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The Meal Plan and Many Questions

posted by Julie O'Toole on October 27, 2016 at 9:25am

A couple of weeks ago, a reader comment on a discussion about hyper-palatable foods (HPF) brought to mind an issue I’ve heard before, one which highlights a key misunderstanding about our approach at Kartini Clinic that I fear may be widespread. So I wanted to dedicate a blog post to addressing this misconception.

The misunderstanding is essentially this: that limiting HPFs is about preventing the patient from “becoming fat,” and it therefore reinforces the idea that their…

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Tolerating our own children’s distress

posted by Julie O'Toole on October 20, 2016 at 8:32am

This post was originally published on November 13, 2013.

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…

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

posted by Julie O'Toole on October 13, 2016 at 10:19am

This post was originally published on June 12, 2013. 

We’ve all heard from parents whose child had (or 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 can be so managed. At Kartini Clinic we practice a day treatment model of family-based care (as well as inpatient medical stabilization and…

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posted by Julie O'Toole on October 6, 2016 at 11:40am

It’s not every day that I read something forwarded to me by another provider in a related field that just stops me cold. This announcement by Dana Sturdevant, MS, RD was one such. In it Dana was advertising a webinar (How Healthism Overshadows Healing: Ethical Considerations in Treatment Planning) that she and her colleague Hilary Kinavey MS, LPC put together on the subject of “Healthism.” I had never heard the term, but the moment I read it I knew exactly what it must mean.


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The Secret Language of Eating Disorders

posted by Julie O'Toole on September 29, 2016 at 10:30am

The canny ability of eating disorders to twist even the most kindly meant words is something that is experienced by almost all our patients. We originally published this post back in the summer of 2011 and have decided to share it again because an awareness of of this facet of ED is so valuable to patients, families and care providers at every stage of recovery.

I find myself explaining this many times to parents and friends of our patients: there is a secret language to eating…

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Why We Limit Hyper-Palatable Foods for One Year

posted by Julie O'Toole on September 22, 2016 at 9:50am

When I was first introduced to the Minnesota Semi-Starvation Study (MSSS), published in 1950 by Ancel Keys and his team, I was overwhelmed by the sheer volume of data they were able to accumulate about the physical and psychological ramifications of semi-starvation in humans.

It was mind-blowing. Then I came across the graph on page 106 of the hardbound edition called “Over-all Changes in Body Weight in the Minnesota Experiment” with the subtitle: “Expressed as a percentage of the…

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Building a Web of Safety

posted by Julie O'Toole on September 15, 2016 at 11:17am

One of the challenges of swimming against the stream -- as when, for example, one insists that parents don’t cause eating disorders when many providers learn and believe otherwise -- is that you become a bit of a pariah. At a minimum, people will prefer to talk to those of their colleagues who think as they do.

So building a web of safety around our patients once they leave the immediacy of Kartini Clinic has been a challenge. What are the needs of our young patients once they leave…

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Back To School And The Risk Of Relapse

posted by Julie O'Toole on September 9, 2016 at 12:51pm

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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Setting Goal Weights

posted by Julie O'Toole on September 1, 2016 at 10:43am

Setting a goal weight is not simple. And it is never harder than in a growing child, where it is a moving target.

I have written some rather lengthy guidelines for determining ideal body weight in the pediatric patient and about what we at Kartini Clinic call “state not weight.” Today, we use the term “goal weight” rather than “ideal body weight” as “ideal” has so much baggage.

Professor Bryan Lask once asked me to participate in a debate in an international journal about whether…

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The Ten Percent

posted by Julie O'Toole on August 25, 2016 at 12:56pm

The literature on lifetime mortality (the death rate) from anorexia nervosa has been cited as 20%, 10% and 5%, but I think whichever turns out to be the real number, we can all agree that it is too high.

When a young person dies, for any reason, we feel a terrible sense of loss if we are close to them, and a terrible sense of waste if we are not. To die because your brain commands you to refuse food, to fear your own body, to resist your family’s attempts to feed you is sad indeed.…

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