HEALTH + NUTRITION CPD – JANUARY 2026

What makes a nutritional consultation successful?

By Dr Katie Williams on behalf of ENFAR

Discussions between feed advisers and horse owners can occur through a variety of media in the modern world. Some forums restrict the amount of detail it is possible to go into but when time and space allow, how do we ensure we’re getting the most from the opportunity to inform and educate so that ultimately, we’re benefiting equine welfare?

In this CPD, we explore the different elements of what makes a consultation productive and a positive experience for all concerned.

What success looks like in a nutritional consultation does of course depend on your frame of reference. We must decide if our objective is to signpost the customer to a suitable product and consider it job done if they purchase it or, are we going to review the complete diet, provide a feeding plan highlighting areas of concern and make recommendations relating to management as well as diet?

The BETA Equine Nutritionist & Feed Adviser Register (ENFAR) has been launched to recognise those who take the latter approach and think about a horse’s care holistically.

Why is good advice important?

Nutrition related issues are prevalent in the equine population with levels of obesity regularly cited to be between 21-45% (Durham et al., 2019) and gastric ulcers at up to 90% of performance horses (Sykes, 2015). These issues have not gone away despite unprecedented levels of information and guidance publicly available.

But in an era when we’re all bombarded with messages, adverts and advice, it is no surprise that horse owners find it hard to know who to believe or trust. In studies carried out in small animal vet practices, researchers found dog owners interested in nutrition typically gathered lots of information, became confused and arrived at their vets with detailed questions on physiology, nutrition and pseudo-scientific statements that many veterinary practitioners couldn’t answer (Bruckner and Handl, 2021).

This certainly occurs in equine nutrition too, with much of the misinformation that circulates seeming plausible and hard to counter without a high level of specialist knowledge. In addition, those adhering to regulations, particularly in relation to product claims, find it hard to make legally marketed products sound as good and effective.

So how do we address this? Well,firstly it is important to know your remit and recognise when others are crossing the line into making medicinal claims. Sharing this with the horse owner is important; they need to know that a company or person is not operating legally. As nutritionists and feed advisers we can’t treat, cure or prevent disease, but we can give advice on nutritional management to maintain health and to do that we need to understand how any clinical conditions influence what the horse should or should not be eating.

Our advice to the horse owner is likely to be more exacting if we know the horse or pony has had an issue in the past or is experiencing other risk factors currently that make them more vulnerable to an issue. The key point here is that we need to know that all-important information about the horse to be able to advise appropriately and it is our ability to take a good case history that determines whether we find out what we need to know!

Asking the right questions

Conversation analysts John Heritage and Jeffrey Robinson explored what happened when doctors changed just one word in a question in consultations. Patients were frequently leaving appointments without voicing all their concerns resulting in reports of dissatisfaction and inefficiencies.

Recognising this issue, medical students were being taught that after discussing the initial problem the patient highlighted to them, they should ask, “is there anything else we need to take care of today?” Knowing that questions containing the word “any” typically receive negative responses, Heritage and Robinson asked one group of doctors in their study to switch “any” for “some” i.e. “Is there something else we need to take care of today?”.

That small change showed a statistically significant uplift in reported concerns and highlights the importance not only of what we say, but how more specific and perhaps direct questions will elicit the information we need for a consultation to be more productive.

Structuring a consultation

So how do we go about structuring our interactions so we give ourselves opportunities to ask the right questions?

The Roter Interaction Analysis System (RIAS) (McHale, 2019) has been used to evaluate communication processes relating to weight management in medical consultations but it can be useful when applied to other consultations too. It divides the interaction to see how much time clinicians spend on each of the four tasks considered to be essential elements of clinical appointments (figure 1).

Data gathering - is essentially where we’re asking the horse owner all the questions we need to be able to obtain Refer to Table 1 for more detail.

Education & counsel – this refers to the advice and guidance we give to the horse owner. Studies have shown that the informativeness of communications, clarity of recommendations and the degree of collaborative decision-making with patients in treatment-related and health management discussions are all associated with positive health outcomes (Stewart, 1995).

Active participation - this builds on the previous point that working with the customer is key to overcoming barriers to implementation of recommendations. There has been a move away from a notion of customers and clients as passive consumers or recipients of services (Hopwood, 2017) and getting them to buy-in to what needs to be done to effect change is an essential component of any consultation.

Relationship building – potentially the hardest part of all especially when time is limited and if there is limited prospect of any further interaction with the horse owner in the future.

In medical consultations, the professional’s ability to empathise with the client is often measured. The CARE system (Mercer et al., 2005) is a patient questionnaire based on a broad definition of empathy. The questions ask patients how their doctor made them feel, whether they took an interest in them and demonstrated they understood their concerns.

There’s a lot we can learn from the questions in terms of how we conduct our interactions with clients, especially if they have a poorly horse or pony. However, an important point to note is that much less is known as to whether a pleasant or positive interaction with a professional is any more or less likely to mean someone will act on their advice.

We also have to be careful not to fall into the trap of evading difficult subjects such as obesity. Avoiding a bad review on social media is often cited as a reason for treading carefully when raising subjects that the customer might not want to hear; but if we don’t highlight that a horse is overweight to a customer for example, we are never going to succeed in addressing wider welfare issues on a population scale. This isn’t just an issue for feed advisers; veterinary professionals have the same challenges and social scientist Tamsin Furtado has written and presented widely on this subject (Furtado, 2020).

Ultimately, when a customer, client or patient has sought advice, the key is that they feel they have been advised by the end of the consultation. If they leave the interaction none the wiser or having to interpret information for themselves, it can’t be considered a successful consultation. Being able to give good advice also requires the professional to keep up to date with the latest information and that is why continuous professional development is so important.

Even if we’ve been advising horse owners for many years, there is still much we can learn about human behaviour change. BETA ENFAR has many aims but one of the most important is to promote the importance of keeping up to date with the latest thinking and consensus amongst nutrition professionals. However well we do our data gathering, if the advice we give is outdated then it cannot be considered a successful interaction.

There is also a temptation to participate in CPD that is most obviously relevant to your role (May, 2019) but actually, CPD that promotes some ‘outside of the box thinking’ can be very valuable so don’t dismiss things because they don’t appear to be relevant at first glance.