• Level of Care Self-Assessment (LoCSA) for an Eating Disorder

  • Purpose: Use this Tool to Help Guide Choices About Your Eating Disorder Care  

    This self-assessment is designed to help identify the level of care that may best support you based on your current needs. Eating disorder care can range from weekly outpatient visits to more intensive support. Your self-assessment results are a guide and should be reviewed with your primary care provider, who can help you decide on a care plan and appropriate treatment referrals.

    Limits: Please Review with Your Primary Care Provider 

    • This tool is intended for individuals aged 16 and older. If you are under 16, please speak with your primary care provider directly.
    • Your responses are not monitored by any healthcare provider or service. Be sure to follow up with your primary care provider after completing the assessment.
    • This assessment does not replace a clinical diagnosis or advice provided by a licensed healthcare provider. Your needs may change over time, and a treatment program may assess you differently once referred.

    Risks: Content Warning 

    • This tool includes questions about eating behaviours, weight, and mental health, including topics like self-harm or suicidal thoughts. Some questions may bring up uncomfortable emotions. You can pause or stop at any time and return when you're ready.
      • For medical emergencies, dial 9-1-1 or go to your nearest emergency department.
      • If you're in crisis, please call 9-8-8 or visit Crisis Services Canada.

    By continuing, you confirm that you: 

    ✔ Understand the purpose, limits and risks of this self-assessment. 

    ✔ Understand your responses and recommendation are for your personal reflection and to inform support recommendations you make with your primary care provider.  

    ✔ Understand the self-assessment is not monitored, and no one will respond to answers indicating risk (e.g., suicidal thoughts or self-harm). 

    ✔ Understand this tool does not provide crisis or emergency support – however, we will provide you with information on resources so you can get the help you need. 

    ✔ Understand that you will need to follow up with your primary care provider (e.g., your family doctor or nurse practitioner) to discuss your results and explore care options. 

    ✔ Know that your responses are confidential and only used in de-identified, combined form to help improve access to services and guide program development.

  • Your Information

  • To find out which level of eating disorder care may be best suited for your needs, please provide your email below. 

    Once you have completed the self-assessment a copy of your LoCSA responses will be emailed to you. 

  • Questions

  • Is your resting heart rate* below 50 beats per minute (bpm)? *Resting heart rate is your heart rate when you are relaxed, haven’t been active, or taken any kind of stimulant like coffee, tea, etc.*

  • Why is this question asked?

    When you are underweight, your overall metabolism slows. One consequence of this is that your heart rate can drop below 50 bpm. As your heart rate drops into this low range, the risk of your heart stopping (cardiac arrest) is greater – particularly at night when your heart rate drops even further. The risk of heart complications can be worsened by the presence of other eating disorder symptoms, particularly symptoms that result in changes in your electrolytes (for example, vomiting, laxatives, diuretics) that put you at risk of further medical complications.

  • Are you pregnant?*

  • Why is this question asked?

    Eating disorder symptoms increase the risk to both you and your baby when you are pregnant (for example, low birth weight, premature birth, etc.). In addition to seeking treatment in a more intensive setting, your primary care provider may recommend that you be followed by an obstetrician as a high-risk pregnancy.

  • Please indicate your current height and weight below

  • Why is this question asked?

    We understand that questions about weight and Body Mass Index (BMI) can be difficult, especially for individuals living with an eating disorder. It’s important to emphasize that we do not believe that an eating disorder, or recovery from an eating disorder, is about weight alone.

    That said, evaluating medical risk is an important part of determining the right level of care. One of the tools we use to evaluate risk is BMI, which is a ratio of weight to height. We know from research that if your BMI is below 16 (or seems likely to drop below 16 in the near future), you are at greater risk of medical complications related to being underweight. When determining what intensity of eating disorders treatment to seek; we consider your BMI along with other risk factors.

