Introduction

Feline obesity continues to be of significant concern for the veterinary profession, with a recent 2022 US-based survey indicating an increased prevalence of overweight and obesity in cats of 61.0% compared to an estimated 59.5% in 2018.^1,2 Obesity in cats has been associated with various health conditions including diabetes mellitus, neoplasia, urinary tract disease, skin disease,³ and others such as respiratory and orthopedic disease.^4,5 Furthermore, obesity may increase the lifetime costs for owners⁶ while reducing life span for cats with severe obesity.⁷ The causes of obesity in pets are complex and include various genetic, metabolic, lifestyle, and environmental factors.^4,8 Some of these factors can be influenced by pet owners; therefore, owner engagement and commitment to weight management plans for cats with excess weight are likely to be critical to the success of these interventions. Effective communication from the veterinary team about a cat's overweight or obese condition and treatment planning with clients may improve the outcome of weight management programs for cats with obesity.

Previous research has identified several opportunities to enhance communication between veterinary professionals and clients related to obesity. A thematic analysis of recorded feline appointments found that veterinarians typically did not discuss weight gain with clients beyond reporting a weight increase and did not offer dietary or weight management recommendations.⁹ Similarly, an observational study of veterinarian-client interactions found that clear weight management recommendations were provided to clients in less than half of obesity-related conversations for dogs and cats, and the overall time spent discussing weight was often brief.¹⁰ It has been suggested that, due to the implications of obesity for animal health and welfare, veterinarians have a professional obligation to address obesity each time it is encountered in practice.¹¹ Pet obesity advocates have also suggested that veterinarians may be reluctant to discuss obesity with clients for fear of causing offense or otherwise harming the veterinarian-client relationship and acknowledge that obesity is a challenging and sensitive topic to broach.¹²

In a focus group study,¹³ a number of participating veterinarians discussed their perception that most clients are not willing to discuss or receptive to discussing pet weight, particularly in cases of a pet with obesity. The perceptions of pet owners when presented with a diagnosis of overweight or obesity for their pet are less clear, though it may be pertinent to distinguish any negative feelings associated with an obesity diagnosis from pet owners’ willingness or readiness to pursue treatment. In a survey, only 17% of pet owners reported feeling embarrassment or discomfort when being told a pet needed to lose weight,² yet a preliminary investigation into pet owners’ readiness to change to address obesity in their cat or dog found overall low readiness to change.¹⁴ Recognizing a client's current readiness and exploring the perceived barriers to pursuing weight management that exist for individual clients may help veterinary teams create personalized, feasible plans, yet little is known about the information that cat owners find important or would prefer to receive, or that would encourage them to take action to address their cat's obesity.

With origins in marketing, discrete choice experiments (DCEs) that capture consumer preferences have been applied to both human and veterinary medical research. In DCEs, respondents are presented with a series of repeated-choice tasks, each consisting of multiple sets of information about a product or service that share the same attributes but differ in levels within each attribute. Respondents are then asked to select their preferred option from the available sets. These repeated choices allow numerical scores to be calculated for the attributes and levels that are preferred by respondents compared to the other available options and can provide insight into the implicit trade-offs that respondents may be willing to make when selecting a product or service.¹⁵ In veterinary medicine, discrete choice methods (DCMs) have been used to evaluate the preferences of dog owners when selecting antiparasitic products¹⁶ and the factors related to preferences for antimicrobial treatments.¹⁷ A number of DCM studies have investigated the preferences for treatment of people with obesity to inform the development of management strategies and programs that may be more effective for these individuals,^18–20 and a parallel opportunity exists in veterinary medicine to elucidate the preferences of pet owners to support veterinary teams in treating obesity.

The objective of this DCE study was to identify the obesity-related information that cat owners consider important from a veterinarian and that would encourage them to pursue weight management for their cat if it was identified as being overweight.

Methods

The present study is one of a series of independent DCM-based studies conducted via the same recruitment process, which has been previously described.²¹ A cross-sectional, questionnaire-based study of pet owners was conducted via an online survey platform (Sawtooth Software) between February 9 and April 18, 2023. The University of Guelph Research Ethics Board reviewed and cleared the study protocol (REB No. 22-09-019).

Questionnaire design

The anonymous pet owner questionnaire was developed in Lighthouse Studio (version 9.15.9; Sawtooth Software) and was offered in both English and French. Participants provided consent to participate by clicking “Agree” to proceed to the questionnaire. Consenting participants were randomly distributed to 1 of the 3 independent DCM studies; only participants who indicated ownership of at least 1 cat were eligible to be randomized into the cat obesity study reported here.

