Starved for attention: pro-anorexia websites glorify eating disorders

Illustration by Jillian Tamaki

“Nothing tastes as good as being thin feels.” So goes the catchphrase of the pro-anorexia and pro-bulimia movement. Pro-anorexia and pro-bulimia websites (pro-ana and pro-mia for short) promote the eating disorders anorexia nervosa (self-starvation) and bulimia nervosa (binging and purging). The sites are generally written by young women with anorexia or bulimia. Many provide flawed, often dangerous information in support of eating disorders.

Pro-anorexia and pro-bulimia sites number in the hundreds, and they are becoming more popular by the day. “Many teen girls are drawn to the sites out of general curiosity. Some of these girls are interested because they have an eating disorder, and others specifically want to find out information about weight loss methods,” says Dr. Mark Norris, a former fellow in the Division of Adolescent Medicine at the Hospital for Sick Children and currently a paediatrician at the Children’s Hospital of Eastern Ontario.

Many pro-anorexia and pro-bulimia websites refer to anorexia nervosa and bulimia nervosa as a “lifestyle choice” rather than an illness. To set the record straight, anorexia nervosa and bulimia nervosa are NOT lifestyle choices. They are psychiatric illnesses included in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

“Anorexia nervosa and bulimia nervosa often deal heavily with issues of control. Many girls with these disorders have used weight-loss strategies to try to increase control over their own bodies. At times, they may also be trying to compensate for the lack of control in their daily lives. When girls refer to their disease as a lifestyle choice, again it comes down to an issue of control. They refuse to believe that they have an illness, and they think they can beat it if they want to,” says Dr. Norris.

The allure and the dangers of pro-anorexia and pro-bulimia websites

The allure of these sites is that they provide a sense of belonging and community to their young members. “Pro-ana and pro-mia sites provide a new voice to an illness that was previously characterized by secrecy and isolation. They provide readers with a forum that describes ways to exert what they think is 'control' over their bodies,” says Dr. Norris.

Dr. Norris led a study on pro-anorexia and pro-bulimia sites during his time at SickKids. The study found that these websites glamourize eating disorders in many ways, such as:

• posting “thinspiration” photos of emaciated models
• providing “tips and tricks” for weight loss and purging, many of which are disturbing and dangerous if acted upon
• promoting the use of “solidarity jewelry” such as thinly beaded red or blue bracelets

“The cognitive and body image distortion that eating disordered patients experience spills over into almost every website. It comes through in the dialogue, in thinspirational pictures, and in some of the tips that put readers at risk medically. In the pro-ana and pro-mia world, success is measured by weight loss,” says Dr. Norris.

Pro-anorexia and pro-bulimia sites have the potential to draw teenage girls further into the trap of anorexia and bulimia, endangering their health in the process. For example, one recent study found that 61% of girls with eating disorders who had used pro-anorexia or pro-bulimia sites picked up new weight loss or purging techniques from the sites. Twenty-eight per cent used new diet pills, supplements, or laxatives after visiting the websites. “The information provided on these sites about diet pills and laxatives are often from the webmaster’s own personal experience,” but they may be passed off as fact, according to Dr. Norris.

The dangers of eating disorders

Teens – and some parents – often do not realize the seriousness of eating disorders. According to a review article by Dr. Debra Katzman, a paediatrician and Head of the Division of Adolescent Medicine at SickKids, eating disorders such as anorexia nervosa and bulimia nervosa can cause significant medical problems in every one of your teen’s organ systems. For example, the brain can be seriously affected. Problems with the structure and function of the brain arise frequently and early in the disorder.

Eating disorders can affect the heart by weakening it and reducing its ability to efficiently pump blood through the body. Heart problems start in the early stages of the disorder. There are many different types of heart complications that can arise as a result of an eating disorder. For example, about one-third of teens with eating disorders develop a serious heart condition called mitral valve prolapse. One-third of the people with an eating disorder who die do so as the result of a heart complication. However, if the eating disorder is identified early and promptly treated, normal heart function can be re-established.

Another frequent and serious complication is a loss of bone mass, which can lead to osteoporosis. People gain most of their bone mass in the teen years. When a teen has an eating disorder, her bone mass decreases, instead of increasing like it should. This boosts the risk of fractures in later life. The best way to treat bone loss is to help your teen achieve a healthy body weight. Gaining lean body mass is especially important.

What can parents do about anorexia and bulimia?

First of all, be aware of the warning signs of anorexia nervosa and bulimia nervosa. These include:

• weight loss and fear of gaining weight
• preoccupation with diet, food, food preparation, calories, and exercise
• refusal to eat with others
• loss of menstrual periods
• fine, downy hair called lanugo all over the body
• in bulimia: loss of tooth enamel, leading to a “ragged” appearance of the teeth

Touch base with your child’s family physician. A healthy teenager should have an annual physical, to assess her growth and development, which can be adversely affected by an eating disorder. The family doctor can also help you to spot warning signs, and to explain information that you are not sure about.

Spend time together as a family. Emphasize healthy eating, and enjoy meals together. This will enable you to monitor what your teen is eating. Try to incorporate exercise into a family routine. “These tips help make for healthy living and also promote communication among family members. With that being said, it’s not always easy,” says Dr. Norris.

Make yourself aware of pro-anorexia and pro-bulimia sites. Don’t try to keep your teen away from the sites, because that is nearly impossible. Instead, educate yourself, and then educate your teens about some of the erroneous information on the sites. If there is health information on a site that you are not sure about, ask your family doctor to help you weed out the facts from fiction.

Seek out reputable resources on eating disorders. One useful website that provides constructive support, information on recovery, and a sense of community for teens with eating disorders is www.somethingfishy.org. Another is www.renfrew.org.

Dr. Katzman has co-authored a book entitled “Help for Eating Disorders,” which helps young people and their parents deal with the problems of anorexia nervosa and bulimia nervosa. The book shows parents how to identify an eating disorder and when to become concerned about it. It tells parents how to collaborate in their child’s treatment, provides practical support, and suggests ways to participate in the child’s recovery.