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…Read More
Viewing blog posts categorized under "Anorexia Nervosa"
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…Read More
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…Read More
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…Read More
No doubt I will make myself unpopular (again) with some of our psychiatric colleagues by speaking out in this way about the use of locked psychiatric units in the treatment of children with eating disorders, but we have had several recent transfers to Kartini Clinic instigated by parents who disagreed with their treatment team’s insistence that their child be admitted to their regional locked psychiatric unit. The parents visited the unit and were scared by what they saw.
There is…Read More
Until I lived in the world of therapists and mental health professionals as part of the Kartini multidisciplinary team treating children with eating disorders, I had never actually heard the phrase “tolerating distress”, particularly as it pertained to parents. Like most parents, I have a very difficult time tolerating pain in my own children, either physical or emotional and, when put in that situation, I immediately get busy trying to save them.
How can that be wrong? It’s…Read More
Many people are shocked when they learn that we have patients with anorexia nervosa as young as six or seven, and, although it is rare, it certainly does occur.
Why are they shocked? Because most of these folks, despite hearing me (and Dr. Tom Insel, among others) say “it’s a brain disorder”, still deeply believe that “the media” and our obsession with thinness causes anorexia. They are horrified that someone so young could be “ruined by society”. And blaming the parents for this…Read More
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?
there’s the “parents in charge” (of all meals) thing
there’s the recording on the food journal thing
there’s the whole-milk-no-low-fat thing
there’s the hyper-palatable food thing…
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…Read More
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…Read More