The questionnaire for this study consisted of 3 sections: the first collected demographic information about participants, the second was a discrete choice exercise to identify obesity-related information that was important to cat owners, and the third was a dichotomous question to elicit participants’ previous experience receiving a diagnosis of obesity for any pet of their own (yes or no). The third section did not pertain specifically to the participants’ present cat(s).

The following hypothetical scenario was presented to participants to set up the discrete choice exercise: “Imagine that you have taken your cat to the veterinarian for their annual wellness exam. The veterinarian mentions that your cat is overweight and makes a recommendation to have your pet lose weight. You will be presented with 3 sets of information your veterinarian could include in the discussion of your cat's weight. Given the information presented by the veterinarian, what set of information would encourage you to act on your veterinarian's recommendation?”

Following the scenario, participants were presented with a series of 12 task blocks, each of which contained 3 discrete sets of information (Figure 1). The sets included 5 cat weight–related items (attributes) that were presented with various combinations of characteristics (levels) shown within each attribute. The 5 attributes, and the order in which they were presented, remained consistent across all 12 task blocks, while levels systematically differed to create diverse sets. Participants were prompted to select the set of information from the 3 available sets in each task block that would most encourage them to follow a veterinarian's recommendation for their cat to lose weight. If none of the 3 available sets of information in a given task block would encourage the participant to pursue weight management, they could select a fourth “none” option.

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Example of a discrete choice task presented to cat owner participants. Participants were presented with 12 such tasks. Attributes, listed on the left, remained constant across tasks, while the levels presented in columns within each of the 3 sets varied across tasks to create diverse sets of information from which to choose. All 12 tasks included a “none” option.

Citation: Journal of the American Veterinary Medical Association 262, 6; 10.2460/javma.23.12.0703

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To achieve a high level of experimental design efficiency (Supplementary Material S1), which allows for information about choice to be gained from the least number of tasks presented to respondents, 300 versions of the discrete choice exercises were generated in Sawtooth Software's Lighthouse Studio.

Results

Participant demographics

A total of 1,589 participants met the inclusion criteria for the study and completed the questionnaire related to cat obesity, and 1,095 questionnaires were included in the final analysis (Figure 2). The majority of participants identified as women (71.8% [786/1,095]), resided in Canada (55.0% [599/1,089]), and had a mean age of 37.2 years (SD, 13.9; median, 32; range, 18 to 89 years; Table 2). Over half of participants indicated that they had previously had a veterinarian communicate that one of their pets was overweight (63.3% [693/1,095]), and the remainder reported never having received this diagnosis from a veterinarian (36.7% [402/1,095]).

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Reasons for inclusion and exclusion of participants’ questionnaires. RLH = Root likelihood.

Citation: Journal of the American Veterinary Medical Association 262, 6; 10.2460/javma.23.12.0703

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Table 2

Demographic characteristics of cat owner participants. Discrepancies in denominators are due to missing values.

Participants (n = 1,095)		n (%)	Mean (SD), median, min-max
Preferred language (n = 1,095)	English	1,060 (96.8)
	French	35 (3.2)
Gender (n = 1,095)	Woman	786 (71.8)
	Man	281 (25.7)
	Prefer to self-describe	3 (0.3)
	Prefer not to say	25 (2.2)
Age (n = 1,086)			37.2 (13.9), 32, 18-89
Country (n = 1,089)	Canada	599 (55.0)
	US	488 (44.8)
	Other	2 (0.2)
Area (n = 1,089)	Urban	637 (58.6)
	Suburban	310 (28.5)
	Rural	139 (12.8)
No. of veterinarian visits (n = 1,095) in the past year			4.7 (5.8), 3, 1-120
Education level (n = 1,094)	Less than high school	8 (0.7)
	High school diploma or equivalent	95 (8.7)
	Some college or university	153 (14.0)
	College degree	288 (26.3)
	Bachelor's degree	370 (33.8)
	Graduate degree	140 (12.8)
	Professional degree	40 (3.7)
Household income (n = 1,093)	< $20,000	36 (3.3)
	$20,000-$34,999	85 (7.8)
	$35,000-$49,999	143 (13.0)
	$50,000-$74,999	272 (24.9)
	$75,000-$99,999	297 (27.2)
	$100,000-$150,000	163 (14.9)
	> $150,000	97 (8.9)
No. of each species owned (n = 1,095)	Cat		1.8 (2.2), 1, 1-40

Discrete choice experiment analysis and relative attribute importance

The relative importance to cat owners of each obesity-related attribute, from most to least important, was as follows: impact on life expectancy (32.66%), change to cost of food (20.40%), future QOL (20.38%), future mobility (14.40%), and risk of developing diabetes (12.15%). Relative preferences for each within-attribute level varied (Figure 3).

