Perceptions and our pets

I'm on a roll with thinking about body perceptions and how we perceive them. This next post is about how we view body image in our four-legged friends. Yes, I know this may sound odd, but again, I'm wondering if those of us with body image issues have a different ideal for our pets than the rest of the population. Are we able to distinguish between thin, normal, overweight, obese in our pets? Are we more vigilant about our pets' health even though we compromise our own? I'm seriously not trying to dumb anyone down, so I hope these questions aren't offensive. They really do have a point.

Recently, my boss loaned me her back issues of BARk magazine, a magazine of modern dog culture. It's actually a fairly interesting magazine with a wide variety of topics. In this 2006 issue, it discussed canine obesity and how it was mostly a human perception problem. According to this article, 34 percent of dogs are overweight but only 30 to 40 percent of their human caretakers realize it. This 2005 study about the prevalence and risk factors for obesity in dogs and cats (may have been the same one the article used) also said how vet practitioners commonly underreported animals who were overweight or obese.

So how are pets assessed for obesity? Well, since there isn't a BMI calculation, it becomes more individualistic. At times, it is obvious to see the body condition of an animal and tell whether it is too thin or overweight. However, if there is a lot of fur, this can easily deceive the pet owner. The standard measurement is to check their bodies around the ribs. An ideal pet has a small layer of fat over the rib bones, however, the rib bones are sufficiently felt. Usually , a "waist" is also easily visible. Pets who on the thin side can have rib, spine, or hip bones easily felt since there is no fat. Pets who are overweight or obese, none of these can be felt without some pressure.

Like humans, there are various reasons why pets gain weight. Genetics of certain breeds, reproductive status (spayed and neutered), hormones, and their human/canine lifestyle (think lack of exercise for many companion animals) are all reasons for weight gain. In reality, it's quite amazing how much our four-legged friends resemble many of the same characteristics as humans, including similar diseases like diabetes type 1 and 2, cancer, hypothyroidism, Cushings's, disease, etc. In animals who are overweight or obese, problems such as osteoarthritis, respiratory, cardiovascular, and dermatological can occur. Some studies have also shown a correlation with high body fat mass and longevity in dogs. (AVMA collections of obesity)

As the reports of obesity in pets has risen over the years, new weight loss products have come onto the market. Slentrol which debuted in 2007 was the first to be approved by the FDA. The key mechanisms are reduced appetite and fat absorption. Though this is the only actual medication for dogs and obesity, there are other products labeled as "natural" to help your pet. lose weight. I'm sure, just like humans, there will be other drugs researched as well. Although I have not heard of gastric by-pass surgery for pets, there are people who have actually asked about it! It's kind of a scary thought.

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Now, that I've given some background information, let's look at human perception versus dog perception. Something funny that Dr. Marty Becker, a well known veterinarian, said in an article for The Whole Pet was,

"No pet is going to catch sight of himself in the mirror and see that hairy derriere and say 'That's it! No more Scooby snacks for me!' There is no canine bikini season, and they don't try to get into last year's jeans and find they don't fit."

Animals for the most part do not have an image problem like humans do.One question I've seen asked is if animals can be anorexic? Yes, anorexic in the medical sense of losing appetite. The nervosa part, however, is not obtainable.

In most cases in terms of eating, it's about survival. There's the line, "dogs eat to live not live to eat." For the most part, it's true, although sometimes I question it as some dog sand cats do appear to live to eat. For some if they could have as much food as they wanted sitting right in front of them, they would eat it in a heartbeat and not think about it or have "guilt-associated" feelings with it. For many, the time elapsed between eating too much and an actual ill event is too long to make an associative cause since they do not have a "conscience." Whenever I think about this, I am reminded of one of my own dogs who ate five pounds of chicken in a sitting or two pounds of organ meat in less than five minutes or the dog I knew who ate over a pound of candy, then suffered an allergic reaction, only to still eat its dinner twenty minutes later. All of them looked like they had a "guilty" feeling, but in reality, it was only because they didn't feel well, or they reacted to their human. In the case of my own dogs, I was pretty upset with them.

