By initiating discussions about nutrition each time pet parents visit the practice, veterinary technicians can directly impact the lifelong health of their patients.
Nutrition applies to every patient of a veterinary practice. Out of three primary components affecting the life of an animal – genetics, nutrition, and environment – nutrition is the one factor the veterinary healthcare team can impact.1 Proper nutrition and feeding management is the foundation upon which healing and the maintenance of health rests.
The positive impact of proper nutrition on health and disease is well established in all animals. Appropriate feeding during each life stage helps maintain health and support healing from disease and injury, as well as prevent diet-associated diseases and assist in the management of other conditions. Incorporating nutritional assessments into each appointment is key; each assessment should consider the animal’s health, current diet, feeding practices, and environment. Nutritional assessments are iterative; each factor affecting the animal’s nutritional status is assessed and reassessed, as often as needed.
The team approach to nutritional education
The American Animal Hospital Association (AAHA) recommends five vital assessments of patient health at every examination to ensure the highest standard of care.2 These five vital assessments are: temperature (T), pulse (P), respiration (R), pain, and nutrition. Thanks to the nutritional assessment guidelines from both AAHA and WSAVA, the initiative to consider nutrition the fifth vital assessment helps promote it as a standard of care. Veterinary technicians are already responsible for TPR and pain recognition; adding nutrition to their essential task list adds a new challenge, along with enhanced job satisfaction, increased client compliance, and most importantly, patient health. Nutritional assessments and client education should be veterinary technician-driven.
Integrating preventive healthcare into a practice requires commitment and engagement by the entire veterinary team. A strong preventive program will promote practice success by optimizing pet health, enhancing the client-pet relationship, and building long-term client relationships with the practice. Nutrition is a key component of any preventive health care program, and client interest in learning about the best nutrition for their pets is growing. Pet parents look to their veterinary team as experts in healthcare, as well as for nutritional advice. In an AAHA study, 90% of clients wanted nutritional recommendations, yet only 15 % perceived they were given any.3 The AAHA compliance study revealed that only 7% of the pets that could potentially benefit from therapeutic foods were actually receiving that therapy.3 There is tremendous opportunity for veterinary technicians to fulfill this role rather than allow clients to gain nutritional information from non-veterinary personnel or the internet.
The nutritional assessment
Every animal that presents to the hospital, and every time they present, should have a nutritional assessment. Feeding goals, determined by the pet’s physiology and/or disease condition, should be created. The role of the veterinary technician is to establish patient history, score the patient’s body condition, work with the veterinarian to determine the proper nutritional recommendation for the patient, and communicate this information to the pet owner.
The first step in evaluating a pet and determining the nutritional status is to take a thorough history, including signalment (i.e. species, breed, age, gender, reproductive status, activity level, and environment). Next, a nutritional history should be taken to determine the quality and adequacy of the food being fed to the pet; the feeding protocol (e.g. whether the pet is fed at designated meals or has free choice, the amount of food given, the family member responsible for feeding the pet); and the type or types of food given to the animal. The technician should ask the owner open-ended questions (see sidebar). This type of questioning helps uncover more information, as it gets the owner talking; closed-ended questions typically end in one-word answers, thus potentially not uncovering everything the patient eats in a day. It also has the potential to put the pet owner on the defensive, thus sabotaging any relationship the veterinary technician is trying to build with her – especially when it comes to nutrition. The technician should also ask the owner about the animal’s access to foods, supplements, and medications, and how much of each the pet consumes each day. Pets also may be fed by more than one family member or receive numerous treats throughout the day. All these factors play a role in proper nutrition.
All members of the healthcare team should be familiar with taking a nutritional history, so that the team can pinpoint a breakdown in owner compliance (e.g. is more than one person in the household feeding the pet, is the animal getting more calories than recommended, etc.) and begin to establish a feeding protocol to insure the patient’s proper calorie consumption (see below for an example of a Nutritional History Questionnaire).
