nutritional management of obese pets richard c. nap dvm, phd diplomate, ecvs & ecvcn

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”