Eating Disorders & Disordered Eating: who to see and what helps

Eating Disorders · Kitchener, Waterloo & Cambridge

An eating disorder is a mental health condition in which food, eating and often body weight or shape take over, and it can do serious physical harm. Guidelines call for assessment and treatment at the earliest opportunity, led by a specialized eating disorder program with a physician or nurse practitioner watching physical health. At CARESPACE, counselling and dietitian care are outpatient support that works alongside that team. They are not a substitute for it.

When an eating disorder is an emergency

Eating disorders can be life-threatening. Anorexia is one of the leading causes of death related to mental health problems, through physical complications or suicide.

Call 911 or go to the nearest emergency department if you, or someone you care for, have been restricting food (eating very little) or bingeing and have any of these:

• Chest pain, with activity or at rest
• Any seizure-like activity
• Any fainting
• Irregular or rapid heartbeats
• Swelling in the ankles with shortness of breath, a cough and chest pressure (like an elephant sitting on the chest)
• Feeling lightheaded for hours
• Weakness or cramps of the legs, confusion, nausea and vomiting (these appear when sodium or potassium is very low)
• Any pain that does not resolve

If you have been bingeing and purging, go for any of the signs above, and also for:

• A large amount of blood in the vomit or stool
• Vomit that looks like coffee grounds
• Black stools (unless you are on iron or taking Pepto-Bismol, which can discolour the stool)

These lists are from the eating disorders program at the Canadian Mental Health Association Waterloo Wellington. Nobody at CARESPACE can rule these signs out, and none of them should wait for an appointment.

HealthLink BC’s list for people diagnosed with anorexia adds two signs that need medical care the same day, from a physician, a nurse practitioner, an urgent care clinic or an emergency department: not being able to pass urine, and a slower-than-normal heart rate. Its other signs (a pounding or skipping heartbeat, fainting, severe belly pain, vomiting blood, black sticky stools, severe pain anywhere in the body) are emergencies, as above.

If you are thinking about suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.

If you are in crisis or thinking about suicide, help is available right now.

• Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
• Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
• Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What an eating disorder is

The NHS describes it as a mental health condition where you use the control of food to cope with feelings and other situations. Anyone can develop one, teenagers and young adults most often. The main types:

• Anorexia nervosa. Keeping weight down by not eating enough, exercising too much, or both.
• Bulimia nervosa. Losing control over how much you eat, then taking drastic action to avoid gaining weight.
• Binge eating disorder. Eating large amounts until uncomfortably full.
• Other specified feeding or eating disorder (OSFED). Symptoms that do not exactly fit one of the others. It is the most common eating disorder.
• ARFID (avoidant/restrictive food intake disorder). Avoiding foods or eating very little for reasons that have nothing to do with weight or shape.

“Disordered eating” is often used for eating problems that may not fit a diagnosis neatly. That is no reason to wait: the Canadian Paediatric Society notes that eating disorders short of a full diagnosis can still cause significant impairment, and that young people who have lost a lot of weight can be as medically unstable at a normal or higher body size as at a low one.

Signs of an eating disorder

• Worrying a lot about your weight and body shape
• Avoiding social plans when food is involved
• Eating very little, or having very strict habits and routines around food
• Making yourself sick or taking laxatives after eating
• Exercising too much
• Mood changes: withdrawn, anxious or depressed
• Feeling cold, tired or dizzy
• A racing heart, fainting or feeling faint
• Pains, tingling or numbness in the arms and legs
• Digestive problems
• Weight that is very high or very low for your age and height
• Periods stopping or not starting, or delayed puberty

Fainting, a racing or irregular heartbeat and lightheadedness that lasts for hours are emergency signs: see the top of this page.

What causes eating disorders

Nobody knows exactly. One is more likely if you or a family member has a history of eating disorders, depression, or alcohol or drug misuse; if you have been criticised for your eating habits, body shape or weight; if you feel pressure to be slim, particularly from a job or activity such as dance, modelling or sport; if you have anxiety, low self-esteem, an obsessive personality or are a perfectionist; or if you have been sexually abused. Risk is highest between ages 13 and 17.

How an eating disorder is diagnosed

By a physician, nurse practitioner or specialist team. The UK guideline says no single measure, such as BMI or how long the problem has lasted, should decide whether someone is offered treatment. For children and teenagers, the Canadian Paediatric Society says initial blood tests, a urine test and a heart tracing (ECG) should be considered for every young person with a suspected eating disorder, partly because coeliac disease, inflammatory bowel disease, an overactive thyroid and type 1 diabetes can look similar. Counsellors and dietitians do not diagnose or prescribe.

