"Almost one year later and our daughter is doing great! She seems to have almost no issues around food...Our vigilance never ceases...
"Ruth" – New York City, NY | read more »

Game Plan For The Holidays

posted by Julie O'Toole on December 18, 2014 at 4:05pm

Christmas is not just one single holiday at Kartini Clinic, it is several. In fact it’s  a season involving many celebrations and special events. Some of our patients’ families do not celebrate Christmas as such, of course, but for those who do, some “highlights”:

Baking… baking… baking. It’s a problem in many ways. And the truth is, no matter how appealing the picture of doing so may be, or how often it’s been done before in your family, probably not everyone should make/bake…

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The Dangers of Staying Slightly Below Weight

posted by Julie O'Toole on December 10, 2014 at 4:35pm

I am a pediatric eating disorder doctor and try my best to limit my practice to patients 22 and younger. Why is this hard? Because I have a great treatment team and good treatment is hard to come by, so we sometimes run into deserving and desperate adult patients, whom we simply must refer to adult providers. I say this so that  readers of this blog may put my recommendations into the context of the age group with which I am most familiar, although it is my opinion that this topic is…

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When The Smile Comes Back

posted by Julie O'Toole on December 3, 2014 at 4:29pm

Re-feeding has its own rewards, though there can be misery and challenge to get there.  I know that some of you who have been through this, either at home or with a team not at home, will be able to relate to what I am talking about.  It’s when the smile comes back.

It’s hard to predict when the tipping point will come.  For some it’s within the first 48 hours of beginning to eat: the circulation improves, the cheeks fill with more color, the eyes brighten and they just feel better.…

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Taking A Moment To Vent

posted by Julie O'Toole on November 19, 2014 at 5:27pm

My good friend and colleague Therese Waterhous, a PhD, RD eating disorder specialist and board member of the parent organization F.E.A.S.T., called me the other day.  She needed to vent, and now, apparently, I do too.

It’s not that her annoying experience was rare or new, it’s just the fact that such ignorance persists and that at this point -- given the avalanche of new information about pediatric eating disorders --  such ignorance seems willful. You can update your database. I…

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Yes, But Where’s The Evidence?

posted by Julie O'Toole on November 13, 2014 at 5:32pm

You may have heard me say it before:  medicine is as prone to fads as the fashion industry.  And worse: tightly held “truths” in medicine can be as entrenched as religious beliefs and providers will respond to being challenged with as much heat and resentment as if you had challenged their religion.  

Didn’t your grandmother tell you (mine did) to avoid talking politics and religion in polite society? Well… here I go anyway. And sorry for the many citations. If you’re going to talk…

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What To Do With An Affected Parent?

posted by Julie O'Toole on November 5, 2014 at 5:15pm

This blog is asking for help from those of you who have a child with anorexia nervosa but who may have experienced an eating disorder yourself.

Any clinic or provider who treats pediatric eating disorders will sooner or later see children whose families have more than one affected (or partially affected) family member.  This is the fancy way of saying that when you do a careful history you are likely to find other family members who have eating disorders in addition to the child.

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Can I speak to the chef, please?

posted by Julie O'Toole on October 22, 2014 at 2:33pm

It's not very common for me to hear things out of the mouths of our patients that I have not heard before -- I have heard most things many, many times.  For example:  “exercise (insert dance, soccer, cheer, ballet, etc) is my only social life, I don’t have any friends without it,” or “school is the most important thing to me.  I can’t get behind because of treatment,” or “I don’t care abut how much weight I gain, as long as it’s muscle,” or “I don’t tolerate milk products, fatty…

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What To Do When The Weight Comes Back

posted by Julie O'Toole on October 8, 2014 at 11:12am

I get asked all the time: will the “extra weight” come off her stomach or his face?  Many people are appalled to hear that parents whose child was starved and wasted could become focused on worrying that “they might have gained a little too much weight”.  But it happens all the time. We talk and talk about weight re-distribution to families, but it’s hard.

I am grateful, therefore, for an article that appeared in the September 2014 issue of the journal Nutrients titled Anorexia…

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You Will See the Doctor Now

posted by Julie O'Toole on October 1, 2014 at 3:32pm

I was born in 1949, the second World War had been over for a mere four years.  As a girl raised in the 50’s and 60’s I was taught to read books, wear dresses, skirts and pinafores, and to sit still.  As long as I had a book the sitting still was no problem.  And I always had a book.  At sixteen I participated in the American ritual of learning to drive a car, and never looked back. At eighteen I went to college and sat in class with everyone else, my class choices limited by what was…

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Genetics of Brain Disorders

posted by Morgan O'Toole-Smith on September 17, 2014 at 9:31am

Medicine is moving at the speed of light.  And that’s a good thing.  We have a long road ahead of us to move out of the pre-scientific eras, where no one required an evidence base to do most anything.  And we face an even longer road to shed the paternalistic roots of “doctor knows best” (not to mention parent blaming for brain disorders!).  But perhaps the longest road of all is the road that is now leading us to real “individualized” or “personalized” medicine.

Actually, I prefer…

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