Survey of Belgian owners’ perspectives on quality of life and difficulties during a weight-loss programme in obese cats

Abstract

Objectives

The aims of this study were to determine owners’ perception of their cats’ quality of life (QoL), and whether there is a correlation with weight-loss variables, as well as to identify the main difficulties owners encounter during controlled weight loss in their obese cats.

Methods

The study was carried out as an e-questionnaire survey addressed to owners of cats starting a weight-loss programme. The e-questionnaire was provided at a single time point after the conclusion of the study (24 weeks).

Results

Nineteen completed questionnaires were included. Eighteen cats had a lower weight at the end of the weight-loss period, two of which had successfully reached their target weight. Mean weight loss was 13.84% body weight at a rate of 0.53% weight loss/week. Although the perceived QoL was not correlated with weight-loss variables (P >0.05), it increased over time, even in cats that did not reach their target weight, and was statistically correlated with increased activity (r = 0.73; P <0.01), mobility (r = 0.78; P <0.01) and play time (r = 0.61; P <0.01). The main difficulties encountered by owners were not giving (32%) or permitting the cat to eat extra food (26%). The main presumed difficulty for the cat was having its food decreased over time (53%). Most owners considered their cats happy (42%) and quite happy (53%) during the study, and no statistically significant correlations were found between the weight loss, food-seeking behaviour and stress parameters (P >0.05).

Conclusions and relevance

Although several difficulties were encountered throughout the study, increased QoL and energy levels in their cats were noticed by owners. A positive perspective on weight-loss programmes is important to keep owners motivated and achieve the target weight in their cats. Furthermore, this survey provides insights into the perceived difficulties of weight-loss regimens in cats.

Keywords

Questionnaire nutrition feeding regimen health weight reduction

Introduction

Reaching a cat’s target body weight (TBW) during a weight-loss programme (WLP) can be challenging and often takes several months. Controlled weight-loss (WL) studies in experimentally induced obese cats have revealed a faster WL rate (%WL/week) than WLPs in privately owned obese cats.^1–5 Poor compliance by pet owners has been identified as a major factor for this lower success rate.⁵ Previous studies have shown that owners may be more compliant at the beginning of the WLP and that their compliance decreases over time.⁵ Keeping owners motivated and committed to the WLP is one of the largest difficulties in helping cats reach their TBW. Despite these difficulties, the motivation and commitment of owners should improve the success rate.

Several adverse health effects have been linked to overweight/obesity.^6,7 Nonetheless, in dogs, a reduction of 6% body weight (BW) is beneficial to health.⁸ Focusing on the cat’s well being and quality of life (QoL) during a WLP is a good approach to keep the owner encouraged, successfully achieve the TBW⁹ and improve the cat’s health. If the perceived increase in QoL is larger than the encountered difficulties, the WLP will succeed.

The assumption has been made that some factors, such as the cat’s perceived QoL, energy level (activity, mobility, interaction, play time), food-related behaviour, stress and difficulties encountered during a WLP, will influence a cat’s WL. Thus, this study aimed to determine the perceived QoL of client-owned obese cats in a WLP, to understand the main difficulties experienced by an owner during a WLP and, consequently, help cats to reach their TBWs.

Material and methods

An online survey was designed to collect information from the owners of obese cats after following a feline WLP facilitated by the first author (unpublished) at the Small Animal Teaching Hospital of Ghent University as part of a broader scientific study. The Ethics Committee on Animal Research and Testing in the Faculty of Veterinary Sciences (EC2017/43) approved this study and written informed consent was obtained from the owners.

Enrolment

The owners of adult obese cats (body condition score [BCS] ⩾7/9) were recruited. They were asked to complete a form with information on the cat’s BW, feeding regimen, the presence of other animals in the household, medical history and whether they were indoor-only cats or had outdoor access. In addition, owners were asked to indicate the cat’s BCS based on a 9-point scale with illustrations.^10,11 To obtain a general health screening and to exclude any underlying conditions, all cats underwent a complete physical examination, blood count, serum biochemical and urinalysis. To be admitted to the study, the cats’ BCS were assessed by a trained veterinarian. Finally, the cat owners were provided with oral and written information on obesity risks and the importance of WLPs.