  • Have you experienced a significant drop in your weight because of changes you made to your eating as an adult. For example, losing more than 10-15 lbs, or going down two or more clothing sizes?*

  • Why is this question asked?

    Losing a significant amount of weight can increase your medical risk, regardless of whether you end up being “underweight” or not. Significant weight loss may lead to nutrient deficiencies, hormone changes, bone density loss, and changes in emotional well-being (for example, increased depression or anxiety). If your weight is already low and/or continuing to drop, a higher level of treatment may be recommended.

  • Are you restricting food intake to maintain your lower weight?*

  • Why is this question asked?

    You may be someone who lost a significant amount of weight months or even years ago. If you are still eating very restrictively to maintain this lower weight – especially if you are also struggling with body image – this can be part of an eating disorder.

  • In the past 3 months, have you experienced episodes of overeating (i.e., binge eating)? In other words, episodes where you feel a loss of control over your eating AND eating what others may consider an unusually large amount of food?*

  • Why is this question asked?

    Binge eating can be part of many eating disorders – it can be present in anorexia nervosa and is by definition part of bulimia nervosa and binge eating disorder.

  • Following a binge episode, do you try to make up for eating food by purging through vomiting, using laxatives or diuretics, fasting or over-exercising?*

  • Why is this question asked?

    Binge eating is a symptom of many types of eating disorders but not everyone who binge eats tries to make up for it through behaviours like vomiting, laxative use, over-exercise or fasting. The medical risk for those who try to compensate for binge eating can be higher, and can be even more risky for people who are also underweight. Treatment recommendations can be different for those who are binge eating without trying to make up for it, and who are not underweight. Sorting these things out helps us make better treatment recommendations.

  • In the past 3 months, have you gone for one or more days without eating (fasting) to influence your weight, shape or size?*

  • Why is this question asked?

    To keep your body's metabolism running smoothly, people ideally should aim to eat breakfast within an hour of waking and consistently consume food every 2 to 4 hours until they go to bed. When you don't eat throughout the day (i.e., fast), the body's ability to function normally is significantly compromised. When fasting is combined with other risk factors (such as purging), it can greatly increase your medical risk of hypoglycaemia and refeeding syndrome.

  • On average, has this happened to you on a weekly basis?*

  • Why is this question asked?

    A person's medical risk increases when fasting is a regular occurrence, happening weekly or more.

  • In the past 3 months, have you been exercising on a daily or almost daily basis in order to change your weight, shape or body size - including days when you are experiencing illness, injury, or at the cost of other important life activities (for example work, school, or social engagements)?*

  • Why is this question asked?

    Physical activity can be such a positive part of a person’s life – it contributes to both physical and mental health. It has even been shown to improve body image in the absence of any change to weight. Unfortunately, physical activity can also be part of an eating disorder. You can start to feel incredible anxiety and guilt if you miss your usual routine, even if you are unwell or have other important commitments. And of course, sometimes the amount of physical activity you feel you “must do” can gradually increase, until it is truly interfering with your life. When it is excessive, or combined with other symptoms of an eating disorder, physical activity can actually be harmful or medically dangerous. Having you think about your relationship with physical activity (do you know it is more rigid than it should be? do you know it is too much?) helps us to understand if it is part of an eating disorder.

  • In the past 3 months, have you tried to compensate for food intake by making yourself sick (vomiting)?*

  • Why is this question asked?

    Frequent purging by vomiting can lead to dehydration, which leads to weakened muscles, fatigue, and electrolyte imbalances. Any activity that causes your body to lose fluids (such as vomiting) can lead to low potassium (also known as 'hypokalemia') - which is very dangerous. In the body, potassium helps regulate fluid balance, muscle contractions, and nerve signals. The most important muscle in your body is your heart. If potassium levels go too low, this can cause heart arrhythmias (or an irregular heartbeat) and heart failure. This is one way people can die from an eating disorder.

  • How frequently did this occur?*

  • Why is this question asked?

