Eating Disorders Program
Referral Process
Before you ask your doctor for a referral to the St. Joseph’s Eating Disorder Clinic, please complete the self-assessment guide to eating disorder treatment using the link below. The self-assessment guide will help you determine the appropriate level of care for treatment of your eating disorder and ensure you are putting in a referral to the right program to meet your needs. Once you complete the self-assessment, you can take the results to your family physician to discuss your options.
Click here to take the self-assessment.
Referrals to this program are processed by Connect, St. Joe’s centralized intake service for Mental Health and Addiction outpatient programs. Click here to access the Connect referral form.
What this program does...
The Eating Disorders Program treats adults suffering from an eating disorder who are capable of making independent change to their eating, activity and eating symptoms. You will receive support and guidance, but you must believe you are capable of making changes without supervision to succeed in an outpatient setting.
You must be aged 16 or over to participate in this program. If you are under 18, living at home and going to school, you may want to contact the Children’s Hospital Eating Disorders Program (Hamilton Health Sciences).
You will need more intensive treatment than we can provide if your weight is dangerously low (below a BMI of 16). We do not offer inpatient treatment, so if you feel that you require this kind of care, we suggest you seek a referral to an inpatient program through your family physician.
We do not offer treatment for obesity, as this is not a weight loss program. We do however, offer treatment for individuals suffering from Binge Eating Disorder. If you are regularly binging on large quantities of food and feel out of control at these times, you can be referred to our program for assessment and treatment.
If you are currently abusing substances or engage in significant self-harming behaviours, you may not be eligible for treatment until these issues are resolved. We suggest that you contact Community Psychiatry at St. Joseph’s Healthcare Hamilton for assessment and treatment of self-harm. For substance abuse, we recommend that you contact the Alcohol, Drug and Gambling Services (ADGS) program.
Individuals who are psychotic will also need treatment before they are eligible for our program. Individuals who would have trouble participating in a group may also be ineligible for treatment.
How this program helps...
The Eating Disorders Program offers comprehensive evaluation and proven treatments to help individuals with eating disorders that may include both psychological treatment and medications. Our staff is available to consult with your family doctor, psychiatrist and other professionals who are involved in your care.
Evaluation Procedure
Every individual who is seen at the Eating Disorders Program receives a comprehensive assessment.
This assessment may include:
A thorough assessment is conducted to ensure attention to:
- Your specific eating disorder symptoms
- Other psychiatric problems that may make recovery more difficult
- Your eating and activity patterns
- Your physical well-being
- Life circumstances in which you find yourself
Specifically, the assessment will include:
- Administration of questionnaires to obtain information that will be used to prepare for the diagnostic interview, and to measure change over treatment.
- Detailed interview to assess the eating disorder in particular, to help clarify any psychiatric diagnoses, and to understand you as an individual.
- Nutritional assessment to provide a detailed understanding of your current eating habits, activity patterns and symptoms, as well as where you are in terms of body weight.
- A medical assessment to address any medical complications associated with your eating disorder.
- Psychiatric consultation to provide further clarification of both the eating disorder and other psychiatric issues you may be dealing with, and to consider the use or modification of medication.
The information obtained in the assessment helps us work more effectively with you and tailor our treatment recommendations to your specific needs. In our assessment report we also provide information on treatment resources for other psychiatric problems you may be dealing with. Your doctor will receive a copy of the report describing the results of the assessment as well as our recommendations for treatment. You will also receive a feedback form outlining your psychiatric diagnoses and our treatment recommendations.
Please go to Treatment Groups to learn more about how individual treatment plans are developed to meet each participant’s specific needs.
What’s in and out: Food trends and body positivity in 2024
Learn how social media can impact our relationships with food and our bodies and what you can do to quash diet culture on social media. Read the story.
