Shelly Bar MD

Shelly Bar MD Eating Disorder Specialist
Internal Medicine & Adolescent Medicine

Outpatient Treatment:
📍 Los Angeles & Newport
💻 Telehealth medicine

Medication safety in eating disorder care means considering the whole person, not just the medication list.Alcohol and o...
09/16/2026

Medication safety in eating disorder care means considering the whole person, not just the medication list.

Alcohol and other substances can affect alertness, coordination, cognition, blood pressure, and overall safety — even when there isn’t a classic drug–drug interaction.

Creating space for open, nonjudgmental conversations about substance use can help patients feel supported rather than judged, while allowing clinicians to identify potential risks and offer individualized guidance.

These conversations are not about blame or assumptions. They are opportunities to build trust, support informed choices, and keep care centered on the patient’s safety and well-being.

Ask with curiosity. Listen without judgment. Support with compassion.



Reference:

U.S. Food and Drug Administration. (2026). Olanzapine tablets: Prescribing information. DailyMed. DailyMed – Olanzapine prescribing information

🍎🍯 Shana Tova!As a new year begins, we’re wishing you moments of hope for what’s ahead.A new year doesn’t have to mean b...
09/11/2026

🍎🍯 Shana Tova!

As a new year begins, we’re wishing you moments of hope for what’s ahead.

A new year doesn’t have to mean becoming a “better” version of yourself.

For someone recovering from an eating disorder, progress may look quieter: eating consistently even when it feels difficult, taking rest without earning it, responding to your body’s needs, and letting go of rules that once felt necessary.

Recovery is not about starting over. It’s about continuing to build a life where food, movement, and your body take up less space—and you have more room for everything else that matters.

Here’s to a year of continued healing, support, and progress, one step at a time. 🤍

When we assess nutritional intake, it can be easy to focus primarily on what a patient is eating and overlook what and h...
09/09/2026

When we assess nutritional intake, it can be easy to focus primarily on what a patient is eating and overlook what and how much they are drinking.

In eating-disorder care, fluid intake can be an important—but sometimes overlooked—part of the medical assessment.

A patient may report drinking “a lot of water,” but the clinically important questions go beyond quantity. What is driving the behavior? When does it occur? Has intake changed recently? Is it associated with meals, weigh-ins, exercise, or purging?

This is why asking about fluid intake should be approached with the same curiosity and specificity as asking about food intake or compensatory behaviors.

For clinicians, consider incorporating questions about fluid quantity, timing, patterns, and function into the medical assessment—particularly when laboratory findings or clinical presentation raise concern.

A routine question about hydration may reveal a behavior that significantly changes the medical risk assessment.

Reference:

Akman, A. O., Cak, H. T., Pehlivantürk-Kızılkan, M., Balik, Z., Akbulut, O., & Kanbur, N. (2020). Sounds unrealistic: An adolescent girl with anorexia nervosa consumes 19 L of fluid in a few hours: What happens to the physiology? Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 25(5), 1487–1492. https://doi.org/10.1007/s40519-019-00777-7

Why does your eating disorder treatment team check your heart rate and blood pressure when you stand up? That’s orthosta...
09/04/2026

Why does your eating disorder treatment team check your heart rate and blood pressure when you stand up?

That’s orthostatic monitoring and it can provide important information about how your body is responding to changes in nutrition, hydration, and overall medical status.

Checking orthostasis isn't about “looking for something wrong.” It’s about understanding what your body is communicating and helping keep you medically safe throughout recovery.

If you experience dizziness, fainting, chest pain, shortness of breath, or a racing heartbeat, let your healthcare team know.

Reference:
Tanner, A. B. (2023). Unique considerations for the medical care of restrictive eating disorders in children and young adolescents. Journal of Eating Disorders, 11(1), 33. https://doi.org/10.1186/s40337-023-00759-2

When phosphorus levels are too low or too high, it’s worth taking a closer look at what may be happening in the bigger p...
09/02/2026

When phosphorus levels are too low or too high, it’s worth taking a closer look at what may be happening in the bigger picture.

