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Viewing blog posts categorized under "Metabolic Weight Management"

It’s Enough to Make You Crazy

posted by Julie O'Toole on October 2, 2015 at 11:25am

Let’s start with the impetus for my morning study focus: requirements by the American Board of Pediatrics (ABP) for what they call “Maintenance of Certification”.  Those of you reading this who are American physicians know what I mean: we are required to take Board Examinations every ten years, something I have just finished doing (again).  Some of you reading this may be lawyers or therapists—imagine if you had to retake your professional exams every ten years.  I am not talking…

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Can Measuring Leptin Lead to Happiness?

posted by Julie O'Toole on August 19, 2015 at 2:27pm

In our clinic we spend a lot of time thinking and talking to our patients about the hormone leptin.

In another instance of the concordance of important findings to obesity science and eating disorder science, the study of leptin and body weight, leptin and menstrual function and now leptin and mood, has revealed relevance to both of these groups.   According to an article titled Leptin Predicts Decreased Depressive Symptoms, from the Neuroendocrine Unit of the Department of…

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The Suffering of Others

posted by Julie O'Toole on May 8, 2015 at 10:04am

“With what incredible courage we are able to endure the suffering of others” -- My favorite quote from English garden writer Christopher Lloyd.  And nowhere does it apply more than in medicine.  And within the world of medicine, nowhere more than in the world of mental health.

When my neighbor is poor, he deserves it for his sloth and lack of thrift.  When I am poor, I am the victim of unfairness and persecution.  When a young man medicates his abdominal pain with narcotics, he just…

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The Surprising Similarities Between Anorexia and Obesity

posted by Julie O'Toole on January 28, 2015 at 10:14am

One thing I've observed over the years is that those readers who are interested in anorexia nervosa seem to have little interest in obesity, which they often seem regard as an lifestyle choice irrelevant to them, while those who study obesity often ask themselves what this rare condition (AN) has to do with their vastly more prevalent (read: important) condition of obesity (OB)? Quite a lot, as it turns out. And by the way, it’s worth repeating at the outset, neither condition is one…

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Tough Calls Parents Have To Make

posted by Julie O'Toole on January 21, 2015 at 9:17am

For people who are high achieving and successful, patience is typically not one of their long suits, especially when “patience” involves rest and restraint.

It’s not enough that our patients are often self-driven high achievers, but as this temperament trait is also highly heritable, many of our parents are as well.  It is not unusual for our kids to be valedictorians, salutatorians, the lead in the school play, talented musicians, or competitive dancers or athletes, whose efforts…

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The Dangers of Staying Slightly Below Weight

posted by Julie O'Toole on December 10, 2014 at 8:35am
I am a pediatric eating disorder doctor and try my best to limit my practice to patients 22 and younger. Why is this hard? Because I have a great treatment team and good treatment is hard to come by, so we sometimes run into deserving and desperate adult patients, whom we simply must refer to adult providers. I say this so that readers of this blog may put my recommendations into the context of the age group with which I am most familiar, although it is my opinion that this topic is… Read More

When The Smile Comes Back

posted by Julie O'Toole on December 3, 2014 at 8:29am
Re-feeding has its own rewards, though there can be misery and challenge to get there.  I know that some of you who have been through this, either at home or with a team not at home, will be able to relate to what I am talking about.  It’s when the smile comes back. It’s hard to predict when the tipping point will come.  For some it’s within the first 48 hours of beginning to eat: the circulation improves, the cheeks fill with more color, the eyes brighten and they just feel… Read More

Taking A Moment To Vent

posted by Julie O'Toole on November 19, 2014 at 9:27am
My good friend and colleague Therese Waterhous, a PhD, RD eating disorder specialist and board member of the parent organization F.E.A.S.T., called me the other day.  She needed to vent, and now, apparently, I do too. It’s not that her annoying experience was rare or new, it’s just the fact that such ignorance persists and that at this point -- given the avalanche of new information about pediatric eating disorders --  such ignorance seems willful. You can update your database.… Read More

Eating Junk

posted by Julie O'Toole on June 26, 2014 at 1:12am

Recently a patient of ours returned from a treatment setting where she had been presented with “challenge foods”.  In her case she had been given cheetos and soda pop.  Now I ask you, why on earth would someone encourage a child to eat such a thing?

A lot of ink has been spilled on teaching Americans in general and children in particular to make good food choices.  Just because you have anorexia nervosa as a child, and desperately need to gain and maintain adequate weight, does not…

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Hard News About Exercise And Recovery

posted by Julie O'Toole on June 5, 2014 at 12:37am

I was recently sent an article from which I will be quoting extensively here (it’s also included in this newsletter - ed.). The article is by Heidi Mills, writing for Outside magazine and features the work of Dr. Emily Cooper of Seattle Performance Medicine. Dr. Cooper has consulted with Kartini Clinic on metabolic health and weight balancing for some time.  Originally, we worked together to try and solve the conundrum of patients with AN who appear to be weight restored but who…

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