Study overview

All cats were randomly assigned to one of two isonitrogenous and isocaloric dry diets containing different concentrations of omega-3 and omega-6 fatty acids (see Table 1 in the supplementary material). These diets had been designed specifically for WL purposes, presenting higher nutrient levels on a calorie basis. For this study, no difference was made between groups for the statistical analysis.

During the study, owners were advised to prevent uncontrolled outdoor access, stimulate the cats’ activity, add food puzzles and give 3–6 meals daily. In multi-animal households, the cats were fed separately or through an automatic feeding station that could only be opened by a specific individual’s microchip. Additionally, owners were not allowed to provide extra food and had to prevent the cats from eating other food.

The study included a 1-week adaptation period, an 11-week weight-maintenance period, followed by a 12-week WLP. Cats that failed to accept the study diet within the adaptation period were excluded. Initial food allocation was determined by the estimation of TBW based on the initial BCS. Each BCS point higher than the ideal (>5/9) represents +10% BW.^10,11 The current BW was then divided by a factor based on the percentage of overweight/obesity (1.2, 1.3 and 1.4 for a BCS of 7, 8 and 9, respectively) and the diet was then given at 70 kcal/kg^0.75. Owners were instructed to weigh the dry food daily on a gram scale and measure the cats’ food intake and weight weekly. Follow-up was regularly done via email, and energy intake (EI) readjustments were undertaken by ±5–10% based on changes in the cats’ BW during the weight-maintenance period. Finally, owners were requested to bring their cats to consultations after 12 and 24 weeks, during which BW and BCS were recorded, and a physical examination performed. The mean %WL/week was calculated and, to start the WL period, EI readjustments were carried out by ±10–20% if the WL was not between 0.5% and 2%/week. At the end of the study, the ‘need to lose more weight’ was set by the veterinarian based on the final BCS, in which a BCS of 5 was considered ‘none’, a BCS of 6 ‘a bit’, a BCS of 7 ‘some’ and a BCS of 8 or 9 ‘a lot’.

Survey design

The non-blinded survey was hosted online on SurveyMonkey (https://www.surveymonkey.com) and was addressed to the owners at a single time point, after the end of the 24-week study period. The e-questionnaire included a 10-point Likert scale (ranging from 0 to 10, where 0 = low/poor and 10 = high/excellent) and single options from a dropdown menu. The survey comprised 52 questions divided into six sections: weight and BCS; QoL; energy level; eating behaviour; general behaviour; and perceived difficulties (see Table 2 in the supplementary material). Answers were mandatory to proceed through the survey, and mostly only one answer per question was possible. Depending on the answer, some questions led the respondents to a set of extra questions. Ten-point Likert scale questions were used to calculate the difference in owner perception ‘before’ and ‘after’ the study (‘difference’ = value ‘after study’ – value ‘before study’). Single options from a dropdown menu were transformed into scores to facilitate statistical analysis interpretation. In addition, respondents were considered unreliable, and their questionnaires were not considered when the answer to a duplicated question was not consistent.

Statistical analysis

Data were exported into Microsoft Excel and descriptive statistics were performed. WLP variables were calculated as an average of the full study period. Pearson correlation coefficients (r) were analysed using SPSS v25.0 software (IBM) to explore the relationship between WLP variables and data from the questionnaire. Variables compared included differences in EI; WL percentage (%WL); %WL/week; difference in veterinarian-assessed BCS; perceived differences in QoL, energy level and food-related/general behaviour; and owner perceptions of initial BCS, initial/final QoL, ‘QoL if the cat was not obese’, WL, ‘need to lose more weight’ and WLP value/usefulness. Furthermore, a non-parametric analysis (Mann–Whitney U-test) was processed using SPSS v25.0 to compare %WL/week, differences in QoL, food-seeking behaviour, stress and happiness of cats that used or did not use food puzzles. The level of statistical significance was set at P <0.05.

Results

Descriptive results

Twenty-five cats fulfilled the primary criteria, as previously specified, and 22 owners completed the questionnaire; three were excluded owing to lack of reliability. Although the study was designed to have a weight-maintenance and a WL period, 57% (n = 11) and 84% (n = 16) lost weight (>5% BW) during the first and second periods, respectively. Full details of the animals and WLP are shown in Table 1. Only two cats reached their TBW by the time that of survey completion.

