The Wagging Tail

Veterinary medicine is such a diverse and flexible career option.  So how do you find your passion?  I knew that I wanted to start a family, and actually be around to raise my family, so I found that what worked best for me from the start was a 5-year career plan.  My five year plan included well-rounded experience, focusing on continuing education and paying off my student loans as quickly as possible.   

The first part of my 5-year plan was to gain well-rounded experience in veterinary medicine.  I started out my clinical experience by securing a position in small animal practice. I chose a feline exclusive practice and although I was nervous the first year out – I really gained great hands-on clinical experience from a great mentor doctor. Obtaining a position that provides a mentor doctor is vitally important the first year out. After gaining clinical experience (ideally it lasts 1-3 years) I left clinical medicine to enjoy a career in disaster services at the American Veterinary Medical Association. Working in organized veterinary medicine opened my eyes to a whole different side of veterinary medicine. I would highly encourage every doctor to either work or volunteer in non-clinical veterinary medicine to experience a whole different side of this vast profession.

Another vital part of my plan involved a commitment to continuing education. No one ever knows all there is to know, and so I focus on learning something new every day.  This makes my career fun and exciting and it’s a huge confidence booster! I encourage humility, I encourage asking questions, and I encourage not being afraid to tell someone you have to look something up. We veterinarians are trained to know what we are looking for, what we are reading and what to do with the information, we are not trained to know all there is to know about veterinary medicine. It is our intelligence and education that prepares us to PRACTICE veterinary medicine, not to master it. By admitting that I did not know everything, it opened up a whole new world of exploration and learning. The consequence – my practice benefits because I am open to learning new information every day and not being afraid to try new things.

The most important part of my five year career plan was to obtain financial freedom – and I began working on this the day I graduated from veterinary school.  It is much easier said than done, let me assure you! I knew that the only way to attain the flexibility and freedom to make my own decisions would come from this.  I can’t emphasize enough how liberating it is to know that you call the shots regarding your hours and work schedule and do not feel pulled in any direction that you do not want to be pulled in. When I started my family I was able to work three days a week and I truly feel like I have the best of both worlds. After having so many life experiences in and out of veterinary medicine, I feel like I am a better, more well-rounded doctor and person for both my clients and my patients. And, I don’t feel like I am sacrificing my family for my career which helps me maintain a positive attitude when I am at work. I think my clients and patients enjoy that part of me as well!

So many outside factors influence what you may think your true passion is – family, prestige, potential to make money, titles, location, etc. As soon as you can – sit quietly, focus on what makes you happy, and most importantly focus on what you think will make you feel like you have contributed in a positive way to this world. The worse feeling is to go to bed at night, and wonder if you have made a difference today. Did you make someone smile today? Did you help a family make a hard decision that affected their family but was in the best interest of their pet? Did you help diffuse an angry person and had them smiling when they left your office? Do those things make you feel like you have made a difference in this world? They should.

I remember the smiles at the end of each day and that is what makes me feel fulfilled and eager to return and do it all over again. Who knows what is in store once my children are grown and gone – but I can tell you one thing – veterinary medicine has a very promising and exciting future in store for me and you alike!

This month, the BARK team finished a research evidence campaign on Pet overweight/obesity (see previous blog postings from June 22 and July 27).  What we discovered in our analyses and literature searches probably won’t surprise you; however, the findings just further support that overweight/obesity is certainly a major health threat to our Pets. 

Below, we listed a few of the highlights from our research, followed by a few questions to facilitate a discussion on these key findings.  Tell us what you think, share your experiences, or let us know what questions you have and want to see answered concerning this growing epidemic.

From an exhaustive literature review on canine, feline and human overweight/obesity:

• Prevalence estimates of canine and feline obesity vary widely; between 22 to 44% in dogs and between 19 to 52% in cats. The prevalence of human obesity amongst adults doubled between 1980 and 2004
• The nature of the human-animal bond is very important. Dogs and cats are more likely to be of normal weight if owners use play as a reward instead of food and owners as overweight or obese cats and dogs tend to over-humanize their pets or use food as a substitute for affection

Study Results: Key factors associated with diagnosis of overweight or obesity in dogs and cats, from a study by the BARK team -

