b. Weight Loss Program*

To see the full weight loss program offered at Beechwood Animal Hospital click on Weight Loss Program This section includes information that veterinary regulations only permit to active clients at Beechwood Animal Hospital

The weight loss program was developed to be run under veterinary supervision by hospital animal technicians (RVTs) to help pet owners, in a big-brother, big-sister fashion,  to get their animals to a healthy ideal body weight. This improves pet health (less morbidity); mobility and studies have shown possibly 2 extra years of longevity!

Body Condition Score (see chart) *BCS as defined in our program

3/5   = ideal body weight (-4% to +4% overweight*)

3+/5 = 5% to 14% overweight

4/5   = 15   to 21% overweight

4+/5 = 22   to 29% overweight

5/5   =   30 to 44% overweight

5+/5 =     >45%  overweight

Brief Program overview (all included in price) 

  1. Introductory  Technician (RVT) appointments 2- 3 visits 20-30 min. each
  2. RVT rechecks for weights/ BCS/ diet calculation and adjustments etc. every 2-4 weeks (ideally in person but phone consults optional).
  3. Weight loss program is linked up to a rebound program to prevent rebound of weight when transitioning to regular diet.  Total duration <12 months.
  4. Veterinary supervision. The same vet and technician are committed to your pet’s program. The vet fills out a supervisory form at 3, 6, 9, 12 and 24 months, reviews your pet’s file and discusses progress with your technician.

Please call us to enroll in either a mini introductory visit or to start the weight loss program. Put your pet on the healthy road to ideal body weight

Program Options:

1. Mini or introductory weight loss visit with a technician (Approx. $29, Dec 2011)

2. Full weight loss program (approx. $162, Dec.2011) * no charge for the mini visit if you pay for the full program the same day or within 1 week of the Mini visit.

3. Starting with a weight loss diet purchase and / or with Slentrol drug therapy with your veterinarian.

 Pharmaceutical Agents

 2 drugs now approved for obesity control in dogs
1. Dirlotapide (Slentrol)

           2. Mitratapide (licensed in Europe only)

Both block the assembly and release of lipoprotein particles in the blood stream. (microsomal triglyceride transfer protein inhibitors)

Human obesity researchers have used drugs that either are intestinal lipase inhibitors (e.g. Orlistat) or drugs that inhibit the re-uptake of the hormones noradrenaline and serotonin (e.g. Sibutramine) and have found in general a modest benefit:

-Increased weight loss by 4-6 kg over diet alone.

-Maintain weight loss by 2-15kg below a baseline level

-A range of side effects are seen with all medications which can limit the overall benefits                                                             

Slentrol

(Generic name:  Dirlotapide)

Type of Drug:  Microsomal triglyceride transfer protein (MTP) inhibitor

Mode of action:  Blocks the assembly and release of lipoprotein particles                        

This action appears to be local in the GI tract as the effects are not similar if the drug is given intravenously.  The assembly and secretion of chylomicrons by intestines are dependent on MTPs. Inhibition ofMTPdelays absorption of fats from the intestine. The drug insert states that the “…mechanism for producing weight loss is not completely understood, but seems to result from reduced fat absorption and a satiety signal from lipid-filled cells lining the intestine”. A second hypothesis is that the accumulation of triglycerides in enterocytes results in secretion of satiety hormones such as PYY and GLP-1, leading to a voluntary decrease in caloric intake. Future studies will likely define the mechanism.

Also, MTPis involved in secreting VLDL (lipoproteins made of apo-lipoprotein B- apoB) into the blood stream from the liver. The assembly of apoB-containing lipoproteins (VLDL and subsequently LDL) requires MTP.  This systemic effect is probably less with Dirlotapide then Mitratapide, but still is the reason it is contraindicated in cats due to fear of liver fat accumulation leading to hepatic lipidosis. 

Effects:    Prevents lipid absorption

                 Reduces appetite (satiety)

The effect of reduced appetite may avoid the need for diet change and may eliminate the negative behaviors (begging etc.) that can lead to poor compliance in weight loss programs.

Side Effects:

  1. Vomiting.

**Most common side effect. Vomiting is usually transient (self-limiting) when first starting Slentrol or when increasing dosages. Vomiting or diarrhea can occur episodic in up to 25% of cases.

