Good evening everybody and welcome to tonight's webinar. My name is Bruce Stevenson and I have the honour and privilege of chairing the webinar tonight. Our presenter tonight is Georgia Woods Lee, who qualified as a registered veterinary nurse in 2004.
In 2015, Georgia took the position of clinical lead for the Royal Canon Weight Management Clinic at the University of Liverpool, Small Animal Teaching Hospital, where she is now dealing exclusively with pet obesity care and nutrition. Georgia was awarded her certificate in canine and feline veterinary Health nutrition in 2017. The American vet tech specialist in nutrition certificate was awarded in 2019, and she got her BSC honours in veterinary nursing top-up degree in 2022.
So more than qualified to talk to us. Georgia is also currently working towards her PhD in pet obesity. Georgia, welcome back to the webinar vet, and it's over to you.
Thank you so much. And, it's lovely to be back. So thank you for, tuning in for this session.
So, today we're thinking about a topic that actually is very close to my heart. Not only are we gonna be talking about obesity care, but we're going to be thinking about those keen communication tools that you'll need for success, and communication is something. That I feel very strongly about.
It's something that I think about daily within my job. And so I'm really hoping that I'm gonna cover a lot of basics within this session that I'm sure you already know, but it will be some little reminders. But then also talk through strategies about how we introduce the topic of obesity with a pet and pet owner, and how do we get that right?
So we'll think very briefly about, you know, what does obesity care, kind of one on one, what does that look like, in most cases. And then we'll think about setting the groundwork for success. So we'll think about types of communication, whether that's verbal, non-verbal, and of course, not only giving communication, but receiving communication is as important.
Then we'll think specifically about communicating around obesity and how we can communicate that with that pet owner for successful obesity care, how do we do as best we can for these patients. We'll think about unconscious bias and we'll also think about weight stigma within that section, and we'll finish by thinking about client readiness. So To get us kind of thinking about obesity and providing obesity care, you know, what does 101 look like?
If we were to read in a manual, you know, what are the steps of getting weight loss for our patients? Well, the first thing that we do is we identify that the pet has obesity. Then we tell the owner that this is what we've discovered.
Then we go ahead and we gather all the information that we need both, from clinical history, dietary history, and then physical parameters. And then we set a plan. We choose a food, we tell them how much to feed, and then we monitor the plan and adjust it as needed.
Now, even though I may make that sound really simple, we all know it isn't. And in fact, although this may be the basic framework of how we provide obesity care, every single plan is going to be different. Every interaction is going to be different, every pet and pet owner are going to be different.
And so we have a big barrier to overcome right at the beginning, and this is about not doing this, not giving this sort of prescriptive approach when we come to obesity. We don't want to, just, you know, hand them a sheet of paper with, you know, this is what you have to do and send them on their way. If it was as easy as that, I wouldn't have a job.
And so we've got, we should recognise that this sort of step by step is really quite a prescriptive approach, and there isn't really a prescription for obesity care. So one of our biggest challenges, once we've recognised that our patient has obesity, is actually telling the owner. And we know that that is not always easy for any of us.
It is essential, though, that we get that right, because if we don't get that right, that pet owner isn't going to listen to the advice that we want to give. We may offend that client. We won't lose that client.
So, you know, it's really, really important that we get this communication right. Nobody wants to cause offence, but we all have our own thoughts and feelings on these topics too, which we'll cover much more later that can influence how we communicate. And we really want to be thinking about overall, it's about working together with that pet owner.
Not against them, not shocking them, not forcing them, you know, that collaborative approach is really how we are going to get success here. So this is a question that I get asked pretty much every time I do a webinar. I'm, I'm pretty sure Bruce has asked me this question a number of times as it's come through on the chat.
And it's how do you talk about obesity with a pet owner that also has obesity. And the pictures just represent, represent that. Now, firstly, we know that obesity in humans is very prevalent.
So the latest figures showed that 94% of adults that are over 18 have overweight or obesity in the UK. So this is something that's gonna come up really frequently. I mean that is over every other every other pet owner that you might meet.
So it's a barrier that we really need to break down and we, we need to deal with. Now, when I'm asked that question, it's very difficult for me often to give an answer, or certainly a, a short or a quick answer, because it really isn't a short or quick thing to get around it. It's about everything that we're going to talk about and think about in this session.
And it really starts with laying the groundwork. So let's think about actually what communication is, first of all. Well, in its barest form, communication is transmission of information.
Maybe it's human to human. Maybe it's human to other species. We all talk to our pets.