• Dogs are more likely to be diagnosed with overweight or obesity if they are female or neutered, or one of the following breeds: Labrador retriever, chihuahua, golden retriever, dachshund, beagle, pug, spaniel (both cocker spaniels and other spaniels), Yorkshire terrier, pomeranian, miniature pinshcer, jack russell terrier or pit bull breeds.
• Medium and small breed dogs were more likely to be overweight or obese than large breed dogs.
• Cats are more likely to be diagnosed with overweight or obesity if they are male or neutered. Mature adult cats (3-10 years of age) were more likely to be overweight or obese than young adult cats
• Cats that are of persian breed are less likely to be diagnosed as overweight or obese
• Dogs and cats with a greater number of hospital visits were less likely to be overweight or obese than dogs and cats with fewer visits (i.e., see their vet more often)

Significant findings from the Critically Appraised Topic (CAT) that researched the effectiveness of exercise and its role when treating overweight/obesity in both dogs and cats:

Overall finding: There is some evidence that exercise has a positive influence on the weight of dogs and cats, but there is limited evidence about the exact efficacy and the specific benefits are uncertain.

• The effectiveness of exercise and its role when treating overweight/obesity in dogs and cats is understudied. 
• Several recent studies have shown promising advances in the ability to accurately record physical activity in dogs using accelerometers and/or pedometers.  These developments will facilitate research into whether physical activity, either alone or as part of a weight loss program, is a beneficial exercise strategy for dogs and cats.

The results of these studies raised a number of questions for us and we’d love to have your input:

• There are a lot of explanations for the wide range of prevalence estimates and we feel that obesity is under diagnosed – how do you think we can address the under-diagnosis of overweight and obesity?
•  Since prevention and/or maintenance of this disease largely deals with the owner’s own behaviors (e.g., controlled feeding, limited treats, daily exercise, etc.), what strategies do you use to address and manage the issue?
• As a veterinarian, do you communicate risk to educate your clients?  What tactics do you use to help make them better informed decision makers, that may help modify their behaviors?
• As a veterinarian, do you think using accelerometers and/or pedometers could be a useful element in a weight loss program?  If they were readily available, would you use them?

 The quarterly white paper on this topic is now available – subscribe today and receive your issue!  The CAT will appear in the Aug./Sept. issue of the Banfield Journal.

If you’d like to subscribe to the Banfield Applied Research and Knowledge (BARK) quarterly white paper, email us at bark@banfield.net and include SUBSCRIBE in the subject line.

Summer is more than half over, and back-to-school time signals the beginning of a busy rush of clients in your veterinary practice. As a veterinary professional, you may begin feeling squeezed, again, with too much to do and not enough time to get it done. This can lead to burnout, a term well known and often used in our industry. Burnout is defined most often as exhaustion of physical or emotional strength, usually as a result of prolonged stress or frustration. ~Figley and Roop, 2006

We all can relate to this, particularly when the work load overwhelms our ability to do it all…and maintain a good attitude at the same time! The good news is that burnout is a process, not an event, and is marked by physical, emotional, and behavioral indicators that can be easily recognized. If we remain aware of our response to the increased workload, we can keep burnout in check by utilizing these coping methods:

• Accept that the situation itself is stressful
• Share your feelings with a trusted friend or colleague
• Enhance your communication skills to lessen feeling of being unheard
• Initiate positive action to change your environment
• Suggest solutions to proper management
• Care for your personal needs (i.e., good nutrition, hygiene, exercise)
• Take time away from your stressful situation, and allow others to help

So then what is this new term, compassion fatigue? As a perfect example, burnout and compassion fatigue were contrasted by member of the “human” medical profession: Burnout results from stresses that arise from the clinician’s interaction with the work environment…while compassion fatigue evolves specifically from the relationship between the clinician and the patient.  ~Kearney et. al., 2009

When the workload is heavy, the hours long, the coworkers grumpy, the equipment shabby, those are all examples of the work environment causing stress, i.e., burnout. But compassion fatigue is different; it’s about personal relationships with your clients and patients. It would stand to reason then that you have some measure of control over burnout. You can use some of those coping methods listed above, and make appropriate changes to your work environment. In fact, you can change your work environment altogether by quitting and getting a new job. Burnout is more about WHERE you work.