So where am I going with this? As I posed the question earlier about whether those of us with body image issues are more vigilant about our pets' health, do we perceive the same thing as the average, normal dog/cat owners? Are we different? Are we more sympathetic to an animal who may be underweight or overweight? I guess I'm asking these questions, because I think of myself and how I perceive my own dogs and the animals I have cared for over the years.

In the almost eight years now that I've worked in a kennel environment, there have been a variety of sizes, breeds, and ages that I've seen. Many have been normal weight, well taken care of, some underweight, and others overweight. In the cases where dogs were underweight and overweight, I do ask their owners whether they realize this (it's of course in a polite way) and how much food they are giving their dogs. Some owners do realize this, say they've tried getting them to lose weight/gain weight to no avail, others have tried different foods, and still others are truly oblivious to the problem or dare I say it, they will tell me their vet said the dog looked fine. I've seen it where you can practically count the number of vertebrae on the spine, or where there is no "waist" in a dog, and that is okay? I've often asked myself how a professional could not see that? But then again, I question my perception at times since my view tends to be skewed.

I remember another case of a dog who hadn't been boarded in three or so months. When she came, I was absolutely shocked at her appearance. This was a dog who normally was about five or so pounds overweight and supposed to be a show dog even though she was already six years old. The dog had probably lost a good twenty to twenty five pounds. She was so thin it aged her in that amount of time. Her face was sunken, her ribs and spine could be counted, and she was so cold, needing a sweater in the fall, typically the season most dogs enjoy. I did inquire about what happened, and the owners only said that she was being trained some place in FL, and that they were being more strict with her food, not giving table scraps and such. I told them my concern and thought she needed labs run. I honestly don't know whether they had the labs run or not. I do think that they maybe realized there really was a problem. Now, she is at the appropriate weight where she should be at which is a good thing.

Another case on the opposite spectrum is my dad's wife's dog. C. is a shih tzu-poo. He weighs in at something like 35 or so pounds. He is by standards way overweight. After realizing that the early influence of his weight was their own fault--many many treats were given, they cut back and gave healthier options. They also realized his weight was a problem when he could no longer enjoy long walks with them and his stamina was much lowered. They tried reducing his meals, they took him to an endocrinologist to have labs run as well as their vet. His thyroid was borderline, the Cushing's Test turned out negative, he had some liver problems, and he had arthritis in his knees. One specialist said he just had a "fat economic" gene, so he couldn't lose weight. They also tried swimming, but everything was to no avail and now they've just given up. Sure, he's a happy dog, but it is obvious he can't keep up with his two housemates.

Another case is with one my mom's dog who is a king charles cavalier spaniel. L. turn three this December I believe. Last year she had some knee issues. It turned out to be a luxating patella (kneecap moves in and out of place) which was more than likely genetic. The vet wanted to do surgery, but L. weighed in at somewhere between 22-25 pounds. She wasn't grossly overweight, but enough that the vet did not want to do surgery until she got her weight lower. He decided to put her on slentrol. The first few months, she didn't lose weight but probably gained instead. My mother said it was more due to the fact that she received so many treats. The treats were a way for her to stop barking at her dad when he wanted to play a computer game instead (similar to the kid who wants something, and in the end the parent gives in and gets them the item). L. also likes food a lot and will shove her way past the other 3 cavaliers to try to eat their share as well as intimidate one while she eats her food. An additional few months later, L. did lose some weight. My mom, however, said she was really wasn't sure whether it was the medication or just the fact that they had reduced her treat intake. She did notice that L. felt better, and they are now adding some exercise.