    While any amount of purging is dangerous, the risk goes up with increased frequency. If you are purging by vomiting two or more times a day, you are considered high risk for low potassium (also known as 'hypokalemia'). This can put you at risk for irregular heart beats or heart failure.

  • In the past 3 months, have you tried to compensate for food intake by using laxatives or diuretics (water pills or diet pills)?*

  • Why is this question asked?

    Frequent purging by laxatives and/or diuretics can lead to dehydration which leads to weakened muscles, fatigue, and electrolyte imbalances. Any activity that causes your body to lose fluids (such as using laxatives and/or diuretics) can lead to low potassium (also known as 'hypokalemia') - which is very dangerous. In the body, potassium helps regulate fluid balance, muscle contractions, and nerve signals. The most important muscle in your body is your heart. If potassium levels go too low, this can cause heart arrhythmias (an irregular heartbeat) and heart failure. This is one way people can die from an eating disorder. Importantly, neither laxatives nor diuretics cause the body to get rid of the calories you have eaten - even if you experience diarrhea. Laxatives and diuretics have no effect on weight – using or abusing them does not lead to weight loss.

  • After you take laxatives or diuretics, are you having watery, loose stools throughout the day?*

  • Why is this question asked?

    Anything that causes your body to lose an excess of body fluid (for example through diarrhea) increases the risk for low potassium (known as 'hypokalemia'). Hypokalemia can put you at risk for an irregular heartbeat and/or heart failure.

  • Are you using laxatives or diuretics most days of the week?*

  • Why is this question asked?

    The more frequently you are taking something that causes your body to lose fluid, like laxatives and/or diuretics, the greater your medical risk.

  • Do you have Type 1 Diabetes? *If you have Type 2 Diabetes, please select "No"*

  • Why is this question asked?

    Research shows that people with type I diabetes are more likely to experience disordered eating.

  • In the past 6 months, have you reduced your insulin dosage to control your weight?*

  • Why is this question asked?

    If you are reducing your insulin dosing in an attempt to manage your weight, you will be experiencing high blood sugars and greatly increasing your risk of diabetic ketoacidosis. This can be life-threatening. Because of the high medical risk, individuals with type I diabetes and an eating disorder are typically treated in an intensive setting.

  • In the past 6 months, have you experienced one or more episodes of diabetic ketoacidosis (DKA)?*

  • Why is this question asked?

    High blood sugars greatly increase the risk of diabetic ketoacidosis, which can be life-threatening. Not only will you need to have your eating disorder treated in an intensive treatment setting, but you will also need to be monitored closely by your primary care provider and/or endocrinologist while you wait for treatment.

  • How is your relationship with food?*
  • Reflecting on your relationship to food, weight, body or shape...*
    Rows

  • Why is this question asked?

    This short screen is a measure that is able to detect people who either have an eating disorder or are at high risk of developing an eating disorder. This screen picks up on the thoughts and emotions that cause distress and can put you at risk of disordered eating even if you aren’t currently engaging in any eating disorder behaviours (like binge eating, purging, restricting your food, etc.).  We want to make good recommendations for everyone – anyone experiencing disordered eating or body image distress.

    Reference: InsideOut Institute Screener (IOI-S) developed by InsideOut Institute for Eating Disorders. Authors: Bryant, E., Miskovic-Wheatley, J., Touyz, S.W., Crosby, R.D., Koreshe, E., & Maguire, S. (2021)

  • Do you avoid or restrict certain foods for reasons that are NOT related to your weight, body shape, or body size? For example: avoiding food because of taste, texture, fear of choking or vomiting, past negative experiences, or low interest in eating.*

  • Why is this question asked?

    You may be avoiding food for reasons other than concerns about weight and shape. You may have difficulty eating because of the taste and texture of food. Or perhaps you avoid food because of a fear of things like choking, vomiting, irritable bowel or allergic reaction – more than makes sense. Or maybe you have trouble finding the interest or motivation to eat. The questionnaire below will give you a chance to let us know if any of these reasons explain some or all of your difficulties with eating. Treatment for these issues can be quite different from that of other eating disorders, so we want to be sure you are directed to the right program.

