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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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Animal Assisted Therapy

posted by Julie O'Toole on August 18, 2016 at 11:34am

Kids and animals, it’s magical. Although some researchers have tried to figure out why, exactly, really - who cares? Many a little kid, or even older kid, who refuses to talk to grown ups will happily spend time with an animal. Some find courage through the presence of one.

I remember a little boy who was sent to us from a distant hospital. They’d told us he was “the sickest kid they had ever seen” and that he “refused to talk to anyone.” Indeed, he was curled up into a ball in the…

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Self Punishing

posted by Julie O'Toole on August 4, 2016 at 10:31am

One of the lesser known symptoms of early onset anorexia nervosa is “self abnegation” or even “self punishment.” Although these symptoms can be seen in older patients (adolescents) too, our experience has shown it to be most common in the younger patients. And most heartbreaking too.

What does it look like? Well, let me tell you, it is torture, both for the child as well as for the parents. It looks like this:

The 12 year old boy of very engaged and devoted parents who calls…

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When to Jump Ship

posted by Julie O'Toole on July 28, 2016 at 9:59am

Part of any successful voyage, especially one that involves reaching a critical destination for you and your loved ones, involves deciding when to keep rowing and when it would be wiser to jump ship.

Rowing, especially when it sometimes seems that people are not pulling together in the same direction (and at least one entity - the eating disorder - is actively punching holes in the hull) is exhausting. Never underestimate the role of exhaustion in decision making.

It occurs to me…

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Eating Flexibly

posted by Julie O'Toole on July 21, 2016 at 11:38am

One of the most common comments and questions we get about our ordered-eating family-style meals is about whether or not such eating is “normal” and whether it doesn’t represent some rigid food plan flying in the face of “real” recovery. Isn’t intuitive eating, well, intuitively better?

This is an area where I feel the perfect is the enemy of the very, very good. It's a bit like saying that the goal of recovery from childhood polio is to walk without a limp or crutch, in a way that…

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First Do No Harm, Then Innovate

posted by Julie O'Toole on July 14, 2016 at 12:32pm

Whichever genius came up with the pithy “first do no harm” knew what they were talking about, or at least had a profound understanding what evil could be committed in the cause of “we need to do something!”

From the journal of Clinical Pharmacology 2005 (Apr; 45(4):371-7). Regarding the Origin and uses of primum non nocere--above all, do no harm! The abstract by CM Smith:

“The so-called Hippocratic injunction to do no harm has been an axiom central to clinical pharmacology and to…

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