None of these people have eating disorders, though a few do have body image concerns, and one I'd say has BED. Still though, many didn't perceive their pets to have a problem whereas I noticed these things right away. Is it the fact I work with dogs everyday or that I'm more attuned to what a dog should look like? Or are my perceptions clouded by my own experiences?

I do remember one client who actually mentioned she had recovered from an eating disorder and had taken in a stray dog. She was concerned about her eating, saying she once knew what it felt like to starve and didn't want the poor dog to feel that. The dog was in no way overweight, but could it have been if her fear of not letting the dog starve got in the way of what was healthy for the dog?

I hope this post doesn't offend. It's just something I've thought about through my observations of dogs and their people. I think for the most part humans love their pets. There are countless things our four-legged companions do for us., but we, as their caretakers, do need to ensure their safety, health, and well being on all levels physically and emotionally.

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On a completely different note, this story recently surfaced with a man being charged on cruelty for allowing his dog to become obese.
Another case last week showed a cat, now dubbed "Prince Chunk" who was found homeless in NJ. (owner's house was being foreclosed) The cat is obese weighing just short of 2 pound on the Guiness Book of World records. The cat has been vet checked and is okay and will be adopted out. The sad thing is that so many people want to adopt the cat since seeing it on television, forgetting about all the other homeless pets out there that need a home.

Perceptions and body image

I've been thinking about body image and perceptions lately. We all know that many of us who have/had eating disorders more or less have a skewed perception of ourselves. Much of the time we can't see how others perceive us. Someone may say we are thin when we think/feel the complete opposite. Or maybe not even think fat but that we need to lose weight, etc.

I've often wondered how/if our perceptions of what is thin/fat has changed compared to other people who have not had eating disorders. Is our definition different? Do we tend to think that someone is too thin whom others would consider "normal?" Or someone whose definition of fat we consider "normal?" Are we just more sensitive to the rest of the general population biased by our own experiences?

In a recent BBC article, it said that adults (Britons) misjudge weight problems. According to the article, just over half (53%) were overweight or obese with only 75% identifying themselves as overweight. This was opposed to 1999 when 43% were classified as overweight or obese and 81% identified themselves that way.

One of the researchers in this article made a few interesting points in that the idea of "normal" for what is considered overweight may have changed. Another factor was that the media often showed those who had very high BMI, thus making people think only if they reached this size were they overweight. Hmm, does this all sound familiar but switch overweight to "thin" and high BMI to "very low BMI?"

I guess I'm just wondering what other people's thoughts are about their perceptions of themselves and other people in terms of body image. For me, I do think having dealt with eating disorders has changed my definitions of the various spectrum of sizes of people. I know I'm more sensitive to any type of body image talk whether it be someone who is too skinny to someone who is obese.

However, yet, at the same time, I can also see the viewpoint of healthcare professionals, though they have unfortunately exaggerated the "epidemic." My opinion is that this would not have been considered had the BMI guidelines remained the same. This article in the Washington Post discussed the possible repercussions when the changes were first made to lower the overweight threshold from 27.8 to 25. I guess I wonder what would have happened if things had been left alone. Would we really be talking about this "obesity epidemic?" And again, how would that have changed how we perceived what is thin/normal/overweight?

Let's check out the bug

Just checking out the latest beetle which waltzed in from outside. I love the fact that I can take this type of photo without there being a chomp, chomp of the bug that I've seen a number of dogs do. I also love the simplicity that a dog has from something as simple as looking at a bug or a leaf or even a grape for that matter!

On a side note, though you can't see Baxter's eyes, those white eyebrows are just a reminder of that he too is getting older. :sigh:

Disappointed...but I'm okay

In a recent post, I talked about my upcoming visitor. Well, I talked with him last night--everything was set. We were going to meet at a restaurant in town, then hang out tomorrow together.

Then, this morning, he called and said he was not going to be able to make it. Later, in another phone message, he said it had to do with money and getting into an argument with his sister.