Our Team
Michele M. Laliberte, Ph.D., C.Psych – Clinical Lead
Phone: 905-522-1155, Ext. 34093
Email: mlaliber@stjoes.ca
Sarah McCoomb, Psychologist
Phone: 905-522-1155, Ext. 36249
Email: smccomb@stjoes.ca
Dr. Kofi Ofosu, Psychiatrist
905-522-1155 ext. 33433
Beth Adams, Psychometrist
Phone: 905-522-1155, Ext. 32779
Email: adamsb@stjoes.ca
Lisa DiFronzo, Nurse-Practitioner
Phone: 905-522-1155, Ext. 35100
Email: ldifronz@stjoes.ca
Erin O’Flaherty, Registered Dietitian
Phone: 905-522-1155, Ext. 32050
Email: eoflahe@stjoes.ca
Laura Davis, Registered Dietitian
Phone: 905-522-1155, Ext. 32050
Email: ldavis@stjoes.ca
Michaela Chiasson, Registered Social Worker
Phone: 905-522-1155, Ext. 32908
Email: mchiasso@stjoes.ca
Megan Rodgers, Administrative Support
Phone: 905-522-1155, Ext. 33433
Email: mrodgers@stjoes.ca
Nicole Atkins, Clinical Intake Worker
Phone: 905-522-1155, Ext. 33561
Email: atkinsn@stjoes.ca
Taylor Hatchard, Manager
Phone: 905-522-1155, Ext 36249
Contact
Eating Disorders Program
St. Joseph's Hospital, West 5th Campus
Level 1, Block D, Room 125
100 West 5th Street
Hamilton, ON L8N 3K7
For information on new and existing referrals, please contact our Intake Worker:
Phone: 905.522.1155, Ext. 33561
For more information, contact:
Megan Rodgers, Administrative Support
Phone: 905.522.1155, Ext. 33433
Email: mrodgers@stjoes.ca
Monday to Thursday
9:00 am to 4:00 pm
We ask that you do not bring any valuables with you as the hospital cannot be responsible for lost or stolen personal items.
Treatment: Transition Age Program
Transition Age Program (Ages 16-22)
If you are transitioning from a pediatric eating disorders program, or you are in the process of transitioning from high school to young adult life (for example starting university, college or a job), St. Joseph's offers individual Cognitive Behaviour Therapy - Enhanced (CBT-E) to help you overcome your eating disorder. After you complete an assessment, treatment will be tailored to you individual needs, helping you target the factors that are specifically maintaining your eating disorder; things like over-valuing weight and shape, perfectionism, and control to a name a few. Treatment lasts from 20 to 40 weeks, after which your progress would be evaluated and you will have access to other services available through the program if appropriate.
Treatment Groups
Symptom Interruption: "Making Changes"
The Making Changes workshop is a 25-week, CBT-based group that takes you through the steps necessary to overcome the symptoms of your eating disorder. For the first weeks of Making Changes you will receive information about factors that maintain eating disorders, the personal and medical consequences of eating disorders, and information about weight regulation. You will also have the opportunity to hear from individuals who have gone through the program before you and have recovered from their eating disorder. You will then develop your own eating and activity plan in consultation with the program dietitian and a personal fitness trainer. Finally, you will work to change the thoughts and behaviours that are part of an eating disorder. You will set goals and work to normalize your eating and activity. You will track your symptoms to identify practical, emotional and interpersonal triggers for disordered eating and learn strategies for managing these triggers. This group meets once a week for 2 hours.
Body Image
For recovery to be complete and to make you less vulnerable to relapse, it is essential that you learn to feel comfortable in your natural body. In this 10-week CBT-based group, we will look at the experiences, thoughts and behaviours that contribute to body dissatisfaction. You will be challenged to make changes that we hope will allow you to feel more confident. This group meets once a week for 2 hours.
Extended Group
This group is intended to respond to individuals who require a longer period of treatment to fully recover from their eating disorder. It is also intended to respond to the needs of individuals who may be returning to Hamilton from residential treatment programs and require outpatient follow-up. This is a group that runs in 15 week cycles and provides an opportunity for you to set food and activity goals, and to problem-solve issues as they arise. A new set of skills or information is presented as part of each 15 week cycle. This group meets once a week for 2 hours.
