie.”
Dr. Andy Roark:
Yeah. No, I think that makes sense. So, real quick, I guess as we wrap up.
Dr. Mike Robbins:
Mm-hmm (affirmative).
Dr. Andy Roark:
The kcal conversation, what points are you trying to … Because I completely agree, I think a lot of people jump to talking about nutrition and calories when the truth is, this is not a calorie conversation, this is a relationship conversation. This is-
Dr. Mike Robbins:
I would argue that it’s probably both.
Dr. Andy Roark:
Okay.
Dr. Mike Robbins:
I would say it’s definitely both but it’s-
Dr. Andy Roark:
Tell me about that.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
So, I always lean towards this is a relationship conversation of what it means to them to feed. Tell me why you push back.
Dr. Mike Robbins:
Well, I guess let me push back a little bit and say-
Dr. Andy Roark:
Please.
Dr. Mike Robbins:
… I may have jumped a little bit ahead and can you explain why you’d say calories? You don’t [inaudible 00:29:32] the calorie thing. Because I’m like, “No,” and now I’m second guessing you-
Dr. Andy Roark:
Yeah, no, no, no.
Dr. Mike Robbins:
… [crosstalk 00:29:37] what you meant.
Dr. Andy Roark:
Yeah, yeah. So, I guess the thing for me is I would say that, generally, this is not a conversation about I don’t think your pet is getting enough calories and you think that we do or even about, “Hey, you should feed a low calorie food instead of the food that you’re feeding.” And I found most pet owners are much more malleable in what they feed than we give them credit for. They want a recommendation from us, they want advice on what to feed their pet, most of them are not willing to fight this battle, they just want to feed a good food that they can feel good about, they want to do a good job. And beyond that, I think that they’re very open to our recommendations and what they want to feed. What they’re less open to, I think, is stepping away from behaviors that make them feel good about themselves and about their relationship with their pet.
Dr. Andy Roark:
And so, I think that I can talk to them all day about the type of food that we’re feeding and the calories in the food but, if I don’t talk to them about what feeding their pets treats means to them, you know what I mean? We can have them on the greatest weight loss food in the world and still lose the battle. And we have all done that, we have all shipped prescription weight loss diet out the door again and again to pets that are gaining weight and just been like, “What is going on here?” I think that we probably won the kcal conversation and lost the relationship interaction with your pet conversation. I guess that’s what I mean.
Dr. Mike Robbins:
Yup, and that I will 100% agree with. I was going to say we’re not talking about changing food to a lower calorie food and we still haven’t necessarily addressed the [inaudible 00:31:19], so I will redact what I said.
Dr. Andy Roark:
No, but to your point, am I wrong to have the idea that a lot of us do these pithily recommendations that don’t really make sense? I guess what pops in my mind is, I’ve talked with a nutritionist on the show before and we’ll be talking about soft stools or having diarrhea, things like that. And I was asked about adding pumpkin or adding psyllium and they’re always like, “You can do that.” The truth is, if you switch to a high fiber food, you’re going to do so much more as opposed to feeding something low fiber and putting some psyllium on top.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
It is night and day. Would you agree with that analogy as far as how we feed pets? I don’t know. When we say, “Feed vegetables but don’t change the food,” are we spitting into the wind or is that a viable approach?
Dr. Mike Robbins:
I think we’re spitting a little bit into the wind here because-
Dr. Andy Roark:
Okay.
Dr. Mike Robbins:
… again, pet parents want that specific recommendation. So, if you’re not actually looking at what they’re feeding and evaluating a little bit. Because, again, I 100% agree, we need to address the behavior because you’re right, you could give a low calorie food and, if you feed a bunch of a low calorie food, you’re still feeding high calories at the end of the day or kcals at the end.
Dr. Andy Roark:
Yeah.
