Introduction
As concerns about the prevalence of pet obesity continue to increase, a clear understanding of veterinarian-client communication specific to pet weight is an important aspect of tackling this growing problem. In human medicine, several barriers to effective conversations about being overweight or obese have been identified for physicians communicating with their patients, including time constraints, stigma, effects on patient mental health, being unclear on appropriate language, fear of damaging rapport, and concerns about patient readiness to consider weight management.1,2 Similar barriers may exist for veterinarians, for whom apprehension about discussing pet obesity due to fear of harming their relationship with the client has been assumed,3–5 and veterinarians have reported perceived issues with client compliance, lack of time, and the client’s own obesity as reasons they may not address pet obesity.6
Currently, a comprehensive understanding of pet owners’ perceptions and expectations when discussing pet weight with veterinarians is lacking. The objectives of the study reported here were to explore and compare veterinarians’ and pet owners’ perceptions of pet weight–related communication in companion animal practice and identify pet owner expectations for weight-related communication and veterinarian challenges when discussing pet weight.
Materials and Methods
Five pet owner and 3 veterinarian focus groups were conducted between July and October 2019, each involving 2 to 9 participants. The study protocol was reviewed and approved by the University of Guelph Research Ethics Board (REB No. 19-05-003).
Data collection
The methodology of the focus groups has been previously described in full.7 In brief, the pet owner and veterinarian focus group discussion guides8 were developed by the research team to explore veterinarians’ and pet owners’ perceptions of information exchange and decision-making during companion animal visits. A semistructured interview format was followed, which included open-ended questions and follow-up probes. Focus groups were used because they have the advantage of allowing observation of how participants express and sometimes modify their viewpoints during interactions with others, producing data that may be less accessible without this participant interaction (eg, during one-on-one interviews or in response to survey questionnaires).9
Purposive sampling was used to select 20 veterinary clinics for pet owner recruitment within a 30-minute driving radius of the Ontario Veterinary College in Guelph, Ontario, Canada. A convenience sample of pet owners was recruited by having one of the authors (NJ) approach clients in the lobby of some participating clinics or by posting a recruitment poster in the clinic lobbies. Pet owner focus groups were 2 hours long. Participating pet owners were provided refreshments during focus group sessions and were paid a CAD $25 honorarium for their participation. All participants were veterinary clients, at least 18 years old, English speaking, and the primary caregiver of a cat or dog.
Randomly selected veterinarians from a list of practicing veterinarians within a 30-minute driving radius of the Ontario Veterinary College were invited to participate in the study. Veterinarian focus groups were 2.5 hours long. Participating veterinarians were provided with dinner and a CAD $50 honorarium. All were English speaking and practiced at least 50% companion animal medicine at the time of the study.
Written informed consent was obtained at the beginning of each veterinarian and pet owner focus group session, and participants completed a demographic questionnaire. At the end of each focus group, the moderator (NJ) reviewed the topics discussed with participants to confirm the accuracy of recorded information, a process known as member checking, to support credibility of the study findings.10 Focus group sessions were audio recorded with standard recording equipment (H2n Handy Recorder; Zoom North America). A transcriptionist was hired to transcribe all sessions verbatim.
Thematic analysis
Only the pet weight–related segments of the discussion guide (Appendix) and related verbatim transcripts for the pet owner and veterinarian focus groups were analyzed for the purposes of the present study. Verbatim transcripts of the weight-related segments of each focus group were reviewed in conjunction with the audio recordings to familiarize the lead author (KAS) with the data. Thematic analysis11 was performed on the transcripts with standard software (NVivo version 12; QSR International). An iterative, inductive approach, through which codes and themes emerge from the data, was used to develop initial codes. Two authors (KAS and JBC) reviewed segments of the transcripts and discussed the interpretation of codes to validate the interpretations being made, a recognized process to support the credibility of the study findings known as peer debriefing.10 Pet owner focus groups were analyzed first, followed by veterinarian focus groups. Codes that arose from pet owner focus groups were used to deductively analyze the veterinarian focus groups, and further codes unique to veterinarian sessions were developed inductively. This allowed for a comparison of the thematic content of the pet owner and veterinarian focus groups as well as an exploration of veterinarian-specific perspectives and challenges related to discussing pet weight with pet owners. No new codes emerged by the time the final focus groups were analyzed for both pet owners and veterinarians, indicating that data saturation had been reached.
