Clinical Case Challenge

Maxy, a 2-year-old spayed female Golden Retriever, presents for her first weigh in after starting a weight loss program. Her initial physical exam reveals no abnormalities other than a body condition score of 9/9 (normal muscle condition). Her starting weight is 105 pounds, with an estimated ideal weight of 80 pounds. Her diet history reveals that she was receiving 2000 kcal from her current diet. You start her on 1600 kcal of a therapeutic diet after calculating that this is 80% of her current estimated caloric intake. After two weeks on the veterinary therapeutic diet, the owner is upset that Maxy has gained one-half pound and is now 105.5 lbs.

Which of the following would be the next best step for Maxy?

a)     Select another veterinary therapeutic weight loss diet that is lower in kcal/cup, as Maxy needs further restriction.

b)    Tell the owner to decrease the amount of the veterinary therapeutic diet by 30% and re-weigh in two months, since Maxy’s energy requirements are lower than expected.

c)     Recommend the owner add carnitine supplements, with excellent quality control, to ‘boost’ her weight loss by increasing fat metabolism.

d)    Rule out any compliance issues (revisit the diet history, etc), then consider reducing the total caloric intake.

Explanation:

Owner compliance and follow up is the most important aspect of a weight loss program. Ruling out problems that may have nothing to do with the diet will prevent those same problems from occurring on a different diet, which is why answer a) is not correct. Similarly, if the owner is still giving table scraps, chews, or treats not mentioned or asked about in the original diet history, simply decreasing the amount of the diet fed will not solve the problem.  Unnecessarily restricting the food may put the patient at higher risk for nutrient deficiencies, drastic reduction (30%) may increase the risk for weight rebound, and waiting two months before rechecking may worsen the situation, which is why answer b) is not correct. More studies that define dosing and efficacy are needed before L-carnitine can be recommended for widespread use, which is why answer c) is not correct. Many people do not include treats or people food in a diet history unless specifically asked, so it is very important to follow up on these items, especially if initial weight loss is unsuccessful. Additionally, studies have shown great inaccuracy in owner measurements of pet food quantities, so the owner should be asked how the food is measured (a level standard 8 oz measuring cup vs weighing). Changes in the home environment including new family members,  a new petsitter responsible for feeding, family members who do not agree with the weight loss plan, or a new pet with easily accessible food can all be factors that should be ruled out before altering the current plan. If compliance and the diet history are confirmed, the best next step is reducing the total caloric intake (food and treat allowance) by 10-20%, then reweighing in 1-2 weeks, making d) correct.