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…

Read More

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…

Read More

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…

Read More

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…

Read More

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…

Read More

Why Weight Restoration in Eating Disorder Treatment Must Come First

posted by Julie O'Toole on December 29, 2016 at 8:46am

This post was originally published on February 13, 2012.

I (among others) have recently been challenged by Laura Collins to get the message out that weight restoration is critical to psychological recovery in anorexia nervosa. Some authority, Laura says, must declare definitively that psychological recovery is tied to weight restoration.

Some authority… okay… but who?

Since the late 1990’s the AAP (American Academy of Pediatrics) has issued guidelines for hospitalization (after…

Read More

Home Away From Home

posted by Julie O'Toole on December 20, 2016 at 1:59pm

If, like me, you have a roof over your head, heat, light, internet and food, reflect for a moment on how fortunate we are.

Many people mistake their good fortune for virtue, believing themselves to be so lucky because of their “good choices,” but that is often far from the mark.  

During the Depression, my father’s family lived in a mountain village in rural Utah, had a roof over their head, some light and heat, but rarely enough food. No one was lazy, no one was in jail, they were…

Read More

Talking Back To ED

posted by Julie O'Toole on December 15, 2016 at 10:12am

In general I do not especially like using the trivializing nickname “ED” to refer to a punishing condition like anorexia nervosa , but many of our families do. Perhaps this popular shorthand allows them to get their minds around an entity that has hijacked their child’s life-- and with it their own-- and which dominates every conversation they have at home.

We teach our parents to “externalize the illness,” that is to separate their child from the condition to help the parents…

Read More

Treatment Fatigue

posted by Julie O'Toole on December 8, 2016 at 9:26am

I feel so weary writing this, I almost can’t start. And I am not talking about provider fatigue, for that is a different subject altogether, and an important one. No, I mean the fatigue I have watched parents feel over all these years of treating children with eating disorders.

Parents are human, even when they can do inhumanly difficult things for the sake of their children. None are saints, of course, but they can come close to sainthood when circumstances require. At least, some…

Read More

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…

Read More
Page 3 of 30 pages   < 1 2 3 4 5 >  Last ›