Table 1

Baseline variables and outcomes of the weight-reduction phase in 19 cats with obesity included in the study

Variable	Summary data
Age (years)	5 (1–11)
Sex (n)
Castrated male	7
Spayed female	12
Breed (n)
European Shorthair	11
British Shorthair	3
Maine Coon	1
Ragdoll	1
Russian Blue	1
Cornish Rex	2
Previous dietary composition (n)
Dry food	13
Dry and wet food	6
Previous supply of treats (n)
Yes	6
No	13
Previously housed (n)
Outdoor access	5
Indoor	14
Multiple household animals (n)
Yes	11
No	8
Weight (kg)
Week 0	6.95 (4.78–13.5)
Week 24	6.03 (3.51–10.98)
BCS (/9)
Week 0	8.37 (7–9)
Week 24	7.53 (5–9)
Energy allocation (kcal/BW^0.75/day)
Week 0	70
Week 12	63.75 ± 10.58
Week 24	59.35 ± 9.18
Duration (weeks)
Weight-maintenance period (0–12)	12.6 (11.6–14.6)
Weight-loss period (12–24)	14.2 (12–19.3)
Total study period (0–24)	25.1 (24–28.6)
Weight loss (%)
Weight-maintenance period (0–12 weeks)	6.29 ± 5.14
Weight-loss period (12–24 weeks)	7.54 ± 4.27
Total study period (0–24 weeks)	13.84 ± 7.39
Rate of weight loss (%WL/week)
Weight-maintenance period (0–12 weeks)	0.5 ± 0.41
Weight-loss period (12–24 weeks)	0.61 ± 0.34
Total study period (0–24 weeks)	0.53 ± 0.28

Continuous data with a normal distribution are expressed as mean ± SD, while continuous data that are not normally distributed are expressed as median (range)

BCS = body condition score; BW = body weight; WL = weight loss

Weight and BCS

The cats’ estimated BCS given by the owners was compared with the BCS as judged by the veterinarian. There was an agreement of 53% (n = 10), while 11% (n = 2) and 37% (n = 7) of owners overestimated and underestimated their cats’ BCS, respectively (Figure 1).

Figure 1

Comparison between veterinarian-assessed 9-point body condition score (BCS) and owner’s estimation of their cat’s BCS before the start of the study. Cats were categorised according to the BCS assigned by the veterinarian before the study. For each score, owners’ responses are depicted as an agreed estimation, overestimation and underestimation

In response to ‘How important is it to keep your cat in a good BCS?’, 100% of owners had a positive reaction; 16% (n = 3), 53% (n = 10) and 32% (n = 6) responded ‘somewhat important’, ‘very important’ and ‘extremely important’, respectively. Concerning the importance of a WLP in obese cats, 16% (n = 3) of respondents described it as ‘somewhat important’, 58% (n = 11) as ‘very important’ and 26% (n = 5) as ‘extremely important’. Owners were also asked if they could see a difference in their cat’s BCS after the study; the median score was 7.81 (range 2–10) on a 10-point Likert scale. Regarding the ‘need to lose more weight’ at the end of the study, 16% (n = 3) reported ‘none’, 26% (n = 5) ‘a bit’, 26% (n = 5) ‘some’ and 32% (n = 6) ‘a lot’. A comparison between the owner’s report and the veterinarian-assessed BCS is shown in Figure 2. Finally, in response to ‘Was it worth the effort of following a WLP?’, 11% (n = 2), 32% (n = 6) and 58% (n = 11) reported ‘more or less’, ‘a lot’ and ‘totally, I would do everything again’, respectively.

Figure 2

Comparison between veterinarian-assessed body condition score (BCS; 9-point scale) and owner’s estimation of their cat’s need to lose more weight at the end of the 24-week study. Cats were categorised according to the BCS assigned by the veterinarian at the end of the study. For each cat, the need to lose more weight was defined by the veterinarian and was compared with the owners’ responses. A BCS of 5 represented ‘no need to lose more weight’; a BCS of 6 represented the ‘need to lose a bit more weight’; a BCS of 7 represented the ‘need to lose some weight’; and a BCS of 8 or 9 represented the ‘need to lose a lot more weight’. For each category, the owner responses are depicted as an agreed estimation, underestimation or overestimation

QoL

When owners were asked to rate their cats’ QoL before and after the study, the median was 7.2 (range 5–10) and 8.6 (range 8–10), respectively (Figure 3). At the end of the study, the reported QoL improved in 14 (74%) cats and remained the same in five (26%). When owners were asked to indicate the cat’s QoL if it was not overweight/obese, 11% (n = 2), 63% (n = 12) and 26% (n = 5) reported ‘about the same’, ‘better’ and ‘a lot better’, respectively.

