How to have nutritional conversations in practice

A nutritional conversation can take many forms. It might be a very short conversation identifying that a pet has a healthy body condition score and ascertaining that their current diet is appropriate, or it could take the form of an extensive nutritional consultation with significant adjustments to the diet recommended. It also covers everything in between!

We need to prioritise these conversations. Nutrition is classed by the World Small Animal Veterinary Association as the fifth vital sign of a physical examination, alongside temperature, pulse, respiration and pain (WSAVA, 2011), and plays a huge part in an animal’s health. These nutritional conversations should be embedded into every consult, reinforcing the habit of discussing nutrition at every visit.

Nutritional conversations should be embedded into every consult, reinforcing the habit of discussing nutrition at every visit

Understanding your role in nutritional recommendations

As veterinary professionals, we are in an ideal position to discuss diets with clients, helping to educate them and make recommendations based on their pet’s individual requirements. However, there is sometimes a perception that discussing a diet is “selling” to clients, which some veterinary professionals do not feel comfortable doing. But we discuss many other medications or strategies to enhance a pet’s health without hesitation, and the same should be true for nutrition.

One study found that 43.6 percent of owners look to the veterinary team as their primary source of nutritional information and that most owners reported giving similar (53.1 percent) or more priority (43.9 percent) to buying healthy food for their pets in comparison to their own diet (Schleicher et al., 2019). These statistics indicate that many pet owners do invest time and money to try to optimise their pet’s nutrition and are likely to appreciate support from veterinary professionals to help guide them when it comes to the staggering number of choices available.

Pet owners may obtain advice or recommendations about their pet’s food from a number of different sources, but it is important to remember that veterinary professionals are their trusted experts (Vet Futures, 2015). If they do not feel they are getting recommendations from you, there are many other sources they may turn to (Table 1). Unfortunately, lots of these might not necessarily be credible or evidence-based, and in some cases, they may give completely unsuitable nutritional advice.

Is a client open to a nutritional conversation?

Before commencing a nutritional conversation, it can be helpful to determine a client’s interest and readiness to have this discussion. Helpful indicators of this can include body language, facial expressions, tone of voice and engagement with the conversation.

Ways to open up a conversation

Does your practice send a reminder for appointments? If they do, could you incorporate a link to complete an online nutritional assessment? Is there a way for owners to share photos of the animal’s food, the amount fed and, if they are not weighing the food out, a picture of what they are using as their scoop?

If a client fills in this assessment in advance of the consult, they are more likely to be ready and open to discussing their pet’s diet. Furthermore, collecting this information in advance will save time during the consultation. If they do not respond, consider revisiting the materials you sent on the day of the consultation. Open questions help to ascertain whether owners are receptive to a nutritional conversation and solicit a more detailed response, as it is often difficult to give a simple “yes” or “no” answer. Such questions normally start with “why”, “what”, “when”, “where” or “how”.

If a client fills in this assessment in advance of the consult, they are more likely to be ready and open to discussing their pet’s diet

For example, if you ask the client, “I have noticed that Barney’s weight is up by one kilogram since we last weighed him. Do you mind if we talk about this?” and their response is “Not at the moment” or “It is my other half that feeds him”, they may not be open to the conversation, whereas someone who responds with “I did wonder if he had put on some weight” may be more receptive.

Tools available to support your conversation

A variety of tools are freely available from pet food manufacturers and/or the WSAVA global nutrition toolkit to help facilitate nutritional conversations with caregivers.

Short and extended nutritional assessments

Nutritional assessments can be emailed to clients as an editable PDF before the appointment or printed out and completed in the waiting room. It is also helpful to email these to caregivers after a consultation where you have identified that it may be beneficial to gather more information about the patient’s current diet.

Body condition scoring charts

Maintenance of a healthy body condition score (BCS) can have significant beneficial impacts on quality of life and longevity, so recording BCS data can make a huge difference. BCS should be recorded during any nutritional assessment and every time a patient is presented to a veterinary clinic using a validated BCS chart (Figure 1). If BCS is not ideal (5 for cats or 4 to 5 for dogs), then this can act as a conversation starter.

Muscle condition scoring charts

In addition to a BCS, a muscle condition score (MCS) should also be recorded at each veterinary visit – for senior pets in particular. MCS is an assessment of lean body mass and is a particularly helpful tool to monitor ageing pets (although this does currently have less validation than BCS).

Scoring is subjective (normal/mild/moderate/severe) and based on visual assessment and palpation. Particular attention should be paid to the bony prominences and epaxial muscles since these are early sites of muscle loss (WSAVA, 2023).

Sarcopenia – a loss of lean muscle mass unrelated to disease – becomes increasingly evident in senior pets and increases the risk of morbidity and mortality (Laflamme, 2018). One key nutritional strategy to try to minimise this is increased protein content in the diet. So where sarcopenia is identified, particular attention should be paid to dietary protein levels and digestibility.

BCS and MCS are not directly related; animals may be overweight and still have significant muscle loss, hidden under excessive fat stores (termed “sarcopenic obesity”), emphasising the need to evaluate muscle condition carefully.

Faecal scoring chart

A faecal scoring chart (Figure 2) can be invaluable when assessing the appropriateness of the diet a pet is currently on. This is because a faecal score gives an excellent indicator of how successfully – or not – a pet is digesting its food, and visual aids can be very helpful in determining faecal quality.

The ideal faecal score is 2; however, caregivers’ perceptions of a “normal” stool may vary significantly from this. For example, if a patient has always produced a faecal score of 5, an owner may perceive this to be “normal” if asked. Therefore, using a standardised chart can allow the gathering of much more information.

Where faecal score is not ideal, it should prompt a conversation around suitability of the current diet as this is one significant impactor on faecal score.

Product information and leaflets

These can help those clients who want further information about a recommended product and like to have time to reflect on the advice given. You may also wish to recommend they contact the customer careline of a brand you have recommended for any in-depth questions about a particular diet.

Identifying communication styles – yours and your clients’

“Insights Discovery” is based on the work of Carl Jung, a psychiatrist and psychoanalyst (Insights, 2021). Jung developed a model consisting of four quadrants that he used to describe different personalities and their preferred communication styles, each represented by a colour (Figure 3). Every person contains a combination of all these communication styles but is likely to “lead” with one or two.

To maximise the likelihood of effective communication, the style of communication should be tailored to the preferences of each colour.

Understanding communication styles and using these to make a recommendation

Table 2 details what you might expect to hear from a caregiver leading with each of the four key colours, key communication points that will help maximise the likelihood of effective messaging to them and top tips for how to start a conversation with people by leading with each of the four colours.

Handling questions, objections and myth busting

If caregivers have questions, objections or pre-conceived ideas, working through these together is important so clients feel listened to. Some of the approaches that you may wish to use include:

• Power of paraphrasing – clients tend to give large volumes of information altogether.  Paraphrasing shows them that you are listening and have understood their key points. This will also help you work through any questions or objections they have and help clarify the priority for the client
• Myth-busting – listen to owners’ concerns and think about your response and how you can direct them to other credible sources to reinforce your view. Examples of “myths” may include a concern that grains are a common cause of food allergies or should be avoided due to the perception that they are a “cheap filler”, or that a diet with the claim “natural” on the front is superior to diets without this claim

Conclusion

Nutritional conversations are a vital part of your consultation and will provide you with key information to manage the health of your patients. We can maximise the effectiveness of these conversations by understanding our caregivers’ communication preferences and using support tools to aid and personalise each discussion.