Gratitude has been a constant feeling for me since Day 1 of my daughter's hospital stay. On that frightening day, my gratitude was...
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Avoiding Negative Energy Balance

posted by Julie O'Toole on February 18, 2015 at 2:21pm

Last week I was pleased to discuss a paper by Walt Kaye and colleagues that I felt strongly supported ordered eating for people with anorexia nervosa. Ordered eating on our Kartini meal plan has always been the cornerstone of our weight restoration strategy for children and young adults who suffer from this condition. It works and Dr Kaye’s research tells us why.

This week I would like to refer you to a blog written by Cindy Bulik of the University of North Carolina. Cindy is a very…

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Connecting the Dots

posted by Julie O'Toole on February 6, 2015 at 4:23pm

Two current Kartini parents handed me an excellent article the other day. Its lead author, Walter Kaye, is likely well known to our readers. The article, Temperament-based Treatment for Anorexia Nervosa, recently appeared in the European Eating Disorders Review.

I was especially pleased to see this article, although many of us have heard Walt speak about meal planning and the latest neuro-biological and neuro-radiological evidence before.  Neuro-biological and neuro-psychological…

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The Surprising Similarities Between Anorexia and Obesity

posted by Julie O'Toole on January 28, 2015 at 5:41pm

One thing I've observed over the years is that those readers who are interested in anorexia nervosa seem to have little interest in obesity, which they often seem regard as an lifestyle choice irrelevant to them, while those who study obesity often ask themselves what this rare condition (AN) has to do with their vastly more prevalent (read: important) condition of obesity (OB)? Quite a lot, as it turns out. And by the way, it’s worth repeating at the outset, neither condition is one…

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Tough Calls Parents Have To Make

posted by Julie O'Toole on January 21, 2015 at 2:44pm

For people who are high achieving and successful, patience is typically not one of their long suits, especially when “patience” involves rest and restraint.

It’s not enough that our patients are often self-driven high achievers, but as this temperament trait is also highly heritable, many of our parents are as well.  It is not unusual for our kids to be valedictorians, salutatorians, the lead in the school play, talented musicians, or competitive dancers or athletes, whose efforts…

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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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