But compassion fatigue is more about the work you DO, and as long as you remain in a care giving role, you will need to be able to recognize and minimize compassion fatigue. First, how do you diagnose compassion fatigue? Here are the some of the symptoms:

• Bottled up emotions
• Impulse to rescue anyone (or anyTHING) in need
• Isolation from others
• Sadness and apathy
• Feeling the need to voice excessive complaints about management and coworkers
• Lack of interest in self-care practices
• Reoccurring nightmare, flashbacks
• Persistent physical ailments
• Difficulties concentrating and mentally tired
• Prone to accidents

As you may imagine, these personal effects also spill over to affect the organization as a whole. So how do we change to a healthier emotional status? It’s mainly about sustainable self-care. We must turn our care giving inward to provide for ourselves, so we have the energy to sustain our care giving role in the profession. Here are Eight Laws Governing Healthy Caregiving, from Patricia Smith, founder of the Compassion Fatigue Awareness Project:

• Sustain your compassion
• Retain healthy skepticism
• Learn to let go
• Remain optimistic
• Be the solution
• Embrace discernment
• Practice sustainable self care
• Acknowledge your successes

Resources:

• Compassion Fatigue workshops and webinars at http://www.katherinedobbs.com/
• Compassion Fatigue discussion forum at http://www.compassionfatigue.org/
• Compassion Fatigue in the Animal Care Community, a book from the Humane Society
• To Weep For a Stranger: Compassion Fatigue in Caregiving, a book by Patricia Smith

Are gender-communication differences contributing to the gender-pay gap? In the June 2008 Veterinary Economics article “Are Women Tough Enough?” Jan Miller explores the role of communication style differences in the revenue discrepancy between male and female veterinarians. As a woman in our profession, I’m intrigued by this. How are women and men in our profession communicating differently, and what can I do to ensure that I am communicating effectively – even though my approach might be different?

Donna Zajonc and David Womeldorff, in the August 2006 workshop entitled “Emerging Perspectives on Feminine and Masculine Leadership Styles-and Why We Need Both” explained that the only area in which males and females tend to consistently differ in the Myers-Briggs personality assessment is decision-making function with two thirds of men assessed as thinking and two thirds of women assessed as feeling.

According to Zajonc and Womeldorff, “Some of the key aspects of ‘thinking’ relate to an emphasis on objectivity, logic, clarity, justice, consequences of action and being firm and fair. Some of the key aspects of ‘feeling’ relate to an emphasis on values, interpersonal relationships, harmony, mercy, empathy and compassion.”

They assert that leaders need to be able to utilize both decision-making styles. While I agree that we need to be able to function as both “thinkers” and “feelers,” I believe improvements in our communication abilities will be best achieved if we identify how we tend to make decisions, and focus on strengthening that tendency. 

If you tend to make decisions based on thinking, you may need to consciously convey compassion, but do not try to negate your “thinking” tendencies. Clients are confident in medical care of their Pets when they know that you are absolutely sure of your recommendations and can firmly lead them through difficult decisions.

If you tend to make decisions based on feeling, nurture that tendency. Beware of the potential of becoming emotionally over-invested in patient care, which may increase your risk of burnout. Protect your compassionate nature, but allow it to emerge when communicating the importance of your medical recommendations. Clients are reassured when they know that you are recommending for their pet what you would do for your own. 

We are not women in a man’s career (or men in a woman’s career). Neither is a feeling or thinking-based mode of decision making superior to the other. We are called to the care of people and pets, and have been endowed with different yet equally valid strengths to assist us in fulfilling our calling.

As we improve our communication skills, honing our strengths and bolstering our weaknesses, client confidence will improve, which will allow our patient care to improve. As we all approach our highest potential as communicators, perhaps the gender pay gap in our profession will begin to narrow as well.

The BARK team has been sweating away (it was a 100 degrees in Portland, OR!) on the latest research studies for the Overweight/Obesity Evidence Campaign. We’ve been looking into factors that are associated with dogs and cats being overweight or obese. In dogs, these factors include age, neutering, being female, having stifle disease and certain breeds – Labrador retriever, chihuahua, golden retriever, dachshund, beagle, pug, both cocker spaniels and other spaniels, Yorkshire terrier, pomeranian, miniature pinshcer, jack russell terrier or pit bull.

Dogs on the Banfield Optimum Wellness Plans, boxers, Australian shepherds and dogs with gastroenteritis, diabetes mellitus, full anal sacs and cardiac disease were less likely to be diagnosed as overweight or obese.

Many of the risk factors identified in the BARK studies are consistent with findings of studies published in peer-reviewed journals. Other risk factors identified in these studies include, endocrine dysfunction (hypothyroidism and hyperadrenocorticism), infection-related obesity, and pancreatitis.

We are currently in the process of analyzing risk factors for feline obesity, but some risk factors that have been published in peer-reviewed journals include breed (Domestic shorthair, Domestic longhair, Domestic medium hair, Mixed and Manx), neutering, age, being male and certain diseases (urinary tract disease, diabetes mellitus, neoplasia, oral disease or dermatopathy).