And maybe also it's, communication between a non-living entity, whether it's a computer, your iPhone, your iPads, or your tablets, and they're communicating with us as humans too. So there's lots of different, areas where we're using communication with different things, different beings. Now of course we have verbal communication, that's what I'm doing with you today.
I'm verbally communicating, what I have in my mind. But there's lots of nonverbal communication that goes on at the same time. Everything that you're looking at is me nonverbally communicating with you.
And that's just as important. Now communication is a two-way street. It is just as important how somebody receives communication or how you receive communication as it is to give communication out.
So it's about listening. It seems very obvious, but it's also about detecting what can you pick up? Is their tone, is there a vibe, is their body language, you know, you're going to need to be observing also, you know, how comfortable does that person look with the communication that you're giving to them, and so on.
So question just to kind of mull over in your mind just for a moment is how good do you think your communication skills are? Do you always feel that you get communication right? Are there times where you don't expect a reaction that you get from a client?
Do you feel bad about that? Do you reflect and think maybe what could I do better next time? I think it's important to reflect on these things because that is ultimately how we learn and it's ultimately how we improve.
Now, I don't know about you, but when I became a veterinary nurse, a very long time ago, started training, I think it was in 2002, I thought I was gonna work with pets. But some years later I, I think it's become very, very obvious that actually my main communication, the main people I work with, Are these people, they're the pet owners, and so although we of course are here for the pets, we also need to be here for the pet owners. And in a world where veterinary industry and particularly the, the pricing and the charges to do it, you know, within the veterinary industry is under such close scrutiny.
How we communicate, how we add value, how we add service, how we look after our clients, that is what's going to really make a difference to them. So the types of communication, I've touched on a couple already, but it's actually a flowing combination of lots and lots of different things. So there's the verbal there's the verbal communication.
Then we might have some written communication. Again, what you're seeing on your screen here is a combination of those two things. Then there's visual communication.
I thought a nice flowing bit of water would visually represent what I'm talking about. Then we've got auditory communication. You're listening to what I'm saying.
And then there are other nonverbal things that are going on. So, appearance, we might be considering, and also body language. And I think if, from my point of view, if I was to sit here with my head down and looking a little bit worried, you would all pick up on that really, really quickly.
And it's because we're very, very sensitive to nonverbal communication as humans, which again, we'll come to in a bit. So, it's about being receptive, looking, listening, and listening to hear what the client is saying, not waiting for your turn to reply. It's a really fine balance, but we all know, I think, people who are, who only stay quiet until it is their turn to speak.
And it's really, we miss so much when we do that. It's really important that our listening is active, and we're taking in what the client is saying. Then we should think about how our communication and our communication skills and methods affect others.
Have we been tactful, or were we blunt? Have we been confusing or were we clear? Have we been thoughtful, or were we a bit thoughtless?
Have we communicated positively, or was it quite negative? Ultimately, when it comes to communication, you want to be treating as you would like to be treated and speak as you would like to be spoken to. And if we remember that, then we can't go too far wrong.
Now we are going to meet many, many people within our careers, within our practise, every day of the week. And we have sort of this pyramid here that represents the types of clients and the frequency that we get them. So we get those perfect clients.
Not as many as we'd like, but we certainly do get clients that follow everything that we say. All our information, they're hungry for it. They're, they're interested, they're engaged.
You know, these are our perfect clients. They're very, very easy to work with. Whatever we say, that they're happy to go ahead and do that.
We will also meet the group of people who I'm going to call the mad, bad, and sad. And I think we all know who those people are. Nothing is ever really good enough.
Nothing ever really works. Probably it's all our faults. These are the people that probably get quite irate or quite frustrated, within our practise, and they can be very difficult to deal with at times, but they are hopefully in the vast minority for all of us.
Then we have everybody else. And what everybody else consists of is a range of different receptiveness, a range of different ability or want or desire to comply with whatever we might be saying, or if we've made a recommendation to follow that up. Different levels of understanding, different levels of time to implement what we're talking about.
So I think it's good to just kind of identify that, you know, we're gonna meet a very big range of people, but hopefully, most people are going to be receptive to what we're going to say. Now, when it comes to communication. I mean, people present on this topic for the, for a full day, and I don't have that time.
So I wanted to just briefly, pop in at some of these things to think about so that you can mu them over. And they, they communication techniques. So when we're thinking about being verbal, we need to be clear.
So speaking clearly. We want to go through things in a methodical manner. We don't want to be rushed in what we're saying.
