Readability and content of online pet obesity information

Tom T. Chen 1Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Deep K. Khosa 1Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Scott A. McEwen 1Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Sarah K. Abood 2Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Jennifer E. McWhirter 1Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Abstract

OBJECTIVE

To assess the readability of pet obesity information, document the presence and absence of types of pet obesity information, and perform comparisons between dog and cat obesity information content on websites.

SAMPLE

68 websites containing pet obesity content.

PROCEDURES

Websites were systematically retrieved with a search engine and predefined search terms and phrases. For each website, pet obesity information was scored by use of 2 established readability tools: the simple measure of gobbledygook (SMOG) index and Flesch-Kincaid (FK) readability test. A directed content analysis was conducted with a codebook that assessed the presence or absence of 103 variables across 5 main topics related to pet obesity on each website.

RESULTS

The mean reading grade levels determined with the SMOG index and FK readability test were 16.61 and 9.07, respectively. Instructions for weight measurement and body condition scoring were found infrequently, as were nonmodifiable risk factors. There was a greater focus on addressing obesity through dietary changes than through increasing physical activity. Few websites recommended regular follow-up appointments with veterinarians. Weight management information and the emphasis on owners’ commitment to achieve their pet's weight loss targets differed among dog- and cat-focused websites.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that pet obesity information on the studied websites was largely inaccessible to pet owners owing to the associated high reading grade levels. Readers of that information would benefit from clarification of information gaps along with provision of guidance regarding navigating online information and counseling on the importance of nutritional and dietary reassessments for individual pets performed by veterinarians.

Abstract

OBJECTIVE

To assess the readability of pet obesity information, document the presence and absence of types of pet obesity information, and perform comparisons between dog and cat obesity information content on websites.

SAMPLE

68 websites containing pet obesity content.

PROCEDURES

Websites were systematically retrieved with a search engine and predefined search terms and phrases. For each website, pet obesity information was scored by use of 2 established readability tools: the simple measure of gobbledygook (SMOG) index and Flesch-Kincaid (FK) readability test. A directed content analysis was conducted with a codebook that assessed the presence or absence of 103 variables across 5 main topics related to pet obesity on each website.

RESULTS

The mean reading grade levels determined with the SMOG index and FK readability test were 16.61 and 9.07, respectively. Instructions for weight measurement and body condition scoring were found infrequently, as were nonmodifiable risk factors. There was a greater focus on addressing obesity through dietary changes than through increasing physical activity. Few websites recommended regular follow-up appointments with veterinarians. Weight management information and the emphasis on owners’ commitment to achieve their pet's weight loss targets differed among dog- and cat-focused websites.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that pet obesity information on the studied websites was largely inaccessible to pet owners owing to the associated high reading grade levels. Readers of that information would benefit from clarification of information gaps along with provision of guidance regarding navigating online information and counseling on the importance of nutritional and dietary reassessments for individual pets performed by veterinarians.

Obesity is a condition characterized by excessive body fat accumulation.1 It is the most common nutritional disorder among companion animals, affecting 50.2 million cats and 56.5 million dogs in the United States alone.2,3 The AVMA classifies dogs and cats that are 30% greater than their ideal weight as obese.4 Risk factors for obesity include age, sex, breed, nutrition, and physical activity, all of which can offset the body's energy balance in favor of weight gain.5 Moreover, obesity has been linked to detrimental health consequences such as diabetes mellitus, cardiorespiratory diseases, osteoarthritis, endocrine abnormalities, and neoplasia in both dogs and cats.3 Results of 1 randomized controlled trial6 indicated that the life span of overweight dogs was shorter than that of dogs maintained with diet restriction (mean difference, 2 years).

Appropriate nutrition can help prevent development of obesity and other nutritional disorders in a companion animal and also improves an animal's response to diseases and injuries.7 Diet requirements are complex and often fluctuate with age, breed, and lifestyle factors.8 Regular nutrition assessments that screen for risk factors can assist with the formulation of an appropriate diet for dogs and cats.8 In recognition of the importance of nutrition for health maintenance, the American Animal Hospital Association classifies nutritional assessment as the so-called fifth vital sign and has published guidelines to recommend nutritional assessment of animals during all physical examinations conducted by veterinarians.8,9 Despite these guidelines, pet obesity remains underdiagnosed10 and is infrequently discussed with pet owners.11,12 Research indicates that pet owners are increasingly using the internet as an alternative to their veterinarian to obtain pet health information, including pet nutrition information.13,14

The internet has become a prominent and influential source of both human15 and pet14 health information. Over 70% of the general public engage in seeking online human health information,15,16 which potentially impacts decisions related to health behaviors.17 Similarly, a recent study by Kogan et al14 shows that the most frequently used and trusted sources of pet health information ranked by pet owners in the United Kingdom are the internet (79%) followed closely by veterinarians (72%). Health topics searched for most often were medical conditions (61%) and nutrition topics (59%)14 with veterinarian guidance on seeking credible online information welcomed by most pet owners.18