Phosphorus should be interpreted alongside other labs, symptoms, nutrition, medications, and other objective and clinical findings.

Check the number. Consider the context. Look at the whole person.

If you have questions about your lab results, talk with your healthcare provider for individualized guidance.



Reference:

Trapani, S., & Rubino, C. (2025). Medical complications of anorexia nervosa. Pediatrics, 156(2), e2024070304. https://doi.org/10.1542/peds.2024-070304

𝗗𝗼 𝘆𝗼𝘂 𝗳𝗶𝗻𝗱 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳 𝗯𝗮𝗿𝗴𝗮𝗶𝗻𝗶𝗻𝗴 𝘄𝗶𝘁𝗵 𝘆𝗼𝘂𝗿 𝗰𝗵𝗶𝗹𝗱 𝗮𝗯𝗼𝘂𝘁 𝗳𝗼𝗼𝗱 𝗮𝘁 𝗺𝗲𝗮𝗹𝘁𝗶𝗺𝗲𝘀?When the eating disorder speaks loudly at the ta...
08/26/2026

𝗗𝗼 𝘆𝗼𝘂 𝗳𝗶𝗻𝗱 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳 𝗯𝗮𝗿𝗴𝗮𝗶𝗻𝗶𝗻𝗴 𝘄𝗶𝘁𝗵 𝘆𝗼𝘂𝗿 𝗰𝗵𝗶𝗹𝗱 𝗮𝗯𝗼𝘂𝘁 𝗳𝗼𝗼𝗱 𝗮𝘁 𝗺𝗲𝗮𝗹𝘁𝗶𝗺𝗲𝘀?

When the eating disorder speaks loudly at the table, parents don’t have to speak louder.

Sometimes, the most therapeutic response is calm, compassionate, and consistent.

Rather than negotiating every change, parents can acknowledge the emotion, stay connected, and remain grounded in the treatment plan.

Parents can understandably feel pulled toward fixing the distress immediately. But parental empowerment does not mean having the perfect response or eliminating every difficult moment.

Parents can acknowledge how difficult recovery feels without allowing the eating disorder to determine the next step. Connection and boundaries can coexist. ❤️👨‍👩‍👧

References:
Bédard, A., Côté, M., Meilleur, D., Di Meglio, G., Gingras, N., Pesant, C., Taddeo, D., Bélanger, R., Thibault, I., Nadeau, P.-O., Agostino, H., Stheneur, C., Frappier, J.-Y., & Bégin, C. (2025). Mother–Father distress, accommodation, and child eating disorder behaviors: A dyadic perspective. Family Process, 64(3), e70070. https://doi.org/10.1111/famp.70070

Kumar, A., Himmerich, H., Keeler, J. L., & Treasure, J. (2024). A systematic scoping review of carer accommodation in eating disorders. Journal of Eating Disorders, 12, 143. https://doi.org/10.1186/s40337-024-01100-1

Are you functioning—or just pushing through?With an eating disorder, showing up to school or work does not necessarily m...
08/21/2026

Are you functioning—or just pushing through?

With an eating disorder, showing up to school or work does not necessarily mean someone is doing well. Presenteeism can look like meeting deadlines, attending class, or getting through a shift while struggling with exhaustion, cognitive symptoms, emotional distress, or the constant effort of managing the illness.

You don’t have to “look sick” to be struggling. And you don’t have to stop functioning for your health to matter.

Recognizing the effort beneath the performance can be an important part of early intervention and compassionate care.