When we are meeting a client, we want to do the three E's, explore, explain, explore. That's how we get to what's actually going on, that's how we get to the information that we need. We think about ice, so ideas, concerns, and expectations, and we should make sure that we've ticked all those boxes with our communications.
Have we heard the pet owners' ideas? Have we expressed our concerns? Have they expressed their concerns?
Have we made our expectations? Have they allowed us to know their expectations, so always thinking about the ice? Then there's ways of screening, you know, questions that allow us to take an overview of what's going on.
Our active listening skills are absolutely essential so that the client knows that we are listening. And there's a difference between listening and hearing, isn't there? You can listen as in, you might be hearing that I'm making noise right now, but to know that I've really listened, that, sorry, that you've really listened, it would be that you give me back something that I've given you, and that's how we actively listen.
We should maybe give warning shots if we've got bad news to deliver. It might sound something like this, so I wanted to discuss Barney's results. I was a little concerned.
That allows that pet owner to not feel slammed in the face by some bad news. It allows them that moment to just prepare for what you're going to say. It is a considerate way of delivering information that the client may not be be wanting to hear, for instance.
What about signposting? So this can be good to show the owner what we're doing and how we're going to do it. First I'll show you what medication is needed, and then I'll show you how to apply it, so they know what's gonna happen.
Road mapping is similar. Once we've got have the diarrhoea under control, then we'll look at a change in diet. So they know not only where we're going in the short term, but also what's coming in the next week or months.
They know that plan too. And then summarising, you know, so something like this, so what I can see, fluffy has skin disease. We're gonna try this cream, but if that's not working for him, we're gonna try the tablets.
And so again, it's just wrapping up everything that you've delivered to that pet owner, because we know that in stressful situations, they don't always remember all the detail. So it's a chance to give them those main points once again. Chunking and checking, it's really how we're gonna summarise throughout the conversation.
Safety netting, it's a way of making sure that this is a safe space, you know, we want our pet owners to tell us, you know, what is actually going on. You know, we also want to let them know that, anything that they say is fine, we're not going to judge them. Getting feedback on your communication is also really important to know if your communication has been received.
Are you happy with the plan? Do you know what you'd have to do first? Asking questions like this mean that it's including the pet owner in this conversation.
We're not just bombarding them with information, we want to hear back from them too. Sharing the decision making, this is something I think we do far better these days than maybe when I first started nursing, we are much more in favour of hearing from the pet owner and giving them options now, rather than just saying take these tablets, it'll fix it. And then always asking at the end of the conversation, do you have any other questions for me?
Because you don't want the pet owner to get to the door about to leave and go, Oh, just one more thing. You know, you want to hear it in this conversation in context with everything that you've been saying. Then, when you've given this advice, we should reiterate it in another form.
And that's because, again, we know that pet owners don't remember everything. So written communication is just so important to back up everything that we've said, something that's clear. So don't use tiny fonts and you know, if you're writing by hand, you know, try and write neatly so the pet owner can understand it.
Not too many images, you know, this isn't really the time or place, and try not to write too much. You want the key points written in your summary. And very much if they have to do a succession of things, take a, take a step by step approach, maybe a numbered approach.
Number 1, we're gonna give this. Number 2, we're gonna give that. You know, bullet point it for them.
And this can be given in paper form, and of course it can be emailed or even text messages can be sent. I think the ease at which this can be done now is, you know, is so much better again than it used to be. We should really utilise the technology we have available to us to really enhance what we communicate to our pet owners.
Now I wanted to think about the environment that we actually are giving this communication in, and actually the auditory environment is worth thinking about. This, you know, I'm lost, so I turn down the sound so I can see better, is a real thing because if you've got too much auditory input, your brain gets overwhelmed and you don't feel like you can concentrate on what you're seeing so well. So if you have a pet owner in front of you, let's think about this.
Speak at a volume that they can hear. It might sound too obvious, but you know, what if you do have a an owner with a hearing aid or that is part, you know, partially. Deaf, for instance, we want to be able to speak so they can understand us.
Then we need to think about auditory overload. We work in busy, noisy environments, and we're very, very used to it. So, you know, maybe rather than, you know, using the corner of the waiting room, you know, that's big and busy, maybe using a quieter room to reduce that noise pollution.
You know, making sure that owner can hear you properly and thinking about distracting sounds. So again, we're really used to the staffy crying, aren't we, in the, in the back panel. We're used to dogs barking, the drip pumps bleeping, the phone ringing, people laughing, you know, talking loudly.
