It was two years ago tomorrow that we came to Kartini Clinic. A very frightening time in our lives.There is not a day that goes by...
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Viewing blog posts categorized under "Anorexia Nervosa"

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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In an article recently in the New York Times, author Harriet Brown reviews a subject that was hotly debated at the London International Conference for Eating Disorders by Glenn Waller, Roz Shafran and Howard Steiger, among others. The issue was what is called “evidence-based” interventions in eating disorders.

For example, cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) and family-based therapy (FBT) are  purportedly evidence-based interventions in the field…

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How Do We Measure Success in Eating Disorder Treatment?

posted by Julie O'Toole on February 28, 2013 at 2:47pm

When discussing the needs of families new to our treatment program, my son Morgan (and Kartini Clinic’s CEO) tells me everyone really wants to know just three things about any treatment:

  1. does it work?  
  2. how long will it take?
  3. and what will it cost?

In today’s blog I hope to be able to begin to answer the first two questions about treatment at Kartini Clinic.  Let’s start with “does it work?”  How many kids who come to us are able to achieve remission?

Physiologic remission is the…

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Physiology of Binge Eating and What Motivates Us

posted by Julie O'Toole on January 25, 2013 at 5:26pm

On the recommendation of Dr. Rod McClymont, of the Center for Eating and Dieting Disorders, Bathurst, Australia, I have been reading a new book, Animal Models of Eating Disorders (Humana Press 2013) edited by Nicole Avena.  The second chapter, by Mary M Boggiano Ph.D., stopped me in my tracks:  “Binge-Prone Versus Binge-Resistant Rats”.

Don’t laugh.  We are mammals; they are mammals.  We study rats to understand the physiology of cancer.  We study rats to understand the physiology of…

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weight gain and percentiles after weight restoration

posted by Julie O'Toole on December 21, 2012 at 12:56pm

I was recently asked an important question which I was unable to address during my breakout workshop at this year's FEAST Symposium 2012.

The question: does a child who has completed their height growth need to continue to gain weight in order to stay on the same growth percentile “line” until they are 20 years old?

A glance at an average growth chart for girls shows a flattening out of the height curves somewhere around age 15.  This is because the average Caucasian girl achieves…

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Congressional Presentation, November 29, 2012

posted by Julie O'Toole on December 7, 2012 at 5:01pm

On Thursday November 29th I went with Laura Collins and the FEAST team to give "testimony" to congressional staffers about the plight of children with anorexia nervosa.  It was an impressive experience to enter the Dirksen building where  many of the senators (including our own Ron Wyden) have their offices.  Senator Schumer (NY) walked past us; the walls and floors were stone and marble and dark wood, the ceilings twenty feet high, the plaster frieze was carved with symbols of the…

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