Results
Participants
A total of 27 pet owners participated in the 5 focus groups. All pet owners owned at least 1 dog or cat and visited a veterinarian at least once per year. There were 3 male pet owners and 24 female pet owners. Median number of pets owned was 2 (range, 1 to 12), and median number of years visiting any veterinarian was 17.5 (range, 1.5 to 47 years).
A total of 24 companion animal veterinarians (2 males and 22 females) participated in the 3 focus groups. Twelve of the participating veterinarians were practice owners or partners, and the other 12 were associates or locums. Median number of years since graduation was 14.5 (range, 2 to 41 years), and median number of veterinarians in the practice was 3 (range, 1 to 19).
Three overarching themes emerged from thematic analysis of the weight-related segments of the focus groups: the importance of discussing pet weight, pet owner expectations, and veterinarian-specific challenges when discussing pet weight.
Perceptions of the importance of discussing weight
Participating pet owners across all focus groups indicated that weight is an important part of their pets’ health that should be discussed with their veterinarian. Participants extensively discussed the importance of weight as a valuable indicator of their pet’s overall health. Many participants shared experiences when a weight change in their pet signaled an underlying condition. One participant indicated that weight is “the benchmark to know whether or not my animal’s sick,” and many participants across sessions had an awareness that “there’s a lot of conditions that are signaled by weight shifts” and agreed that “in and of itself [weight] is important as an indicator.” The pet owner participants also recognized that not all weight changes were cause for concern and indicated that they look to their veterinarian for information on when to investigate weight changes further. Participating pet owners expected this weight-specific information to be provided to them by veterinarians in the context of their pet’s overall health, age, and lifestyle.
Participating pet owners expressed an expectation that weight would be measured at every appointment. Across all focus group sessions, participants agreed that “taking a weight every time you go should be standard,” and many pet owner participants indicated that weighing the pet is the first thing they expect to happen. Some participants indicated that they often initiate the weight discussion when they arrive for their appointment. As one owner said, “it’s such an easy thing to keep track of and it can help so much so why try and save the 5 seconds it takes? Like you might as well just do it while you’re there.” Participating pet owners expressed that they expected and appreciated that their pet’s weight was recorded at each visit, again citing weight’s importance as a health indicator. Despite agreeing that weight should be measured at every visit, participating pet owners did not necessarily expect weight to be discussed at every appointment and indicated that the extent to which weight was discussed was dependent on the reason for the visit and the pet’s weight itself. Most pet owners indicated that weight is important to bring up at routine or regular appointments, but that during emergency or problem appointments, they were not interested in discussing weight if weight was not related to the problem. Participating pet owners also did not expect to have in-depth discussions about weight at every routine appointment. For instance, one pet owner shared they “wouldn’t expect it to be a very detailed conversation or even come up at all unless it’s a deviation from the norm as far as the pet’s weight.” Another indicated that “the majority of the visits I go, the pet is the normal weight and in good condition. So, we don’t talk about it, but if it changed, then we would have a discussion.”
Participating pet owners spent more time discussing underweight or ill pets during the focus group sessions than did participating veterinarians, who almost exclusively focused on overweight pets during their sessions. Pet owners in some of the focus groups discussed the importance of being aware of overweight pets, although participants in other sessions did not share this concern about overweight pets. In 1 session, a participant indicated that overweight status was “not something personally I put a lot of stock into. I mean there’s obviously reasons that being overweight or underweight is really unhealthy, but I think as someone mentioned, they’d rather have their animal have to lose weight than gain it … and I felt the same way.” Another participant mentioned that weight was not a concern that they felt should be prioritized over other aspects of a pet’s health. Pets being overweight was not necessarily considered worrisome if there were no other presenting health issues, and one pet owner indicated “they say oh you should be ideal, but … that’s not the only indicator of health and you know, if you have a pet that’s well taken care of and overall their health indicators are good, then that’s what’s important.”