Dr. Mike Robbins:
So, all that is correct, yup. So, I think what we’re missing is, sometimes, and especially as time comes up, you’re pressed for time in an appointment or, again, as Sadie is just a little bit overweight, not necessarily obese, weight loss is a journey. It needs to happen, it needs to happen at an adequate rate because we don’t want to happen too quickly and, obviously, if it’s too slow then pet parents just forget about it. So, I think what we do is we give ambiguous or relatively ambiguous recommendations and we don’t give something specific that the owners can follow and that’s really we need to be specific. Even if it is just a simple overweight conversation, we still need to be specific. If I went into my primary care physician and they just were like, “You know what? Just eat more fiber or something.” What does that mean? [crosstalk 00:33:30]
Dr. Andy Roark:
Yeah, [crosstalk 00:33:32] myself.
Dr. Mike Robbins:
I’m going to go get more cereal.
Dr. Andy Roark:
I would be like, “Yeah, I’m totally doing this.”
Dr. Mike Robbins:
[crosstalk 00:33:34] and eat a bunch of fiber. That’s in that, right?
Dr. Andy Roark:
Yeah.
Dr. Mike Robbins:
That’s not a good recommendation. So, we still need to do our due diligence as the veterinary team and give these specific recommendations. So, that still gets into what are you feeding and whatnot.
Dr. Andy Roark:
That’s a weakness of mine. I tend to say things like, “All right, let’s work on this,” or, “Yeah, let’s try to get this down a little bit.” I think that’s the thing I need to work on too, is being more specific. What follow up do you recommend for this BCS six to seven of nine dog? Are you getting them back in, you putting them on the scale? If so, when are you doing that?
Dr. Mike Robbins:
Biggest recommendations for weight loss, I’m going to say very quickly, always use the same scale if you can because there are going to be variabilities between scale and the last thing you want is them to come into your clinic and weigh two pounds less and then go home and now they’re two pounds more automatically and something like that. So, using the same scale same time of day, ideally before meal and after going to the bathroom. So, let’s just set up the ideal time to look at weight.
Dr. Mike Robbins:
Because just with you and I, our weight fluctuates throughout the day depending on if we’ve eaten, if we’ve chugged a bunch of water because we’re really thirsty, something like that. So, I think that’s important. But initial follow ups and, again, for Sadie’s case too, I would also praise the owners or maybe not praise but let them know we’re starting this early so this is going to be so much easier or this is going to be a lot easier than if we dealt with this a year or two down the road. It’s going to be easier on you, it’s going to be easier on Sadie.
Dr. Mike Robbins:
So, again, just positive reinforcement on that. And then, coming in, I usually like to have rechecks to every two weeks, probably for the first month, month and a half depending on how successful the weight loss is going. If I feel like I’ve been able to change those habits, checking in with the owners, seeing how everything’s going at home with the new plan, if it seems like they’re doing really well, you can start going out every month, every four weeks and these don’t have to be in person appointments either. So-
Dr. Andy Roark:
No? Oh.
Dr. Mike Robbins:
… you might want to open up your clinic for larger animals to bring the animals on to weigh them, but they don’t need to be there for an appointment. [inaudible 00:35:45].
Dr. Andy Roark:
That’s great. That makes a ton of sense. I was going to say, I know a lot of people are like, “Look, we’re so busy. Where do these appointments go?”
Dr. Mike Robbins:
Yup.
Dr. Andy Roark:
It doesn’t have to be big deal.
Dr. Mike Robbins:
Yeah, and you can even email. That email gets into a whole how do you bill for that and I would say, if you’re going to do a weight loss plan, build that into the structure if you’re going to have email because, I think as we all know, owners, you give them an email and that opens up an unlimited communication door for them. So, we need to make sure that there are boundaries set for that, I think, for everyone’s benefit, both veterinary healthcare team member and the pet parent so they don’t get frustrated by not hearing back if they’re sending 12 emails a day and only hearing back once.
Dr. Andy Roark:
Yeah, yeah. No, I agree with that. Using the clinic email for something like that is ideal so it’s not a personal email and then, also-
Dr. Mike Robbins:
Yes. Oh, my gosh, please don’t. Don’t give them your personal.
Dr. Andy Roark:
Well, even a personal email as like andy@andys.hospital.com.
