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The Misuse of BMI in Diagnosis of Pediatric Eating Disorders

posted by Julie O'Toole on December 1, 2016 at 8:00am

Parents, doctors, therapists, dietitians and patients: don’t even think about using BMI as a measure of “state!”

You have heard me say in my blog posts many times that, at Kartini clinic, we try to focus on “state,” not “weight.” That is, the state of good health as opposed to a given weight. As measures of this state of health, we use our metabolic labs, including measurements of thyroid health, sex hormones, leptin, glucose, insulin, cortisol and others. We also look at the return…

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Giving Thanks

posted by Julie O'Toole on November 27, 2016 at 2:19pm

Late in the afternoon on the day before Thanksgiving, a mother of a former patient emailed our clinic and here is what she said:

She wanted to call and let us know how grateful she is and how well her daughter is doing. She said that her daughter graduated from college, has been teaching kindergarten for about three years, and just recently got married.

Every year, around Thanksgiving time, she gets very emotional and always gives thanks for our clinic, since it helped them so much…

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Anorexia Nervosa meets Thanksgiving: It’s A Mess

posted by Julie O'Toole on November 17, 2016 at 8:41am

This post was originally published on November 23, 2010.

Thanksgiving is one of my favorite holidays. As is probably true for many of you, it's all about giving thanks, and in our own family we have a lot to give thanks for this year, not least for a tiny new granddaughter (3 weeks) and a healthy, happy grandson (one year old this weekend). It's also important, in my view, to have a holiday that focuses on gratitude, especially when life gets challenging, as it does for many of our…

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How to weigh an eating disordered child

posted by Julie O'Toole on November 10, 2016 at 8:01am

This post was originally published on November 30, 2010.

Reading through the latest comments on Laura's Soap Box, and those on Around the Dinner Table message board, I see many requests for educating medical professionals in the community about eating disorder treatment. "Colleen" says, for example:

"We still don't have any effective professional guidelines for treatment. My doc can't go to any definitive reference source and find a 'recipe' of what to do once he's made the…

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Collaborative Medicine: Inching Our Way Foward

posted by Julie O'Toole on November 3, 2016 at 9:39am

Inching our way forward into medical care that is truly collaborative, we face many challenges.

The first is internal: our medical training (pretty much no matter when we trained) reflects a very long history of “doctor knows best”-- not because doctors have an ingrained desire to be seen as superior, but because they like to be seen as heroes. War has been described as “long periods of boredom punctuated by moments of sheer terror,” and this could, in some ways, describe the life…

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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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