Using a Diet History to Improve Adherence to Dietary Recommendations
ACVIM 2008
Kathryn E. Michel, DVM, MS, DACVN
Philadelphia, PA, USA

Introduction

Communicating effectively with people about nutrition and dietary management of pet dogs and cats can be difficult, particularly when the goal is to persuade the pet owner to alter his/her practices. And circumstances frequently do arise where a change in feeding management may be in the best interests of a pet. Obtaining a complete dietary history is the essential first step in this process. The diet history will provide information about what the pet is being fed and whether it is complete and balanced and appropriate to the pet's life stage and health status. Just as important, however, the diet history will provide information about how food is used in interactions between the pet and the other members of the household. Understanding this relationship will be a key element in the design of dietary interventions that will both meet the health and nutritional needs of the patient and be acceptable to the pet's caregivers.

Elements of the Diet History

A complete diet history will give an accurate accounting of all foods fed to a pet on a typical day. It will be an opportunity to evaluate all the ways that food is involved in interactions between the pet and the other members of its household. It is also when the pet's caregivers should be given the opportunity to offer their viewpoints regarding the proposition of modifying their feeding practices.

The Household

Begin by asking about who lives with pet. How many adults and children are in the household? Are any of them at home all day with the pet? Inquire about whether there are other pets in the home and whether they are or can be fed separately from the pet in question. Can the patient get into other pets' food? Find out if the pet is confined indoors or not. If the pet can go out of doors, is it supervised when it is outside? Ask if this pet has the opportunity to steal food, get into garbage, scavenge, or hunt.

The Principal Diet, Feeding Routines and Eating Behaviors

Obtain the precise names (including flavor, if appropriate) and brands of any commercial pet foods that the patient is receiving and the specific amounts fed. Often the caregiver will not be able to provide this information accurately by recall alone, and will need to check labels and measure feeding portions. Specify that dry pet foods be measured with a standard 8-oz measuring cup. Often people don't recognize that the "cup" or scoop that they are using is in excess of 8 oz. If the pet is eating a canned diet ask what size can. Sometimes a specific variety of pet food is sold in different sized cans (e.g., 5.5 and 12 oz) so be certain to inquire about what size is used by the client. Don't forget to ask about whether the food the pet is currently eating is its usual diet and, if not, when the diet change was implemented.

If the pet is eating a commercial pet food don't forget to ask if the diet is being supplemented with any human foods. If this is the case or if the pet is being fed a home-prepared diet it is important to get accurate details including measured amounts of all foods routinely given to the pet. Be certain to inquire about any dietary supplements that are being used. It is useful to have the client bring in the supplements or at least the label information so you can see exactly what nutrients are being supplemented and in what quantities. Sometimes people are not using a standard recipe. In such circumstances it is useful to ask the pet's caregiver to keep a diary of all food fed to the pet for 5-7 days.

Ask about the feeding management that is employed. Is the pet fed at certain times during the day or is food given free choice? If the pet is fed with other dogs or cats, are the meals supervised? Does one person assume responsibility for feeding the pet or can it vary day-to-day? This is important to know, especially when you are making a dietary recommendation because you may not be speaking with the person who will be implementing the new plan. Ask about how the food is stored (sealed container, under refrigeration, etc). If the pet is fed a dry food, is it bought in large quantities and how long does it take to use up a bag of food? Food can lose its freshness over time, especially if not stored under optimal conditions.

Inquire about the pet's normal feeding behavior. Is the pet an easy keeper or a picky eater? Does the pet eat the food as soon as it is offered or is it content to graze throughout the day? Does the pet usually eat all the food that is offered? Does the pet beg for food in between meal times? If the pet is not eating as it normally does, find out what has changed and for how long the behavior has been altered.