Figure 3

Mean owner rating of their cat’s quality of life, activity level, grooming behaviour, and hair quality before and after a 24-week study on a 10-point Likert scale. Error bars represent the SD

Energy level

At the end of the study, owner-reported activity increased in 14 cats (74%) and was maintained in five (26%). The median activity score was 4.5 (range 1–8) and 6.5 (range 2–9) before and after the study, respectively (Figure 3). Meanwhile, owner-reported mobility increased in 11 cats (58%) and was maintained in eight (42%). Ninety-one percent (n = 10) of owners that used food puzzles believed their cats were more active; 9% (n = 1) reported no difference in activity over time. In contrast, 50% (n = 4) of the cats that did not use puzzles were considered more active; the other half showed no presumed change.

When owners were asked to indicate how interactive the cat was with people/animals after the study, 53% (n = 10), 42% (n = 8) and 5% (n = 1) of owners reported ‘the same’, ‘a bit more’ and ‘much more’, respectively. Additionally, 5% (n = 1), 26% (n = 5), 63% (n = 12) and 5% (n = 1) of owners reported that their cat’s play time ‘decreased a bit’, ‘was kept the same’, ‘increased a bit’ and ‘increased a lot’, respectively.

Food-related behaviour

Appetite decreased in nine cats (47%), was maintained in three (16%) and increased in seven (37%), according to the owner reports. Meanwhile, food-seeking behaviour decreased in two cats (11%), was maintained in 12 (63%) and increased in five (26%). Fifty-eight percent (n = 11) of owners reported attempting to use food puzzles; of these, 36% (n = 4), 18% (n = 2), 36% (n = 4) and 9% (n = 1) reported ‘great success’, ‘success’, ‘mild success’ and ‘no success at all’, respectively. Forty-two per cent (n = 8) of owners reported using automatic feeders and only 16% (n = 3) combined their use with food puzzles. The median percentage of food given through food puzzles and automatic feeders was 53.5% (range 0–100) and 61% (range 1–100), respectively.

When owners were asked why they did not use food puzzles, 50% (n = 4) reported that they did ‘not know it was possible’ and 50% (n = 4) reported it was ‘not possible due to another animal(s) at home’.

General behaviour

After 12 weeks owner-reported stress increased in three cats (16%), was maintained in 15 (79%) and decreased in one (5%). After 24 weeks, owner-reported stress was maintained in 18 cats (95%) and decreased in one (5%) vs 12 weeks. Furthermore, only one owner (5%) reported that their cat ‘did not seem happy’ during the study, while 53% (n = 10) considered their cats to be ‘quite happy’ and 42% (n = 8) ‘happy’.

Owner-reported grooming time increased in eight cats (42%), was maintained in nine (47%) and decreased in two (11%). Hair quality increased in seven cats (37%) and was maintained in 12 (63%). The grooming time and hair quality score increased over time vs baseline, ranging from 5.9 (range 1–9) to 6.6 (range 1–9) and 7.1 (range 3–10) to 8.1 (range 6–10), respectively (Figure 3). Sixty-eight percent (n = 13) and 95% (n = 18) of owners reported normal cat faeces before and after the study, respectively.

Difficulties

Finally, respondents were asked to report the main difficulties they encountered during the study. Thirty-two per cent (n = 6) of owners responded it was difficult ‘not to give extra food’, 26% (n = 5) that it was difficult ‘to limit the access of the cat to other types of food’, 21% (n = 4) that it was difficult ‘to weigh the cat weekly’, 11% (n = 2) that it was difficult ‘to bring the cat to appointments’, 5% (n = 1) that it was difficult ‘to measure the cat’s daily food intake’ and 5% (n = 1) that it was difficult ‘to keep the cat indoors’. More details regarding the perceived difficulty level for each statement are presented in Table 2. When owners were asked what would possibly present as the main difficulty for their cats during the WLP, 53% (n = 10) believed it was ‘to have the [cat’s] food decreased over time’; 21% (n = 4) thought that the main difficulty to their cats was ‘not to have access to other food’. Sixteen percent (n = 3) thought that their cats were struggling to ‘not receive extra food’, 5% (n = 1) presumed that their cat’s main difficulty was ‘being kept indoors’ and 5% (n = 1) thought the main difficulty for their cats was ‘coming to the appointments’.