Previous research on online pet health information has reported suboptimal readability, accuracy, and completeness. In 1 study,13 exploration of veterinary anesthesiology websites directed at pet owners revealed the content to be mostly incomplete and occasionally misleading when benchmarked against a medical textbook. Another study19 involving the assessment of canine osteoarthritis information found that 77% of the websites were incomplete or of minimal usefulness when considering key topics such as clinical signs, treatments, and prognosis. Readability, defined as the ease of comprehension of written material20 and commonly assessed with reading grade level measures, is another important aspect of content accessibility. In an evaluation21 of the readability of 10 popular information pamphlets veterinarians share with pet owners, 9 pamphlets were deemed to be written at a level above the national reading grade recommended for publicly accessible health information, thereby potentially rendering the information inaccessible to many people. Online content pertaining to canine cranial cruciate ligament disease has also been investigated, with researchers reporting that accurate information on websites was written at high reading grade levels, whereas websites with content written at lower reading grade levels were found to contain inaccurate information.22 In light of evidence demonstrating the inconsistent quality of online pet health information, the World Small Animal Veterinary Association released guidelines designed to help pet owners navigate the internet on a variety of pet health topics, including pet nutrition.23

Despite the growing concern of pet obesity and the frequent use of the internet by pet owners to gain information regarding pet disease and nutrition topics, there is no published research regarding the nature of online pet obesity information, to our knowledge. We sought to address this gap by conducting a directed content analysis24 to investigate the presence or absence of predetermined types of pet obesity information on websites identified from internet search engine results. To characterize the online content that pet owners might encounter, the websites’ information was evaluated for readability (as assessed by reading grade level); the presence of information regarding pet obesity in general, body assessment, risk factors for obesity, health consequences, treatment, and management of obesity; and differences in the frequency of related pet obesity information (eg, modifiable vs nonmodifiable risk factors). Because of suggested differences in various aspects between dog and cat ownership (such as owners of cats spending less time interacting with and not needing to walk or exercise their cats, compared with owners of dogs10), the content of obesity information on dog- and cat-focused websites was assessed for differences.

Materials and Methods

Data collection

A list of candidate English-language search terms and phrases pertaining to pet obesity was compiled and run through a search engine databasea to establish their frequency of use. The most actively searched terms and phrases, such as “obesity,” “overweight,” and “weight management” were retained, and terms with minimal search activity, such as “pet obesity precaution” were eliminated. In total, 18 search terms and phrases were deemed to be frequently used; 6 were related to dog obesity content (eg, dog overweight), 6 were related to cat obesity content (eg, cat weight management), and 6 were related to pet obesity content (eg, pet obesity).

By use of an internet search engine,b website searches for each of the 18 search terms and phrases separately were performed during September 2018. All searches were conducted by one of the authors (TTC) with a private browserc to prevent user histories from influencing search results. Websites on the first page of the search engine results were used for data collection on the basis of results of previous studies25,26 on consumer search behavior.

To be included in the study, websites on the first page of the search engine results also had to contain information on at least one of the following subtopics relating to pet obesity: introductory or general information (eg, definitions and prevalence), body condition evaluation (eg, measurement of weight), risk factors for obesity (eg, overfeeding), obesity-induced health consequences (eg, diabetes mellitus), and treatment or management information (eg, controlled feeding and dog speed-walking). Websites that were public discussion forums, personal blogs (ie, written diaries), vlogs (ie, video diaries), online shopping websites, and websites that were sponsors of the search engine (indicated by “Ad” next to the website URL) were not included in this study because they may have contained less structured content (eg, personal anecdotes in chat forums), little or no written content (eg, shopping websites), or more biased content (eg, paid sponsors).

The landing page of each website (hereafter referred to as the website) was recorded in a list for later coding, and duplicate websites were removed. Landing page content that extended beyond the initial page was also coded (eg, paragraphs that spilled onto a second page). Embedded hyperlinks in the content that led to different web pages were not coded. Each website was categorized on the basis of the nature of its content as dog obesity content, cat obesity content, both dog and cat obesity content, and non–species-specific content.

Codebook development

Codebook variables were developed with reference to veterinary peer-reviewed literature and discussions with the research team, which included a clinical veterinary nutritionist (SKA). The 103 variables consisted of 87 that were dichotomously coded as 0 or 1 (1 indicating the variable criterion was present), 3 continuous variables, and 13 open-ended text entry variables. These variables collectively covered 5 key topic areas, as follows: introductory or general pet obesity information (eg, definitions or prevalence), body condition evaluation, risk factors for obesity, obesity-induced health consequences, and obesity treatment or management information. Website characteristics and demographic information, which included readability (ie, reading grade level), visual features (ie, use of photographs, infographics, videos, or charts), the presence of any internal content sponsorships, and whether the content was verified or written by a veterinarian, were also coded.