I was really disappointed and quite bummed to say the least. Even though I was nervous and had anxiety, I was really looking forward to meeting him. Oh well. I hope there is a next time. I guess the good thing out of all this is that my place is nice and clean and everything in order. Not that it wasn't before, it just kind of forced me to straighten things up.

Anyway, I refuse to let this get me upset and revert toward ED thinking of "it's me that is the problem" and that is why he really didn't come. You know how all the ED stuff can play with your mind.

Tomorrow, I'm hoping to sleep in. I just really need a day to rest after working so much the last two weeks.

Olympics, athletes, eating disorders, and the anxiety connection

As the Beijing Olympics near, the issue of the various aspects of sports is often discussed. Everything from the athlete stories (there are usually some very inspirational ones) to doping charges (no Olympics is ever filled without any) to what athletes are wearing (the buzz is on the new skin tight, fast swimsuits and running shoes) to eating disorders (though that one isn't as publicly mentioned).

In today's Telegraph from the UK, Susan Ringwood, the chief executive of BEAT, a UK charity which helps those with eating disorders, said that up to 40% of the female athletes at these Games could have eating disorders. She said, "there is increasing pressure on female athletes to not only perform well, but also to look good." The obvious sports where this would likely be more apparent are gymnastics, diving, and swimming.. However, other sports to consider would be rowing,, track and field, especially long distance running, equestrian, cycling, and wrestling. I'm sure there are others, those are just the ones I can think of off the top of my head.

Ringwood also made the point how it can be difficult to determine whether an athlete has an eating disorder when they already carefully control their food intake and exercise. She asked, "Does someone have a body like that because they want to win a gold medal, or because they would feel useless and disgusting if they looked any different, and want to have some emotional control?"

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I recently read a brief interview in People about the swimmer Dara Torres and her bout with bulimia. If you don't already know, Dara is the 41-year old swimmer who is making headlines going into her fifth Olympics with a good shot at winning the 50m freestyle. She went through a five year battle with the disorder, including at the1988 Seoul Games where the number one ranked female swimmer in the world finished seventh. So depressed after that, she retire from the sport all together. Eleven months prior to the 1992 Olympics, she knew she had to end her bulimia if she wanted to do well. She amazingly stopped "cold turkey" and has since then been recovered. Here is one article where Torres and a few other swimmers who also went public with their eating disorders talk in depth about their struggle.

The connection between elite athletes and eating disorder is now new. There have been a number of studies explaining the higher risk for disordered eating/eating disorders in certain sports as mentioned above. Last week, a new study in the International Journal of Eating Disorders showed that women who participate in a high level of athletics and have sports anxiety are more at risk for eating disorder symptomology. This is a significant study, because it looks at the factor of anxiety which has been linked to eating disorders.

So as the Olympics is only a week away, I can only imagine what some of these athletes may feel. While there is the thrill of making the team and representing their country, there is also an enormous amount of pressure which some will succumb to well and others may not. For some, the medal will make the difference in their own lives as well as their families.

Those with sports anxiety and/or eating disorders/disordered eating may have a harder time if they are constantly worried about both their performance and how they look which we know is always just the surface issue. However, in some sense, how can they not be? They have the whole world watching them, cheering them on for their victories, yet recounting every misstep too. For some athletes, this will definitely be "16 days of glory," while for others it may be "16 days of agony." Okay, I'm being dramatic here, but you get my drift. It's a lot of pressure from all realms and is a real test to both the body and mind.

Related posts: The female athlete triad
Olympics, gymnastics, and mentality

Anti-depressant prescriptions increase

According to US government, prescriptions for anti-depressants have increased over the last three years. The Agency for Healthcare Research and Quality spoke with people in-persona and over the phone who had received anti-depressant prescriptions. The interesting finding is WHO wrote the prescriptions.

