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Stanford Report, April 30, 2003

Eating disorders clinic opens its doors offsite


The new home of Lucile Packard Children’s Hospital’s Comprehensive Eating Disorders Program sports Packard’s trademark friendly style: bright and sunny with colors and design elements handpicked by the program’s nurses, staff and physicians. The surprise is its location.

The facility, which opens at full capacity today, is at El Camino Hospital in Mountain View. The move from Packard gives the program new, expanded digs, including a school room, a group eating room, a room devoted to physical and occupational therapy and the space to grow.

"Throughout all these years, we — like everybody else — have been constrained by space limitations," said Iris Litt, MD, chief of Packard Children’s Hospital’s division of adolescent medicine. "We now have the opportunity to grow the program and better meet the needs of a wider range of teens."

"The new unit is configured well for our patient population," said James Lock, MD, PhD, associate professor of psychiatry and behavioral sciences, who co-directs the program with Litt. Jointly directed by the divisions of adolescent medicine and child and adolescent psychiatry, the comprehensive eating disorders treatment program — the only one of its kind in Northern California — is unique in its approach to treatment.

"We are one of the few, if not the only, eating disorders program in the country with a coordinated medical and psychological treatment approach and an interdisciplinary team," said Litt.

The expanded program will treat adolescents with anorexia nervosa, bulimia and other eating disorders in a customized space housing 15 inpatient beds, nearly twice the number that existed at Packard Children’s Hospital. Telemedicine technology, including interactive video conferencing, will bridge the distance between the two hospitals, allowing subspecialists at Packard Children’s Hospital to consult with patients at El Camino and permitting Litt and her colleagues to host pediatric grand rounds at the new facility.

After discharge, program staff members help patients and their families find and use community resources, and work with patients’ primary physicians to craft individual treatment plans. Some patients will also be treated without hospitalization.

"We are now able to conduct cognitive behavioral therapy, interpersonal therapy for bulimia and family treatment for anorexia on an outpatient basis," said Lock.

Packard Children’s Hospital physicians have also long been involved in basic research to improve patient care, including an investigation into the long-term effects of extreme malnourishment. Litt and pediatric endocrinologist Laura Bachrach, MD, found that one consequence, osteopenia, or weak bones, can be reversed with proper treatment — unlike osteoporosis. Other studies by Litt and her colleagues have shown that the average inpatient stay can be reduced from six weeks to about 18 days with no loss of safety and effectiveness.

The move of the Comprehensive Eating Disorders Program is part of Packard Children’s Hospital’s long-term plan to create an adolescent medicine service at El Camino Hospital. Although medical center physicians have been treating adolescents for more than two decades, adolescent medicine became a board-certified subspecialty only in 1994.

"There is a general misconception that — other than emotional issues — adolescents are basically healthy," said Litt. "But virtually every organ system in the body is impacted by changes during puberty, and there are many things that can go wrong." Packard’s adolescent clinic offers consultation on the health and psychological issues faced by teenagers and regular health maintenance for adolescents.

"We’ve done so well educating the parents of young children about the importance of immunizations that they may feel that once their child has gotten their shots and is in school, it’s over. In fact some of the greatest need occurs during high school and college," said Litt.

Finally, Packard’s adolescent medicine specialists also address the psychosocial issues arising during the physical changes of puberty, particularly in children with chronic illnesses.

"These kids may have many more problems in their teen years," said Litt. "They don’t want to be different from their peers, so they may stop taking medication or appropriately restricting their activities."

Doctors team with parents to tackle eating disorder (11/20/02)

New anorexia therapy makes family a key to recovery (11/15/00)