Table 2

Difficulties encountered by the owners during their cats’ weight-loss programme

	A lot/really hard (%)	Quite a lot/hard (%)	Not that much/not too hard (%)	Not (hard) at all (%)	Number of participants (n)
Not giving extra food	42	11	42	5	19
Limiting the cat’s access to other types of food*	29	36	21	14	14
Adding food puzzles/slow feeders to the cat’s daily routine^†	18	0	9	73	11
Preventing the cat stealing human food	16	32	32	21	19
Keeping the cat indoors^‡	14	0	29	57	7
Weighing the cat weekly	5	32	32	32	19
Bringing the cat to appointments	5	32	42	21	19
Measuring the cat’s food intake	0	11	58	32	19
Increasing the number of meals^§	0	27	67	7	15
Getting the cat used to food puzzles/slow feeders^†	0	9	64	27	11

Only for owners that had other animals at home

†

Only for owners that added food puzzles and/or slow feeders to their cat’s daily routine

‡

Only for owners of cats that had access to the outdoors before the start of the study

Only for owners that increased the number of meals for their cats

Association between variables

Table 3 shows the Pearson correlation coefficients for the survey variables. Owners’ WL perception was positively correlated with the %WL (r = 0.63; P <0.01) and %WL/week (r = 0.65; P <0.01), and negatively correlated with the difference in BCS (r =−0.66; P <0.01) and to the need to lose more weight after completing the study (r =−0.55; P <0.01). The difference in BCS assessed by the veterinarian was negatively correlated with the owners’ perception of WL (r =−0.66; P <0.01) and positively correlated with the ‘need to lose more weight’ after the study (r = 0.56; P <0.05).

Table 3

The associations between the different questions of the survey (Pearson correlation coefficients)