Participating pet owners in 3 focus groups shared that they thought that veterinarians have a responsibility to discuss weight for pets of any weight status, and they look to their veterinarians for information about their pet’s weight. Some indicated that they felt able to monitor their pet’s weight or body condition score at home, whereas others recognized that there may be a disparity between an owner’s perception of their pet’s weight and the veterinarian’s assessment. As one participant expressed, “I think that people look to their vet[erinarian]s to give them that information, those guidelines. They can’t count on their own idea of what’s fat and what’s skinny, what’s normal.” Another pet owner stated that in the case of overweight animals, “it is a vet[erinarian]’s job to … tell you that you’re killing your dog with kindness.” Pet owners also felt that it was important for veterinarians to discuss weight with them to ensure that they were feeding their pet an appropriate amount of food, particularly when the pet was growing, as well as when the pet was an adult.
Participating veterinarians across all focus groups agreed that sharing information with clients about their pet’s weight was very important. Like pet owners, veterinarians expressed that they had a responsibility to discuss weight and that not doing so was a significant “omission.” As one veterinarian said, “I don’t think an exam is complete unless you’ve had that conversation.” Unlike pet owners, veterinarians did not discuss the importance of weight as a health indicator in any focus group. Participating veterinarians did place value on achieving or maintaining a healthy pet weight as a financially affordable aspect of preventive medicine for clients, which may reduce costs of veterinary care over the pet’s life. Veterinarians across all 3 focus groups also expressed that they did not think clients place the same value on discussing weight as veterinarians. As one veterinarian participant stated, “I don’t think clients think it’s very important, but I think we do.”
In addition to professional responsibility, veterinarians in 2 focus groups also expressed that they feel a need to advocate for pets, especially in the case of overweight pets. Some veterinarians felt that focusing on advocacy helped them approach difficult weight conversations. One participant indicated that when dealing with overweight pets, veterinarians “have to educate the owners that whatever they’re doing right now is not okay. [Advocating for the pet] gets me through some of those hard conversations sometimes.” Some veterinarians indicated there were limits to what they felt they could take responsibility for in terms of the pet’s weight, while others believed that “those conversations need to be had whether they’re heard or not.” Veterinarians across all focus groups also shared experiences of feeling the need to “pick their battles” and avoid engaging in weight conversations with certain clients, and one veterinarian indicated that “I’m not going to stand there and fight with them.”
Veterinarians also acknowledged that the extent to which they discuss weight at a given appointment is context dependent. Many indicated that they try to always mention weight at an annual or wellness appointment and may skip that conversation if the pet is present for a problem that is unrelated to weight. Others indicated that they might still try to discuss weight at problem appointments, although they may not make time for that conversation in the same way they would during a wellness visit.
Pet owner expectations when discussing pet weight
When discussing underweight or overweight pets with a veterinarian, participating pet owners in all 5 focus groups expressed a desire to have the context of their lifestyle and their pet’s lifestyle taken into consideration by the veterinarian, especially during discussions related to overweight pets. Additionally, pet owners expressed that breed and age were important factors for veterinarians to consider as well as exercise potential or activity level. These factors, as well as the pet’s individual medical and general life history, were things pet owners felt were important for the veterinarian to understand and consider when discussing weight. One participant indicated that “every time we come in, we’re told that she’s underweight; however, she’s extremely active and she’s been through a lot of health issues,” and expressed that this context not being considered was a source of frustration for the participant. Participating pet owners also wanted veterinarians to recognize physical limitations for their pets, particularly for overweight pets. For instance, one owner indicated “we wouldn’t be able to take our dog for a vigorous walk even if we wanted to” and “then you have to have a conversation now that you know, my dog can only amble.” Participating owners wanted these challenges to be taken into consideration when veterinarians provided information about how to approach weight management for these pets and expressed that weight management becomes increasingly difficult for clients when the veterinarian is not working with the client in the context of their individual life and challenges. Regarding undertaking weight management for an overweight pet, many participating pet owners indicated other challenges like the stress of bringing an anxious pet into the clinic for frequent weight checks, dealing with begging behavior, and increasing physical activity. In 2 focus groups, participating pet owners indicated that these challenges are more frustrating when they do not feel supported by the veterinarian. Encouragement, follow-ups, and concrete feeding and exercise directions, coupled with options, were mentioned across focus groups as ways for pet owners to feel supported.