Veterinary technicians should be comfortable with calculating the amount of food needed to meet the appropriate energy needs of each patient. The pet’s daily energy requirement (DER) reflects his activity level, and is a calculation based on his resting energy requirement (RER). Veterinary technicians should have these calculations memorized or on laminated note cards in every exam room (along with a calculator) for easy access! The most accurate formula for determining the RER for a cat or a dog, regardless of the breed, is:
RER kcal/day = 70(ideal body weight in kg)0.75
RER kcal/day = (kg x kg x kg, √, √) x 70
Once RER is determined, DER may be calculated by multiplying RER by a standard factor specific to the life stage and body condition of the animal.
Body condition scoring
The healthcare team should document the pet’s body condition score (BCS) and weight at every visit, as part of the physical examination. Body condition scoring is a subjective assessment that is important when determining whether a dog or cat is at a healthy weight, and when substantiating a diagnosis of obesity. It allows healthcare team members to assess a patient’s fat stores and muscle mass, helps in evaluating weight changes, and provides a value that can be used in team communication.
The two most common BCS systems are the five-point scale and the nine-point scale. Both rating scales use nine points, but the five-point scale is scored to the nearest half-point, whereas the nine-point scale is scored to the whole point.4 It is important for all members of the healthcare team to use the same scoring system from the outset so as not to confuse or miscalculate the patient’s weight.
Body condition is assessed by beginning at the head of the pet and working toward the tail. Fat cover is evaluated over the ribs, down the topline, around the tail base, and ventrally along the abdomen. On the five-point scale, a score of 1 represents “too thin” and 5 represents “obese”; a score of 3 means “ideal.” According to body composition studies in cats and dogs, a body condition of 15% to 25% fat is optimal; therefore, a pet with an ideal BCS has 15% to 25% body fat. A pet with a BCS indicating he’s overweight has 26% to 35% body fat, and a pet with a BCS indicating obesity has more than 40% body fat.5
BCS is a tool that owners can use at home to monitor their pets. Veterinary technicians should demonstrate how to assess body condition on the animal while in the exam room and have the client perform one as well. Doing this together helps ensure understanding and proper scoring. Have the client perform a BCS monthly at home and forward the results to the clinic to have it added to the patient’s medical record!
A veterinary technician’s goal is to help patients live a long, happy, and healthy life, and proper nutrition is the cornerstone of that goal. Therefore, it is imperative that veterinary technicians play an active and leading role in educating clients about proper nutrition for their pets. Even animals that are not sick may not have optimum wellness. Pet parents who understand that nutrition preserves and lengthens their relationship with their animals are much more likely to become regular consumers of veterinary medical services, regardless of economic conditions.
The veterinary healthcare team should focus on proper nutrition for every animal that presents to their hospital. To do this, veterinary technicians should be responsible for performing complete nutritional histories and patient assessments, as well as for educating pet parents about proper nutrition for their beloved animals.
1Burns KM. “Proper Nutrition: Is the New Emphasis a Fad?” Veterinary Team Brief. June, 2014:8-9.
2Baldwin K, Bartges J, Buffington T, et al. “AAHA Nutritional Assessment Guidelines for Dogs and Cats”. JAAHA. 2010;46:285-296.
3“The path to high quality care: practical tips for improving compliance”. American Animal Hospital Association, Lakewood, CO:AAHA Press;2003.
4Burns KM. “Why is Rocky so Stocky? Obesity is a disease”. NAVTA Journal Convention Issue. 2013:16-19.
5Brooks D, Churchill J, Fein K, et al. “AAHA weight management guidelines for dogs and cats”. J Am Anim Hosp Assoc. 2014;50(1):1-11.
6Fascetti AJ, Delaney SJ. “Feeding the healthy dog and cat”. Applied Veterinary Clinical Nutrition. Ames, IA: Wiley Blackwell; 2012: 75-94.