Intercoder reliability

Prior to coding, an intercoder reliability test was conducted on all dichotomous variables in a randomly selected subset of 10 websites. Four individuals with different backgrounds (a researcher [TTC], veterinarian, pet owner, and non–pet owner) were chosen to independently code the 10 websites. The Krippendorff alpha reliability estimate was subsequently calculated.27 Individual coder feedback was used to optimize clarity and consistency in the description and application of variables in the updated codebook for website content analysis.

Readability

The readability of website content was assessed with the FK readability test by use of computer software,d and the SMOG index was determined with an online calculator.e Furthermore, SMOG indices for a subset of 7 websites were also calculated manually for comparison with results from the online SMOG calculator.

Data analysis

All data were compiled, organized, and analyzed with computer software.f,g Descriptive statistics, such as frequency counts, were generated for all dichotomous variables. A Pearson χ2 or Fisher exact test was used to assess for differences between dog- and cat-focused websites by comparing the frequency count of each variable for dog-focused websites with the corresponding (matching) variable for cat-focused websites. All statistical tests were 2 tailed, and differences with a value of P < 0.05 were considered significant. For continuous variables, the mean, range, and SD were computed.

Results

The intercoder reliability test provided a calculated Krippendorff alpha reliability estimate of 0.74, which was indicative of good agreement among the 4 coders.27 In total, 68 websites were used for content analysis; 25 (36.8%) had dog obesity content, 27 (39.7%) had cat obesity content, 7 (10.3%) had both dog- and cat-focused content, and 9 (13.2%) contained non–species-specific content.

Word count and reading grade level

Website content ranged in volume from 297 to 3,672 words (mean, 1,095.97 words; SD, 645.30 words). The mean reading grade level varied depending on the measure used; values were 9.07 (SD, 1.89) for the FK readability test, 16.61 (1.40) for the online SMOG index, and 10.60 (1.01) for the manually calculated SMOG index for the subset sample of websites (n = 7).

Website characteristics and demographic information

All 68 websites had a title and most had section subtitles (n = 55 [80.9%]). The majority of websites had content with embedded hyperlinks (n = 61 [89.7%]) and some form of contact information (57 [83.8%]). Other common features included the use of sans serif fonts (n = 63 [92.6%]) and navigation toolbars (62 [91.2%]). Photographs were the most frequently coded visual feature (n = 51 [75.0%]), compared with infographics (11 [16.2%]), videos (6 [8.8%]), charts or graphs (3 [4.4%]), and other forms of visuals (8 [11.8%]) such as drawings and animated pictures.

Regarding authorship, approximately one-third of the 68 websites had information that was indicated to be written or verified by a veterinarian (n = 25 [36.8%]). Less than a quarter of the websites (14 [20.6%]) provided a reference list to accompany any cited information. Website domains were classified as a veterinary association (n = 12 [17.6%]), veterinary hospital or clinic (7 [10.3%]), commercial or branded (20 [29.4%]), and all other types (29 [42.6%]). Most websites had written content that showed no external affiliations (n = 60 [88.2%]), whereas a small proportion of websites was commercially branded (6 [8.8%]) or sponsored (2 [2.9%]).

General pet obesity information

Frequency counts for variables that were used to assess website content for general information about pet obesity were calculated, and obesity information on dog- and cat-focused websites was compared (Table 1). Of the 68 websites, 11 (16.2%) defined obesity and 25 (36.8%) mentioned the role of energy balance in weight management. Although most websites included pet obesity prevalence data (n = 43 [63.2%]), few stated that the prevalence of obesity among pets was increasing (11 [16.2%]). Twenty-eight (41.2%) websites mentioned the impact of pet obesity on the human-animal bond. Eight (11.8%) websites had comments on the association of human obesity and pet obesity (eg, overweight owners being more likely to care for overweight pets). Overall, a greater proportion of dog-focused websites mentioned energy balance in relation to obesity, compared with cat-focused websites (χ2 = 4.964; df = 1; P = 0.026).

Table 1—

Distributions of general or background information regarding pet obesity on 68 websites containing pet obesity content and comparison of those information variables between 25 dog-focused and 27 cat-focused websites.