Variables			1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25
WLP data variables	1	Difference in energy intake throughout the study	1.0
	2	Total weight loss (%WL)	0.477*	1.0
	3	Rate weight loss (%WL/week)	0.473*	0.996**	1.0
BCS assessment	4	Initial BCS assessment – owner	0.3	0.3	0.3	1.0
	5	Initial BCS assessment – veterinarian	0.1	0.2	0.3	0.490*	1.0
	6	Final BCS assessment – veterinarian	−0.4	−0.525*	−0.500*	0.2	0.538*	1.0
	7	Difference in veterinarian-assessed BCS	−0.523*	−0.794**	−0.782**	−0.1	−0.1	0.800**	1.0
QoL perception	8	Initial QoL	−0.1	0.0	0.0	−0.3	−0.1	−0.2	−0.1	1.0
	9	Final QoL	0.478*	0.546*	0.569*	0.3	0.2	−0.2	−0.4	0.3	1.0
	10	Difference in QoL	0.4	0.3	0.4	0.457*	0.2	0.1	−0.1	−0.831**	0.3	1.0
	11	QoL if cat not obese	0.3	0.0	0.0	0.4	0.1	0.0	−0.1	−0.605**	−0.4	0.4	1.0
Weight and BCS perceptions	12	Importance of keeping the cat in a good BCS	0.2	−0.1	−0.1	0.1	−0.1	0.2	0.3	−0.2	0.1	0.2	−0.1	1.0
	13	Value/usefulness of WLP	0.4	0.0	0.0	0.0	−0.2	0.0	0.1	−0.1	0.2	0.2	0.0	0.820**	1.0
	14	Weight loss – owner’s perception	0.3	0.628**	0.653**	0.2	0.0	−0.528*	−0.656**	−0.1	0.4	0.3	−0.1	−0.1	−0.1	1.0
	15	Need to lose more weight	−0.3	−0.528*	−0.497*	−0.1	0.3	0.626**	0.559*	−0.3	−0.3	0.1	0.2	0.2	0.3	−0.547*	1.0
Energy level	16	Difference in activity level	0.3	0.2	0.2	0.2	0.0	−0.2	−0.2	−0.707**	0.0	0.727**	0.4	0.2	0.3	0.4	0.0	1.0
	17	Difference in mobility	0.3	0.3	0.3	0.3	−0.1	−0.2	−0.2	−0.674**	0.2	0.781**	0.3	0.3	0.2	0.3	0.0	0.814**	1.0
	18	Difference in interactivity	0.1	0.3	0.3	0.2	0.0	−0.2	−0.2	−0.490*	−0.3	0.3	0.516*	0.1	0.1	0.2	0.2	0.2	0.3	1.0
	19	Difference in playing time	0.3	0.1	0.1	0.3	0.2	0.1	0.0	−0.613**	0.0	0.605**	0.543*	0.1	0.1	−0.1	0.2	0.640**	0.803**	0.2	1.0
Food-related behaviour	20	Difference in appetite	0.2	0.3	0.2	−0.1	−0.2	−0.3	−0.2	−0.1	0.0	0.1	0.1	0.4	0.4	0.2	−0.3	0.4	0.2	0.0	0.0	1.0
Food-related behaviour	21	Difference in food-seeking behaviour	−0.490*	0.1	0.1	−0.2	0.0	−0.1	−0.1	0.1	−0.3	−0.2	−0.1	−0.3	−0.4	0.3	−0.3	0.1	−0.1	0.0	−0.2	0.477*	1.0
General behaviour	22	Difference in stress after 12-week study	0.634**	0.4	0.4	0.487*	0.0	−0.1	−0.1	−0.3	0.3	0.479*	0.3	0.3	0.3	0.3	−0.2	0.4	0.4	0.2	0.3	0.4	−0.1	1.0
	23	Difference in stress after 24-week study	0.521*	0.4	0.4	0.4	0.1	−0.1	−0.2	−0.1	0.3	0.3	0.1	0.3	0.3	0.2	−0.2	0.2	0.2	0.1	0.2	0.5	0.0	0.900**	1.0
	24	Difference in grooming	0.535*	0.3	0.3	0.0	−0.4	−0.603**	−0.4	−0.1	0.3	0.3	0.3	0.1	0.2	0.3	−0.3	0.3	0.535*	0.1	0.4	0.3	−0.1	0.514*	0.510*	1.0
	25	Worthiness of following the WLP	0.3	0.0	0.1	−0.1	−0.1	−0.1	0.0	−0.1	0.1	0.2	−0.1	0.4	0.612**	0.4	0.1	0.4	0.2	0.2	0.0	0.2	0.0	0.2	0.1	0.1	1.0

P <0.05

P <0.01

WLP = weight-loss plan; WL = weight loss; BCS = body condition score; QoL = quality of life

Perceived QoL was positively correlated with an increase in cat activity (r = 0.73; P <0.01), mobility (r = 0.78; P <0.01) and playing time (r = 0.61; P <0.01). The stated QoL before the study was negatively correlated with the perceived ‘QoL if the cat was not obese’ (r = 0.61; P <0.01). The QoL of the cats perceived by their owners at the end of the study was positively correlated with the difference in EI (r = 0.48; P <0.05), %WL (r = 0.55; P <0.05) and %WL/week (r = 0.57; P <0.05).

There were no significant correlations between %WL and %WL/week with energy level, food-seeking behaviour or stress. However, the difference in EI was positively correlated with perceived stress (r = 0.52; P <0.05) and negatively correlated with food-seeking behaviour (r =−0.49; P <0.05). The difference in the activity was also positively correlated with the difference in mobility (r = 0.81; P <0.01) and play time (r = 0.64; P <0.01). The WLP value/usefulness was positively correlated with the degree of importance of carrying out a WLP in a cat (r = 0.61; P <0.01).

No significant difference was observed between cats fed in combination with or without food puzzles in the %WL/week (P = 0.37), QoL (P = 0.65), food-seeking behaviour (P = 1.0), happiness (P = 0.17) or stress (P = 1.0; see Figure 1 in the supplementary material).

Discussion

To our knowledge, few studies have shown improvement in perceived QoL in cats after a WLP;^12–14 nonetheless, one study¹⁴ compared perceived QoL with BCS and %WL/week, and did not find a statistical correlation with the cats’ QoL. Additionally, there are no published data assessing the difficulties encountered by owners during WLP.