Related to the importance of context, pet owners expressed a desire for options when it came to weight management for their pets. Across all sessions, participating pet owners discussed wanting options when it came to managing their pet’s weight, largely in the context of overweight pets. In terms of diet, owners indicated that they wanted veterinarians to consider their personal preferences for what to feed their animal when discussing diet options. Participating pet owners did not want to feel pressured to purchase a diet that did not fit with their preferences and indicated that these situations make it seem “like they were just trying to sell us the vet[erinary] food.” Ideally, pet owners would feel that “instead of it being a sale it’s actually like ‘I care about what your dog is weighing.’” Pet owners also wanted options for activity changes and other weight management approaches, and they wanted this information to be clearly explained. Participants did not want to leave the visit having only been told their pet was overweight without clear direction for dealing with it. As one participant suggested, “Don’t just tell us she’s overweight, like tell us how we can kind of fix it, you know what I mean? Give ideas and don’t give just 1 idea. Give multiple ideas.” Pet owners in 4 focus groups also expressed that follow-up from the veterinary team was ideal and helped to keep owners on track. When dealing with an overweight pet, several pet owners indicated that they prefer “direct information. It’s telling you exactly what to do and I know that sounds like you’re being spoon fed but some of us need that when it comes to that type of information,” and this might include diet and exercise options as well as information about the pet’s required calorie intake and breed-specific reference points.
Participating pet owners acknowledged the potential difficulty for veterinarians in having a veterinarian-client conversation regarding an overweight pet. Pet owners indicated that the relationship between the client and veterinarian was important and that a perceived problem with that relationship could lead to defensiveness or a desire to see a different veterinarian. Many participants expressed that it was important for veterinarians to be encouraging instead of condescending when a pet needed to lose weight, although some also indicated an awareness that it might be “hard to make the person realize a change is needed without sort of guilting them.” Participating pet owners indicated that they would feel more comfortable approaching a veterinarian with an overweight pet if they were confident they were not going to be judged or made to feel guilty. The language used by veterinarians was considered by some pet owners to be an important component of creating a nonjudgmental atmosphere. For instance, it was indicated that “a person doesn’t want to go in and [hear] ‘you[r pet is] fat.’” Pet owners again expressed a desire for follow-ups with the veterinarian as well as ongoing encouragement when pursuing weight management for a pet. They also expressed that they felt that only addressing the issue once at an annual appointment is ultimately ineffective for pet weight management. As one participant said, “What about follow up, like not, oh well, we’ll see you next year. How about in a couple of months; like make a plan … don’t just wait until the next routine appointment and then, because nothing’s ever going to get solved.”
Veterinarians indicated they felt pet owners should expect to discuss weight at most appointments. However, they also expressed the belief that most owners do not want to have a weight conversation when the pet is overweight. One veterinarian described their perception of a pet owner’s ideal conversation as “Nothing. They either want it or they’re like ‘I don’t want to talk about it, I don’t want to acknowledge it.’” Many of the participating veterinarians expressed that they believe owners want validation regarding the diet they feed their pet as well as a clear target number for body weight. As one veterinarian stated, “What they really want to hear is that, yes, you’re feeding the world’s best dog food and you’re feeding the right amount.” Veterinarians in this focus group later expanded on this statement by further explaining that it is difficult to offer these reassurances when many clients do not come to the appointment with information about what or how much they feed their pet. There were some veterinarians who wondered if this lack of information is a “dodge,” a tactic used by pet owners to avoid entering a nutrition conversation during which the veterinarian may question the owner’s choices. Many participating veterinarians expressed that “getting an accurate diet history to start with” can be a substantial barrier to having productive nutrition and weight conversations.
Veterinarians in all 3 focus groups acknowledged that when it came to weight management, clients wanted options. In contrast to participating pet owners, the participating veterinarians specified that these options often revolve around diet and cost, not usually a pet’s physical activity. Similar to the participating pet owners, veterinarian participants expressed that they felt pet owners want veterinarians to work within “their means and sometimes their food preferences” and that in the case of overweight pets, “they appreciate a treatment plan with options,” which may include a target weight and a timeline.
