Clients’ knowledge, attitudes, and practices related to pet nutrition and exercise at a teaching hospital

Abstract

Nutrition and exercise are key components of an animal’s overall health; however, these topics may not be discussed with clients during veterinary visits resulting in suboptimal practices. This study sought to i) estimate small animal clientele knowledge, attitudes, and practices on nutrition and exercise; and ii) evaluate client recall of (and interest in) veterinary recommendations related to nutrition and exercise. Clients visiting the Atlantic Veterinary College Small Animal Teaching Hospital over a 1-month period were invited to complete a 5-minute written questionnaire. Of the clients invited to participate, 71% (101/143) completed the questionnaire. An unexpectedly high proportion of clients reported feeding homemade (37%) and raw meat-based diets and products (30%). Most participants indicated an interest in veterinary directed discussions on nutrition (63%) and exercise (63%). Our study provides a benchmark for needed ongoing (and targeted) client education and has led to expansion of our hospital infection control policy.

Introduction

Nutrition is an essential component of an animal’s survival needs and overall health. As stated by the World Small Animal Veterinary Association (WSAVA) in their Nutritional Assessment Guidelines, “Nutrition affects quality and quantity of life” (1). The flip side of nutrition as a survival need is the increasingly common diagnosis by veterinarians of canine and feline obesity (2–6). Weight gain in dogs occurs gradually and is progressive over time, with most dogs being diagnosed as they reach “middle age” (2–7). Pet owner risk factors for canine obesity have been reported as pet diet choice, lower exercise, owner age and income, feeding method (ad libitum, meal, volume, or weight restrictions) and underestimation (inaccurate perception) of body condition score (BCS) (8–11). Furthermore, pet owners appear likely to consider a higher BCS as normal or optimal (8,10–12).

Given these concerns surrounding the importance of nutrition and rise in obesity diagnosis (2–6), it is critical that veterinarians and clinic staff discuss nutrition and exercise for pets with their clientele. However, as reported in a recent Canadian study, it appears far too common that veterinarians are not performing complete nutritional assessments nor communicating to clientele about nutrition during veterinary visits (13). In this same study, assessment of BCS or muscle mass was infrequently (and inconsistently) performed by staff at veterinary clinics (13).

It is understood that canine obesity and weight gain result from several factors. Increasing evidence has shown the positive effects of exercise on weight loss and ongoing weight maintenance (14–17). However, there is little information regarding the effect of quantified exercise on weight (17). Even less data are available on forms of exercise beyond walking, nor are there published resources that characterize exercise amounts, levels or targets. Recent research indicates that pet owners are more likely to exercise their dog due to a sense of responsibility or for reasons of dog health and enjoyment (18,19). As such, the discussion of exercise and provision of guidelines would seem sensible and support their utility as a tool for lifelong healthy habits and weight management, particularly when begun in puppy or kittenhood.

In veterinary medicine, studies have shown that there can be a disconnect with respect to perception of what clients recall discussing and wish to discuss (or stress as important) and what veterinarians regard as desired. This lack of agreement in client recall has been observed during comparison of veterinary and client perceptions surrounding euthanasia discussions (20). Similarly, a disconnect between understanding veterinary client motivations, desire for and interest in nutrition information appears to be occurring in veterinary medicine, with clients wanting information on nutrition and this going undiscussed at veterinary visits (11,12,21,22). This disconnect can surface in misunderstandings of client pet food purchasing decisions and motivations for feeding homemade, and/or raw diets and subsequently impact both pet and human health through infectious disease risks related to handling and feeding raw food (22–26). Additionally, it is currently unknown whether clients have an interest in discussing their pet’s exercise with veterinarians. As such, there appears to be a strong need for research determining pet owner knowledge, attitudes, and practices (KAPs) surrounding nutrition and exercise. This research is critical to aid veterinary understanding of client choices, identify gaps in veterinary-client communication, and thereby provide competent advice and communication on these topics.

Recognition of the importance of nutrition, concern over rising obesity rates in cats and dogs, together with awareness of limited understanding in client KAPs and recall of discussed nutrition and exercise related topics during veterinary visits led to this survey and associated analyses. The objectives of our study were to i) estimate small animal clientele KAPs on nutrition and exercise; and ii) evaluate client recall of (and interest in) veterinary recommendations related to nutrition and exercise.