2. Diarrhea or loose stools.  Usually < 2days

3. Lethargy usually < 2 days

4. Mood altering (uncommon/ rare) some reports (as in humans) that if cholesterol is lowered too much aggression or depression can occur. Slentrol can lower cholesterol, so it should be stopped if serious mood swings occur. However dogs can get MORE aggressive on calorie restriction too (often there is an underlying tendency already).

Anticipated results

Weight loss can be highly successful, but there is a predictable rebound once the drug is discontinued. It is only approved for a 12 month course.

It does not work on 100% of patients.  You need compliant owners to keep the kilocalories consumed low.

It could, or will likely take 3-4 months to notice a difference (especially on drug alone).

Hasn’t been fully evaluated clinically yet; however it has at least been evaluated in a multi-center veterinary school trial, with 70 dogs, and over 450 dogs in a practitioner-based clinical trial.   Mixed responses are out there:  some have really good responses, some slow and some no response after 9 months on Slentrol.

E.g. some dogs respond rapidly and have very little appetite while others maintain a good appetite throughout treatment, yet lose little weight. Others gain weight despite best efforts.

Some have said to stay on regular food as the drug may work better with a “fatty meal”. Fatty meals may allow for more accumulation of fat in enterocytes leading to satiety signals to the brain (as above). Unfortunately this approach has no regard to caloric intake and no long term outlook for the predictable rebound after 12 months with this drug. For this reason we don’t recommend it unless you feed regular food for the first few months of the weight loss program (3-6 months) and then use a reducing diet after that.

Be aware that there will likely be a weight plateau at some point. If you haven’t reached the goal weight don’t give up. That plateau may last for several months. It is not uncommon to take a year of use to see good weight loss. It is NOT a quick fix. 

 Risks and Contraindications:

– Safety in breeding, pregnant, or lactating dogs has not been established. Caution should be taken when considering any weight loss program in growing dogs, including treatment with SLENTROL.

– Has not been evaluated in dogs less than 1 year of age

– All dogs should undergo a thorough history and physical examination that includes laboratory tests to screen for underlying conditions. Pre-existing endocrine disease, including hyperadrenocorticism (Cushing’s disease), should be managed prior to use of SLENTROL.

– May produce a mild to moderate elevation in serum hepatic transaminase activity. If the elevation in alanine aminotransferase (ALT) activity is mild, continue SLENTROL and monitor as needed. If there is a marked elevation in ALTactivity above the normal reference range, or there is a simultaneous increase in aspartate aminotransferase (AST), alkaline phosphatase (ALP),  gamma glutamyl transpepidase (GGT), or total bilirubin, discontinue treatment with SLENTROL. Elevations in hepatic transaminase activity usually decrease when SLENTROL is discontinued.

– The safety of SLENTROL use in dogs has not been evaluated beyond 1 year.

– Contraindicated in cats – concern of liver fat accumulation leading to hepatic lipidosis (a commonly fatal condition)

– Must not be used in humans: The FDA warned that humans who consume Slentrol might suffer abdominal distention, abdominal pain, diarrhea, flatulence, headache, nausea, and vomiting.

– May transiently lower fat soluble vitamin (A, D, E & K) absorption in the first 6 months. It levels off then returns to normal once the drug is discontinued.  There was no effect on prothrombin bleeding times, or no clinical signs of abnormal homeostasis in the 12 month drug evaluation trial.  Transient low vitamin absorption is insignificant for dogs on normal commercial dog foods but because home-cooked foods often have inadequate vitamin content, especially vitamin E, home-cooked diets are not recommended during Dirlotapide use.

– Dirlotapide is not recommended for dogs with liver disease.

– Dogs receiving corticosteroids such as prednisone, dexamethasone, depo-medrol or others, will have a harder time losing weight. Some say Slentrol may be contraindicated or at least not recommended (controversial) when the pet is on corticosteroids, others specialists do not see are real contraindication.

Dose Schedule:   

A starting Dirlotapide dose is first prescribed. Give medication orally once daily. Package insert lists a maximum daily dose of 0.2ml/kg. 5mg/ml is the bottle concentration.

0.01 ml/kgPOq24h x 14 days, then 0.02 ml/kgPOq24h x 2 weeks. If needed, increase dose volume once every 30 days by 50% (1.5 times) of the prior month’s dose to maintain a target percent weight loss of 0.7% per week (3%/month). At no time should the maximum daily dose exceed 0.2 ml/kg.

This monthly adjustment is based on the drug alone. We could increase the drug faster if everything else is in place to reach target weight loss rate.

Overdosing:  One time over ingestion (chewed bottle) should only cause GI signs if anything.

 

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