Many participating veterinarians expressed a belief that pet owners do not want to be blamed or judged for any issues with their pet’s weight, whether the pet was under- or overweight. They also indicated that they believe most pet owners want praise and encouragement, and this can be used to improve the veterinarian-client relationship. The importance of this relationship was discussed across all focus groups, and veterinarians indicated that a strong, nonconfrontational relationship was important for pet owners to feel comfortable sharing information. Some veterinarians also indicated the relationship can be used to the veterinarian’s advantage to collect a thorough diet history. Others expanded on this by commenting that client adherence can be improved by speaking to pet owners in a way the client wants to be spoken to or starting the conversation with what the client might want to hear, often in the form of praise or validation. Participating veterinarians in 2 focus groups also agreed that language matters when discussing weight with pet owners as part of building rapport, especially in the case of overweight pets. Words like “fat” and “obese” were indicated as ones to avoid, while there was a range of terminology that was preferred, from phrases like “chunky monkey” used to “diffus[e] the situation” to clinical terms such as “increased body condition.”
Veterinarians’ challenges when discussing pet weight
Throughout the 3 focus groups, veterinarians identified many challenges to discussing pet weight with owners. A common experience was difficulty discussing an overweight pet with an overweight owner. Veterinarians indicated that “if [the client is] also very heavy, sometimes I feel bad pointing out their animal is overweight” and they “feel like it’s almost a judgement on their health.” Veterinarians in all focus groups also discussed the issue of perceived pet owner resistance or denial when discussing weight. Participating veterinarians expressed a belief that pet owners do not want to enact changes to manage an overweight pet’s weight and that in some cases, the conversation “becomes somewhat adversarial because you’re telling them they’re not as good a pet parent as they think they are.” Diet change suggestions by veterinarians were not thought to be received well by pet owners in general because “now you’ve challenged a whole faith-based belief system” and pet owners were likely to perceive the veterinarian as trying to make a sale. This potential pet owner perspective, wherein the veterinarian is financially motivated, was suggested as a reason clients might “get their backs up” and was a source of frustration for many veterinarians who expressed that they did not have a preference for where the client purchased the diet. Some veterinarians also expressed that pet owners who are reluctant to restrict food or who offer food and treats as a form of affection were challenging to communicate with owing to a perception that such owners are often unwilling to alter their current habits.
Participating veterinarians in some focus group sessions also indicated that pet owners who have a skewed perception of healthy body weight or body condition score for their pet, receive information on weight and nutrition from other sources (eg, a breeder, pet retail staff, other pet owners, social media, or the internet), and do not understand the health risks associated with excess weight were all challenges that made weight discussions difficult.
Other challenges indicated by veterinarians were related to the actual process of weight management. Veterinarians indicated that often the family dynamics of pet owners could be a barrier to the conversation when the owner present with the pet was not aware of important information or an owner who was contributing to the weight issue was not present to speak with the veterinarian. One participant explained that “[for] my own sanity, for me to be able to sleep at night, I can’t be your marriage counselor and your nutritionist consult.” Multiple-pet households were also cited as a challenge because pet owners may be unaware of the nutritional history of individual animals. These circumstances resulted in veterinarians not feeling as though they have a complete picture of the pet’s diet, which created a barrier for moving to the planning stages of a weight management conversation.
When asked about their views on the use of humor in weight conversations, many participating veterinarians indicated that they would use humor to reduce the threat that they believed can exist when initiating a weight management conversation for an overweight pet. As one veterinarian put it, “Humor keeps the mood a bit lighter. It’s less accusatory.” Veterinarians also expressed that the relationship with the pet owner was an important factor and that in some cases, “maybe you’d have to have a longstanding relationship with that client before you use humor.” On the other hand, veterinarians indicated that they perceived pet owners’ use of humor as a method to deflect or brush off concerns about pet weight. Pet owners’ joking was considered a barrier to the weight conversation for veterinarians. Pet owners were not asked about their perspectives on humor specifically, although one participant described that with their overweight cat, “We kind of make it like a game at this point … we like guess if she’s lost or gained or stayed the exact same. We all make bets, like the vet[erinarian] does too … so it just makes it less stressful for everyone involved.” All pet owners participating in this focus group indicated that using humor to maintain a guilt-free atmosphere was considered a positive when it came to their comfort level in approaching their veterinarian about an overweight pet.
