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Alice Roberts is a final-year veterinary student at the University of Surrey. She is particularly interested in pet obesity and effective client communication.
You are a newly qualified veterinary surgeon working in a small animal first-opinion practice. Your next client is bringing in her pug, Max, who needs his annual vaccinations. As you read their notes, you see they are new clients to the practice and when you call them into the consulting room, Max pants heavily as he walks in, immediately lies down on the floor and is visibly obese. The owner, who also appears to be overweight, tells you the reason she recently left her old veterinary practice was because they had told her Max was ‘fat’ and was unhappy with their statements on his condition. On palpation, you can’t feel Max’s ribs and you assess that he has a body condition score of five out of five. You continue with your clinical exam while thinking about how to proceed. What should you do?
Issues to consider
Obesity is always a delicate subject that can be difficult to discuss with owners. It can be particularly daunting to discuss this with an owner who is also overweight. Many veterinary surgeons are reluctant to discuss pet obesity with owners due to fear of causing offence or upset (Churchill and Ward 2016), but successful weight loss requires effective communication with clients (Larsen and Villaverde 2016). Language that is not offensive or accusatory should be used to try to prevent upsetting the client.
As difficult as this topic may be, it is your responsibility as a veterinary surgeon to address this issue. The RCVS Code of Professional Conduct states that veterinary surgeons must make animal health and welfare their first consideration when attending to animals; in this instance, Max’s welfare is compromised – he has a very high body condition score, pants heavily when walking and often needs to rest after only a few paces.
There are several parties involved in this case: you as the attending vet, Max, the client and the practice – ideally you want to find a solution that benefits all parties. Max’s welfare must be put first, but there are concerns that by discussing Max’s weight problem with his owner, you may end up offending her; she has already left a previous practice because of similar issues/statements. Moreover, you don’t want to cause the practice to lose a client, especially as you are a relatively new employee and you want to make a good impression with your new employer.
Possible ways forward
Following the RCVS Code of Professional Conduct for Veterinary Surgeons, you could consider one of the following approaches. First, you could directly ask the owner what she thinks about Max’s weight, using language that is less accusatory. For instance, avoid using derogatory terms such as ‘fat’ or ‘chubby’, as this has clearly had a bad reaction from her in the past. Nevertheless, it is also important not to passively diminish the significance of obesity by using phrases such as, ‘I’ve seen worse’ or ‘it’s a common problem in most dogs of this breed’.
However, initiating a conversation that is focused on Max’s weight could result in the owner becoming agitated, or could even escalate further and cause her to not return to the practice, as happened with her previous practice. If this is the case, you will have lost your chance to try to improve Max’s welfare, and you will have lost the practice a client. Therefore, great care must be taken to maintain a calm, non-accusatory tone when approaching such a sensitive topic.
It is important to note that obesity is a disease filled with judgement and misunderstanding, and people can be quick to blame poor lifestyle choices and laziness for its cause. But remember that it is a disease that can also be caused by complex hormonal, genetic, microbial and neurophysiological factors – don’t just immediately point the finger and blame the owner for failing to exercise the dog sufficiently.
Indeed, asking inviting, open-ended questions may help to build a good rapport with the owner. This will help to make her more receptive to any recommendations you advise and increase her interest in any potential weight-loss programmes or nutritional counselling that could be offered. You could focus your attention on Max’s apparent lack of energy, and ask general questions about diet and lifestyle, without mentioning weight specifically. Make suggestions to help with weight loss, but frame them as ways to improve Max’s health and increase his energy, rather than solely helping him to lose weight. Asking questions such as, ‘What sort of food do you feed Max?’, ‘What are Max’s favourite treats?’ and ‘How often does Max enjoy a long walk?’ may elicit a more positive and honest response from the owner, and may prevent her from becoming disengaged as soon as the word ‘weight’ is mentioned.
If you attempt to discuss Max’s weight with the owner and she bluntly refuses to acknowledge the issue, you could consider reporting her to the RSPCA. Section 9 of the Animal Welfare Act 2006 places a duty of care on the owner of an animal to provide their animals with ‘a suitable diet’ and look after them so that they are able to ‘exhibit normal behaviours’. In this instance, the owner may be in breach of this – Max’s weight seems to be preventing him from exhibiting normal behaviours, as it seems he is unable to walk very far without panting and needing to rest.
We welcome views on this article. Please email your comments by 23 November 2020 so we can consider them for inclusion in the next issue of In Practice. Please limit contributions to 200 words.
This series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved. In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach.
The series is coordinated by Steven McCulloch, senior lecturer in human animal studies at the Centre for Animal Welfare, University of Winchester. It aims to provide a framework that will help practising veterinarians find solutions when facing similar dilemmas.
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