Nutrition Assessment in a Dog with Osteoarthritis & Obesity

THE CASE

An 8-year-old neutered male pug was presented for a weight-loss plan 2 weeks after bilateral cranial cruciate ligament (CCL) repair; the surgeon had suggested the weight-loss plan to aid in healing and long-term health. The owners reported that, before CCL repair, the dog was reluctant to walk, seemed stiff, and spent the majority of most days in a recumbent position.

On presentation, the dog weighed 71.9 lb (32.6 kg), with a BCS of 9 out of 9 and adequate muscle mass. Body fat percentage was estimated at 65% based on palpation and a body fat index chart.¹ He was able to walk only a few steps at a time with substantial sling support, which had not been necessary before surgery. The owners had been instructed to maintain crate rest because of the CCL repair until otherwise directed by the surgeon.

CBC, serum chemistry profile, urinalysis, and T4 results were within normal limits. Bilateral stifle radiographs obtained before surgery showed periarticular osteophytes on both patellae and trochlear ridges, bilateral effusion, and bilaterally compressed fat pads.

Dietary History

The dog was reportedly fed once daily in the evening. A typical meal consisted of either 2 hot dogs, half a grilled boneless skinless chicken breast, or a grilled hamburger and one to 2 chocolate chip cookies. He also had access to an adult dry feline maintenance diet, which was always available for the 5 cats living in the home. No commercial dog food was included in his diet. Based on the USDA National Nutrient Database for Standard Reference, the human foods contributed approximately 374 to 566 calories per day.² The owners were unable to identify the manufacturer of the feline diet or estimate the dog’s daily consumption of this diet, so additional caloric contribution could not be determined.

DIAGNOSIS:

OSTEOARTHRITIS & OBESITY

Treatment

Based on the dog’s weight on presentation and estimated body fat percentage, the dog’s ideal body weight (IBW) was approximately 31.5 lb (14.3 kg).^3,4 Using this IBW, his resting energy requirement (RER) was estimated to be 515 kcal/day, and maintenance energy requirement (MER) was 412 kcal/day using a 0.8 life stage factor (see How to Calculate IBW, RER, & MER).⁵ A life stage factor of 0.8 to 1.0 is recommended for weight loss; the lower factor was chosen in this case due to the patient’s high BCS. These calculations mirrored similar caloric recommendations reported in other weight-loss regimens.⁶ If a treat allowance is required, reserving 10% MER for this purpose is generally recommended.

Of this patient’s 412-kcal/day MER, 377 kcal/day was allocated to the selected maintenance diet and 35 kcal/day to treats. One and two-thirds cups (375 kcal) per day of a dry therapeutic weight-loss diet formulated to meet the nutrition requirements established by the Association of American Feed Control Officials (AAFCO) Dog Food Nutrient Profiles for maintenance was prescribed. The owners were given a list of various human foods—and their associated caloric content—that could be used for the dog’s 35-kcal/day treat allowance. He was also started on eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) provided via a liquid fish oil product (see Suggested Reading). Each teaspoon contained 690 mg of EPA, 414 mg of DHA, and 41 kcal, which was not factored into the dog’s weight-loss plan due to concerns about owner compliance (see Owner Education). The owners were instructed to remove access to the feline dry food.

Outcome

The dog’s progress was rechecked once weekly for the first month of the weight-loss plan, then every 4 weeks over the next year. Once he was cleared for activity by the surgeon who performed the CCL repair, the owners were instructed to start 5-minute leash walks twice daily, with an eventual increase to 20 minutes twice daily. Daily feeding amounts were periodically adjusted to maintain a weight-loss rate of 1% to 2% of the dog’s current body weight per week. As he lost weight, the owners reported it was easier for him to rise from a sitting position and that he seemed less stiff when walking as compared with before CCL repair. When the dog achieved his ideal weight and BCS, the owners reported return to an apparent normal gait. He no longer had difficulty rising and was able to take 30-minute daily leash walks with at least one 60-minute walk per week.

Owner Education

The owners were feeding an unbalanced diet consisting of human food of low nutritional value. Part of the initial weight-loss consultation included discussing the challenges the owners may have faced when switching the dog from a human-food–based diet to an extruded kibble-based diet. The owners were instructed to introduce the new diet by adding a small portion of the new diet to the evening meal and removing a portion of the human food items. The owners were also instructed to stop feeding chocolate chip cookies. Over approximately 4 to 7 days, the kibble portion was increased while the human food portion was decreased. If they could not make this transition within that time frame, a balanced homemade diet plan could be considered. 

The owners were concerned about continued begging for food. Specific scenarios and suggested responses were discussed. For example, when the dog would beg for food, the owners could initiate an activity (eg, playing with toys, going for a leash walk); however, due to the CCL repair and the osteoarthritis, all activity also had to be based on this dog’s ability and with the approval of the referring surgeon.

Ideally, the calories provided from supplements, including fish oil, are included in a daily treat allowance. In this case, however, the owners felt the recommended treat allowance was too low, and the veterinary team was concerned about plan adherence if fish oil was the only allowed daily treat. Because total caloric intake—including diet, treats, and supplements—was assessed at each weight recheck, treat allowance could be adjusted based on rate of weight loss. This information was used to further educate the owners about the effect excess calories can have on weight-loss success. If fish oil needed to be incorporated as part of the treat allowance, a reasonable alternative would have been to reserve some of the daily portion of the complete and balanced kibble as a treat.

Conclusion

This case illustrates the importance of nutritional management for weight loss and pain management to improve clinical signs associated with osteoarthritis. It also demonstrates the importance of owner education and compliance.

ASK YOURSELF...

AAFCO = Association of American Feed Control Officials, CCL = cranial cruciate ligament, DHA = docosahexaenoic acid, EPA = eicosapentaenoic acid, IBW = ideal body weight, MER = maintenance energy requirement, RER = resting energy requirement

Diet in Disease is a series developed by the WSAVA, the Academy of Veterinary Nutrition Technicians, and Clinician’s Brief.