VariableNo. of websites overall (%)No. of dog-focused websites (%)No. of cat-focused websites (%)χ2 value (df = 1)P value*
General information     
  Definition of obesity11 (16.2)5 (20.0)3 (11.1)0.458
  Obesity prevalence statistics43 (63.2)14 (56.0)17 (63.0)0.2610.609
  Obesity prevalence increasing11 (16.2)4 (16.0)5 (18.5)1.000
Energy and calories     
  Energy balance (intake vs expenditure)25 (36.8)13 (52.0)6 (22.2)4.9640.026
  Caloric intake formula8 (11.8)3 (12.0)4 (14.8)1.000
Human-animal relationship     
  Effect of pet obesity on the human-animal bond28 (41.2)11 (44.0)10 (37.0)0.2610.609
  Connection between human and pet obesity8 (11.8)3 (12.0)1 (3.7)0.341

Websites were systematically retrieved with a search engine and predefined search terms and phrases. A directed content analysis was conducted with a codebook that assessed the presence or absence of 103 variables across 5 main topics related to pet obesity on each website. Websites were categorized as dog-focused, cat-focused, dog- and cat-focused (n = 7; data not shown), or pets in general (9; data not shown).

Significance level was set at 5%; a value of P < 0.05 indicates a significant difference for a given variable between dog- and cat-focused websites.

— = When the assumption of the χ2 test was violated, the P value was derived with a Fisher exact test; in those instances, no χ2 value is reported.

Information regarding body condition

Data for all body condition–related variables in website content were summarized (Table 2). A description of BCS was provided on 15 (22.1%) of the 68 websites. For the assessment of a pet's BCS as indicated on 68 websites, 2 (2.9%) recommended the 5-point scale, 9 (13.2%) recommended the 9-point scale, and 2 (2.9%) suggested both scales. Whereas 29 (42.6%) websites provided instructions on how to perform a visual evaluation of the animal's body, only 4 (5.9%) included visual aids to guide this process. Over half of the websites (n = 37 [54.4%]) included instructions for conducting a ribcage assessment. Most (n = 58 [85.3%]) websites recommended consulting a veterinarian for advice (eg, physical examination of or diet recommendations for a pet) on obesity-related issues.

Table 2—

Distributions of specific pet obesity information regarding body condition evaluation and weight loss on 68 websites containing pet obesity content and comparison of those information variables between 25 dog-focused and 27 cat-focused websites.

VariableNo. of websites overall (%)No. of dog-focused websites (%)No. of cat-focused websites (%)χ2 value (df = 1)P value*
Body condition evaluation     
 Description of BCS15 (22.1)7 (28.0)6 (22.2)0.2310.631
 Type of BCS scale†     
  5-point2 (2.9)0 (0.0)0 (0.0)  
  9-point9 (13.2)6 (24.0)3 (11.1)  
  Both2 (2.9)1 (4.0)1 (3.7)  
Instructions for visual assessment29 (42.6)12 (48.0)12 (44.4)0.0660.797
Type of instructions for visual assessments     
  Graphic depiction4 (5.9)2 (8.0)1 (3.7)  
  Text18 (26.5)5 (20.0)9 (33.3)  
  Both7 (10.3)5 (20.0)2 (7.4)  
Subjectivity of visual assessments3 (4.4)2 (8.0)0 (0.0)0.226
Instructions for ribcage assessment37 (54.4)17 (68.0)14 (51.9)1.4060.236
Suggested weighing the pet26 (38.2)11 (44.0)11 (40.7)0.0560.812
Instructions regarding weighing the pet10 (14.7)5 (20.0)4 (14.8)0.722
Suggested creation of a weight log12 (17.6)5 (20.0)4 (14.8)0.722
Suggested creation of a food log11 (16.2)6 (24.0)4 (14.8) 
Weight loss information     
 Recommendation of initial consultation with a veterinarian58 (85.3)22 (88.0)23 (85.2)1.000
Rate of weight loss27 (39.7)12 (48.0)14 (51.9)0.0770.781
Duration of weight loss11 (16.2)6 (24.0)5 (18.5)0.2340.629
Quantity of weight loss1 (1.5)1 (4.0)0 (0.0)0.481

Website content was evaluated for mention of a 5-point scale, a 9-point scale, both scales, or none (data not shown) to assess BCS.

See Table 1 for remainder of key.

Information regarding risk factors predisposing to obesity

Website content was examined with regard to information about risk factors for obesity that are modifiable (ie, can be changed) and nonmodifiable (ie, cannot be changed; Table 3). Among the 68 websites, both diet (n = 56 [82.4%]) and physical activity (47 [69.1%]) were commonly mentioned modifiable risk factors. Of the nonmodifiable risk factors, endocrine abnormalities (n = 18 [26.5%]) and age (17 [25.0%]) were most commonly mentioned. Overall, the number of websites providing information about modifiable risk factors (n = 56 [82.4%]) was greater than the number of websites providing information about nonmodifiable risk factors (20 [29.4%]). Dog-focused websites provided information about nonmodifiable risk factors (χ2 = 3.957; df = 1; P = 0.047) and endocrine abnormalities as a risk factor (χ2 = 7.137; df = 1; P = 0.008) more often than did cat-focused websites.

