The Role of Parents in Treatment

posted by Julie O'Toole on April 27, 2017 at 9:30am

This post was originally published on December 16, 2015. 

Possibly nothing has changed so much over the last ten years as the acceptance of parents’ role in the treatment of children and adolescents with eating disorders.

When I founded Kartini Clinic in 1998, “dysfunctional” parents were widely considered to cause eating disorders in general and anorexia nervosa in particular. Toxic and enmeshed mothers were commonly cited by therapists, doctors and lay people as the common…

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Processed Food the Foodie Way

posted by on April 13, 2017 at 9:29am

Nearly every day I am anxiously asked whether or not our young patients can have rice “milk,” almond “milk,” soy “milk” or coconut “milk” instead of the whole milk that is on our menu. These inaptly named “milks” are about as related to milk as cheese whiz is to cheese, and although not harmful (and even delicious), should not be mistaken for the white beverage given to early mankind by dairy animals as a source of protein, fat, calcium and vitamins. They are perhaps more properly…

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posted by Julie O'Toole on March 30, 2017 at 9:49am

Approximately 1.25 million American children and adults have type 1 diabetes (T1DM), according to the American Diabetes Association. Type 1 diabetes is an autoimmune process whereby the insulin-producing cells of the pancreas are irreversibly destroyed and the ability to use food as energy is impaired. It can lead to growth stunting, intellectual impairment, blindness, vomiting, poor circulation and even limb amputation. It is not the kind of diabetes that you read about in the press…

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Traveling Kartini Style

posted by Julie O'Toole on March 14, 2017 at 9:40am

We are pleased to present a guest blog this week, written by a Kartini Clinic parent. We hope you enjoy her first-hand tips for traveling with a child on the Kartini Clinic meal plan. Many suggestions will be useful to parents who do not share our meal plan, but want general parent-to-parent tips about travelling with a child with an eating disorder.


“There’s no place like home.” Dorothy’s famous words from The Wizard of Oz could not ring more true for a patient managing an…

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This post was originally published March 31, 2016. 

In few fields have the twin forces of genetics and neurobiology worked as synergistically to profoundly change conceptualization and treatment as they have in the field of eating disorders. And this is particularly true for pediatric eating disorders, where the stakes are so high and the field so new.

The first description of anorexia nervosa in English by Richard Morton (pictured to the right) in 1689 was presented as part of a…

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Five Things Every Parent Should Know About Childhood Eating Disorders

posted by Julie O'Toole on February 28, 2017 at 3:00pm

1) Weight loss in children isn’t normal

Imagine you’re a parent of a bright, active 12 year old boy. He gets good grades and has lots of friends. He excels at sports. Then something changes; he begins to lose weight. At his last checkup his pediatrician registers a heart rate in the low 50s. He starts to withdraw, not doing many things he used to enjoy, with the exception of exercise. He now exercises with a new intensity.

His doctor tells you not to worry. “It’s just a stage”, she…

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posted by Julie O'Toole on February 16, 2017 at 9:30am

In the treatment of children and adolescents with eating disorders, depression is a not uncommon finding. Sometimes we identify it on admission to Kartini Clinic, sometimes it has already been identified before the patient ever saw us, and sometimes it is a residual of otherwise successful treatment. The latter is especially frustrating.

There is a saying in medicine, “when you leave the appointment feeling depressed, you know the patient's diagnosis.” Which might be why many…

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Resting Your Athletes

posted by Julie O'Toole on February 2, 2017 at 9:43am

Oh God, it’s so hard. Hard for the kids. Hard for the parents. Hard for me.

Resting an injury is not an easy concept when you don't feel direct and immediate pain if you don’t. This makes it hard to rest an injury such as a heart attack, cancer, a surgery or… anorexia nervosa. And it’s harder for some people to rest than for others.

Case in point: my partner pediatrician Dr. Naghmeh Moshtael. I know she won’t mind me revealing that she has had to undergo chemotherapy several times…

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Can Complex Disorders be Extinguished?

posted by Julie O'Toole on January 19, 2017 at 9:48am

When I was a pediatric resident in Honolulu, Hawaii, I had the great and unusual opportunity to spend time with patients with a condition now largely unknown to most American doctors, except in text books: leprosy, or Hansen’s Disease, as it is more properly termed.

Behind Diamond Head is a small hospital whose history is described as “...a community’s quick response to the serious threat of the bubonic plague... In an effort to halt the spread of the plague, houses were burned, and…

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Why Can’t Everyone Get a Good Result?

posted by Julie O'Toole on January 5, 2017 at 10:03am

Anorexia nervosa is a complex illness, like most illnesses that involve the brain. There is a wide spectrum of severity, ranging from cases that easily turn around with re-feeding and seem to disappear for good, to those that are  crippling and debilitating for an entire life.

I think it goes without saying that neither the patient nor their family are to blame for which form the patient has been afflicted with (mild, moderate, severe, chronic disabling)-- but in case there are a…

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