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…Read More
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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
At Kartini Clinic we have been embarking on something we call “weight restoration 2.0”. In other words we are trying to move beyond mere weight restoration (as critical as that is) towards a deeper assessment of each patient’s full physical recovery. We have noticed, over the years of faithfully weight restoring each and every patient, that people respond differently to recovery from starvation, depending no doubt on their genetics and on the duration of their illness. Just one…Read More
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…Read More
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…Read More
Patient: I have battled with my weight all my life, doctor. It's my major health issue.
Doctor: What does that mean, Susan?
Patient: (irritated) It means, doctor, that I have been fat since I was a kid.
Doctor: I see. Are other family members overweight too?
Patient: The word is fat. F.A.T. Let's call it what it is. And no, they aren't. I was adopted.
Doctor: In that case, Susan, it seems reasonable to assume that your weight problem is not a result of anything you…Read More
You’ve heard it everywhere: your friends, your doctor, the New York Times, your personal trainer, virtually anyone who talks to you about health for more than five minutes will give you the same litany: we need to lose weight to be healthy and all we need to do to achieve that loss is to change what we eat (fewer refined high glycemic index carbs, leaner meats, more fish, better quality fats, etc.) and, ultimately, how much of it we eat -- otherwise we will not only get fat and look…Read More
According to Wikipedia Medscape is: a web resource for physicians and other health professionals. It features peer-reviewed original medical journal articles, CME (Continuing Medical Education), a customized version of the National Library of Medicine's MEDLINE database, daily medical news, major conference coverage, and drug information—including a drug database (Medscape Drug Reference, or MDR) and drug interaction checker. All content in Medscape is available free of charge for…Read More
Today I was seeing a young patient who had just been cleared to resume her sport activities. At the start of the appointment she was nearly trembling with anxiety, for the results of her labs were to determine whether or not the timing was right for her to return to volleyball. Fortunately (for all concerned!) the labs were good and I could clear her.
“But I still need to know something,” her dad said nervously “Honey, how will we know if your eating disorder is returning as a…
On February 18 I attended the annual conference of the Columbia River Eating Disorder Network (CREDN) and heard Dr Ken Weiner of ERC speak there. Ken spoke about the uselessness, hopelessness and mirage of dieting, but he also spoke about some of the issues pertinent to managing the patient with anorexia nervosa.
In Dr. Weiner’s experience, and the experience of his colleague Dr Craig Johnson (founding editor of the International Journal of Eating Disorders and founding member of…