This is the environment we live in, but many, many pet owners will find listening to you in that environment very difficult, and so we should consider that. We should also consider our appearance. This is very much about how you present yourself.
We'll make an immediate impression upon the pet owner. So this nurse here, she has turned up pretty prepared. She's got a stethoscope, she's got a pen, she's got a name badge on, so we know who she is.
She's got her trusty scissors that she's not let the vet have. You know, she is ready to go. And that would be what you would assume when you saw her.
However, we do have things that maybe don't represent us in the best way. So this, nurse here, she's got, probably too much jewellery on, she's got a big rock on her finger, not clean from the elbow down in terms of she has her watch on. She's got a bit of blood on her scrub top from earlier on, and there's some mysterious.
Stains, uniform's a bit tatty, she's got a rip in the knee, and she's got a bit of poo on her shoe. It's not a great look, is it? And it may be very understandable, given what we do for a living.
However, we should still think about what the pet owner's perception of us is going to be if we present ourselves in that way. They are thinking about our body language, so are we closed in our appearance? Are we defensive?
Have we got our arms crossed, covering our body, covering our vital organs, just in case? Are we blocking the pet owner physically? Unconsciously maybe, but are we doing that?
It makes us less approachable. What we'd like to do of course is be open, you know, hands and arms relaxed, people want to see your hands, that that means it's a show of confidence. We want to invite conversation and invite communication.
We want to appear approachable. Now, this setup here that I've got pictured, just where the arrow is, is an interesting one. It's my consulting room.
And this is my boss, you know, with a cat and a pet owner. But this is not my favourite way of of setting this up. I would be wanting to stand at the end of the table where that blue arrow is pointing, because I really don't like having this big table.
Barrier in between me and the pet owner. I don't like the us and them feeling that it gives us. So I very, very rarely will actually stand behind my consulting room table because it just makes me much more open and approachable for that pet owner.
Now facial expressions are really interesting. I think we all know what an RBF is, and we've got a great example of the picture just here. And this really is because, again, we as humans are very sensitive to this, and first impressions do make a big impact.
On a new client that you may not have met before. On our face, it conveys thoughts. And I'm afraid I suffer a little bit with this.
You know, people say it's OK, you don't have to tell me. It's written all over your face. And even though I try very hard not to let that happen, it does, unfortunately, I think.
And it's causes faces, convey emotions, you know, so smile. You know, even if you don't feel like it, smiling will immediately make you more approachable and more friendly. Fake it if you have to.
Let's be honest, there are some really bad days in work, you know, some sad days, some very busy days, but we can't let that show to the client, you know, we have to be there for them, you know, friendly, approachable, and receptive. If there has been that very bad day, you know, it's important that when you walk into your consulting room with this next client that we leave all that at the door. So take a deep breath, take a moment, compose yourself and then meet your meet your client as you would like to meet them.
So we know humans are very highly receptive to facial expressions, but so are dogs actually, and really interestingly are brachycephalics. Other dogs find them really hard to read and it's thought that there are some behaviours that dogs display to brachycephalics. That are to do with this mismatch or misunderstanding of their facial expression.
They always look like they're frowning cause they've got this big, heavy brow, which, you know, could be a bit of a repelling behaviour or, or body language. So, just remembering, faces are so important. Now visual aids come in real useful, so other things that the pet owner can see.
So these things here are all really useful resources. We're talking about obesity, so these are some of the visual aids within my consulting room. I have a wall of fame and I have.
A wall of ongoing patients to tell owners, you are not alone. You're not the only one with a pet that has obesity. We are in it together, we will get through this together, that sense of community, and you can do that just through some visual displays.
So how do we make our pets and the pet owner feel comfortable in the environment that we want to talk to them in? Well, it's about thinking of it ground up. So this is groundwork again.
Getting that welcome right, you know, warmly welcoming them every member of the team, if you're walking through reception, say hello to the people that are there. It doesn't matter that you're not going to be interacting with them. Have a comfortable waiting area, again, this all sounds very basic, doesn't it, but it is just so important to think about these things and maybe think how things could be improved potentially, reflect, that's all we're suggesting.
So having things up on the wall that are relevant and that are current, that change regularly, neat product stands, all products should be priced, and we know that owners of far, or people in general, I should say, are far less likely to buy something if they don't know how much it is. So going around putting prices on can be very useful. Having separate waiting areas if you possibly can.