Weight and BCS

Agreement between veterinarians and cat owners on cats’ BCS differ between studies, being better in poor/ideal BCS than overweight/obese conditions.^15,16 The present study also showed an increased underestimation for higher BCS points, and, for the first time, cat owners kept underestimating BCS after the WLP, and underestimated their cat’s need to lose more weight. Clear communication about BCS and TBW¹⁷ reassessment is essential to avoid premature WLP discontinuation. Interestingly, owners could identify larger differences in the cat’s BCS when %WL and %WL/week were higher. At the same time, their perception of the need to keep decreasing the cat’s weight diminished. Moreover, by the end of the study, all owners demonstrated positive reactions towards WLP, to ‘keep a good BCS in their cat’ and the value/usefulness of the WLP.

QoL

In a previous feline WLP study, improved activity and QoL were detected after 5.5% and 8.1% WL, respectively.¹² Although no correlation was seen in the current study between the perceived QoL in cats and %WL, QoL increased over time and the final QoL rating was positively related to the difference in perceived energy level. This suggests that owners might relate their cat’s energy level with its QoL; thus, emphasis on these parameters (mobility, playing time, activity) to keep the owner motivated can be decisive.

Energy level

A prior study found that lean cats have higher energy levels than overweight cats;¹⁸ however, energy expenditure was reduced after energy restriction.¹⁹ During a WLP, the cat’s activity should be promoted to increase energy expenditure and achieve a negative energy balance.¹⁷ In humans, WL increases activity,^20,21 but, in cats, literature supporting this idea is inconsistent.^19,22,23 In the present study, an increase in the activity score was seen without a correlation between the WL variables and the cat’s perceived energy level. Although the role of a cat’s activity during a WLP is not understood, stimulating it can be a good alternative to strengthen the human–animal bond and decrease stress.²⁴

Food puzzles

Food puzzles have been suggested to increase activity²⁵ and promote mental well being;^26,27 therefore, they are often proposed in WLP.¹⁷ Although group-controlled studies have failed to prove an increase in activity,²⁸ in the present study the vast majority (91%) of owners believed that their cats were more active when puzzles were used. However, the use of puzzles did not influence the perceived QoL in the cats, as was observed in another study.¹³ Environmental enrichment has been shown to decrease signs of stress,²⁹ facilitate WL⁴ and decrease food-seeking behaviour.³⁰ In contrast, owners that added food puzzles did not see a decrease in stress level, %WL/week or food-seeking behaviour in their cats. Nevertheless, including food puzzles was not difficult for the majority of owners, and most cats adapted to it well. Even after the veterinarian advised adding food puzzles to the cats’ routine, four owners reported they did not know it was possible, highlighting the importance of improving communication between veterinarians and owners as owners might not understand or, owing to an overload of information, not remember all the recommendations given. Although there are no proven benefits of food puzzles in improving WL results, their inclusion is recommended to help mental well being,^26,27 especially in indoor cats.

Weight loss, and food-related and general behaviour

To ensure 0.5–2% of WL/week and the achievement of TBW, readjustments of EI over time might be needed.³¹ Consequently, food-seeking behaviour could be increased,³ as was observed in the present study. Nonetheless, despite this finding, stress did not appear to decrease the perceived QoL in the cats. Although the perceived stress increased at the beginning of the study, it remained stable during the WLP (12–24-week study). In addition, there was no statistical correlation between stress and %WL/week. These findings suggest that an initial diet and/or food-management change might be more relevant in affecting stress than WLP.

Grooming is a normal cat behaviour, but excess or lack of grooming may affect a cat’s well being. Decreased grooming time has been described in obese cats due to a reduced ability to reach all body areas,⁶ increasing the risk of dermatological disorders. However, overgrooming has been linked to stress,³² and in some cases it can result in alopecia.^33,34 Although evaluating grooming behaviour is difficult, by the end of the current study, owners described an increased grooming time together with improved hair quality, suggesting a positive consequence of the WLP.

Difficulties

More than half of owners (53%; n = 10) believed that the main difficulty of the WLP from the cats’ point of view was having their food decreased over time. Nevertheless, owners still associated the increased %WL and %WL/week with greater overall QoL. In the present study, the average %WL/week was in the lower advised range (0.5%/week), with a mean decrease of 15% EI over time (59 kcal/kg^0.75). To avoid decreasing food over time, a larger decrease in the initial EI to achieve a higher %WL/week (1–2%/week) at the beginning of a WLP might be suggested.