Factors that we weren’t able to analyze in the BARK studies, due to limitations of our database, include demographic factors and aspects of the human-animal bond. The peer-reviewed literature that has examined these factors is quite interesting – basically, people often use food or treats as a substitute for affection and this contributes to the development of obesity.

According to Dr. Denise Elliott, a board-certified specialist in nutrition, “In addition to the daily diet, it is quite often all the little extras, especially those ones that we give to our Pets to appease our own guilt (home late from work, too busy to play ball, etc.), that really provide the excess calories in our Pets’ diet.”

We asked the following questions last month and would like to ask you again:

1. As a veterinarian, how are you addressing this epidemic in your clinic and how do you think we can address the under-diagnosis of overweight and obesity? 
2. What questions do you have and want to see answered regarding this health topic? 
3. How do you educate clients on the prevention of overweight/obesity in their Pets? 

In the meantime, look for more updates coming soon!  The quarterly white paper on this topic will be available to subscribers next month!

If you’d like to subscribe to the Banfield Applied Research and Knowledge (BARK) quarterly white paper, email us at bark@banfield.net and include SUBSCRIBE in the subject line.

I always say that we spend our lives looking for people just like us so we can talk about how everyone else is crazy. “Can you believe he said that?!” “What was she thinking?!” “Who does that?!” Well, apparently there is someone who does that. And thank goodness.

 In the past, this phenomenon has worked out really well for veterinarians. Chances were that you would end up learning from and working with veterinarians who were just like you. As it turns out, according to the Myers-Briggs or Keirsey personality theorists, most veterinarians have traditionally fallen under the ISTJ/ESTJ categories.  A larger majority are ISTJs, who tend to be introverted, data-loving, logical decision-making, list-checkers.  There might be an occasional ESTJ – an outgoing, data-loving, logical decision-making, list checker.  The ESTJs tend to be more comfortable in the exam room with clients and buddying up to the team while the more introverted ISTJ might prefer to unwind in the peace and quiet of the surgery suite. Because of the fundamental similarities in vets personalities, potential communicative conflict only occurred with clients because all veterinarians thought the same or nearly the same way.

Nowadays, not only do you have to deal with significant generational and gender differences working with other veterinarians, but you’ll have to learn to deal with “different” personalities on your side of the table as well. The fundamental personality of veterinarians is shifting to ESFJ/ISFJ. A recent study in the Journal of Veterinary Medical Education shows evidence of a significant shift in veterinarian student personality from 2004 to 2007 (click here to read a related article).  Move over logical decision-maker, there is a new vet in town. The ESFJ/ISFJ is influenced more by feelings than logic. “What?!” You say. That’s right, these new vets use their values and client’s feelings to help make decisions. I’m with you E/ISTJs, “Who does that?!”

So, what will this new veterinarian add to the profession? E/ISFJ vets are more suited towards communications and relationship-building. This paired with more E/ISFJs in the general population will certainly lead to improved relationships with Pet owners. Understand that although they might value individuals over systems and data, that does not mean they are lacking in knowledge and skill.

What if you are one of these new-fangled veterinarians? Know that you add value in empathizing with others and addressing the emotional impact of a Pet’s health. Still, your logical decision-making colleagues might help you out when feelings need to be pushed to the side to make a decision. But, don’t mistake their focus on facts and figures for a lack of caring.  

The bottom line is that people are different; not right or wrong or good or bad, just different. There is a lot of evidence that mere diversity in the workplace adds value. Different perspectives provide new ideas and improved problem-solving. Understand that differences are a part of our world and the more we can understand and acknowledge these differences (maybe laugh about them a little), the better for our own work experience, our practices, and the care of the Pets we see each day.

Let’s face it, bringing a Pet to the vet clinic is not always an easy task.  Managing an excited Pet in the exam room can be far more daunting.  Then, hearing that the Pet is sick and listening to the vet talk about diagnostics, prognosis, and medications is enough to get anyone’s blood pressure up.  As veterinarians and paraprofessionals exposed to medical equipment, Pet illnesses, even the typical veterinary hospital odors, we tend to lose sight of the different triggers that can make our clients nervous and anxious.  Sometimes, our clients can become upset, even with us, if they are very worried about their Pets, and this is the case with many of our clients since we deal with their “fur-children” and their health every day. I am the same way when it comes to my Pet.  A health problem with my Pet will make me nervous, cautious and every decision is questionable whether it is the right one or not. I feel the best way to calm a nervous client is to put yourself in their situation and treat them the way you would want to be treated. It’s kind of like what they taught us in grade school right?  Here a few pointers to keep in mind when working with a nervous client:

1. Introduce yourself with confidence with a warm, friendly smile and always use soft, calm speech.  If you approach a client with overpowering, firm speech then they will tend to back off and not trust you. Trust is the key to keeping a client’s nerves at ease.
2. Talk to your nervous client like you would talk to a good friend. Make them feel at ease and allow them to approach you with what is really making them nervous. If they don’t tell you, then ask them directly what is making them most concerned about the situation. I would stay away from mentioning “being nervous” because nobody really wants to be called nervous, use the words concerned or worried.
3. Address the issue that concerns them most first. A nervous client wants to know or wants an answer right away. If this isn’t possible then explain why it is not, and what you will do to find that answer as quickly as possible.
4. Assure them that their Pet is in good hands.  It’s amazing what these words will do.
5. Assure them that they aren’t the only one to go through this. Tell them it’s ok to be concerned, for this is a sign of a good Pet parent. I sometimes tell them a story about myself going through a similar situation and how I felt.
6. Make sure that you keep them super- informed of what is going on with their Pet.  A couple of hours can feel like 24 to a nervous client.
7. Nervous clients can quickly escalate to irate clients if they aren’t getting the outcome that they expected. Always explain all possible outcomes before they occur to avoid this.  Don’t sugar coat things just because the client is nervous – be honest and direct with the client’s concerns.  The worst possible scenario CAN happen.
8. And most importantly – do NOT get nervous yourself – this will make clients even more uneasy. I would be wide-eyed nervous if I had a fidgety, squirrely doctor talking to me about my precious little Pet.

Veterinary technology positions may be the closest things to a recession-proof career in the current economic climate with all the data recently coming from the veterinary industry. According to the US Bureau of Labor Statistics, the veterinary technology profession is projected to increase 36% by 2018.  The American Veterinary Medical Association Committee on Veterinary Technician Education and Activities (AVMA – CVTEA) currently has 170 accredited veterinary technology programs that they oversee.  There are 6 more new programs that AVMA – CVTEA is reviewing in 2010.  Twenty-one new programs are already on the schedule for review in 2011.  These programs produced approximately 4,302 graduates of associate degree programs and 279 graduates of bachelors degree programs in 2008/2009 school year.  However, there is still said to be a technician shortage.

Veterinary technician careers have expanded into many areas.  The government, private veterinary sector and various other industries have started to realize the huge knowledge base and skill set technicians have.  Veterinary technicians are hired in research, USDA/government, public health, animal control, zoos, wildlife centers, shelter/humane societies, meat packing plants, 4-H/FFA/Agricultural, herd health and production, artificial insemination labs and facilities, rehabilitation (human and animal), human/animal bond therapy, animal behavior, nutrition positions and the list goes on and on.

The question of whether or not veterinary technology positions are recession proof for your career goals can depend greatly on many things.  There is a need for credentialed veterinary technicians in many areas of the profession as mentioned previously.  Yes, the most obvious vet tech needs are in the food animal industry and in certain geographic areas, but there is still much opportunity in general practice as well. Just check out Banfield’s career page for evidence! This is great news for those individuals who have their hearts in their work and love the profession and what they do.  

Credentialed vet techs can add enormous value to the practices they work for.  By completing an AVMA accredited veterinary technology program and passing the Veterinary Technician National Exam, credentialed vet techs prove that they have the ability to perform lab work, assist in surgery, educate and relate to clients, take radiographs, do dental work and more! This gives veterinarians and hospital managers an advantage in hiring credentialed vet techs, since they have an almost guaranteed knowledge base and skill set.  Having this education can also give clients a sense of security knowing that their Pets are being taken care of by someone who has been formally educated in caring for Pets.

Clients have changed throughout the years. They are not just dependent on animals as a means for making a living, etc. Animals are a part of our families. Although some of the greatest need for credentialed vet techs is in large-animal practice, the growing popularity of Pets ensures that credentialed vet techs can find a career in small-animal practice. We depend on Pets to be there for us when we get home, when we are afraid, when we are alone.  Some of us depend on them for us to succeed in this world as being our eyes, our ears, our guardian angels.  Others depend on them as their partners at work (police dogs, search and rescue dogs, research animals, etc).  They are always there for us when we need them and because of these reasons and many more, we want to do everything we can do to make them happy, keep them safe and healthy, and be able to go that extra mile in times when they are sick, getting older or in times of need (broken bones, etc).  These things do not go away with the recession and neither does the compassion and love we have for our animals and Pets.