One for cats, one for dogs, and a separate one for exotics. Difficult but achievable in some cases. And of course there's cat, the cat friendly clinic and now dog friendly clinic schemes which give you so much information on how to really maximise the space that you have available.
Cat trees and cat shells shows that you care that that cat has a good experience whilst in your practise, as does having blankets or towels to put over cat carry boxes, it it communicates very clearly that you care. Having water available on request, having a sign up saying that this is possible again helps that pet owner understand that you really do want to make this as pleasant as possible. So thinking about your different patients, your familiar ones and your new ones.
Introduce yourself if you've never met them before, and really try and take them under your wing. So, I'm gonna look after you. Come with me.
You know, immediately that helps the pet owner feel good. Know the pet's name and how to pronounce it. And if you're not sure, ask someone else or ask the pet owner immediately so they know that you actually do want to get it right.
Also know the sex of your patient. Come on, we all know that males and females have different names. Dave is a girl, yes, and Poppy is a boy.
I have met both of those individuals, just, just by the way, and it does cause confusion, and so we should be mindful and careful that we get that right. Making an effort to remember owner details is also really important to them. And you can write them down if you have to, you know, we all see an awful lot of clients.
But remembering, oh, how was your holiday or how was your other cat I saw they were in last week, makes them feel valued, makes them feel, that they are part of your practise, much more bonded to you, if you remember these types of details. And if you can use them later on in the conversation, again, the difference between listening and hearing your pet owner. Now, what ultimately I'm talking about here in terms of communication is having a collaborative approach.
We are definitely better together, we've heard this, you know, phrase so many times, but it is so important when we're thinking about the client communication. So remembering we are here to educate and not dictate. We're here to provide guidance, not give them orders.
We're here to be supportive and not prescriptive. We should come to a consensus rather than only offering up one way of doing things. We should listen to that pet owner's preferences and not be single minded about what we think is best.
We should give options, not only discussing the gold standard. I think that is, an easy pitfall to fall into. You know, there may be other options that are better for that case, showing them the way.
Not leading and expecting them to follow you and working together, not working against them, it's all so, so important. So is this easy? Does, do you find this easy?
I'd like to know, you know, if you have a, a comment or a question on this, pop it in the chat box and we can talk about it at the end. You know, are there topics that are difficult to discuss? Well, this is a really interesting and growing area of research in veterinary medicine, and particularly when it comes to obesity, which we're going to talk much more about now.
But there are 3 Cs that I would really like you to remember when it comes to communication. That is, that it should be considered, considerate, and collaborative communication. And if we can do that, we will be very successful.
So how do we go about communicating for obesity care? That's what we were here to discuss, wasn't it? Now there was a lot of groundwork and rightly so, because I think we do have to work on all of that before we can get here, before we have that ease of introducing this conversation.
Now, it might be important at this point to just think about how obesity occurs and the assumptions that we might make at this point when we've identified our patient has obesity. Well, in it's very simplest form, we all know this, don't we, that we get obesity in the face of when we have energy utilisation outweighed by the energy intake. So more is taken in than it's used and therefore it is stored.
And there's lots of areas that contribute to this, not just one. We know the pet owner contributes to this. We know genetics contribute to this.
The pom C gene in Labrador and flat coat retrievers is now well established. There's around 50 genes in humans that have been discovered and play a role in causing obesity. But genetics are not the only part of the story.
There's also the environment that that pet lives in. Metabolic disorders, we think about hyperthyroidism. The food types might influence what's going on.
The pet's own behaviours and motivations might be influential. And then we have lack of knowledge and understanding on the pet owners' part. This particular study here showed that 89% of pet owners underestimated their dog's body condition score.
And even when they were given a chart and showed how to use it, 65% of them still misperceived their dog's body condition scores. So we have this kind of disconnect between what is normal and what isn't. Now this Labrador here is called Sydney's Beautiful, Beautiful Boy.
And how many dogs do we think, how many Labradors do we think that we would find looking like this? Many, I would imagine. But Sydney does have obesity, so he would be scored as 7 out on the body condition score, which gives him 20% above his ideal weight.
I think lots of pet owners would be quite shocked to find that out, that actually, he should be looking like this. And it's not until you show them what is normal that they actually understand what normal looks like. And this is really understandable because what they're being influenced by is many outside influences, not least what they see on TV, in social media, you know, in magazines and books.
And this here. This Labrador picture is interesting because this picture I took, from a simple Google search, looking at Labradors at one of the world's biggest dog shows. And I think if we just compare the shapes of these two Labradors just.