What the evidence says about treating eating disorders

• Where this comes from. The UK’s national guideline (NICE), the Canadian guideline for children and adolescents, and Ontario’s quality standard. NICE’s “offer” is firmer than its “consider”; the Canadian guideline labels its recommendations strong or weak.
• The therapy is specific to eating disorders. For adults in Ontario, eating-disorder-focused cognitive behavioural therapy (CBT-ED) should be offered for anorexia, bulimia and binge eating disorder. In the UK, a guided self-help programme is offered first for binge eating disorder and considered first for bulimia.
• For children and teenagers, family-based treatment comes first. It is a strong Canadian recommendation for any child or adolescent with anorexia or bulimia. CBT and the other options are weak ones: each “may be a reasonable treatment option”.
• The least intensive setting that is safe. This is the other strong Canadian recommendation. If outpatient treatment is not working, a higher level of care may be needed.
• Physical health is monitored the whole way: vital signs, lab tests, height and weight, including for people who are not in active treatment.
• Dietitians work inside a team, and medication is never the whole plan. For anorexia, NICE says to offer dietary counselling only as part of a multidisciplinary approach. It says not to offer medication as the sole treatment for anorexia or bulimia.

Levels of care, and where CARESPACE fits

Eating disorder care in Ontario runs from self-directed programs and outpatient therapy, through day treatment and live-in treatment, to hospital care for medical stabilization. CARESPACE offers outpatient counselling, dietitian care and nurse practitioner care. We do not run day treatment or live-in treatment, and we do not provide medical stabilization.

General counselling and dietitian care are not a substitute for treatment designed for eating disorders. The UK guideline’s position is that anyone with a suspected eating disorder after a first assessment should be referred immediately to a community-based, age-appropriate eating disorder service.

Ontario’s standard lists signs of serious risk that include, among others, rapid substantial weight loss, unstable vital signs, electrolyte disturbances, cardiac abnormalities, hemodynamic instability (unstable blood pressure and circulation), medical complications of malnutrition, and suicidal thoughts or behaviours. People at serious risk may need emergency care, admission to hospital, or both. If weight is dropping quickly, see a physician or nurse practitioner as soon as you can, without waiting for a routine appointment. The signs in the emergency list at the top of this page are for 911 or an emergency department, and the crisis numbers are there too. Most of the other signs take an examination and tests to find.

The specialized programs we could confirm for Waterloo Region are run by the Canadian Mental Health Association Waterloo Wellington and by Waterloo Regional Health Network (WRHN). Adults 18 and over can refer themselves to the association’s Adult Eating Disorders Program by calling Here 24/7 (the number is in the crisis box above). Children and teenagers in Cambridge go through Here 24/7 too. In Kitchener and Waterloo they go to WRHN’s outpatient children and adolescent program, which needs a physician’s referral.

If you are moving here for university or college, set up follow-up in Waterloo Region before term starts. Ontario’s standard asks for care that stays continuous when young people move from youth to adult services.

How each CARESPACE service helps with an eating disorder

Counselling & Psychotherapy

CARESPACE counsellors offer cognitive behavioural therapy (CBT). The therapies in the guidelines are more specific: CBT-ED for adults, family-based treatment for children and teenagers. When you book, ask for a counsellor trained in the one you need; if nobody is, the specialized program is the place for that therapy. A counsellor can also work on what tends to come with an eating disorder (NICE’s list includes depression, anxiety and obsessive-compulsive disorder) and can support relatives, which the same guideline says to consider.

See our counselling team →

Nutrition & Dietitian

Nutrition care for an eating disorder covers education, dietary recommendations, meal planning and meal support. A Registered Dietitian offers nutritional counselling to build healthy eating patterns. This is not weight-loss care: for binge eating disorder, the UK guideline states that weight loss is not a therapy target in itself. Because dietary counselling belongs inside a team, tell your dietitian who else is treating you. When you book, ask for a dietitian who has worked with eating disorders; if nobody has, nutrition care comes through the specialized program.

See our nutrition team →

Nurse Practitioner

Nurse Practitioners in Ontario are authorized to diagnose, to order and interpret tests, and to prescribe, and Ontario’s standard counts them, with family physicians, as primary care providers. For an eating disorder that is the medical side: checking vital signs, weight and height, ordering blood tests, assessing whether a heart tracing is needed, and referring to a specialized program. If a family physician or nurse practitioner already follows you, stay with them.

