A large-scale study finds pro-ana sites reflect the mixed feelings of site visitors.
Reprinted from Eating Disorders Review
September/October 2010 Volume 21, Number 5
©2010 Gürze Books
Pro-Ana Web sites that promote anorexic and bulimic behavior offer interactive communities where site users can encourage one another in unhealthy eating behaviors. However, the majority of these sites also recognize eating disorders as diseases, according to new research from the Johns Hopkins Bloomberg School of Public Health and Stanford University School of Medicine.
Rebeka Peebles, MD, and colleagues recently reported the results from their study, the first large-scale analysis of pro-eating disorder Web sites. The study points out the complex emotions with which eating disorder patients grapple and provides valuable insights into the variety of material they encounter online as they seek support from their peers.
Dr. Peebles recently noted that “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.” Peebles is an instructor in pediatrics at Stanford and an adolescent medicine specialist with the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital. The paper reports on 180 web sites that were found using search terms such as “Pro-Ana,” “Pro-Anorexia,” “Pro-Bulimia,” and “Thin and Support.” The researchers evaluated each site’s basic logistics; accessories such as 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.
Most offer interactive features
Nearly 80% of the sites offered interactive features, 85% displayed “thinspiration” materials (such as photos of very thin models or celebrities), and 83% offered suggestions on how to use disordered eating behaviors. Ironically, most of the sites also mentioned that eating disorders are a disease, and more than a third included recovery information. Twenty-four percent of the Web sites had high perceived-harm scores (4 or 5 on a scale of 1 to 5); the rest of the sites received medium or low perceived harm scores.
“Although pro-eating-disorder Web sites are often portrayed in a black-and-white manner, most of them exist on a continuum,” Dr. Peebles said. That is likely the result of the mixed feelings eating-disorder patients have about their disease, she added. Dr. Peebles also commented that, “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 characteristics of the people visiting them.”
Clinicians who treat people with eating disorders and family members need to be aware that the sites exist, are easy to access, and can help reinforce disordered eating patterns, Peebles concluded. “If these sites make us uncomfortable, the focus at the public health level should be asking how we can reach and treat more people struggling with disordered eating, and how we as providers can become more comfortable with the difficult feelings that people with eating disorders feel,” she said. “Right now, many patients are going to the Web to express those feelings, instead of handling them through traditional models of care, such as psychotherapy.”