For a moment, we can see that the black Labrador does have obesity, and yet he's being held up as the best of his breed, the perfect example. And so this disconnection from reality really isn't too surprising from the pet owner's point of view. We also have things that maybe we are responsible for or could influence, so we worry about causing offence, of course we do.
We may have a severe time pressure, and I think time and the time pressures that we have now have probably never been worse. And so this is going to play a role in how we deal with this disease. Discomfort with the conversation we've already touched on, I'll talk more about that in a moment.
We maybe have different priorities. Maybe the wait is something that we feel could be left for now and returned to later on. There's poor recognition within the veterinary industry, not just among pet owners.
And this goes alongside a good deal of apathy in terms of obesity as a disease. This study here, looked at records, of dogs that were presented at veterinary practise. 30% of those dogs were never weighed, so, you know, who knows if they had a problem with their weight or not.
And out of 148 cases that were looked at, only 1 had a body condition score. Now this study is some years old now, so I'd really hope that we do a little bit better, but I think there's still work to do often, but I, I think there has been improvements in recent years. Then we need to think about unconscious bias and weight stigma.
So weight stigma and unconscious bias are well recognised now, both in human medicine and in veterinary medicine medicine really sadly. Both of these two studies here showing the sorts of thoughts and feelings that doctors and vets have towards those with obesity. So in humans, when they ask doctors with their perceptions, doctors described those with obesity as awkward or ugly and non-compliance.
Those are some harsh words and some very judgmental thoughts and feelings that are coming through. When vets were asked a similar question, they expressed frustration. They often blamed the pet owner and were very pessimistic that anything was likely to change, and this is weight stigma.
That blaming, that apportioning blame to those with a disease. And so when we look at this picture of this overall difficulties when it comes to how obesity actually occurs, and when we think about actually this chaos in the middle of the screen here is what the cause of obesity actually look like, there is no simple answer here. But weight stigma and unconscious bias starts us pointing the finger.
And unfortunately, it gets pointed directly at the pet owner. So we've seen there's so, so many different causes, and we kind of know that, but yet still people strongly feel that, well, it must be all the owners' faults. They provide the food after all.
They must be giving too much food at the end of the day, or they must be just giving far too many treats. How can they let this happen? You know, don't they know they're killing their pet with kindness?
These are all things that I have heard many, many times, and this is all weight stigma. And when you hear it, or if you are having these thoughts, which is very, very normal, by the way, I'm not blaming or judging anyone for feeling like this, we should be curious and think, well, how come the sibling in that family, that pet is of normal weight? And how come the other pets in that household are of normal weight too?
It often happens that it is 1 out of the 4 cats that has obesity, or 1 out of the 3 dogs, and not every member of that household. Now I've got 3 short videos here for you, and what I would like you to do when I play these videos is just let your initial thoughts and feelings come up. What are the emotions?
What are you thinking about? This is video number one. This is video number 2, and I, I apologise for the sight poor quality of this one.
Don't worry, the video hasn't stopped. He's having a good think about it. Having another go.
And this this is video number 3. And I apologise for some not so pleasant pictures. So what were your thoughts?
Were they different, those 1st 2 videos to that 3rd video? I wouldn't be surprised if they were, and it's because in society we treat obesity really differently to other diseases. Now if you go onto YouTube and type in funny fat pet videos, funny fat cat videos, you will get literally millions of hits and videos showing those like that poor cat trying to get himself through the cat flap and people having it as humour, something to laugh at.
Of course when you type in funny cats with cancer videos, you get nothing at all, because of course it isn't funny either. But this is because we see cancer in a very, very different light, and yet both of these are chronic diseases. Both of them are are considered to be incurable diseases in some cases, and both are affected by the environment.
And yet our perceptions of them, and it's in groundund into us, we get this right from the moment we understand it is that it is very different. So whenever I show pictures like Molly, and particularly when I show them to the vet students at, at, the small animal teaching hospital, most people laugh. Some people say, Oh, look at her, she looks like a melted cat.
And it's because at this point, you know, in their careers, they haven't understood the importance of recognising the suffering that's going on in this cat's case. And that's known as unconscious bias. Now, unconscious bias, there are many types of bias, but the particular one that we're concerned with is perception bias.
So stereotyping and making assumptions about groups of people or individuals. And if you want to spend a pretty uncomfortable afternoon, go onto the. Website and it will, take you through different tests to see what your implicit biases are, where, where your unconscious bias is.