Treats, Supplements, and Exercise

When inquiring about treats, ask the question several times in different ways. Ask specifically about which commercial treats are used (name, flavor, brand and size!!!). Ask about human foods and table scraps. Ask about products that are used to promote chewing and dental hygiene. People do not always consider such things treats, and many of the products used for this purpose are high in calories.

It is very important to remember to inquire as to whether the pet routinely receives any supplements or medications that are disguised with food. Foods that are typically used to pill a dog or cat, such as cheese, lunch meats, or peanut butter, are often high in sodium, fat and calories. For example, one study evaluating dogs with cardiac disease showed 62% of the owners used human or pet food for pill administration and that many of these foods were high sodium table foods such as cheese or lunch meats.1

One further point to ask about is the pet's level of activity and opportunity to exercise. Is the pet walked regularly and how often and how far? Find out whether the pet goes out of doors, has a fenced in yard (how big is the area), or participates in regular activities that involve exercise such as going to a dog park or an agility class. See if you can gauge whether increasing the opportunity to exercise would be feasible in the household or not.

Gathering the Information

This may seem like a great deal of information to gather in a routine office visit but the process can be expedited by having a diet history form available for the client to fill out while they are in the waiting room. As already mentioned, the client may not be able to provide all of the information on recall and may need to take the form home. If your practice has a web site, your can have a link to a downloadable version of the form so that a client may be able to fill it out in advance of the office visit.

Negotiating a Diet Change

Clearly the information obtained in the diet history will be invaluable for making appropriate and, hopefully, acceptable dietary recommendations for your patients. Knowing what the pet has been eating will inform your decision about what kind of dietary modification may be necessary to address the patient's health condition and what kind of diet the pet may find most acceptable. It should reveal owner preferences and potential obstacles, so that your recommendations can be tailored not only to the pet but to the entire household to ensure the greatest probability of success and adherence. The diet history should also reveal attitudes and concerns a client may have about the dietary management of pet dogs and cats. This will present an opportunity for client education and for the client to express his/her concerns or to ask questions.

Investigations in human medicine have found that when physicians make an effort to talk with patients about their knowledge, beliefs, concerns, and expectations about their condition the result is better adherence to treatment regimens.2 Exploration of all of these issues from a patient's perspective on his/her illness permits the attending health professional to address deficiencies in knowledge or understanding of the condition and its treatment and the patient's ability and willingness to pursue a particular course of therapy.

With regard to dietary practices, despite a basic uniformity in nutritional requirements and physiologic needs, there is considerable variation in what humans eat. In the case of pet dogs and cats, their owners largely determine what these animals eat on a daily basis. Yet in many if not most cases, client education alone will not succeed in changing habits and behaviors relating to how a pet is fed. Just as a person's social and cultural context will influence his/her own dietary habits, it will also have an impact on how and what a pet is fed. Therefore it is important to consider the social and cultural aspects of food consumption by people in order to communicate effectively with them about their pets' nutritional needs and appropriate dietary management, particularly if you are attempting to change current behaviors.3

The information that can be obtained from a diet history will greatly facilitate the process of implementing dietary therapy for the patient. Not only will it will help in making an appropriate diet selection and in making an accurate feeding recommendation, it will aid in understanding the pet owner's rationale for current feeding practices, and in assessing any concerns that may arise from a diet change. By anticipating problems you should be able to craft the dietary intervention in a way that will be more acceptable to the pet's household or, at the very least, to communicate more effectively with the pet owner about the rationale for the changes in feeding management. You will be in a better position to explain why you feel the changes you are proposing are in the pet's best interest, and to look for compromise when your recommendations and the pet owner's preferences are in conflict.

References

1.  Freeman LM, et al. J Nutr 2002; 132:1632S.

2.  Kurtz S, et al. Teaching and Learning Communication Skills in Medicine, 2005;p. 13-27.

3.  Michel KE, Vet Clin NA 2006 36:1269.

Speaker Information
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Kathryn Michel, DVM, MS, DACVN
University of Pennsylvania
Philidelphia, PA


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