Materials and methods

This was an observational cross-sectional study, whereby clients visiting the Atlantic Veterinary College (AVC), Small Animal Veterinary Teaching Hospital (VTH) over a 1-month period (June 8, 2018 to July 4, 2018) were invited to complete a 5-minute written questionnaire. Clients waiting for veterinary appointments (referral and general practice) while the study recruiter was present were individually approached and invited to participate. Referral services available for client appointments during the 1-month timeframe included surgery, internal medicine, cardiology, and dermatology. Any clients who appeared distressed or had appointments booked under stressful circumstances (e.g., euthanasia, emergency) were not approached in order to avoid undue stress. The survey utilized combinations of open-ended (e.g., short answer, lists) and closed-ended (e.g., multiple choice) questions to gather information about, i) veterinary clientele KAPs surrounding nutrition and exercise; and ii) recall of discussion of these topics by veterinarian, veterinary student and/or staff. A copy of the survey is available from the corresponding author upon request.

Data were analyzed using commercial statistical software (Stata version 14; StataCorp LP, College Station, Texas, USA). Descriptive statistics were used for data analysis and reported as counts and percentages with corresponding 95% confidence intervals (CIs).

The questionnaire used in this study was reviewed and deemed a program evaluation by the University of Prince Edward Island Research Ethics department and exempt from further review.

Results

A total of 143 clients were approached to participate in the study, with 140 clients consenting to participate. Questionnaires were fully completed by 101 pet owners (72% response), representing 112 pets. In some cases, clients responded on multiple pets or did not answer specific portions of the survey. Most respondents were female (63%).

Client pet feeding practices

Participants were asked open-ended questions regarding pet feeding practices (n = 112). These questions included whether the pet was eating a diet for a particular reason “Does your pet require a particular diet for any reason (i.e., allergies, kidney disease)?” and what types of food were fed by clients to their pet(s) in a typical week “Please list the brands, product names and amount of all foods (including treats, snacks, bones, dental hygiene products, dietary supplements, and any other foods or flavored waters) your pet eats or drinks in a typical week (including food used to give medications).” A closed-ended check box question followed by an open text box for “other” queried whether their pet was fed the following items in a typical week, i.e., “Please select all options below that you feed your pet in a typical week: commercial canned food, commercial dry food, commercial treats, commercial pet chews (e.g., dental), dietary supplements, cooked homemade food, homemade raw food, commercial raw food, raw fruits or vegetables, rawhides or bones, other — please specify.”

One third of pets (34%) were reported as consuming a veterinary recommended diet advised for the following indications: allergies and/or skin disease (23), gastrointestinal disease (5), kidney disease (3), dental health (2), specific breed requirements (1), weight loss or gain (2), diabetes and urinary disease (1), and hepatic disease (1).

Clients reported they fed pets (n = 112) a wide variety of food items (Table 1). This included homemade diets (37%), which were cooked (29%) or raw (8%). Raw meat-based diets (30%) were exclusively (14%, 16/112) or partially fed (15%, 17/112). Partially fed raw meat-based diets included the following compositions: i) raw meat-based commercial and homemade diets supplemented with cooked commercial dry and/or wet diets (10%); and ii) cooked commercial dry and/or wet diets supplemented regularly (i.e., daily or regularly during the course of a typical week) with raw bones, raw meat, raw eggs, and/or raw meat treats or products, i.e., chews, treats (6%).

Table 1.

Types of food pets reportedly fed during a typical week (n = 112).

Category	Frequency	Percentage (95% CI)
Dry	99	88.4% (81.0, 93.7)
Treats	64	57.1% (47.4, 66.5)
Raw fruits/vegetables	46	41.1% (31.9, 50.8)
Wet (canned)	36	32.1% (23.6, 41.6)
Cooked homemade	32	28.6% (20.4, 37.9)
Pet chews	27	24.1% (16.5, 33.1)
Rawhides/raw bones	17	15.2% (9.1, 23.2)
Dietary supplements	14	12.5% (7.0, 20.1)
Commercial raw	7	6.3% (2.5, 12.5)
Raw homemade	9	8.0% (3.7, 14.7)
Othera	5	4.5% (1.5, 10.1)

^aFood items reported in the “Other” category included peanut butter, cheese, eggs (cooked and raw), and cream cheese.

Nutritional knowledge, attitudes, and information sources

Participants were asked open- and closed-ended questions regarding their nutrition knowledge “How knowledgeable do you feel you are regarding your pet’s nutrition? Very knowledgeable, somewhat, neutral, not very, no knowledge” ; trust in veterinarian nutrition recommendations “Do you trust your veterinarian’s recommendations regarding your pet’s nutrition? Yes — I strongly agree, maybe — I somewhat agree, neutral, No — I somewhat disagree, No — I strongly disagree” and interest in learning more about nutrition “Are you interested in learning more about your pet’s nutrition from your veterinarian? Yes, no, unsure.”

Most participants (n = 99) indicated that they felt somewhat knowledgeable (56%) when it came to their pets’ nutrition, followed by those who felt very knowledgeable (30%), neutral (10%), not very knowledgeable (4%), or knew nothing about the topic (0%). Most participants (76%) reported that they trusted their veterinarian’s recommendations regarding their pet’s nutrition. Most (63%) indicated an interest in nutrition, with 37% reporting reduced interest, i.e., 22% with no interest and 15% unsure or neutral in their interest surrounding the topic.