  • Please select how much you agree or disagree with each statement below*
    Rows

  • Why is this question asked?

    Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder that can involve restricting food intake due to sensory sensitivities to the taste, texture, or smell of food, low interest in eating or low appetite, or fear of eating due to things like choking or stomach discomfort. It is different from other eating disorders in that restricting one’s eating is not due to a desire to control one’s weight, shape, or eating habits. This screener helps us understand if your eating challenges might fit with ARFID, especially when other eating disorder symptoms are not present.

    Reference: Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) developed by Zickgraf., H.F. & Ellis, J.M. (2018)

  • Over the past 2 weeks, how often have you been bothered by any of the following problems?*
    Rows

  • Why is this question asked?

    This brief questionnaire assesses depression symptoms. If you are struggling with symptoms of depression, it can make it very difficult for you to engage in treatment for your eating disorder. We would strongly recommend that you speak to your primary care provider about the difficulties you are having with your mood. Your primary care provider can speak to you about medication options and/or refer you for psychological treatment. There are some very effective options available online for the treatment of depression. We will provide you with a few resources in the recommendations section at the end of the survey.

    If your depression is interfering with your functioning in your everyday life, this suggests you might also have difficulty making changes in the treatment of your eating disorder. We strongly recommend you speak to your primary care provider about treatment options for your depression.

    Reference: Patient Health Questionnaire-9 (PHQ-9) developed by Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (1999)

  • Are you currently using substances (such as alcohol, cannabis, other drugs) in a way that could: (1) interfere with your eating (for example, decreasing your appetite or increasing the urge to binge); or (2) interfere with your ability to participate in treatment for an eating disorder/disordered eating (both attending treatment and meeting treatment-related goals)?*

  • Why is this question asked?

    The regular use of substances (including alcohol) can:

    1. increase the medical risk associated with your eating disorder;
    2. interfere with your eating (e.g., suppress appetite or cause binge eating); or
    3. make it more difficult to participate effectively in the treatment of your eating disorder.

    For all of these reasons, we recommend you talk to your primary care provider about treatment for substance use. If you are not sure whether your substance use is problematic or could interfere with treatment for your eating disorder, we recommend you look into one of the substance use treatment options provided in the recommendations section at the end of the self-assessment. Some of these options are “low barrier”, do not require a referral to a treatment program, and are designed to help you decide if you do have a reason to be concerned about your substance use.

  • In the past 3 months, have you made a suicide attempt?*

  • Why is this question asked?

    Your eating disorder care should support your overall mental health, including your safety. The time after a suicide attempt can be one of increased risk, and it's important that your care team is aware so they can help put the right supports in place. If this applies to you, we strongly encourage you to speak with your primary care provider about connecting to mental health resources, if you haven’t already.

    Please note: This self-assessment is not monitored by any healthcare provider and is intended to help you reflect on your needs and risks. It does not provide crisis intervention or emergency support. If you are in distress or experiencing thoughts of suicide, you can call 9-1-1 or reach out to a free, confidential crisis line such as 9-8-8 (Crisis Services Canada) at any time. If you are not in crisis but are having thoughts of suicide, please speak with your primary care provider for further support.

  • In the past 3 months, have you self-harmed (for example, cutting, burning, banging, etc.)?

  • Why is this question asked?

    Some of the individuals use self-harm as a way of managing difficult emotions. Some know that if their eating disorder symptoms were to decrease, their self-harm behaviors would increase. When the self-harm behaviors are frequent or have needed medical attention, we find that people do much better in treatment for their eating disorder if they have already received treatment to help them manage difficult emotions using skills – for example, through dialectical behavior therapy (DBT). If this is the case, we strongly recommend that you and your primary care provider look into DBT treatment options.

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