Table 3—

Distributions of specific pet obesity information regarding risk factors for obesity on 68 websites containing pet obesity content and comparison of those information variables between 25 dog-focused and 27 cat-focused websites.

VariableNo. of websites overall (%)No. of dog-focused websites (%)No. of cat-focused websites (%)χ2 value (df = 1)P value*
Nonmodifiable risk factors20 (29.4)11 (44.0)5 (18.5)3.9570.047
  Endocrine abnormalities18 (26.5)11 (44.0)3 (11.1)7.1370.008
  Age17 (25.0)9 (36.0)4 (14.8)3.1070.078
  Breed11 (16.2)5 (20.0)4 (14.8)0.722
  Sex6 (8.8)1 (4.0)3 (11.1)0.611
Modifiable risk factors56 (82.4)20 (80.0)22 (81.5)1.000
  High-calorie diet56 (82.4)21 (84.0)21 (77.8)0.729
  Insufficient physical exercise47 (69.1)19 (76.0)16 (59.3)1.6530.199
  Direct effect of neutering on obesity14 (20.6)5 (20.0)5 (18.5)1.000
  Indoor dwelling (cats)13 (19.1)NA11 (40.7)NANA
  Effect of neutering on appetite2 (2.9)1 (4.0)1 (3.7)1.000

NA = Not applicable.

See Tables 1 and 2 for remainder of key.

Information regarding obesity-induced health consequences

The inclusion of obesity-induced health consequences in website information was evaluated (Table 4). Among the 68 websites, diabetes mellitus (n = 54 [79.4%]), osteoarthritis (54 [79.4%]), shortened life span (47 [69.1%]), and cardiovascular disease (41 [60.3%]) were the most frequently mentioned diseases related to pet obesity. Compared with cat-focused websites, a greater number of dog-focused websites mentioned cancer as a health risk (χ2 = 4.877; df = 1; P = 0.027).

Table 4—

Distributions of specific pet obesity information regarding obesity-induced health consequences on 68 websites containing pet obesity content and comparison of those information variables between 25 dog-focused and 27 cat-focused websites.

VariableNo. of websites overall (%)No. of dog-focused websites (%)No. of cat-focused websites (%)χ2 value (df = 1)P value*
Diabetes mellitus54 (79.4)18 (72.0)22 (81.5)0.6570.417
Osteoarthritis54 (79.4)20 (80.0)21 (77.8)0.0380.845
Shortened life span47 (69.1)18 (72.0)17 (63.0)0.4820.488
Cardiovascular diseases41 (60.3)17 (68.0)16 (59.3)0.4280.513
Cancer29 (42.6)14 (56.0)7 (25.9)4.8770.027
Respiratory tract diseases27 (39.7)13 (52.0)8 (29.6)2.6980.100
Hypertension26 (38.2)11 (44.0)6 (22.2)2.7980.094
Urinary tract diseases9 (13.2)4 (16.0)4 (14.8)1.000
Insulin resistance4 (5.9)0 (0.0)1 (3.7)1.000
Congestive heart failure3 (4.4)2 (8.0)0 (0.0)0.226
Tracheal collapse (small dogs)0 (0.0)0 (0.0)NANANA

See Tables 1 and 2 for remainder of key.

Information regarding treatment and management of obesity

Content relating to pet obesity treatment and management information on the 68 websites was assessed (Table 5). There were 64 (94.1%) websites that contained actionable content for owners to help their companion animal lose weight. More specifically, most websites mentioned making alterations to diet (n = 63 [92.6%]). Recommendations for the use of weight loss foods (n = 40 [58.8%]) and an increase in exercise level (54 [79.4%]), including suggestions on types of physical activity (43 [63.2%]), were fairly common among the websites. Few websites commented on the issue of weight regain after weight loss (n = 13 [19.1%]) or provided details on how to maintain a pet's healthy weight (16 [23.5%]). Twelve (17.6%) websites had information on the topic of pet owners’ acceptance of the diagnosis of pet obesity. Only 2 (2.9%) websites provided advice that could help owners acknowledge that their pet is overweight. More dog-focused websites included information regarding owner acceptance of a diagnosis of obesity for their pet (Fisher exact test, P = 0.022), the importance of owner commitment to pet weight loss (Fisher exact test, P = 0.046), and adverse effects of weight loss (χ2 = 7.137; df = 1; P = 0.008) than did cat-focused websites. In contrast, more cat-focused websites recommended pet toys for physical activity, compared with dog-focused websites (χ2 = 6.257; df = 1; P = 0.012).

