Pondering Pro-Anorexia Websites: What Effects Do They Have?

During the last decade, the Internet has joined other mass media as a powerful image-maker. The emergence of pro-anorexia websites on the Internet is a cause for concern, according to the results of a recent study of female undergraduates (In J Eat Disord 2007; 40:537.

Pro-anorexia websites promote eating disorders by encouraging extreme thinness and advocating anorexia nervosa as a lifestyle choice rather than as an illness. Thus far, only one study, which included 24 women, has empirically studied the effects of viewing these websites (Eur Eat Disord Rev 2006;14:256). That small pilot study by the same authors found that exposure to such a website has negative affective and cognitive consequences for college women.

Three test websites

To further evaluate the effects of viewing such sites, Anna M. Bardone-Cone, PhD and Kamila M. Cass, MA, of the University of Missouri, Columbia, constructed a prototypical pro-anorexia site and tested its effects with 235 female undergraduates. The undergraduates were randomly assigned to view either the pro-anorexia site or one of two comparison websites related to female fashion (using average-sized models) and career dressing tips, or to home décor.

The authors constructed the test website after intense research that included viewing more than 300 pro-anorexia websites. The authors’ test website included information about the “Ana Creed,” information related to anorexia nervosa, bulimia, and exercise, a tips and tricks section for restricting eating, a chat board, purging tips, ways to make excuses for not eating, and a “Thinspiration” photo gallery of thin models and celebrities, severely emaciated women, and morbidly obese women.

Participants were told they would be participating in a study examining contents of Internet websites. After completing a set of pre-website questionnaires, the women were randomly selected to view one of the websites for 25 minutes. Of the 235 women, 84 viewed the pro-anorexia website, 76 viewed a comparison website focused on the female image, and 75 viewed the neutral home décor website. They then completed a second set of post-website questionnaires, including the Positive and Negative Affect Schedule, the State Self-Esteem scale, the Appearance-Modified General Self-Efficacy Scale, the Eating Attitudes Test (EAT-26) and the Eating Disorder Examination-Questionnaire.

Negative consequences after a single viewing

The authors reported that viewing a website featuring overly thin images and a strong, consistent message that being thin is important had negative consequences on the viewers. Study participants exposed to the pro-anorexia website had greater negative affect, lower social self-esteem, and lower appearance self-efficacy than women in the other groups. They also perceived themselves as heavier after viewing the site than did viewers of the other websites. Women who viewed the pro-anorexia website also reported that seeing the website made them more likely to exercise and to think about their weight in the near future (today or tomorrow) than if they had not seen the website. They viewed themselves as heavier and engaged in more image comparison than did women in the other groups.

In contrast, the women who viewed the other websites typically reported that viewing the website would not affect their likelihood of engaging in the behaviors and cognitions assessed. Also, even though the women who viewed the pro-anorexia website and the female image website were more likely to think about their appearance than were women who viewed the home décor website, pro-anorexia viewers were more likely than female fashion website viewers to report comparing themselves with the website images of women.

The authors point out that these effects occurred after only a single viewing of the pro-anorexia website. It would seem reasonable that if a single viewing caused such a reaction, that multiple viewings would only increase these reactions. However, the authors reported that viewing the pro-anorexia website had a significantly greater negative impact than viewing a website with images of average-sized women, suggesting it is something about how the female image is depicted and discussed on a website that produces the negative effects rather than merely a focus on the female image.

Some actions that can help now

The authors suggest that future studies might be designed to study whether the multiple components of photos, interactive chat room conversations, and tips and tricks have greater effects than images alone.

The authors also suggest that while pro-anorexia sites are unlikely to disappear, some actions could conceivably reduce their negative consequences. For example, parents could use technology to block these websites from their children and should be encouraged to keep any home computers in a common area where online activity can be supervised. Clinicians can take time to thoroughly discuss the negative effects of such websites with clients they discover are visiting pro-anorexia sites for support.