One owner (20%) reported struggling to keep the cat indoors and although the cat’s EI was reduced by 12% and the owner observed a slight increase in the activity level, the cat maintained its weight. However, non-supervised outdoor access and food indiscretion cannot be excluded.

Although only six owners fed treats to their cats before starting the study, all owners reported difficulties with not feeding extra food when the study ended. This finding emphasises the importance of a detailed anamnesis and a complete overview of the diet.³⁵ Giving treats is common in feeding regimens,^36,37 and positively affects the owner’s psychological health;³⁸ however, it can increase EI and is a risk factor for obesity.^15,39,40 No treats were included in the present study; however, anecdotal data suggest a possibility of treat feeding <10% EI^14,41,42 without causing nutritional imbalances.⁴¹ To overcome this difficulty, low-calorie treats could be included under energy reallocation. Previous studies have suggested greater outcomes in WLPs using exclusively dry diets;^12,43 however, wet diets designed for WLPs can be an alternative to treat feeding.

Limitations

The data obtained in this study should be interpreted with caution as the population was small, there was no control group and the questionnaire was not formally validated. Although a time frame (before the study, at 12 weeks and at 24 weeks) was described in the questionnaire, all data were collected by the end of the study. This implies a limitation on the study design and could have led to an overestimation of the ‘24-week study’ parameters and an underestimation of ‘before the start of the study’ and ‘12-week study’ answers. As relying on owners’ recall imposes a bias in the study, it would be interesting to repeat a similar survey at different time points for more consistent data. Furthermore, energy-level parameters were only assessed subjectively, and more objective measures should follow to confirm these findings. Despite its limitations, the study certainly offers valuable insights into the difficulties that cat owners have during a WLP, assisting veterinarians with managing difficulties in achieving a cat’s TBW and improving cats’ QoL.

Conclusions

The current study showed an improvement in cats’ QoL after a 24-week period, which was positively correlated to a difference in perceived energy level. The main difficulties with the WLP were related to not feeding extra food and decreasing the amount of food over time. Finally, stress did not significantly influence the perceived QoL of the cats, owners had a good impression of the WLP and the majority expressed the significance of the WLP to their cats.

Supplemental Material

Table 1

The composition of experimental food used for weight loss in cats.

Supplemental Material

Table 2

Description of survey domains and representative survey items.

Supplemental Material

Figure 1

Comparison of weight loss rate, differences in the perceived quality of life, food seeking behaviour, happiness and stress of cats that used or did not use food puzzles.

Footnotes

Acknowledgements

The authors thank all the cat owners who completed the survey and allowed their cats to participate in the study. They also acknowledge Sofie Moreels for the grammar revision.

Accepted: 28 July 2022

Author note

This paper was presented, in part, as an abstract and a poster presentation at the European Society of Veterinary and Comparative Nutrition Congress, in Munich, Germany, 2020.

Supplementary material

The following files are available online:

Table 1: The composition of experimental food used for weight loss in cats.

Table 2: Description of survey domains and representative survey items.

Figure 1: Comparison of weight loss rate, differences in the perceived quality of life, food seeking behaviour, happiness and stress of cats that used or did not use food puzzles.

Conflict of interest

The study was supported by Dechra Veterinary Products, which employs Francis Pastoor and Lobke Heip.

Funding

Food and funding were provided by Dechra Veterinary Products. The sponsors were involved in the study design. At the time of the study, Camila Baptista da Silva was undertaking a residency in comparative animal nutrition sponsored by Dechra Veterinary Products.

Ethical approval

The work described in this manuscript involved the use of non-experimental (owned or unowned) animals. Established internationally recognised high standards (‘best practice’) of veterinary clinical care for the individual patient were always followed and/or this work involved the use of cadavers. Ethical approval from a committee was therefore not specifically required for publication in JFMS. Although not required, where ethical approval was still obtained, it is stated in the manuscript.

Informed consent

Informed consent (either verbal or written) was obtained from the owner or legal custodian of all animal(s) described in this work (either experimental or nonexperimental animals) for the procedure(s) undertaken (either prospective or retrospective studies). No animals or humans are identifiable within this publication, and therefore additional informed consent for publication was not required.

ORCID iD

Camila Baptista da Silva

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