Table 5—

Distributions of specific pet obesity information regarding treatment and management of obesity on 68 websites containing pet obesity content and comparison of those information variables between 25 dog-focused and 27 cat-focused websites.

VariableNo. of websites overall (%)No. of dog-focused websites (%)No. of cat-focused websites (%)χ2 value (df = 1)P value*
Acknowledgment of obesity     
  Owner acceptance of pet's overweight condition12 (17.6)7 (28.0)1 (3.7)0.022
  Role of owner commitment for successful pet weight loss12 (17.6)6 (24.0)1 (3.7)0.046
  Provides advice to help pet owner overcome denial of their pet's obesity2 (2.9)2 (8.0)0 (0.0)0.226
Diet     
  Address diet63 (92.6)23 (92.0)26 (96.3)0.603
  Reduce total calories fed46 (67.6)21 (84.0)19 (70.4)1.3580.244
  Alter feeding strategies44 (64.7)15 (60.0)20 (74.1)1.1690.280
  Reduce food quantity22 (32.4)7 (28.0)10 (37.0)0.4820.488
  Adverse effects of weight loss diet15 (22.1)11 (44.0)3 (11.1)7.1370.008
  Adverse effects of rapid weight loss (cats)14 (20.6)NA10 (37.0)NANA
  Increase dietary fiber intake13 (19.1)7 (28.0)5 (18.5)0.6570.417
  Increase dietary protein intake22 (32.4)7 (28.0)13 (48.1)2.2260.136
  Recommendation of weight loss food40 (58.8)16 (64.0)19 (70.4)0.2390.625
  Recommendation of weight loss medications8 (11.8)5 (20.0)1 (3.7)0.094
Physical activity     
  Increase exercise level54 (79.4)20 (80.0)22 (81.5)1.000
  Types of exercise43 (63.2)19 (76.0)17 (63.0)1.0360.309
  Toys for exercise38 (55.9)11 (44.0)21 (77.8)6.2570.012
  Physical rehabilitation3 (4.4)2 (8.0)0 (0.0)0.226
Weight maintenance     
  Possibility of regaining lost weight13 (19.1)7 (28.0)3 (11.1)0.167
  Instructions to prevent weight regain16 (23.5)10 (40.0)5 (18.5)2.9180.088
  Recommendation of follow-up visits with veterinarian during weight loss program19 (27.9)7 (28.0)9 (33.3)0.1730.677
  Recommendation of BCS reevaluations during weight loss program7 (10.3)2 (8.0)4 (14.8)0.670
  Website contained actionable content64 (94.1)25 (100.0)26 (96.3)1.000

See Table 1 for remainder of key.

Between-variable frequency comparisons

For all 68 websites, the frequencies of 4 pairs of information variables were compared (Table 6). Websites provided obesity prevalence information more often than they mentioned that obesity prevalence was increasing (χ2 = 29.516; df = 1; P < 0.001). Information about modifiable risk factors for obesity was found on more websites, compared with the frequency with which nonmodifiable risk factors for obesity were mentioned (χ2 = 36.535; df = 1; P < 0.001). Pertaining to the treatment and management of obesity, websites suggested making dietary changes more frequently than they mentioned increasing a pet's level of physical exercise (χ2 = 3.915; df = 1; P = 0.048). Lastly, websites recommended arranging an initial consultation with a veterinarian more than they recommended subsequent follow-up examinations (χ2 = 43.228; df = 1; P < 0.001).

Table 6—

Comparisons of distributions of dichotomous variables of interest regarding specific pet obesity information on 68 websites containing pet obesity content.

Variables for comparisonNo. of websites overall (%)χ2 value (df = 1)P value*
Prevalence of obesity43 (63.2)29.516< 0.001
Increase in obesity prevalence11 (16.2)  
Nonmodifiable risk factors20 (29.4)36.535< 0.001
Modifiable risk factors56 (82.4)  
Address diet Increase exercise level63 (92.6) 54 (79.4)3.9150.048
Recommendation of initial consultation with a veterinarian58 (85.3)43.228< 0.001
Follow-up consultations with veterinarian19 (27.9)  

*Significance level set at 5%; a value of P < 0.05 indicates a significant difference between the frequencies of the 2 variables.

See Table 1 for remainder of key.

