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The fourth feature in our Changing for the Better series was submitted by my colleague and friend, Dr. Debbie Linder. I asked her to share an exceptional nutritional resource (original research article, review paper, etc.) that has influenced or changed how she practices nutrition in her consulting practice. If you would like to contribute to this series, please contact me at aboodsarah@gmail.com
~Sarah Abood, DVM, PhD, Newsletter Editor
Changing for the Better
How to Address Obesity by Not Talking About It:
Taking A Bite from Human Nutrition and Psychology
Deborah Linder, DVM, MS, DACVIM (Nutrition)
Board Certified Veterinary Nutritionist ®
Cummings School of Veterinary Medicine at Tufts University
Catherine Williams, Psy.D
Psychologist, Assistant Professor of Psychiatry
University of Massachusetts Chan Medical School
‘How do I bring up obesity? How do I tell a family their pet is fat?’
My answer currently is a bit surprising to most: Don’t!
In my work at the Tufts Obesity Clinic for Animals and partnering with colleagues in human nutrition and psychology, I’ve learned the way we talk about obesity has to change if we want to see better outcomes for the dogs and cats we work with. What if we didn’t talk about obesity, pounds, or body condition scores, but instead talked about quality of life and helping pets live happier and healthier lives?
I often joke with colleagues that I am in the role of a psychologist more often than a veterinarian. However, once I learned more about how psychologists approach conversations like these in human nutrition, I realized there is a lot we can learn by working together to improve the lives of the families we work with. After all, it’s the humans that we need to enact behavior change in! So, for the resource that’s changed the way I practice and communicate about nutrition, it’s my colleague, Dr. Cathryn Williams, a psychologist with a specialty in disordered eating with some insights to share.
Cathryn Williams, Psy.D: Working with families to change patterns (which can be behavioral, cognitive, emotional, or any combination thereof) is contingent upon a nuanced understanding of the function of the pattern. This requires a combination of compassionate curiosity and acknowledgement that behaviors don’t exist in a vacuum. In my work treating adolescents diagnosed with eating disorders, the bulk of my clinical intervention occurs with the patient’s parents or caregivers. No intervention, no matter how clinically sophisticated, can succeed without parent or caregiver “buy-in.” This becomes especially charged due to our society’s embedded fat-phobic ideology, wherein food and weight have become a metric of an individual’s moral and intellectual standing. As a result of this ideology, people are “primed” to become defensive whenever food, weight, or exercise are discussed.
To effectively get “buy in” to our treatment plan, I have to formulate my delivery to prophylactically disarm this defensiveness. My best chance of accomplishing this is by avoiding discussion of metrics like weight and caloric needs (which can be triggering for both patients and parents separately) and instead focus on quality of life metrics like attendance at school or extra-curricular activities, concentration or on specific health metrics that are unquestionably correlated with health such as resting heart rate, blood pressure, or electrolyte levels. Doing so circumvents the defensiveness that inevitably accompanies any discussion of weight goals or caloric intake and allows the parents to align with me on a treatment plan that cannot be effectively implemented without their efforts.
Putting Theory into Practice: With this approach, it’s no longer a veterinarian’s job to tell families that their pet is overweight. Instead of ‘obesity’ as a diagnosis that requires treatment, ‘not being able to jump off the couch’ is a specific measurable quality of life deficit with treatment focusing on movement without pain or hesitation. The conversation now focuses on what every family wants to hear: how to make their pet happier and enjoy their time together more (without fear of judgement!).
Examples of How to Change the Conversation
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