And there is one for weight. So it'd be interesting just to find out, you know, what is going on beneath the surface. So when we are faced with a cat like this, and you know, maybe somebody walks into the room and goes, oh wow, that cat is really fat.
What I'd really like your brain to do and my brain now I've trained it to do it, is they're saying no, Molly has obesity. She's suffering from a chronic disease. And the words that we use when we talk about obesity is just so important.
They cannot be fat, they have obesity. Just like they have kidney disease, just like they have cancer. You cannot be cancer, you cannot be kidney disease, you cannot be fat either.
So it's this internal work that I'm describing that would be worth some, again, some reflection. What do we think? What thoughts come up for us?
What thoughts and feelings do we have? What do we assume when we are met, with pet owners and their pets, such as the ones on the right here? Do we make judgments?
Do we make assumptions? The only way to combat our unconscious bias is to be aware of our unconscious bias. We can't get away from it.
We all have it whether we like it or not, but our conscious mind can get in the way and make us talk without stigmatising and allow us to deal with our pet owners without passing any judgement. And so it's thinking about that internal and external conversation and because of course, we are only here to help, we're not here to judge. So I sort of pose this to you for reflection, you know, what are your fears?
Do you worry about saying the wrong things and causing offence, you know, losing that client, you know, and again with our financial pressures at the moment, this is a real concern, isn't it? And do you feel like you have the right words to have these discussions? We're gonna be talking about words quite a lot.
Now, interestingly, this recent paper, looking at what happens when we are worried about communicating on topics like obesity, showed that 54% of vets, avoided having the conversation about obesity because of these concerns, the fears, the worries, the not knowing how to approach it. So I'm hoping that by the end of this session, I will have helped you. Now, there are many words that it might feel easier to use to describe our patients, such as portly or chubby, a bit fat, you know, a bit, rotund, where actually we shouldn't be using these terms.
And my favourite term is above ideal weight. Now, I've left the term obese up there because we should talk about these patients with colleagues in terms of that patient with obesity in that top kennel, not that fat one in the corner. Yeah, it's make it, it's that practise of talking about obesity in correct terms.
Also, when we're talking to pet owners, the words again really matter, and particularly when we're gathering information. So what does your dog eat? We might ask that very, very frequently and what the owner will tell you is what they have for breakfast and what they have for their evening meal.
Now again, this paper here looked at these specific terms and one and was exploring how they could get better information from the, the pet owner. And phrases and questions such as starting first thing in the morning, tell me everything that your pet eats throughout their day will get you much, much more detailed information. And so now you'll find out about the bit of toast they get when Mrs.
Jones has her breakfast. We'll then hear about the chicken that goes on top of the kibble in the bowl. We'll then think about the ham for the tablets, the boos at lunchtime, the crisps, because I had some for lunch, the biscuits because Nan comes round, and has her cup of tea with us and the dog, then more chicken again on the evening meal, and then ham before bedtime, followed by a dental tube to go to bed with.
It will get us much, much better information. So we are challenged, aren't we? We've got lots of communication challenges to overcome.
You know, that question of is the is the owner in an obese state also, you know, we've got discomfort with this conversation. We have to get acknowledgement from the pet owner that there is a problem if we're going to help them. They have to understand what it is that we're trying to advise them to do.
They will come with their own fears and preconceptions. It takes a lot of time, it might not be the owner's priority. You know, there are lots of different expectations when they walk in the room, and there might be concurrent diseases to be dealing with.
But the biggest question really and where I want to finish this session today is thinking about is the pet owner ready to have this conversation? So, the stages of readiness is a theory is a theory that was developed actually in the early 80s and it was to do with human behaviour change for giving up smoking. But actually now this model is being used for a wide variety of things and as you'll see in a moment, it very much is useful to us to consider when we talk about pet obesity.
So it's a cycle of stages. So our first stage in our cycle is the pre-contemplation stage. This owner has no intention of making any changes, don't see why they should.
Thank you very much. Our second stage is contemplation. So this owner knows that there's a problem, but it's not the right time.
They're not committed to actually doing anything about it. Our 3rd stage is an owner who's intent upon action. They're coming to you maybe with a concern and they're ready to hear your information and to get going with making changes.
Then in the action phase, you're going to help them make these changes and sustain them into the maintenance phase where all the new behaviours are gonna replace their old behaviours. Now unfortunately, this is a cycle and the last portion of our cycle is relapse. And this is where we know that so, so often owners will fall back into old patterns of behaviours.