See our nurse practitioner team →

Other services people ask about

NICE says not to offer physical therapies as part of treating an eating disorder, and names acupuncture, weight training and yoga among them. The Canadian guideline differs on one: yoga added to standard treatment may be a reasonable option for medically stable youth (a weak recommendation). Young people who are medically compromised should not exercise, so ask your physician or nurse practitioner what is safe for you now.

Where most people start

With a physician or nurse practitioner, for the physical check and a referral to a specialized program. A first visit with a CARESPACE counsellor or dietitian is booked alongside that medical care, not in place of it.

How your team works together

The therapist works on the thoughts, feelings and habits that keep the eating disorder going, the dietitian on eating itself, and the physician or nurse practitioner on physical safety. Tell each of them who else is treating you.

Browse by service: counselling, nutrition and nurse practitioner.

What to expect at your first visit

1. When you book, ask which practitioners see children and teenagers, if the visit is for someone under 18.
2. With a counsellor. The counsellor works to understand your concern and comes up with a plan. You may be asked about your eating, your mood and what you want to change.
3. With a dietitian. You may be asked about your usual eating and what makes it hard.
4. Bring the names of anyone already involved in your care and a list of any medicines.
5. You leave with a plan. It may include seeing a physician or nurse practitioner, or contacting a specialized program.

What you can do at home

• See a physician or nurse practitioner as soon as you can, even if you are not sure it is an eating disorder, and take someone you trust. Waiting to see what happens is not safe when an eating disorder is possible.
• If you are worried about someone else, tell them so, encourage them to see a physician or nurse practitioner, and offer to go along. They may not realise there is a problem, or may deny it or get defensive.

Outlook

Most people can recover with treatment, though it can take time and is different for everyone. Young people with anorexia who start treatment early usually do well, HealthLink BC says, and a longstanding illness is harder to treat. None of the sources gives a typical length of illness.

Eating disorder support in Kitchener, Waterloo and Cambridge

Kitchener. Counselling in Kitchener and Nutrition in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Counselling in Waterloo, Nutrition in Waterloo and Nurse Practitioner in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Counselling in Cambridge and Nutrition in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Can CARESPACE treat an eating disorder?

We provide outpatient support: counselling, dietitian care and nurse practitioner care. We are not a specialized eating disorder program, and the UK’s national guideline says anyone with a suspected eating disorder should be referred to one. Use us alongside that program and your physician or nurse practitioner.

Where can I get help for an eating disorder in Cambridge?

CARESPACE offers counselling and dietitian care in Cambridge. For the specialized program, adults, children and teenagers living in Cambridge are all referred through Here 24/7 to the Canadian Mental Health Association Waterloo Wellington.

Do I have to be underweight to have an eating disorder?

No. An unusually low or an unusually high weight are both among the signs the UK guideline takes into account, and BMI alone should never decide whether someone is offered treatment.

Is disordered eating the same as an eating disorder?

No. An eating disorder is a diagnosis; disordered eating is a looser term. Both are worth an assessment.

Is medication used for eating disorders?

Not on its own. Antidepressants may be prescribed when depression, anxiety or obsessive-compulsive disorder occurs with anorexia. That decision belongs to a physician, nurse practitioner or psychiatrist.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69). 2017, last updated December 2020.
• Couturier J, Isserlin L, Norris M, et al. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. Journal of Eating Disorders, 2020.
• Ontario Health. Eating Disorders: Care for People of All Ages (quality standard). 2023.
• Coret M, Vyver E, Harrison M, et al; Canadian Paediatric Society, Adolescent Health Committee. A guide to the community management of paediatric eating disorders. Position statement, 2024.
• NHS. Overview: Eating disorders and Overview: Anorexia nervosa. Reviewed January 2024.
• HealthLink BC. Anorexia Nervosa. Current as of October 2022.
• Canadian Mental Health Association Waterloo Wellington. Services for Eating Disorders and When to seek Medical Care for an Eating Disorder (undated). Read November 2026.
• Waterloo Regional Health Network. Refer a patient: children and youth. Read November 2026.
• College of Nurses of Ontario. Nurse Practitioners: practice resources. Read November 2026.

Related conditions

• Anorexia
• ARFID
• Picky Eating in Children
• Emotional Eating
• Body Image Issues

Ready to book?

Book online with a counsellor or a dietitian, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

Online booking