"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 »

Why the basic sciences may save us all

posted by Julie O'Toole on February 12, 2014 at 3:10pm

In previous blogs I have spoken to the importance of bench science -- the kind done in the lab to decode the “basic” science that underlies human physiology -- to us as clinicians and to us as patients. And the branch of the sciences which explores the connection between bench science or lab science and clinical medicine, including mental health, is called translational medicine.

This last night I couldn’t sleep. This happens to me when I have any viral illness and I have learned to…

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FEAST 2014 and Weight Restoration 2.0

posted by Julie O'Toole on February 5, 2014 at 2:44pm

Morgan and I just returned from the parent-founded and parent-lead F.E.A.S.T. conference, familiar to many of you as an online resource for parents whose children are struggling with an eating disorder.

The conference lasted two days, and we spoke at noon on the second day, to a group of (mainly) parents and a few activist providers.  The following comments are just some of my personal impressions, not necessarily shared by anyone else.

The keynote speaker was Laura Hill, PhD.,…

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How to diagnose the child who “won’t eat”

posted by Julie O'Toole on January 29, 2014 at 1:57pm

This blog will be short as I am preparing to attend and speak at the F.E.A.S.T. conference in Texas this week.  Very exciting!

Recently I was asked to consult on a child who “won’t eat” and who hasn’t eaten for several weeks. Her situation is complicated by English not being the family’s first language and by her entrance into the medical “system” being through the emergency room, but it did remind me how complicated making the correct diagnosis can be in a child who won’t eat. This…

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Vegetables and Kartini’s Meal Plan

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

Despite the fact that we occasionally receive criticism of our Meal Plan for its supposed “rigidity”, what has struck me after years of reading people’s food journals is the degree to which people self-limit their food choices.  This is especially true of vegetables.  I have also noticed that our families’ food journals fall roughly into two categories: those who seem to relish a more Mediterranean style of eating (the original intent of the Meal Plan, by the way) and those who eat a…

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Quiet hero, mother, activist dear Charlotte

posted by Julie O'Toole on January 15, 2014 at 5:22pm

This is the second time I have blogged about a mother named Charlotte and her brave, sassy and in-your-face crusade to find great care and justice for children with eating disorders.

Only this time it is not only to sing her praise but to mourn her death.

On the website she founded to promote Charlotte’s helix. her bio reads: “Charlotte Bevan is the youngest of three, the mother of two and the wife of a farmer, but definitely not a farmer's wife.  She left school with barely a…

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Tincture of Time

posted by Julie O'Toole on January 8, 2014 at 5:35pm

I was thinking about the notion of healing at our weekly All Staff meeting recently as we went through the recitation of our patients and examined their progress as a group.  I can’t tell you how often we need to remind ourselves of that “fifth dimension” to healing: time.  There’s a reason old fashioned physicians counseled younger ones to prescribe a “tincture of time” for many of the ills their patients experienced.

It’s actually a bit like baking bread. Bread needs basically five…

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Thank you for this patient

posted by Julie O'Toole on December 31, 2013 at 6:23pm

In my life as a pediatrician I have twice now had the astonishing, humbling and even joyous experience I am about to relate.  Only twice.

The first time was many years ago when I was a younger doctor.  I had recently moved to Portland and joined a busy general pediatrics office as the first (and only) female.  It was a busy practice, with each of us seeing about 30 patients a day.  One Friday, after an exhausting week, the nurse handed me the afternoon’s schedule and said “the last…

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Appeasing The Monster

posted by Julie O'Toole on December 18, 2013 at 2:55pm

Some blog topics draw in a continuous trickle of commentary long after they've been published.  One such blog is entitled “Determining Ideal Body Weight”. And little wonder.

The other day I answered a comment by a young reader named Charlotte. It started me thinking how urgent her question might be for others who may not have read the original blog (or at least not for some time).  Charlotte wrote:

"I am an 18 year old female with a history of initially EDNOS and then AN B/P…

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Anorexia and Siblings

posted by Julie O'Toole on December 11, 2013 at 8:58pm

From one of our favorite international (Australian) treatment teams comes an article published online November 2013 in the journal Advances in Eating Disorders: Theory Research and Practice discussing “Anorexia nervosa in the family: a sibling’s perspective”. (Simon Clarke, Michael Kohn, Sloane Madden et al.).

Every team treating pediatric eating disorders struggles with the effects of the illness on unaffected siblings. Siblings suffer right along with everyone else in the family…

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Eating for Life

posted by Julie O'Toole on November 27, 2013 at 2:59pm

A recent book by UCSF professor and pediatric endocrinologist Dr. Robert Lustig -- horridly titled Fat Chance -- has turned my mind to past discussions of our program’s dietary recommendations, aka the Kartini Meal Plan.

In its primary and original form the Kartini Meal Plan was developed to refeed children with restrictive eating disorders and weight loss following principles I have spoken about before: real food, cooked at home, eaten together in a spirit of joy.  Kartini’s Meal…

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