And so we wind up again at pre-contemplation with no intention of making any more changes. Now at this point, you might think, well, if I meet an owner who's in pre-contemplation or contemplation, can I not just kind of shock them a little bit, you know, either, you know, be blunt with them or, or quite sort of quite shocking to, you know, butch them round the cycle. And unfortunately, the answer is no.
If you try and apply pressure to owners in either one of these stages, you will probably lose them as a client. They are certainly not going to have you on their Christmas card list. It is going to repel them in some way because they are simply not ready to deal with this.
And so we, when we meet these clients, we say, OK, that's fine. We will revisit this topic another time. The next consultation, the next booster vaccination, they might now be ready.
They may have thought about that seed you planted, and now they're prepared and they're now in preparation, they're intent on action again. So, in real terms, what does this actually look like? How do you start the conversation?
So finally, we are here at the, at the bit that you may have been tuning in for. And it's because there is all that back work to do first before we get here. Now, step one is to weigh and body condition score every patient every visit.
And it's so, so important that we do this, and this becomes a routine assessment, and this is how we're gonna use it. So these are just my words and some examples. You of course will fit them for how it suits you, but this gives you an idea of how we can start.
So I'd like to talk about the findings of our routine assessment. Is it OK if I, if we talk about your pet's weight? And in asking for permission and getting consent, you've already got much better buy-in from that pet owner.
They're much more likely to, to take on your advice than if you just hit them with it. So we then say, how do you feel about your pet's weights? We're working together here.
We want to understand their readiness. You know, so they might go, don't think there's a problem. OK, we know what's, what stage they're in.
They might also go, yeah, I've been worried about this for a while. And again, we have assessed their readiness, that owner is ready to do something. And it also allows us to understand their starting point.
You know, they might say, I don't know, is the weight OK? Which means they don't have the knowledge yet and we can help them with that. Then we move on and say, can I show you how to body condition score and would you like to have a go?
We're gaining acknowledgement here. We're allowing the pet owner to discover it for themselves. Note at this point, I have not said, I think your pet has obesity.
I think that your pet is overweight because I want my pet owner to recognise this because they'll be much more accepting. And then when we have that acceptance, we come to a consensus on the body condition score. It doesn't matter for this purpose, whether you scored the pet as an 8 and the owner scored it as a 7.
The owner has still recognised that we are in an overweight or above ideal weight state and that you can help. And so, really, when we think right back to the start, we can't hand out a prescription at this point. We've got to work with the pet owner.
So to summarise, we have to set all that groundwork in place to get that good relationship with our pet owner to start having these conversations. Communication is that constant flow of information through many different sources, and that you're going to be listening to and receiving, but so is your pet owner. And of course, That listening bit just as important as the giving of communication.
Now, there are good approaches to talking about obesity with any pet owner at all, without causing offence, without alienating your pet owner. If we remember, we have to do it when we are considered, considerate and collaborative. And if we can do that, then we will be successful.
Or as my boss is doing here, you can tell the cat and see if the cat knows. It has been my pleasure as always to speak with you. Thank you very much for listening.
Georgia, that was absolutely amazing. And, I'm sure that everybody that tuned in to get the weight loss bit was a bit surprised to start with. But I don't have any doubt that at this stage of the webinar, everybody fully understands why you started where you did.
It is an amazing idea to think like that before you even start to Bring it up and push people into it, because I loved your circle of not being ready and that, there was a, I can't remember who it was, but a famous person many years ago said, a man convinced against his will is of the same opinion still. And, yeah, you, you can talk at them, but it doesn't work. Never does.
No, absolutely, they have to be receptive, and we have to make some sort of judgement on that quite quickly. So we know where we are. Yeah, and the people on the journey with you because it is a teamwork.
It's, it's never easy. And those that are most successful are always the ones that have been part of a team working together. So, you're absolutely right.
I thank you for your time tonight. We haven't had any questions come through. I think everybody was absolutely stunned by all the great information.
And, I have no doubt that if you, get Dawn to give you a heads up in a week or two's time, you'll find that most of the people on this video, on this webinar tonight have gone back and watched the video over and over to get your great tips. So, thank you so much for your time. And I have to be honest, I can now see why your clinics are so successful.
Thank you very much, it's been my pleasure. To everybody that's attended tonight, I hope you enjoyed this as much as I did, and you learned that this is a team effort and that communication with the client and not at the client is the key to success here. So, thank you for your time tonight.
And, as always, my controller in the background, Dawn, for making everything run smoothly. Thank you so much, for your input in making this all happen. From myself, Bruce Stevenson, it's goodnight.