Discussion

The objectives of the present study were to investigate pet obesity–related online content and assess the readability (accessibility) and presentation of pet obesity information on frequently searched websites. To accommodate for literacy disparities in the US general population, the American Medical Association and the NIH recommend that publicly accessible health information be written at a sixth-grade level.28,29 In the present study, the mean estimated reading grade levels of the 68 examined websites were 9.07 (derived from the FK readability test) and 16.6 (derived from the online SMOG index), which were both notably higher than the recommended threshold. This finding was consistent with results of previous research regarding human and pet health information on the internet. For example, with regard to human congestive heart failure information, Kher et al30 concluded that only 5 of 70 patient education websites contained information suitable for public consumption. Likewise, all 53 veterinary consent forms assessed in a recent prospective study31 exceeded the recommended grade level for readability, potentially jeopardizing the informed consent process by not adequately conveying the benefits and risks associated with each medical procedure to clients. Because reading grade level can indicate whether a target audience will grasp the intended message of the text,32 compromised readability may negate the potential benefits of online information that is intended to improve pet owners’ knowledge and decision-making.

On the 68 websites evaluated in the present study, information regarding the prevalence of pet obesity was presented significantly more often than was information regarding the increasing prevalence of obesity among pets. Indeed, pet obesity has become a highly prevalent disorder worldwide.2,11,33 However, the number of obese pets in the United States is also rising year after year.2 Conveyance of this rising trend to pet owners may alter their perception of their pet's susceptibility to developing obesity; the perception of a heightened risk of obesity for their pet would underscore the urgency of taking preventative actions against its development.34,35

The investigation of weight and body condition assessment information in the present study revealed that < 25% of the 68 websites informed readers as to what a BCS is; even fewer websites mentioned the typically used 5- or 9-point scale for quantifying BCS. Twenty-six (38.2%) websites suggested measurement of a pet's weight, but only 10 (14.7%) provided instructions on how to properly weigh a pet. The BCS and body weight measurement are the 2 most commonly accepted clinical methods used by veterinarians as part of the evaluation of a pet's nutritional status.5 Regular monitoring of weight, particularly between veterinary clinic visits, can help detect early signs of weight gain.8 However, Yam et al36 noted that only 1 in 2 pet owners was capable of accurately determining their dog's BCS with visual guidelines. Furthermore, half of the pet owners in the same study were also inaccurate in measuring their dog's body weight despite the use of electronic scales.36 One might speculate that if there is a potential for confusion and inaccuracy when pet owners conduct BCS assessments and weight measurements, it may be reasonable for websites to suggest the importance of regular veterinarian-conducted body condition assessments of pets and not necessarily provide instructions for pet owners to conduct such assessments. Future research is needed to explore the effectiveness of the types and formats of information regarding BCS assessment and weight measurement provided to pet owners with the intent to improve the accuracy of these monitoring tools in pet owners’ hands.

Numerous modifiable and nonmodifiable risk factors have been previously identified to cause weight gain.3,37–39 Encouragingly, modifiable risk factors, such as diet management and promotion of physical activity, were documented significantly more often on the websites than were nonmodifiable risk factors, such as age, breed, sex, and reproductive status. Because pet ownership directly influences modifiable risk factors, information regarding proper nutrition and exercise may prompt healthy caregiving habits that can effectively reduce a pet's risk for obesity. Moreover, an owner's motivation to address or prevent pet obesity can be predicted by the HBM. The HBM explains and predicts health-related behaviors on the basis of one's perceived susceptibility to and perceived seriousness of a disease or negative element in life, as well as the perceived benefits of and barriers against addressing that disease or negative element.34,35 In the context of pet obesity, the HBM accounts for an owner's perception of their pet's susceptibility to and the seriousness of obesity, as well as the owner's perception of the benefits of preventing or addressing pet obesity. In the present study, most websites discussed pet obesity health consequences with frequent mentions of diabetes mellitus, osteoarthritis, cardiovascular diseases, and shortened life span; pet owners who are informed of the severity of obesity-associated health consequences and recognize the control they have over modifiable risk factors may be more inclined to act in a way that minimizes their pet's susceptibility to weight gain.

Information on nonmodifiable risk factors was infrequently contained within the websites assessed in the present study. Given the complexity of these risk factors (eg, preexisting diseases and neutering) and their impact on weight gain,3 websites should ideally state the importance of them without providing excessive detail, thereby preventing potential confusion among or providing misinformation to pet owners. Prompting pet owners to consult a veterinarian may be a better alternative to in-depth discussion of nonmodifiable risk factors considering that nutritional assessment guidelines strongly encourage screening for all risk factors during every physical examination of a pet. As posited by the HBM, awareness of nonmodifiable risk factors for pet obesity can heighten attention towards modifiable risk factors, over which pet owners have greater control.34,35

Information on dietary and exercise changes was commonly found on the websites assessed. However, significantly more websites recommended addressing diet over increasing exercise, with most websites providing further dietary advice including feeding strategies and diet food recommendations. Strikingly, websites less frequently presented information that encouraged physical activity despite its known benefits in weight loss.40,41 Furthermore, significantly fewer cat-focused websites had information regarding owner commitment toward weight loss and other aspects of weight management advice and obesity, such as information about adverse effects of diet foods and the risk of cancer, compared with dog-focused websites. The apparent imbalance in cat- and dog-related information may reflect research findings that indicate the percentage of cats regularly brought in for veterinary care is notably lower than the percentage of dogs.10,42 The deficit in cat obesity information may be concerning because research also suggests that owners spend less time interacting with cats, compared with time spent interacting with dogs, and are thus less likely to detect health concerns.10 Overall, less information may lower a cat owner's vigilance with regard to pet health issues and reduce the urgency of seeking treatment for weight gain in cats.