Dr. Mike Robbins:
Yeah, yeah.
Dr. Andy Roark:
But yeah, using the clinic email and then, also, just one of the things I really like about clinic texting these days is that you can send it from your own computer and it goes through the clinic text outlet and when it comes back, it goes to the front desk and they can respond and say, “We’ll pass this message on to Dr. Roark and he’ll generally respond within 24 to 48 hours,” and you give them that feedback and set expectations.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
Well, Mike, this has been fantastic. Thank you so much for taking time. Thanks for talking through everything with me. Where can people learn more? What resources do you recommend for people who thought, “Oh, that’s really good. I want to tighten these screws in my own practice. I’m a technician who is interested in the nutritional advocate position that you talked about.”?
Dr. Mike Robbins:
So, Hill’s, we have a bunch of really great resources. Queue the first quarter of every year now, we’re going to start making our annual weight loss campaign. Hill’s is really behind building and strengthening the quality of life and relationship between pet and pet parents. So, we are really trying to get as many vets and vet hospitals and stuff on board with making sure that we keep pets ideal weight. So, hillsvet.com has a lot of great tools. Quick Reco is really nice that Hill’s has set up.
Dr. Mike Robbins:
You can provide visuals for pet parents showing graphs and whatnot, where weight has been, where we want to see weight going and WSAVA. I think externally, outside of that, WSAVA is a really great organization. And then ACVN, I’m pretty sure it’s still running, I should have checked this earlier. Again, with the college of nutrition now being incorporated in the college of internal medicine, I’m not sure what’s going to happen to our big website, but acvm.org, you can get some good information there.
Dr. Mike Robbins:
And then further, one other thing that I’d like to say too, even with these Sadie’s cases, again, as we talked about positive reinforcement, setting up milestones or very attainable goals and emotional goals is going to be important. Let’s see Sadie fit into a jersey of her favorite team or something like that.
Dr. Andy Roark:
Got you.
Dr. Mike Robbins:
And then, also, sending home super simple certificates. Just like, “Yay, Sadie got her first goal,” and they can put it up on the refrigerator. I’ve had pet owners send me a picture of their dog or cat next to their certificate and they love it, so just something to get them on board.
Dr. Andy Roark:
That’s so silly and simple and I 100% believe it works. While you’re saying that, I’m like-
Dr. Mike Robbins:
It really does.
Dr. Andy Roark:
Oh, you blew my mind. I love those simple things but, man, people love a certificate and they especially love an award for their pet.
Dr. Mike Robbins:
Yes.
Dr. Andy Roark:
That is awesome.
Dr. Mike Robbins:
I [inaudible 00:39:14] especially if they’re like a dog with a collar, if can get them a gold medal or something once they reach their ideal weight that they can put on their collar. If you can find something like that, pet owners eat this stuff up.
Dr. Andy Roark:
Oh, well that’s social media goal, too.
Dr. Mike Robbins:
Yeah, that too, yeah.
Dr. Andy Roark:
Your clinic newsletter-
Dr. Mike Robbins:
Mm-hmm (affirmative).
Dr. Andy Roark:
… there’s so much you can do with that.
Dr. Mike Robbins:
Yeah.
Dr. Andy Roark:
Oh, man. Mike, thanks again for being here. I really appreciate you.
Dr. Mike Robbins:
Of course, yeah. Andy, this was great, this is a lot of fun. I really hope that all your listeners learned some things. I know I learned some stuff from you which is great and, hopefully, you learned some stuff from me.
Dr. Andy Roark:
I did as well.
Dr. Mike Robbins:
Great.
Dr. Andy Roark:
Awesome. Thanks, buddy.
Dr. Mike Robbins:
All right, man.
Dr. Andy Roark:
And that is our episode. Guys, I hope you enjoyed it. Thanks a lot to Dr. Robbins for being here, thanks for Hill’s Pet Nutrition, making this episode possible. Guys, I have taken the links from Mike and put them in the show notes, so you should have those there. Please check them out. Gang, take care of yourself and I will talk to you again soon.
Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram