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Probability-scaled part-worth utilities of the main effects model, arranged from attributes of greatest to least importance according to respondents. A higher part-worth utility value indicates a comparatively stronger preference relative to other test values.

Citation: Journal of the American Veterinary Medical Association 262, 6; 10.2460/javma.23.12.0703

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Discussion

Understanding what information clients value and that may encourage them to initiate and adhere to weight management plans for cats with obesity is essential to supporting veterinary teams in communicating effectively about obesity with clients. Results of this study suggest that, when compared to attributes including the change to cost of food, future QOL, future mobility, and risk of developing diabetes, it is most important for veterinary professionals to consider discussing information about the impact of excess weight on life expectancy with clients who own a cat that is overweight or obese.

Cat owners participating in this study prioritized the impact on life expectancy over the other presented attributes. This is in line with dog owners in a related study,²¹ in which impact on life expectancy was also the most important obesity-related attribute relative to the others presented. An observational study¹⁰ of obesity-related interactions in companion animal practice found that life span was mentioned only rarely by veterinarians while discussing reasons for a pet to lose weight. Additionally, a discussion of the overall importance of weight management, the benefits of weight loss, or reasons to lose weight occurred in only 28% of these appointments.¹⁰ A qualitative study of feline appointments specifically found similarly absent or ambiguous messaging from veterinarians during both obesity-related and preventive weight conversations.⁹ This suggests there are opportunities for veterinary professionals to increase both the frequency of discussing the importance of maintaining or achieving an ideal weight with clients generally and the relationship between obesity and life span specifically.

Prevention of obesity, through establishment of healthy practices early on, is likely to benefit a cat's long-term health and is likely easier than disrupting unhealthy practices once obesity has been established. This necessitates regular monitoring and discussion of body weight and BCS, yet there is evidence that suggests weight and obesity-related information-sharing between veterinary teams and cat owners may be limited; a large study³² of cat health records found that many cats had only 1 body weight recorded, and examination of medical records for cats in the UK found that BCS was recorded less than a quarter of the time and free-text areas of the records rarely contained words or phrases related to overweight or weight loss.³³ A similarly low prevalence of veterinarians recording dogs as overweight or obese has been reported, with only 1.4% of medical records from a large sample of consultations indicating overweight or obesity in text entries.³⁴ Utilizing weight trends in practice to monitor weight over a cat's lifetime can help detect divergences in weight early, yet use of trends can only be facilitated by regular recording of body weight and BCS. An observational study³⁵ found that veterinarians predominantly used weight trends reactively rather than proactively, suggesting that there are opportunities for veterinary teams to monitor trends and share this information with clients regularly as a preventive health measure. Additionally, an observational study of the talking physical exam found that when a pet's weight or BCS was assessed by the veterinarian and conveyed to the client, the impact of BCS on pet health was explained in under a third of interactions.³⁶ Missed opportunities to communicate weight management value to cat owners, including the impact of obesity on life span, may negatively impact cat owner weight management decision-making later. However, when suggesting increased proactive communication about weight and nutrition in practice, it should be recognized that small animal veterinarians have reported time and misinformation to be barriers to nutrition communication.³⁷ While effective solutions to help overcome barriers to nutrition communication are yet to be determined, possible solutions have been proposed, including empowering veterinary technicians and support staff to discuss nutrition.³⁷

