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…Read More
Viewing blog posts categorized under "Nutrition"
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
Almost anyone who works in a specialized field (such as pediatric eating disorders) spends a great deal of time thinking about diagnostic criteria for diseases and conditions. This is true throughout medicine and psychiatry, of course: is it type 1 or type 2 diabetes? Is it autism or pervasive developmental disorder? Is it bulimia nervosa or binge purge anorexia nervosa? Is it eating disorder not otherwise specified (EDNOS, a term no longer included in DSM-5) or anorexia nervosa?… Read More
Advances in medicine come in all shapes and sizes: vaccines, antibiotics, anti-virals, immune system boosters and reducers, technological changes and recently, the hope that faster, cheaper and more accurate genetic analysis can bring us the new approach to medicine and medications: personalized medicine.
As I have mentioned in a previous blog, a leading proponent of personalized medicine has been Dr Eric Topol, editor-in-chief of Medscape and director the Scripps Translational…Read More
Lots of ink is been spilled on the subject of the stigma associated with having an eating disorder. And in order to discuss the subject sensibly we need to get a few terms straight. It was considered a giant step forward in our field when Dr. Thomas Insel, head of NIMH, began blogging, writing and speaking about the fact that all mental illnesses are brain disorders, and that anorexia nervosa in particular was a severe mental illness. Prior to that it had been possible to…Read More
Recently I was making our daily rounds at Randall Children’s Hospital and received a lesson from a very young patient of ours. I say it over and over: “your patients are your teachers”, and it is really true. I was first told this by Dr. Mizuo Tottori, pediatrician and mentor to many other pediatricians in Hawaii. And life itself has borne out the truth of it, again and again.
This particular little patient has anorexia nervosa and has done very well. Her parents are competent and…Read More
Thinking about obesity: calmly, rationally and outside the box
When I was a rotating intern at Sacred Heart Medical Center, long ago, I attended rounds with the then head of medicine Dr. Patrick Tennison. Dr. Tennison was a thin, dark haired, intense guy who years later would save my life, but at that time was obsessed with imbuing young doctors with a sense of urgency about diagnostic dilemmas. He was more like a highly competitive detective than your typical doctor.
“The main…Read More
This blog will be short as I am preparing to attend and speak at the F.E.A.S.T. conference in Texas this week. Very exciting!
Recently I was asked to consult on a child who “won’t eat” and who hasn’t eaten for several weeks. Her situation is complicated by English not being the family’s first language and by her entrance into the medical “system” being through the emergency room, but it did remind me how complicated making the correct diagnosis can be in a child who won’t eat. This…Read More