A new study by Johns Hopkins and the Stanford University School of Medicine represents the first large-scale analysis of pro eating-disorder websites. It identifies the complex emotions that eating-disorder patients struggle with, and provides key insight into the types of content they discover online when seeking support from their peers.
Pro-eating websites are defined as containing materials that describe, endorse self-abuse through starvation or purging, and support the eating disorders anorexia and bulimia (often referred to in slang as ‘pro-ana’ and ‘pro-mia’). These sites typically list the benefits of being anorexic/bulimic, offer interactive communities where those with eating disorders can encourage and celebrate one another as they strive to attain, and maintain, their thinness goals give diet tips (what to eat to stay under 700 calories a week!) and may provide ‘buddy’ services to pair one anorexic up with another.
Many of these sites have been created by people with eating disorders and who “falsely believe that they are okay [and] falsely believe that anorexia is a lifestyle choice ” according to Toronto-based National Eating Disorder Information Centre (NEDIC).
According to the study, about 1 % of young women struggle with anorexia, a disease in which patients maintain dangerously low body weight and fear weight gain. An additional 2% of young women are affected by bulimia, a disorder in which patients continually binge on food, then “purge” themselves by vomiting, using laxatives or diuretics, or by compulsively exercising. A smaller number of young men, and adults also suffer from these disorders. Both diseases can cause long-term health problems, and may lead to death in severe cases. (See Eating Disorder Statistics in part 2 of this series for more information).
However, it is far more than the 1-2% of youth struggling with these disorders that turn to these internet-facilitated high risk cultures for inspiration. Many more teens and young adults who want to lose weight visit to the sites for inspiration and dieting tips. (See a typical example of this in ‘Bride2be’s posting in the image below).
Pro eating-disorder site content
Researchers involved in this study evaluated 180 websites and evaluated each for content and design elements including looking for interactive forums or calorie counters; themes (including control, success and perfection); “thinspiration” images, tips and techniques for weight loss; and recovery information. They assigned each site a “perceived harm” score based on their assessment of how harmful the site would be to users.
The research reviewed found using search terms such as “Pro-Ana,” “Pro-Anorexia,” “Pro-Bulimia” and “Thin and Support” and found that:
- Nearly 80% of the sites had socially interactive features allowing members to communicate.
- 85% of these websites include ‘thinspiration’ materials. Thinspiration,” Thinspo”, includes anything that a person with an eating disorder uses to “inspire” herself to lose weight or stay thin, such as photos and videos of very thin celebrities, success stories and encouragement by others struggling with eating disorders, and tips and techniques for weight loss.
- 83% of the pro-ana, and pro-mia sites offered suggestions on how to engage in extreme dieting behaviors. One such diet is the Ana Boot Camp diet (Also called the ABC Diet).
At the same time, the research found that most of the websites also recognized that these behaviors are eating disorders and more than a third provided recovery information.
- During their evaluation, researchers found that 24% of these websites had high perceived-harm scores, (4 or 5 on a scale of 1 to 5); the rest of the sites received medium or low harm scores.
“These sites are fairly diverse. Some sites have very hard-core information about how to intensify your eating disorder, some have a lot of pro-recovery content and many have a mix of both.” Said Dr. Rebecka Peebles, an instructor in pediatrics at Stanford and an adolescent medicine specialist with the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital.
“Although pro-eating-disorder Web sites are often portrayed in a black-and-white manner, most of them exist on a continuum,” Peebles said. This is likely due to the ambivalence eating-disorder patients have about their disease, she added: “Many people with disordered eating behaviors have days when they want to get better, and days they have no interest in getting better. The Web sites reflect the individual characters of the people visiting them.”