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Nutritional Management Nutritional Management of Obese Petsof Obese Pets
Richard C. Nap DVM, PhD
Diplomate, ECVS & ECVCN
Obese/Fat/Heavy/Weight Challenged
Definition:Body weight 15 - 25% > ideal, due to
excess body fatExcess body fat sufficient to result in
impaired health or body function– generally recognized as 20 - 25% > ideal body
weightWhat is a pet’s ideal body weight?
Assess the Patient
Body Condition Score (BCS)Subjective assessment of patient’s body fat
– accounts for animal’s frame size but independent of body weight
Scale of 1 to 5– 1 = < 5% body fat– 2 = ~ 6 - 14% body fat– 3 = ~ 15 - 24% body fat– 4 = ~ 25 - 34%body fat– 5 = ~ 34 - 45+% body fat
Assess the Patient
Risk Factors:GeneticsAge (“life stage”)Gender
– reproductive statusActivity levelConcurrent diseases
– endocrinopathies, orthopedic diseases, etc.
Body Condition Score by Species
0
10
20
30
40
50
60
70
% o
f P
op
ula
tion
Very Thin Under-Weight
Ideal Over-Weight
Obese
Canine (30,517)Feline (14,270)
Lund EM, et al. J Am Vet Med Assoc 1999;214(9);1336-1341
Dog % OverweightDog % Overweight
Cat % OverweightCat % Overweight
1010
1515
2020
2525
3030
3535
4040
4545
5050
0-50-5 5-65-6 6-76-7 7-87-8 8-98-9 9-109-10 10-1110-11 11-1211-12 12-1312-13 13-1413-14 14-1514-15 15-1615-16
Age Group (Years)Age Group (Years)
% P
ropo
rtio
n O
verw
eigh
t%
Pro
port
ion
Ove
rwei
ght
Body Condition Score by Age
Lund EM, et al. J Am Vet Med Assoc 1999;214(9);1336-1341
Assess the Patient
Gender– higher incidence in females than males (intact
and neutered)Reproductive status
– neutered male cats DER = 28% fewer calories – neutered female cats DER = 33% fewer calories
– neutered male & female cats consume more food
Root MV, et al. Am J Vet Res 1996; 57(3); 371-374
Fettman MJ, et al. Res Vet Sci 1997; 62; 131-136Flyn MF, et al. J Am Vet Med Assoc 1996; 209(9); 1572-1581
Assess the Patient
Energy Intake Factors Energy Expenditure Factors
Internal:•GI fullness•Hormones/peptides•Substrate storage
External:•Food availability•Food palatability•Social pressures
•RER•TEF•Environment•Activity level•Growth•Pregnancy/lactation
Energy Requirements
Components of Daily Energy Requirements– RER (Resting Energy Requirement)– EER (Exercise Energy Requirement)– TER (Thermic Effect of Food)– AT (Adaptive Thermogenesis)
REREERTEFAT
RER60-80%
EER10-20%
TEF10%
AT
Energy Needs of the Patient
Assess the Patient
Leptin:Primary means of communication between
adipose tissue & CNS - lipostatic roleProduct of ob gene in adipose tissue
– mutation results in obesity & type-II DM– obese individuals less sensitive
Obese cats & dogs have increased serum levels
Backus RC, et al. Am J Vet Res 2000;61(7):796-801Sagawa MM, et al. Am J Vet Res 2002;63(1):7-10
Assess the Patient
Consequences of obesity:Musculoskeletal diseaseType II DM
– glucose intolerance & hyperinsulinemiaFeline idiopathic hepatic lipidosis & lower
urinary tract diseaseRespiratory diorders
– Pickwickian syndrome & collapsing tracheaHyperlipidemiaHypertension
Scarlett JM, et al. Proceedings The Waltham Intl Symp 1997; 90Scarlett JM, et al. J Am Vet Med Assoc 1998;212(11):1725-1731
Obesity Health Risks (feline)
Assoc. between body condition & disease:
Lameness - 4.9Diabetes - 3.9Dermatopathy - 2.3Mortality - 2.7Survival (8 - 12) = 53%
% Survival
8080
7070
6060
5050
4040
3030
2020
1010
00
1 1 2 2 3 3 4 4
CachecticCachectic
ObeseObese
LeanLean
Years
Assess the Patient
Pet’s owner (guardian):Relationship to foodOverweightLife style/activity levelAge“Child substitute”
Assess the Food
Palatability vs. AcceptabilityNutrient content
– high fat foodsTreats – commercial & humanTable scrapsHunting & scavenging
Assess the Feeding Method
Free choice feeding
Who feeds the pet?
Access to other pet’s foods?
Treating behaviors of pet & owner?
Location of pet during food preparation & meal time?