Change to cost of food and future QOL had nearly equivalent relative importance values and were identified as the next most important attributes for cat owners when deciding whether to act on a weight management recommendation. Recognizing that, in this study, the cost attribute was relatively important to cat owners and willingness to pay varies for clients, veterinary teams should explore the role of cost when engaging clients in weight management decisions for cats. Recent research found that less than a quarter of recorded veterinary appointments included a discussion of cost and that veterinarians primarily framed cost around the time or service provided and not the value of that service to the health and well-being of the pet.³⁸ The study supports an ongoing opportunity for veterinary teams to discuss costs of care and the benefits associated with a recommendation, which may influence decision-making, before the client leaves the appointment. Qualitative studies also report clients’ expectation that the costs of care be discussed up front³⁹ and indicate that presenting options to clients may help to mitigate the perception that veterinarians’ recommendations are financially motivated, specifically regarding nutrition.⁴⁰ Open discussions of weight management and dietary options for cats, as well as the costs associated with these options and the value of each, may be critical to improving client acceptance of veterinary recommendations to treat obesity. Therapeutic diets have been ranked by pet owners among the lowest of preferred methods to achieve pet weight loss and in terms of perceived efficacy,² yet these diets are relied on by veterinarians to ensure safe calorie restriction that will not result in nutritional deficiencies. Opportunities exist for client education and clear communication that speaks to the cost as well as benefits of therapeutic diets for safe and effective weight loss in cats.

Future QOL was a near equally important attribute for cat owners as the change to cost of food attribute. Obesity has been shown to diminish the QOL of dogs and QOL improved after weight loss,²⁶ though there are few investigations specific to the relationship between QOL and obesity in cats. One study²⁷ of owners of cats with obesity reported numerically lower QOL scores that were not statistically different from the scores for cats at ideal weight. Another recent study⁴¹ of cats on a prescribed weight loss plan found that owner-perceived QOL was significantly higher at the cats’ last recheck compared to baseline. QOL assessments are used in veterinary practice to facilitate end-of-life decision-making, and similar tools, if developed to detect the impact of weight loss, could support veterinary professionals’ discussion of QOL related to obesity with owners. Helping owners identify and recognize improvements to their cat's QOL that may occur because of weight loss may motivate client adherence to weight management plans. Cat owners have been reported as citing QOL as a motivator to pursue weight loss for their cats,²⁷ yet in the present study life span was relatively more important to participating owners than QOL. Aspects related to overall well-being, such as emotional disturbance and vitality, may be improved by weight loss in dogs²⁶ and were not explicitly included in the attributes selected for the present study; future studies may consider exploring the value cat owners place on these aspects of QOL for their pets. Further education of clients by veterinary professionals about observable QOL aspects might also be important for clients to recognize the impact of obesity on their cat.

Future mobility was the fourth most important attribute of the 5 presented in the current study, suggesting that cat owners may not associate mobility with overall QOL. This aligns with findings of an investigation of the items cat owners consider important for QOL, where items requiring mobility accounted for less than half of the most important items and there was no difference in importance scores between owners of healthy cats compared to those with diagnosed degenerative joint disease.⁴² Degenerative joint disease, including osteoarthritis, is very common in pet cats and has a clear relationship with age,⁴³ yet clinical signs such as lameness are not often observed.^44,45 Owners may find it challenging to relate a lack of observable behavior changes to the experience of pain that may be caused by a cat's joint disease or arthritis. While mobility and arthritis are among the reasons for a pet to lose weight that are most discussed by veterinarians,¹⁰ clients may not recognize subtle changes to a cat's mobility or may attribute a cat's “slowing down” to age above other factors such as excess weight. By shifting the focus of discussion to life expectancy and QOL, which have been observed as rarely discussed by veterinarians in obesity-related conversations,¹⁰ veterinary professionals may be able to target the reasons to lose weight that are most meaningful and motivating for cat owners.

Risk of developing diabetes was the least influential attribute for participants relative to all other attributes considered in this study. Interestingly, diabetes was the second most frequently mentioned reason veterinarians provided clients for an overweight or obese pet to lose weight, as observed in 150 recorded obesity-related interactions involving a dog or cat.¹⁰ The reasons for the lack of importance of diabetes relative to other attributes in the present study are unclear. It is possible that cat owners struggle to forecast the long-term impact of diabetes on their cats’ health and QOL, as well as the impact of management on their own lifestyle and the associated costs. However, diabetes is a serious condition in cats that requires significant owner commitment to manage and can be costly to treat.^46,47 In cats, diabetes can also result in euthanasia at the time of diagnosis,⁴⁸ and while prognosis may be fair for many cats, survival time is variable and mortality rates are high soon after diagnosis.⁴⁹ Considering the importance cat owners placed on life expectancy in this study, it may be beneficial for veterinary professionals to frame the potential impact of obesity-associated diseases such as diabetes in relation to the overall impact on a cat's life span when discussing obesity with clients. Pet owners’ decision to treat diabetes in companion animals may be influenced in various ways by their individual human-animal bond with their pet, as well as by prior personal experiences of diabetes management in human health, either their own or of someone they know.⁵⁰ Drawing parallels between the experience of diabetes in humans and pets has been recommended as a potential way to support client understanding and act on the health issue,⁵⁰ yet further investigation is necessary to understand cat owners’ perceptions of diabetes and how this factors into a decision about whether to address their cat's weight.