Discussion
In line with previous research that has shown owners may have limited concern for overweight pets,12–14 the notion expressed by several pet owners participating in the present study was that it is better for a pet to be overweight than underweight, suggesting clients may not recognize an achievable, affordable form of preventive medicine through lifetime maintenance of a pet’s healthy weight. Monitoring the weight of pets over their lifetime may help maintain lean body mass, reduce the risk of numerous chronic diseases, and increase quality of life.15,16 Using trends to monitor a pet’s weight from visit to visit is likely to be beneficial, yet recent research has shown limited use of trends to communicate with clients about various health parameters, including weight.17 Pet owners in this study were especially interested in veterinary guidance when feeding growing pets, suggesting there are opportunities for veterinarians to leverage weight trends in practice. Further, monitoring a pet’s weight over their lifetime supports having conversations with clients that can prevent obesity and highlight the relationship between pet weight and health.
It was important to pet owners in this study that veterinarians hear and incorporate their preferences and limitations into developing relevant options for managing their pet’s weight, especially for overweight pets. In the present study, many participating owners described frustration when being recommended physical activity changes that they felt were inappropriate or inaccessible or that did not have value for them or their pet. Veterinarians should consider strategies that support gathering a comprehensive history from their client, such as open-ended inquiry,18,19 to increase their understanding of a client’s perspective and improve the veterinarian’s ability to provide tailored nutrition and weight management options for that client. Veterinarians’ recognition that a one-size-fits-all approach to weight management may not adequately address individual clients’ concerns may help to improve engagement when pursuing weight management.
Although results of the present study are not intended to be generalized to the wider pet owner and veterinarian populations, they nevertheless offer insights into the perceptions, expectations, and challenges of participating pet owners and veterinarians when discussing pet weight in companion animal practice. Veterinarian participants discussed their perceptions of pet owner expectations that partly aligned with what pet owners shared in this study, particularly related to the desire for options and a nonjudgmental atmosphere when discussing pet weight and nutrition. Veterinarians also indicated several challenges they have experienced when communicating about weight, including the perceptions that pet owners do not value discussing pet weight with the veterinary team, pet owners’ perception that the veterinarian may be financially motivated, and the many barriers to gathering a comprehensive nutritional history. Developing best practices for weight-specific communication in veterinary practice should be further explored and assessed for effectiveness in improving the outcomes of pet weight–management conversations in companion animal medicine.
Acknowledgments
Funding for the focus groups was provided by a grant from the Ontario Veterinary College Pet Trust. Dr. Coe regularly receives research funding from, consults for, and receives honoraria from various veterinary organizations and commercial companies.
Dr. Coe currently holds the VCA Canada Chair in Relationship-Centred Veterinary Medicine at the University of Guelph Ontario Veterinary College. Dr. Parr is presently the Nestlé Purina Petcare Clinical Assistant Professor of Nutrition at the University of Georgia College of Veterinary Medicine. Dr. Parr regularly receives research and program funding from and consults for various veterinary organizations and commercial companies. The authors declare that there are no conflicts of interest.
The authors thank Dr. Caitlin Brown for assistance conducting the focus groups.
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Appendix
Questions from pet owner and veterinarian focus group discussion guides analyzed for a study of veterinarians’ and pet owners’ perceptions of pet weight-related communication in companion animal practice.
Pet owner discussion guide questions:
When taking your pet to the veterinarian, how important is it that the veterinarian share information with you about your pet’s weight?
What does an ideal conversation about your pet’s weight look like?
Veterinarian discussion guide questions:
When interacting with your clients in an appointment, how important do you feel it is that you share information about their pet’s weight?
What do you think your clients expect in an ideal conversation about their pet’s weight?
What are some of the challenges you have experienced when having a conversation about a patient’s weight with your clients?