A large proportion of websites in the present study suggested seeking an initial veterinary consultation for pet obesity–related issues. Indeed, veterinarians remain a top-ranked source of credible information among pet owners despite the popularity of viewing online pet health content.14 More importantly, a veterinary consultation allows for screening of a pet for any risk factors that may contribute to weight gain; any such factors identified can be subsequently accounted for when designing a weight loss program.8,9 In contrast, only 19 (27.9%) websites in the present study recommended follow-up appointments. This finding is of concern, given that pet owners who regularly engage with their veterinarians regarding diet and nutrition topics have improved compliance with the advice they receive.10 Furthermore, most websites did not stress the possibility of or how to prevent regaining lost weight or the importance of BCS reevaluations. Nutritional assessments of pets should occur on a regular basis, and any initial nutritional recommendations by a veterinarian should be followed up. Regular follow-up examinations enable timely detection of any weight or BCS changes that allow corresponding adjustments of the diet and exercise routines to be made. These tasks are part of the veterinarian's commitment to helping owners achieve long-term health goals for their pets43 and should therefore be relevant parts of client-veterinarian discussions, especially if websites do not emphasize the importance of regular follow-up examinations.

There were a few study limitations and factors to consider. First, the search phrases used in the search engine were purposely constructed to target general or broad websites on pet obesity to examine the range of topics relating to pet obesity that are commonly covered. Online content retrieved with specific search phrases for specific conditions (eg, “best weight loss food for dog” or “cat obesity causing congestive heart failure”) was not explored and may have yielded different results. As well, the present study was conducted solely with English-language search phrases and websites.

Although the online searches were performed under private browser settings in the present study, results nearest to the user's location are prioritized. Therefore, the results were geographically restricted. A virtual private network can mask the user's current location to a different location (resulting in local results of the new location) but does not remove this limitation. Although the sampled website content included some European websites, the extent to which the results of the present study can be generalized outside of North America are unknown. Future research should include assessment of European and Australian websites, given that pet obesity is equally widespread in those regions.44 Establishing the accuracy of online pet obesity information is another direction for future research.

Obesity in companion animals is a growing concern, and the internet can provide a wealth of information to help pet owners address the problem. However, as illustrated by the websites assessed in the present study, such information may be largely inaccessible to the public as a result of it having been written at higher than recommended reading grade levels. Various types and amounts of information about pet obesity were also observed with no single website containing all information. Likewise, some discrepancies were identified between dog and cat obesity content that may leave cat owners less informed regarding weight management and owner commitment and compliance with weight loss regimens. Under these circumstances, pet owners would need to browse multiple websites to obtain the breadth of information needed for understanding pet obesity. A high reading grade level may also pose as a barrier to comprehension of the information. The findings of the present study highlighted the need for veterinarians to assist pet owners with navigating online sources of pet obesity information, offering clarifications to address information gaps, and encouraging regular veterinary visits to update nutritional recommendations and reassess pets with obesity.

Acknowledgments

No third-party funding or support was received in connection with this study or the writing or publication of the manuscript. The authors declare that there were no conflicts of interest.

The authors thank Caitlin Grant, Gillian Hachborn, and Mohamed Ugas for their assistance with conducting the intercoder reliability test used in this study.

ABBREVIATIONS

BCS

Body condition score

df

Degrees of freedom

FK

Flesch-Kincaid

HBM

Health belief model

SMOG

Simple measure of gobbledygook

Footnotes

a.

Google Trends, Google LLC, Mountain View, Calif. Available at: trends.google.com/trends/?geo=US. Accessed Aug 17, 2018–Sep 12, 2018.

b.

Google search conducted in Guelph, ON, Canada. Available at: www.google.ca/. Accessed Sep 12, 2018–Sep 26, 2018.

c.

New incognito window, Google Chrome, Google LLC, Mountain View, Calif.

d.

Word 2016, Microsoft Corp, Redmond, Wash.

e.

Learning and Work Institute online SMOG calculator. Available at: www.learningandwork.org.uk/SMOG-calculator/smogcalc.php. Accessed Oct 24, 2018.

f.

Excel 2016, Microsoft Corp, Redmond, Wash.

g.

SPSS, version 25, IBM Corp, Armonk, NY.

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