Reference:

Gallagher, L., Allen, K. L., & Schmidt, U. (2026). Evaluating the impact of eating disorder early intervention on young people's work, education and social functioning. European Eating Disorders Review, 34(1), 288–295. https://doi.org/10.1002/erv.70029

An eating disorder diagnosis should never be dismissed—or assumed to be "just part of" a child's neurodevelopmental cond...
08/19/2026

An eating disorder diagnosis should never be dismissed—or assumed to be "just part of" a child's neurodevelopmental condition.

While neurodivergent individuals may experience unique feeding or eating challenges, clinically significant eating disorders can also occur and deserve timely recognition, compassionate assessment, and evidence-based treatment.

Not every eating disorder presents in the same way. Remaining open-minded and recognizing that every individual deserves to have their concerns understood helps ensure that no one is overlooked.

References:
Bertelli MO, Paletti F, Piva Merli M, Hassiotis A, Bianco A, Lassi S. Eating and feeding disorders in adults with intellectual developmental disorder with and without autism spectrum disorder. J Intellect Disabil Res. 2025 Feb;69(2):153-164. https://doi.org/10.1111/jir.13195

Sader, M., Weston, A., Buchan, K.,Sader, M., Weston, A., Buchan, K., Kerr-Gaffney, J., Gillespie-Smith, K., Sharpe, H., & Duffy, F. (2025). The co-occurrence of autism and avoidant/restrictive food intake disorder (ARFID): A prevalence-based meta-analysis. International Journal of Eating Disorders, 58(3), 473–488. https://doi.org/10.1002/eat.24369

Could an eating disorder leave clues before anyone notices?For many children and adolescents, the answer may be yes.Rout...
08/13/2026

Could an eating disorder leave clues before anyone notices?

For many children and adolescents, the answer may be yes.

Routine growth monitoring is often viewed as part of preventive pediatric care—but it can also provide valuable clinical context when concerns arise. Research suggests that changes in a child's expected growth trajectory may precede the recognition of eating disorder symptoms by caregivers, highlighting the importance of looking at patterns over time, not just a single weight measurement.

Current clinical guidelines support incorporating longitudinal growth charts into a comprehensive eating disorder assessment. At the same time, they emphasize that growth charts are not diagnostic. Eating disorders occur across all body sizes, and no single measurement (including weight or BMI) can confirm or exclude an eating disorder.

Early recognition comes from putting the whole picture together: growth history, nutrition, eating behaviors, physical health, psychological symptoms, and developmental context.

The goal isn't to label children by a number; it's to recognize changes early, ask thoughtful questions, and ensure timely, compassionate care.

This post is for educational purposes only and is not intended to replace professional medical advice or evaluation.

References:

Marion, M., et al. (2020). Earlier diagnosis in anorexia nervosa: Better watch growth charts! Journal of Eating Disorders, 8, Article 44. https://doi.org/10.1186/s40337-020-00321-4

Hornberger, L. L., & Lane, M. A., on behalf of the American Academy of Pediatrics, Committee on Adolescence. (2021). Identification and management of eating disorders in children and adolescents. Pediatrics, 147(1), e2020040279. https://doi.org/10.1542/peds.2020-040279

Society for Adolescent Health and Medicine. (2022). Medical management of restrictive eating disorders in adolescents and young adults. Journal of Adolescent Health, 71(5), 648–654. https://doi.org/10.1016/j.jadohealth.2022.08.006

Do you wake up tired no matter how much you rest?Constant low energy isn't always explained by a busy schedule or poor s...
08/04/2026

Do you wake up tired no matter how much you rest?

Constant low energy isn't always explained by a busy schedule or poor sleep.

Feeling physically drained all the time can be a medical symptom, not a measure of determination or willpower. This can leave even simple daily tasks feeling overwhelming.

If this sounds familiar, a comprehensive evaluation by a healthcare professional experienced in eating disorders can help identify the underlying cause and guide appropriate treatment.

Reference:
Haines, M. S. (2023). Endocrine complications of anorexia nervosa. Journal of Eating Disorders, 11, Article 24. https://doi.org/10.1186/s40337-023-00744-9

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