Medications
The recommended first line of treatment for an eating disorder is psychotherapy, and particularly Cognitive Behavior Therapy (CBT). However, there may be some important uses for medication in your treatment.
If you are binge eating and purging…
Some anti-depressant medications have proven effective in reducing binge episodes. The program psychiatrist may recommend these for some individuals.
If you are underweight…
Although there is not an effective medication for helping people who are underweight recover from their eating disorder, there are some medications that may be used in the short term to help you through the anxiety associated with change. There are also medications that may be recommended to help with any digestion issues.
If you are obese and binge eating…
In your treatment group you will have weight management options fully described to you. One option is to take a medication that has been found to help reduce body weight by 5 – 15%. The program psychiatrist will discuss this option with you.
If you have another psychiatric illness…
Many individuals participating in the eating disorders program are also struggling with mood, anxiety or other psychiatric problems. The program psychiatrist will work closely with you to try to find medications that will effectively treat the symptoms of these other disorders. Every effort is made to find weight-neutral options in choosing a medication to mitigate anxiety associated with possible weight gain.
Additional Resources
Please contact the National Eating Disorder Information Centre (NEDIC) for information about treatment resources across the country, or if you or family members would like written information about eating disorders.
Email: nedic@uhn.on.ca
Tel: 416-340-4156 or 1-866-NEDIC-21 (1-866-633-4221)
Fax: 416-340-4736
Web: www.nedic.ca
Local Support:
Body Brave in Hamilton
Offers support for individuals struggling with eating disorders, as well as their family and friends.
Email: info@bodybrave.ca
Phone: 905-312-9628
Self-Help Material:
Two helpful books co-authored by professionals working at St. Joseph's Healthcare Hamilton and Toronto General Hospital include:
The Cognitive Behavior Workbook for Weight Management: A Step by Step Program by Michele Laliberte, Ph.D., Randi E. McCabe, Ph.D. and Valerie Taylor, MD, Ph.D.
While intended for the general public this publication also includes useful information for those with eating disorders regarding the body’s regulation of weight, planning eating and activity, overcoming hurdles, staying on your plan, and body image. The information on weight management options is particularly relevant to individuals with Binge Eating Disorder.
The Overcoming Bulimia Workbook: Your Comprehensive Step-by-Step Guide to Recovery by Randi E. McCabe, Ph.D., Traci L. McFarlane, Ph.D., and Marion P. Olmsted, Ph.D.
This book provides an overview of strategies for reducing binge eating and purging, as well as helping individuals explore and work on issues underlying the eating disorder.
Signs and Symptoms of Eating Disorders
Anorexia Nervosa
- You have deliberately lost weight and are now below what would be minimally healthy (for example falling 15% or more below the minimal weight expected for your height).
- Intense fear of gaining weight or becoming fat, even though you are underweight.
- You see yourself as fat when others clearly disagree; your weight has a huge impact on your feelings about yourself; you don’t think being underweight is a problem when others around you clearly do.
- You may be maintaining this low weight through restricting your food and/or exercise alone or you may also be binge eating and purging your food.
Bulimia Nervosa
- You are experiencing recurrent episodes of binge eating (eating what everyone would agree is a lot of food in a limited time and feeling a loss of control over your eating).
- You try to compensate for these binges by “ridding yourself” of the calories in some way – for example, by self-induced vomiting, abusing laxatives, fasting, over-exercising.
- You have been binge eating and compensating for these binges on average once or more per week, for at least the last 3 months.
- You feel like your weight determines your worth.
- You are not significantly underweight (if so, you likely have Anorexia Nervosa).
Binge Eating Disorder
- Binge eating on average 1 time per week, for at least the past 3 months (a large amount of food in a limited time; experiencing a loss of control over eating).