Myriad responses were reported when clients (n = 101) were asked how they made feeding decisions. Most clients (72%) disclosed that ingredients were most important in diet selection (Table 2) in response to the question, “Indicate what affects your choice of what food you feed your pet. Please select all options that are important to you: ingredients, brand name, ease of access (e.g., pick up at the grocery store), what is on sale (i.e., cost of product), veterinarian recommended, non-veterinary recommended.” An open-ended list was also provided to clients in order to enter other text, “Please list what resources you use.”

Table 2.

Items reported to affect clientele choice in feeding pets (n = 101).

Category	Frequency	Percentage (95% CI)
Ingredients	78	77.2% (67.8, 85.0)
Veterinary recommendations	44	43.6% (33.7, 53.8)
Own research	37	36.6% (27.3, 46.8)
Brand name	32	31.7% (22.8, 41.7)
Ease of access	14	13.9% (7.8, 22.2)
Non-veterinary recommendationa	6	5.9% (2.2, 12.5)
Cost of product	3	3.0% (0.6, 8.4)

^aNon-veterinary recommended resources for nutritional information and feeding practices included breeders, Humane Society or shelters, teammates from canine sporting events, dog food advisors (online), and pet store employees.

Client recall of veterinary nutrition discussions

A closed-ended question was used to evaluate client recall of nutrition discussions, “Do you recall your veterinarian speaking to you regarding your pet’s nutrition or dietary needs during your appointments?” with available options as: “always, sometimes, unsure, rarely, or never.”

Participants (n = 101) recalled always discussing nutrition with their veterinarian approximately 1/3 (35%) of the time during veterinary visits. The remainder of respondents (65%) reported their recall of a nutrition discussion as occurring intermittently (44%), unsure if occurred or not (19%), or never (3%).

Reported pet exercise practices

Participants were asked open- and closed-ended questions regarding pet exercise practices phrased similarly to the above nutrition queries. Responses from cat owners (n = 12) were separated from those of the dog owners (n = 99).

Dogs

Participants (n = 99) reported various amounts of exercise for their dogs (Table 3). Less than half of respondents (40%) reported 30 min or more of daily exercise for their dog, with most (85%) reporting that their dog only went out into their yard to exercise (56%), exercised less than 10 min daily (17%), or that their dog’s only exercise was going outside to go to the bathroom (12%).

Table 3.

Reported exercise dogs typically received in a day (n = 99).

Category	Frequency	Percentage (95% CI)
Daily < 10 min	17	17.2% (10.3, 26.1)
Daily 10 to 30 min	30	30.3% (21.5, 40.4)
Daily > 30 min	40	40.4% (30.7, 50.7)
Othera	36	36.4% (26.9, 46.6)
Bathroom only	12	12.1% (6.4, 20.2)
Goes in yard	56	56.6% (46.2, 66.5)

^aExercise reported in the “Other” category included swimming, hiking, walks (beyond daily), various forms of fetch, unleashed dog parks, dog sporting events, and training, working as a service dog, playing with other animals, and having freedom to roam while outdoors.

Cats

Owner responses to exercise queries varied markedly. Exercise for cats (n = 12) was reported as goes out in yard (n = 2), daily exercise 10 to 30 min (n = 1), and other (n = 9). The “Other” exercise was reported as consisting of going outdoors (roaming or freely), being walked on-leash or being outside in an enclosed area, playing with other animals or toys and running throughout the house.

Client pet exercise knowledge and attitudes

Similar to the nutrition questions posed on knowledge and attitudes, participants were asked open- and closed-ended questions regarding their pet exercise knowledge, trust in veterinarian exercise recommendations, and interest in learning more about exercise.

Half of participants indicated they felt somewhat knowledgeable (50%; 49/97) when it came to their pets’ exercise needs, followed by those who felt very knowledgeable (25%), not very knowledgeable (15%), or neutral (10%) on the topic.

Most clients (63%) indicated an interest in having a veterinarian discuss (or make) exercise recommendations regarding their pet and reported their trust in these recommendations when (or if ) provided as: strongly agree (27%), somewhat agree (36%), neutral (26%), somewhat disagree (3%), and disagree (8%).

Discussion

This work highlights a need for client nutrition education and reveals a client interest in receiving both nutrition and exercise communication. Most client participants wanted to discuss nutrition and exercise and trusted their veterinarian’s recommendations. However, similar to another study (13), it appears that these client wishes for education and communication were not always met during veterinary hospital visits. This is unfortunate in light of the rise in prevalence of pet obesity and need for regular and ongoing client direction and recommendations for pet health on these topics (2–6).

