Viewing blog posts tagged with "Eating Disorders"

Eating for Life

posted by Julie O'Toole on November 27, 2013 at 11:59pm

A recent book by UCSF professor and pediatric endocrinologist Dr. Robert Lustig -- horridly titled Fat Chance -- has turned my mind to past discussions of our program’s dietary recommendations, aka the Kartini Meal Plan.

In its primary and original form the Kartini Meal Plan was developed to refeed children with restrictive eating disorders and weight loss following principles I have spoken about before: real food, cooked at home, eaten together in a spirit of joy.  Kartini’s Meal…

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The Locked Psychiatric Unit

posted by Julie O'Toole on November 20, 2013 at 9:46pm

No doubt I will make myself unpopular (again) with some of our psychiatric colleagues by speaking out in this way about the use of locked psychiatric units in the treatment of children with eating disorders, but we have had several recent transfers to Kartini Clinic instigated by parents who disagreed with their treatment team’s insistence that their child be admitted to their regional locked psychiatric unit.  The parents visited the unit and were scared by what they saw.

There is…

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Selective Eating revisited

posted by Julie O'Toole on November 7, 2013 at 1:30am

I recently blogged on one of the childhood eating disorders (incidentally not yet recognized as such in the DSM system) called selective eating.  I got a deluge of parental comment and interest, which I would like to try and address here.

What exactly is selective eating?

Selective eating (SE) is a condition present since earliest childhood where a child eats only a very narrow range of foods and refuses all others and yet where his or her linear growth is normal. Such children are…

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The Very Young Child With Anorexia

posted by Julie O'Toole on October 31, 2013 at 12:18am

Many people are shocked when they learn that we have patients with anorexia nervosa as young as six or seven, and, although it is rare, it certainly does occur.

Why are they shocked?  Because most of these folks, despite hearing me (and Dr. Tom Insel, among others) say “it’s a brain disorder”, still deeply believe that “the media” and our obsession with thinness causes anorexia.  They are horrified that someone so young could be “ruined by society”.  And blaming the parents for this…

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The Kartini Meal Plan De-Mystified

posted by Julie O'Toole on October 17, 2013 at 12:17am

There is a common misconception out there that Kartini patients are fed on a strict meal plan for the rest of their lives.  But what exactly is our meal plan? And while we talking about it, what's our approach to meals and food in general?

Well…

  1. there’s the “parents in charge” (of all meals) thing

  2. there’s the recording on the food journal thing

  3. there’s the family dinners thing/ home cooking thing

  4. there’s the whole-milk-no-low-fat thing

  5. there’s the…

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The importance of cooking at home

posted by Julie O'Toole on September 4, 2013 at 8:23pm

For those of you who remain unconvinced that the value of home cooking goes beyond the cost savings, please be aware of the effects that processed food packaging can have on all of us, especially on infants and children.

An increasing body of research has suggested that obesity may be associated with (triggered by? exacerbated by? caused by?) so-called “obesogens” in our environment, such as known endocrine disruptor Bisphenol-A (aka BPA).

Take the example of green beans.  Say you…

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Portrait of a Nurse

posted by Julie O'Toole on August 28, 2013 at 8:10pm

Depictions of nurses and of the relationship between nurses and doctors have been the subject of many films and books and stories.  Doctors are usually portrayed as leading and demanding, telling the nurses what to do.  Nurses are usually portrayed as carrying out the doctor’s orders, and occasionally talking back or standing up to them.  My mother and one of my favorite aunts were both nurses in the old mold, largely deferential to doctors, they wore uniform dresses of modest length…

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Health Is A State, Not A Weight

posted by Julie O'Toole on August 7, 2013 at 11:40pm

This week’s blog covers a topic - menstruation in female patients - which I have written about before, but, given its critical importance to our female patients and their parents, I’d like to bring it up again.

First let me distinguish between menarche (first period) and the resumption of menses (monthly periods). Menses is an important marker of recovery in girls who menstruated prior to the onset of their eating disorder, and something I’ve written about before.  Today I would like…

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The Eleventh Hour

posted by Julie O'Toole on July 25, 2013 at 7:36pm

I’m sure all specialties have their frustrations, but here is a major one of mine: patients who come to Kartini Clinic needing -- indeed deserving -- help but at the “eleventh hour.”

 

What do I mean by this?  I mean families who come in seeking help for a condition which is characterized by anosognosia, having waited for a variety of reasons, until shortly before their child’s 18th birthday, at which age their child will be able to refuse treatment, and often will do.  Even in…

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10 Steps to an Accurate Eating Disorder Diagnosis

posted by Julie O'Toole on July 11, 2013 at 12:59am

Inspired to think outside my usual box by Dr. Eric Topol, author of  Creative Destruction of Medicine this morning, I began to ask myself: how can I help parents who may not have access to experienced care, who fear that their child may have an eating disorder, make that diagnosis and get help?  Where do I start?

Well, start first with self-examination.  

We doctors are made very uncomfortable by any talk of patient autonomy or patient empowerment. The words “self diagnosis” are said…

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