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Viewing blog posts categorized under "Anorexia Nervosa"

The Kartini Meal Plan De-Mystified

posted by Julie O'Toole on October 16, 2013 at 2:17pm

There is a common misconception out there that Kartini patients are fed on a strict meal plan for the rest of their lives.  But what exactly is our meal plan? And while we talking about it, what's our approach to meals and food in general?

Well…

  1. there’s the “parents in charge” (of all meals) thing

  2. there’s the recording on the food journal thing

  3. there’s the family dinners thing/ home cooking thing

  4. there’s the whole-milk-no-low-fat thing

  5. there’s the hyper-palatable food thing

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Back To School And The Risk Of Relapse

posted by Julie O'Toole on September 18, 2013 at 1:15pm

When you practice as long as I have in the field of childhood eating disorders one thing becomes abundantly clear: there are cycles to the frequency with which patients appear on our doorstep for treatment -- and on the doorsteps of all the other treatment centers as well.  The trouble is, it has proven difficult to understand the peaks and troughs of these cycles and correlate them to much of anything.  But there do seem to be a few tentatively recognizable patterns. And these peaks…

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Health Is A State, Not A Weight

posted by Julie O'Toole on August 7, 2013 at 1:40pm

This week’s blog covers a topic - menstruation in female patients - which I have written about before, but, given its critical importance to our female patients and their parents, I’d like to bring it up again.

First let me distinguish between menarche (first period) and the resumption of menses (monthly periods). Menses is an important marker of recovery in girls who menstruated prior to the onset of their eating disorder, and something I’ve written about before.  Today I would like…

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The Eleventh Hour

posted by Julie O'Toole on July 25, 2013 at 9:36am

I’m sure all specialties have their frustrations, but here is a major one of mine: patients who come to Kartini Clinic needing -- indeed deserving -- help but at the “eleventh hour.”

What do I mean by this?  I mean families who come in seeking help for a condition which is characterized by anosognosia, having waited for a variety of reasons, until shortly before their child’s 18th birthday, at which age their child will be able to refuse treatment, and often will do.  Even in states…

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Why do some people just get it?

posted by Julie O'Toole on July 17, 2013 at 2:28pm

This is a tribute to two people who just plain “get it.”  And, you know, it can be hard to get.  I certainly know many professionals who deeply do not get it, and some who claim they do and yet who really only give it lip service.

The two people I am referring to are mothers of children with eating disorders; they are F.E.A.S.T. mamas, and they are filmmakers.  I am referring, of course, to Charlotte Bevans and Mary Gutteridge, the Bobbsey twins of enlightened animation.

And what…

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10 Steps to an Accurate Eating Disorder Diagnosis

posted by Julie O'Toole on July 10, 2013 at 2:59pm

Inspired to think outside my usual box by Dr. Eric Topol, author of  Creative Destruction of Medicine this morning, I began to ask myself: how can I help parents who may not have access to experienced care, who fear that their child may have an eating disorder, make that diagnosis and get help?  Where do I start?

Well, start first with self-examination.  

We doctors are made very uncomfortable by any talk of patient autonomy or patient empowerment. The words “self diagnosis” are said…

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Diet and exercise: the obsessions that will not die

posted by Julie O'Toole on June 26, 2013 at 8:27pm

Aaargh! 

Although dieting has been shown repeatedly to be destructive, counter-productive and useless in most settings (i.e. you re-gain everything you lose and then some…), it simply will not die as a panacea for improving health.  The belief in weight loss/dieting and exercise as a health tool is so entrenched that people, even highly educated people, continue to insist that the emperor does have clothes, despite all evidence to the contrary.

I was happily reading over-due emails…

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Family-based Treatment:  why is it so wretchedly hard?

posted by Julie O'Toole on June 12, 2013 at 12:44pm

We’ve all heard from parents whose child had (has) an eating disorder and who re-feed them at home, single-handedly and successfully.  The Around the Dinner Table forum is full of such stories from parents who help other parents trying to do the same.  But not all children’s illnesses are or can be so managed.  At Kartini Clinic we practice a day treatment model of family-based care (as well as inpatient medical stabilization and outpatient follow-up, where needed).  Everybody knows…

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Gene Mutations and the Weight Problems That Plague Us

posted by Julie O'Toole on May 29, 2013 at 4:10pm

You’ve heard it everywhere: your friends, your doctor, the New York Times, your personal trainer, virtually anyone who talks to you about health for more than five minutes will give you the same litany:  we need to lose weight to be healthy and all we need to do to achieve that loss is to change what we eat (fewer refined high glycemic index carbs, leaner meats, more fish, better quality fats, etc.) and, ultimately, how much of it we eat -- otherwise we will not only get fat and look…

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The Day Treatment Model for Pediatric Patients

posted by Julie O'Toole on May 8, 2013 at 9:21pm

With the publication of results for models of family-based home treatments, the treatment of children with eating disorders has changed a lot in the past five or six years, or at least it has in many communities.  In some places,however, it is still the “same ol’, same ol’” of individual eclectic therapy, nutritional advice and a doctor’s infrequent monitoring - a combination known for some time to give substandard results.  

For some patients  “Maudsley” and other forms of newer…

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