29% of prescriptions were filled by psychiatrists (physicians who specialize in mental health disorders)
23% were from general practitioners (physicians who provide general care and are specialty trained)
21% came from family practitioners (physicians who provide primary care and completed a family medicine residency)
10% were from internal medicine specialists (physicians who focus on diseases in adults and have completed an internal medicine residency)

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When I think about this report, there are a few things that run through my mind. First, it's a good example of how there is a growing trend in primary care physicians treating mental health disorders. I think it is good in some sense that people are going to their primary care physicians for all aspects of their health (just getting people to go is a good things), however, at the same time, many primary care, general/family practitioners do not have enough knowledge in mental health disorders to really know which medication to dispense as there are often a lot of factors involved. I'm sure there are many general/family practitioners who continue their medical education, but it's hard to say the exact number.

The other problem with primary care physicians treating mental illness is that many patients do not follow up with their physician to make sure they are not having side effects or that the medication adjustment is correct. Of course with personalized medicine, in the future, tests may be on the horizon to eliminate some of the guesswork of which medication to prescribe.

This report also reminds me about the few instances when I saw a nurse practitioner. Usually, I was going to some other ailment and the depression/eating disorder would come up as an aside. I'd tell her how I was feeling, and then she'd ask me what I'd like to try as if it was candy. She mentioned wellbutrin once, but I told her no since it was contraindicated with those who had bulimia. She did not know this fact and would have easily prescribed it to me had I not piped up at all. I had told her I liked to stay current on eating disorder research, and her reply was that I'd know better than she would about these things. While it's true I certainly like to think of myself as an informed consumer, I really thought the wellbutrin/bulimia contraindication was just a well known fact.

You may wonder why I didn't see a psychiatrist at the time. I probably fell into what other people have--not really finding the mental health side of me that important and seeing my regular, convenient doctor for another ailment with the happen to bring up the depression/eating disorder. Plus, I liked my nurse practitioner, I just know now not to go to her if I want to really talk mental health.

I think this is another reason why more general practitioners are filling prescriptions. Many people want the convenience of an all-in one stop shop. However, with mental health, I do think we all need to think about it more closely. That and general, family, and internal specialists continue their education in the world of medications. It's not a huge part of medical school, so it truly is important for them to stay on top of the research. In the end, it makes for better health of the patient and more knowledge for the physician.

Pharmacogenetics and depression

A few weeks ago, the Mayo Clinic recently published a new study on phamacogenetics (the study of how people's genetic makeup affects their response to medication) and depression. Researchers genotyped DNA from 1,914 individuals from a sample of the Star-D study (Sequenced Treatment Alternatives to Relieve Depression Study), a seven year study that analyzed treatment of depression in adults. In this particular study, they looked at the serotonin receptor gene, SLC6A4, and the likelihood to respond to the anti-depressant, citalopram (celexa). The results showed that there are two variations in the gene which determine who may respond to this anti-depressant.

The researchers also investigated among racial populations of white, black, and hispanic individuals. They found only the white patients with the two distinct variations in gene were more likely to have remission of depression symptoms as compared to the other two groups.

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Personally, I find pharmacogenetics really fascinating. It's essentially an extension of personalized medicine. If you have read this blog before, you know I'm a big advocate of this. I talk about it in this post awhile back with rEEG and eating disorders. There's just so much out there that we don't know about the very nature of our own human genetic make-up--what works, what doesn't, etc., but we continue to learn everyday new discoveries for implications in a variety of disorders. The chairman of the Mayo Clinic, Dr. Mrazek, sums it up nicely in regards to this study.

He says, "Each step is a step toward greater accuracy in prescribing the right medication for each patient. "First, we started with trial and error - which feels like flipping a coin to select a medication. The Holy Grail would be to be able to consider the implications of variations in many genes. Ultimately, we hope to be able to determine with great accuracy which patients will respond to specific antidepressants and which patients will almost certainly not respond."

He also estimates that within two years there will be more extensive tests available which will focus on more than one gene. I guess this is a stay tuned for now to see what new research will emerge.