Risk Assessment
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Risk Assessment

Obesity can increase the risk of other health issues, in particular it can more than double the risk of laminitis.

If risk factors are identified early and action taken to reduce the risk, this painful and potentially fatal condition could be avoided in many cases. 

Assess the risk of laminitis

Use our laminitis risk assessment tool to assess the contributing factors with owners.

Insulin: a pro-active approach to laminitis

There is now a large body of evidence body of evidence that hyperinsulinaemia is central to the development of most cases of laminitis:

  • Laminitis can be induced by maintaining high insulin levels.
  • The pathological changes that occur in “pasture associated” laminitis are the same as those in hyperinsulinaemic models.
  • Horses with higher insulin concentrations are more likely to develop laminitis.
  • In experimental studies, treatment with insulin-lowering drugs prevents the development of laminitis.

Equine Metabolic Syndrome (EMS)

Hyperinsulinaemia is central to ‘Equine Metabolic Syndrome’ (EMS) which describes a conflation of obesity, hyperinsulinaemia and risk of laminitis. Obesity presents a growing threat to equine welfare and initiatives to tackle it have had limited impact. Studies of horse owner behaviour highlight a need for owners to be “awakened” to the negative impacts of focal and generalised obesity ​(Furtado et al 2021)​. Demonstrating the presence of hyperinsulinaemia can help to demonstrate that there is a metabolic abnormality, and the fat is potentially harmful. Recent studies also allow us to estimate the risk of laminitis associated with different insulin levels in ponies at pasture ​(Menzies-Gow and others 2017; Knowles and others 2022)​:

Insulin concentration (u/l)

3-4 year risk of laminitis

Insulin <20


Insulin > 20


Insulin > 45


'Awakening' owners

In order to “awaken” owners to the threat of laminitis in horses with EMS, and to facilitate conversations around obesity and managing laminitis risk, BEVA are urging vets to consider assessing insulin concentration in the following situations:

  • Generalised obesity
  • Regional adiposity
  • Current or previous laminitis
  • Abnormal hoof growth potentially consistent with previous laminitis
  • Chronic multi-limb lameness

There are a number of different tests that can be performed to assess hyperinsulinaemia and insulin dysregulation. Further information is available above in the EEG 2022 document.

Rasting (basal) insulin

Assessment of resting (basal) insulin concentration in a horse that is in a fed state (hay or pasture, nor cereals) is the easiest way of assessing the laminitis risk of the current diet. A single red top tube is collected for assessment of insulin concentration.


​FURTADO, T., PERKINS, E., PINCHBECK, G., MCGOWAN, C., WATKINS, F. and CHRISTLEY, R. (2021) Exploring horse owners’ understanding of obese body condition and weight management in UK leisure horses. Equine Veterinary Journal 53, 752–762.

​KNOWLES, E.J., ELLIOTT, J., HARRIS, P.A., CHANG, Y.M. and MENZIES‐GOW, N.J. (2022) Predictors of laminitis development in a cohort of non‐laminitic ponies. Equine Veterinary Journal. doi:10.1111/evj.13572.

​MENZIES-GOW, N.J., HARRIS, P.A. and ELLIOTT, J. (2017) Prospective cohort study evaluating risk factors for the development of pasture-associated laminitis in the United Kingdom. Equine Veterinary Journal 49, 300 306.

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