Following the nutritional assessment, interpret and analyze the information that has been gathered to devise an action plan. Consider the following:

Animal factors

1. Evaluate the animal's condition with respect to the current food intake. Estimate current energy needs. For inpatients, RER may be estimated using any of a variety of published formulas. For outpatients, either label recommendations or a formula may be used as a starting point. These are just population-based starting points for energy requirements, which can vary by 50% in either direction for cats, and by 30% in either direction for dogs (particularly with the MER).³⁶ These levels are further influenced by life stage, activity and environment variables.
2. Create a monitoring plan. Teach the client to monitor BW, BCS and/or MCS as appropriate. Adjust intake as needed to match changing needs over time.
3. Adjust or include dietary supplements if necessary, recommending specific types and amounts.
4. A diet change is sometimes necessary. Preferences for and recommendations about diet transition methods vary, with no clear evidence showing any one method is superior. Clinicians should use and recommend techniques based on their individual assessment of client and animal. Some animals tolerate an abrupt change in diet with little problem, although some appear to have fewer GI issues when food is gradually changed over a 7- to 10-day period.

Diet factors

1. Determine if current amount and type of food is appropriate, based on life stage, lifestyle/activity, disease, body condition, concurrent medications and/or medical procedures.
2. If diet factors are determined to be inadequate, prepare a plan for food and treats that provides appropriate calories and nutrient intake for the animal.
3. Consider other food sources in total intake recommendations if necessary.
4. Recommend a specific feeding plan that incorporates pet food, treats, table food, feeding method, frequency and location.

Feeding management and environmental factors

1. Determine any changes in feeding management and any necessary environmental changes.^37,38
   1. Whereas some dogs and cats can maintain good body condition when fed free choice, others require meal feeding of appropriate amounts to maintain good body condition.
   2. Confirm the use of an appropriate food-measuring device (e.g., an 8-oz measuring cup), and provide food in measured amounts (whether feeding free choice or meals).
   3. Management changes may include provision of feeding toys, and reducing conflict and competition for food.
   4. Environmental enrichment may include increased opportunities for activity (play, exercise), as well as efforts to decrease perception of threat from other animals (as well as humans) and reducing the frequency of unpredictable change in the animal's environment.
2. Create a plan for hospitalized animals.
   1. Create a monitoring plan and a feeding plan as discussed under "Animal Factors" and "Diet Factors."
   2. Offer usual and favorite ("comfort") foods if at all possible to promote food intake. Avoid introduction of novel diets intended for long-term feeding to avoid the risk of inducing an aversion to the diet. A food aversion is avoidance of a food that the animal associates
      with an aversive experience.
   3. The optimal route required to achieve nutrient requirements should be reassessed daily, and may include:
      1. Voluntary oral feeding.
      2. Coax feeding — small changes, such as warming the food, taking the animal to a quiet area for feeding, having the owner feed the animal or stroking the animal while eating, can enhance food intake.
      3. Syringe feeding (be careful in animals with any nausea or who are stressed, as this can induce food aversions).
   4. Other nutritional support techniques will be required for animals that have not eaten sufficient amounts by the aforementioned routes for 3-5 days (this includes the time of reduced appetite at home before hospitalization), and are not expected to resume reasonable amounts of food intake prior to further compromise of their nutritional status.^39,40
      1. Use a feeding tube with animals that are not eating adequate amounts voluntarily. Use parenteral nutrition with animals that have gastrointestinal dysfunction or in animals whereby enteral feeding has increased risk of aspiration.
      2. Evaluate closely and watch for complications associated with the route of nutrition used, particularly with recumbent or neurologically impaired animals.
3. Create a plan for non-hospitalized animals.
   1. Create a monitoring plan and a feeding plan as discussed under "Animal Factors" and "Diet Factors."
   2. Clearly inform the client of the recommended feeding management factors to ensure success. The client is part of the decision process and implementation of the specific action plan.
   3. If obesity is present, provide a comprehensive plan to modify the environment (e.g., exercise, behavior modification and/or prescription weight control medication).
   4. Create specific schedule for:
      1. Follow up via telephone to elicit questions and verify compliance/adherence to recommended feeding management or environment changes.
      2. Repeat examination/assessment.
4. Consult with a specialist or refer any time one feels unqualified to take action and monitor an animal [Table 3].