Another concerning aspect of this limited client education and communication is that many pets were presenting to the AVC Teaching Hospital for specific health care needs (i.e., referral patients) and yet only 1/3 of participants reported feeding a specific diet aimed at nutritional modification of an underlying medical concern. The results of this survey provide valuable information for the teaching hospital on clientele wishes and may prove relevant for veterinary curriculums by allowing veterinary schools to expand programs in order to “build” general practitioners who can: i) effectively perform nutritional assessments; and ii) subsequently communicate nutrition and exercise recommendations in accordance with their (and their practice’s) clientele education and interest needs.

Studies have shown that many pet owners seek information on diet and feeding methodology from sources other than their veterinary clinic, such as the Internet or pet store (4,8,11,12,19,22). Some of these sources may lead pet owners towards selection of homemade or raw meat-based diets as a perceived healthier feeding choice for their dog or cat. One US survey reported that 17% of pet owners fed raw or cooked human food to their pets, and that 3% of dog and 4% of cat owners fed raw meat-based diets (26). There is little information on the prevalence of homemade and raw meat-based diet feeding practices in Canada. However, this number appears to be rising in the United Kingdom and the United States (21,24,26,27). In our study we found an unexpectedly high proportion of clients who reported feeding homemade (37%) and raw food (30%) diets and products to their pets on a daily or during a typical week basis.

It has been hypothesized that addition of raw meat-based ingredients and homemade food to a pet’s diet may be perceived by owners as healthier, natural, and more nutritious (22). Similar to other studies (11,12,21,22), we found that pet owners listed ingredients as most important in diet selection and this may have led in part to our finding of a higher reported prevalence of homemade and raw meat-based ingredients, products, and diet. Unfortunately, many home-prepared and raw meat-based diets do not meet the criteria for complete and balanced feeding, which can lead to nutritional imbalances and deficiencies, thus creating the opposite of a client’s intended effect on their pet’s overall health and wellbeing (23,25). The information obtained in our study provided important and practical information for our hospital in order to ensure and reinforce the need for thorough and open-ended diet history questioning and nutritional assessment to occur during every veterinary visit to help identify nutritional imbalances and best meet patient needs.

Raw meat-based diets and treats have been increasingly implicated in infectious disease and zoonotic concerns (24). Examples of these zoonotic concerns include transmission of salmonellosis from dog to owner or due to human handling of contaminated dog food products (24,28–30). The unexpectedly high proportion of raw food diets and product feeding noted in our study allowed for identification of these infectious disease risks to other hospital patients, along with humans, and led to the refinement of our infection control policy. These policy modifications were aimed at minimizing and mitigating risks associated with transmission of infectious disease between patients, staff, students, and clientele.

Limitations of this study include the sparse information obtained on study population demographics and potential limitations with generalizability to other regions or veterinary practices. Participants in our study were primarily female, and the convenience sample respondents were composed of a mixture of AVC-VTH general practice clients and referrals (new appointments and reassessment visits) presenting to speciality services, i.e., internal medicine, surgery, dermatology, cardiology. As such, our sample (and findings) may not reflect the “average” general practice veterinary clientele population. Additionally, as many participants were presenting for specialty (referral) care and participation was voluntary, this may have biased our results towards a group with a higher than typical interest in nutrition and exercise and desire to have these topics discussed by their veterinarian. However, given the high response proportion we observed (72%) and the inclusion of general practice clients the impact of response bias is likely limited.

The results of our study provide a benchmark for ongoing (and targeted) education, communication, and future interventional studies. In conclusion, our work will help veterinary teaching hospital faculty and staff (along with veterinarians in the Atlantic Canada region) to better understand KAPs of pet owners who bring their animals to the veterinary teaching hospital. Ideally, this will inform nutrition and exercise communications ongoing and improve effectiveness of discussions surrounding these topics by the veterinary team through awareness of potential client knowledge and recall gaps.

This work has also brought attention to previously unknown infectious disease risks at the AVC-VTH due to the practice of feeding raw food diets and treats by 30% of our clientele, some of whose pets are admitted to the hospital as patients and may be diarrheic and actively shedding potential pathogens. This information has been used to develop a clinic raw food feeding policy to help protect pets, patients, students, staff, and our clientele through reduction of infectious disease transmission risks.

The results of our work highlight the importance of performing a complete and thorough diet history and nutritional assessment on all cats and dogs presenting to veterinary hospitals for the benefit of patient health and improvement of pet owner communication. Obtaining a thorough nutritional history will lead to the reduction of health risks to patients by identifying the feeding of potentially unbalanced diets and mitigating concerns related to infectious disease transmission to animals and humans due to the feeding of raw food diets and products.