The present study elucidates what information may most encourage cat owners to pursue weight management when receiving a recommendation to do so, yet all of the attributes included in the choice tasks are worth being discussed by veterinary professionals when recommending weight loss for an overweight or obese cat. Additionally, it is important to note that the results of DCM studies must be interpreted within the context of the attributes and levels chosen for the study. Here the attributes were selected on the basis of relevance and prior research involving both dogs and cats and can only be considered relative to one another. The relative importance values reported should not be extrapolated to suggest that the attributes considered most important by cat owners would be similarly important compared to possible attributes that were not selected for inclusion in the present study.

The hypothetical scenario used to contextualize the discrete choice tasks presents a limitation of this study, and results may not be representative of the real-life decision-making of cat owners. This study captured a large sample of English- and French-speaking respondents, yet generalization to the wider cat-owning population, particularly outside of Canada and the US, may be limited by pet owners’ access and willingness to participate in an online survey. Another limitation was that participants’ motivations or rationale for their selections were not captured in a quantitative survey. Qualitative research is recommended as a complement to DCEs to capture context along with preference data and facilitate a deeper understanding of the results,⁵¹ and future research based on focus groups or interviews could explore cat owners’ perceptions of the importance of weight management for cats with obesity and what would motivate them to pursue it. Opportunities may also exist for DCEs to elicit cat owner preferences between different weight management programs themselves. The feasibility of proposed weight management programs, in addition to monitoring the progress of weight loss, may be of particular concern for cat owners. Recently, a survey study² found that only 58% of participating owners reported trying to get a cat to lose weight and only 19% of those participants reported success, with both values being less than what was reported by dog owners participating in the same survey. Future DCE studies to provide insight into client preferences may support veterinary professionals in addressing the challenges associated with cat weight loss, such as bringing cats to the clinic for rechecks, which may help to mitigate loss to follow-up and ensure patient safety in terms of appropriate rate of weight loss and dietary management.

Data from prior studies^9,10,35 suggest there are missed opportunities for veterinary professionals to discuss healthy weight maintenance or healthy weight loss with cat owners. The present study's results suggest veterinary professionals should consider highlighting the impact of obesity on life span in hopes of moving cat owners toward action regarding excess weight management and prevention. These conversations should begin early in life, and by educating clients about the benefits of an ideal weight to their cat's future health and life expectancy, veterinary professionals may encourage clients to proactively maintain their pet's weight. Other factors may also influence cat owners’ decision-making related to weight management, including financial costs, the impact of excess weight on a cat's QOL and mobility, as well as the increased risk for chronic disease such as diabetes, and these should also be considered for discussion. Ultimately, eliciting individual clients’ thoughts and preferences about their cat's weight and the outcome of management provide the starting point for developing a tailored weight-loss plan in which the client perceives value. This study offers initial insight into what cat owners consider important when deciding to pursue weight management and can be used by veterinary professionals to inform conversations with clients about weight management for their cat.

Supplementary Materials

Supplementary materials are posted online at the journal website: avmajournals.avma.org.

Disclosures

Dr. Coe currently holds the VCA Canada Chair in Relationship-Centered Veterinary Medicine at the Ontario Veterinary College, University of Guelph. Dr. Sutherland's position is funded through a Mitacs Elevate fellowship in partnership with Royal Canin Canada. Dr. Shepherd is currently the Scientific Communications Nutritionist at Royal Canin US. The other authors declare no conflicts of interest.

No AI-assisted technologies were used in the generation of this manuscript.

Funding

This study was funded by an unrestricted gift from Nestlé Purina PetCare Canada to the Ontario Veterinary College. Nestlé Purina PetCare Canada was not involved in the development of the survey, data management, data analysis, interpretation, or writing of this manuscript; they did assist with survey distribution. Dr. Coe regularly receives research funding, consults for, and receives honoraria from various veterinary organizations and commercial companies, including Nestlé Purina PetCare, the Purina Institute, Royal Canin, and Hill's Pet Nutrition. Dr. Shepherd has received research funding and honoraria from Hill's Pet Nutrition and Nestlé Purina.