The veterinary technician career recession proof?  I say yes it is about as close as you can get!

I remember my first day as a Banfield veterinarian well, and frankly, I was terrified! It was my first day as a vet. I walked into the hospital all the while thinking that veterinary school had prepared me for everything I would ever need to know – that I was equipped to deal with the adisonian crisis, the mucoceole and the pyometria. (And months into the job I think I finally may have seen one or two of those cases.) The patients that I did see on the job were the ones that weren’t clear cut—that didn’t have a definitive diagnosis.  That was how I started to learn about what life was like outside of the ivory tower of veterinary school. I thought I had all the right answers, but sometimes I needed to have a little guidance when it came to everything that wasn’t clear cut.

That’s where my mentor doctor came in. My mentor encouraged me to use all the skills that school had equipped me with while adding in her dose of real-world practical experience. Whether I had questions about something crucial or trivial—she was there. When I was having a minor panic attack in surgery—she was there. And when I needed someone to reassure me that I was giving the right dose of a medication—she was still there. Not only was my mentor doctor there to help guide me when I needed advice, but she helped build my confidence and set me on the path to becoming a great doctor.

Looking back, I realize now how crucial my mentor was in those early days. I thought I had all the answers, but I didn’t.  I’m really glad that Banfield’s Mentorship Program afforded me such a great mentor to answer all my questions and help ease my transition during my first few months as a practitioner.

As more evidence is generated on the topic of Pet overweight/obesity, there is now little debate that this is a major health issue for our Pets in the US – the latest research is revealing alarming statistics. In fact, the prevalence of canine obesity has been reported at between 22.4 and 44 percent and between 19 and 52 percent for feline obesity ^(1-6)!

Over the next few months, the BARK team will focus on the on the topic of Pet overweight and obesity.  They will be conducting additional research on this health topic by evaluating trends and identifying risk factors associated with Pet obesity.  Their aim is to use the findings to better equip doctors with concise, succinct reports that enhance risk communication with their clients.  Since the goal of evidence-based medicine is to enhance clinical expertise in concert with consideration of patient needs and client circumstances, the BARK team will develop evidence-based tools to provide to Banfield hospital associates. For instance, client talking points will be written to incorporate evidence that PetNurses can use to educate clients on the dangers of having an overweight Pet. To integrate with the rest of the veterinary community, this research initiative will also include publishing a Critically Appraised Topic (CAT) report, an exhaustive literature review (quarterly white paper) and results from these studies will appear in future blog postings on this site.

As a veterinarian, how are you addressing this epidemic in your clinic and how do you think we can address the under-diagnosis of overweight and obesity?  What questions do you have and want to see answered regarding this health topic?  How do you educate clients on the prevention of overweight/obesity in their Pets?  Post your inquiries here and we may pick yours to answer by leveraging our nationwide medical e-record database.

If you’d like to subscribe to the Banfield Applied Research and Knowledge (BARK) quarterly white paper, email us at bark@banfield.net and include SUBSCRIBE in the subject line.

1. Burkholder, W.J. and P.W. Toll, Obesity, in Small Animal Clinical Nutrition,4th edition, M.S. Hand, C.D. Thatcher, R.L. Reimillard, P. Roudebush, M.L. Morris, and B.J. Novotny, Editors. 2000, Mark Morris Institute: Topeka, KS. p. 401–430.
2. Hill, R.C., Conference on “Multidisciplinary approaches to nutritional problems”. Symposium on “Nutrition and health”. Nutritional therapies to improve health: lessons from companion animals. Proceedings of the Nutrition Society, 2009. 68(1): p. 98-102.
3. McGreevy, P.D., et al., Prevalence of obesity in dogs examined by Australian veterinary practices and the risk factors involved. Veterinary Record, 2005. 156(22): p. 695-702.
4. Lund, E., et al., Prevalence and risk factors for obesity in adult dogs from private US veterinary practices. International Journal of Applied Research in Veterinary Medicine, 2006. 4(2): p. 177-186.
5. Lund, E., et al., Prevalence and risk factors for obesity in adult cats from private US veterinary practices. International Journal of Applied Research in Veterinary Medicine, 2005. 3(2): p. 88-96.
6. German, A.J., The growing problem of obesity in dogs and cats. Journal of Nutrition, 2006. 136(7 Suppl): p. 1940S-1946S.