Treating Obesity
Successful treatment depends upon:
Owner education
Owner motivation
Long-term lifestyle changes
Success in obesity treatment
– humans: 0 - 5%
– animals: up to 50%
Treating Obesity
Owner educationIdeal body weightHealth/wellness benefitsFeeding methodFood dosageNon-food related attention
Treating Obesity
Responsive client Easily motivated Ask questions Health conscious Commits to new
lifestyle
Non-responsive client Denial Avoids topic Often overweight Family conflict
Owner motivation
Treating Obesity
Estimate ideal body weightSelect foodCalculate food dosageRecommend exercise regimenFollow-up
– bi-monthly weigh-ins– graph weight loss– support group/weight loss club
Key Nutritional Factors
Food caloric density– dog food
» dry < 3.1 kcal ME/g DM
» canned < 0.9 kcal ME/g DM
– cat food » dry < 3.25 kcal ME/g DM
» canned < 0.95 kcal ME/g DM
Key Nutritional Factors
Food caloric densityFat
– dog: < 10% (DM)– cat: < 12% (DM)
FiberProteinOther
Nutrient Content
Weight loss in dogs– All dogs obesified on low fiber, high fat food – Group 1: high fiber, low fat food– Group 2: low fiber, high fat food
– 60% of maintenance energy requirement– Group 1 lost 33% more weight and 70% more
body fat than group 2
Gorne AT, Wofsheimer KJ, Truett A, et al: Obesity Res 4:337-345, 1996
KNF – Fat
Diacylglycerol (DAG)– Vegetable oils contain small amounts
– 1,3 DAG poorly re-esterified in enterocytes
Triacylglycerol 1,2 DAG 1,3 DAG
KNF – Fat
Obesity control by feeding a DAG-containing dog food– 16 Beagle dogs/group
» 7% TAG or 7% DAG + 9% dietary fat in a dry dog food
» fed at maintenance levels for 6 weeks
– DAG group significantly less body fat (deuterium dilution method)Umeda, T, JAVIM 2004
Key Nutritional Factors
Food caloric densityFatFiber
– > 12% crude fiber (DM) – weight loss– > 5% crude fiber (DM) – prevent weight gain
ProteinOther
The Effect of Fiber on Energy and Total Diet Intake
highhigh
highhighlowlow
lowlow
Fiber (energy dilution)Fiber (energy dilution)
EnergyEnergy DietDiet
Inta
keIn
take
Approx.Approx. 7% 7%
Approx.Approx. 17% 17%
Satiety Studies
Comparison 1.3% vs. 7.8% fiber– 6 dogs– fed 40% of maintenance energy requirements– offered palatable, high energy canned grocery
brand dog food 3 hours after meal.– no measurable difference in satiety
Foods with less than 7.8% crude fiber (DM) do not satisfy appetite
Butterwick RF, et al. Journal of Nutrition 1994; 124: 2695S-2700.
The Effect of Diets Containing 1.5% or 21% Fiber on Energy Intake
500
600
700
800
900
ME Offered ME Consumed
Low FiberHigh Fiber
** P < .001 P < .001**
Die
tary
En
erg
y (k
cals
)D
ieta
ry E
ne
rgy
(kca
ls)
Toll PW et al,Vet Clin Nut1996;3(4)
The Effect of Diets Containing 1.5% or 21% Fiber on Food Intake
0
100
200
300
400
Grams Calories
Low FiberHigh Fiber
** P < .001 P < .001
**
**
Intr
usi
on
Inta
keIn
tru
sio
n In
take
Toll PW et al,Vet Clin Nut1996;3(4)
Effect of Satiety on Body Composition
-25
-20
-15
-10
-5
0
5
Bod
y M
ass
Cha
nge
Fat (g/d) Lean (g/d)
Low FiberHigh Fiber
Jewell DE et al,Vet Ther 2000;1(1);
Key Nutritional Factors
Food caloric densityFatFiberProtein
– dogs: > 25% crude protein (DM) or 1 g/lb BWt– cats: > 35% crude protein (DM) or 2 g/lb BWt
Other
Key Nutritional Factors
Food caloric densityFatFiberProteinOther
– L-carnitine
KNF – L-Carnitine
Effect of dietary L-carnitine on weight loss and body composition of obese dogs
36 adult dogs with > 30% body fat– Canine r/d® – Canine r/d® with supplemental L-carnitine (300
ppm)– DER = 70 kcal/kg/day until body fat < 20%– L-carnitine supplemented group gained 7% LBM
Gross KL, et al. J Animal Science. 76 (suppl 1): 175, 1998
KNF – L-Carnitine
Feline hepatic lipidosis (FHL)Critical role in the ß-oxidation of FAReduces hepatic lipid accumulation during
rapid weight lossReduces recovery time in cats with FHL50 – 100 mg/kg/d or 500-1000 ppm of food
KNF – Feline
Atkins-type diet– high protein, high fat & low carbohydrate– “natural” feline diet
» ~ 7% carbohydrate (DMB)
– canned feline growth formulas, CNM DM® Formula & Feline m/d™
Scientific support of this hypothesis?
Feline Weight Loss
Treating Obesity
Daily energy requirementDogs:
– 1.0 × RER– 60% × 1.4 × RER
Cats:– 0.8 × RER– 70% × 1.2 × RER
Use ideal body weight for all calculations
Treating Obesity
Food dosage calculation13.5 kg obese dog (ideal B. Wt. = 10 kg)
– RER kcal/day = 70 + (30 × 10) = 370 kcal/day
– Weight loss food = 200 kcal/8 oz cup
– 370 kcal/day ÷ 200 kcal/cup = 1.85 cups/day
Treating Obesity
Feeding methodFood-restricted meal feedingMultiple meals/day
– thermic effect of food– decrease begging– use part of food dose as “treats”
Switch foods once goal is reached
Summary
Obesity is the most common form of malnutrition in dogs and cats
Body composition is controlled by energy balance
Health risks associated with obesity are reversible with weight loss
“An ounce of prevention is worth a pound of cure”