- During a binge episode, you feel three or more of the following:
- Eating much more rapidly than normal
- Eating until you feel uncomfortably full
- Eating large amounts of food when you don’t feel physically hungry
- Eating alone because your are embarrassed by how much you are eating
- Feeling disgusted with yourself, depressed or very guilty after overeating
- You feel very distressed about your binge eating.
- You do not try to compensate for your binge eating in any consistent way (for example, by purging or fasting, etc.).
Other Specified Feeding or Eating Disorder
- You have all the symptoms in common with Anorexia Nervosa, except that despite significant weight loss, your weight still falls in the "normal" range.
- You have all the symptoms in common with Bulimia Nervosa, except the binge eating and compensating behaviours occur, on average, less than once per week and/or for less than 3 months.
- You have all the symptoms of Binge Eating Disorder, except that binge eating occurs, on average, less than once per week and/or for less than 3 months.
- You are regularly using purging behaviours (for example self-induced vomiting, laxative abuse, and so on) to influence your weight or shape, but you are not binge eating.
- You have regular episodes of night eating - awakening from sleep to eat, or eating an excessive amount of food late into the night after dinner.
Resources for Professionals
Our program offers manualized treatment for symptom interruption, including one for patients with Anorexia, Bulimia and related eating disorders. We also have a separate manual for patients with Binge Eating Disorder. Both patient and therapist treatment manuals are available for purchase at the following web site: Eating Disorder Manuals
Making Changes: Group-Based CBT for Eating Disorders (Patient Manual)
Making Changes is a 21 week program. Group members initially receive education about eating disorders, factors that help to maintain their eating disorder, and what they will be required to do to overcome their eating disorder. Group members will plan their eating and activity, self-monitor for symptoms, and learn skills for addressing practical, emotional and interpersonal triggers. The manual contains all worksheets patients will need each week, as well as a copy of the self-monitoring form used throughout the last 13 weeks of treatment.
Making Changes: Group-Based CBT for Eating Disorder (Therapist Manual)
The Making Changes Therapist manual provides the background information necessary to narrate the psycho-education for the group (power point presentation is also provided). The therapist manual advises the therapist each week of the materials that will be needed, as well as the information required to lead each group activity. The therapist manual is considered essential if you are going to use the patient manual described above.
Making Changes: Group-Based CBT for Binge Eating Disorder (Patient Manual)
Making Changes for BED is a specialized treatment program designed specifically to meet the needs of individuals with BED. The psycho-education begins by looking at the nature of BED, and then moves to address the issues of weight management (and in particular, weight loss) in detail. Group members are given updated information on different recommended weight management options (healthy living; weight loss through lifestyle change; weight loss with the use of medications; weight loss through bariatric surgery), with particular emphasis on what is known for people with Binge Eating Disorder. Group members choose the weight management approach they feel is right for them. Group members plan their eating and activity; use self-monitoring to track eating and symptoms and learn skills to manage practical, emotional and interpersonal triggers.
Making Changes: Group-Based CBT for Binge Eating Disorder (Therapist Manual)
The Making Changes Therapist manual provides the background information necessary to narrate the psycho-education for the BED group (power point presentation is also provided). The therapist manual advises the therapist each week of the materials that will be needed, as well as the information required to lead each group activity. The therapist manual is considered essential if you are going to use the patient manual described above.
Body Image: A Manual for Group-Based, Cognitive Behavior Therapy for Body Image (patient)
The Body Image manual is specialized CBT for body image concerns experienced by individuals with eating disorders. This is a 10-week group that helps patients transition from treatment focused on symptom change to treatment focused on addressing body image concerns. Group members first learn to address the cognitive aspects of body dissatisfaction. They then focus on managing checking and avoidance behaviors. Group members learn how to effectively manage days when they “feel fat”. Special topics include dealing with media, with shopping for clothes, and with friends and family who may say things that trigger dissatisfaction.
Body Image: A Manual for Group-Based, Cognitive Behavior Therapy for Body Image (therapist)
The Body Image manual for therapists provides detailed instructions on how to run the various group exercises outlined in the patient manual. The therapist manual is considered essential if you are going to use the patient manual described above.