Choosing to be thin
For three years, when Alison Devenny wanted weight loss tips, she turned to the internet. But she didn’t look for typical dieting websites.
Pro-anorexia website authors claim the condition is a lifestyle choice
For three years, when Alison Devenny wanted weight loss tips, she turned to the internet. But she didnt look for typical dieting websites. The George Washington University sophomore visited websites that encourage visitors to embrace anorexia and bulimia as lifestyle choices and provide instruction on how to do so.
The sites provide thinspirational pictures of extremely underweight women, menu suggestions, discussion boards and tips on topics including ways to overcome hunger pangs such as doing household chores and drinking lemon water.
Pro-anorexia sites
Despite attempts to encourage internet service providers to close down such sites, many continue to exist. A recent Google search using the term pro-anorexia yielded 30,000-plus results.
Many were links to pages by health authorities warning about the pro-anorexia movement, while others were links to sites no longer in operation. But many linked to live sites. A Google directory called Pro-Anorexia links to more than 50 sites.
Carol Day, director of health education services at Georgetown University in the United States and a member of the schools eating disorder treatment team, called the sites dangerous and disturbing. Experts say the sites can reinforce unhealthy behaviour, slow the recovery process and discourage people from seeking help.
I think anyone who is working in the field of eating disorders realises how unhealthy the sites are, Day said.
I always kind of knew that what I was doing was stupid, said Devenny, now 19, who has since begun treatment for multiple eating disorders. She used to visit the sites about twice a week, she said, picking up tips on how to avoid eating and how to keep her illness a secret from her family.
The terms Ana and Mia - short for anorexia (a condition characterised by eating so little that ones health and life are at risk) and bulimia (overeating and then purging by vomiting or taking laxatives) - are often used by those with eating disorders who dont want treatment.
Safe haven
Frequent visitors to these sites refer to themselves as Anas and Mias and say the sites offer a safe haven where they can talk, share advice and commiserate away from the harsh criticism of family, friends and others.
The sitess creators are typically teenagers and young adults who have eating disorders. Many are directed at women, who experience eating disorders more often than men.
About 0.5 to 3.7 per cent of women suffer from anorexia in their lifetimes, according to the United Statess National Institute of Mental Health. About 1 to 4 per cent are bulimic.
NIMH estimates that about 2 to 5 per cent of Americans experience binge eating disorder (characterised by excessive eating that occurs, on average, at least two days a week in a six-month period).
Those with eating disorders exhibit serious disturbances in eating behaviour and feelings of extreme concern about body shape or weight, the NIMH says.
Researchers are investigating how voluntary behaviour, such as eating different sizes of food portions, at some point develop into an eating disorder. Experts agree that eating disorders are not due to a failure of will but are treatable medical illnesses.
Eating disorders are often accompanied by depression, substance abuse and anxiety disorders. Common personality characteristics include excessive anxiety, perfectionism and low self-esteem.
Treatments include hospitalisation or outpatient treatment, as well as psychotherapy, nutritional counselling, cognitive therapy, behavioural therapy and antidepressant medication, according to the Harvard Eating Disorders Centre.
About half of people with anorexia or bulimia recover completely through treatment, according to the Harvard centre. About 30 per cent make a partial recovery, and 20 per cent have no substantial improvement. The mortality rate for anorexia is about 5.6 per cent per decade, according to NIMH. Cardiac arrest and suicide are common causes of death for anorexics.
But Anas and Mias say they are not sick, dont need to be fixed and dont want sympathy. They develop creeds and post poetry and online diaries reciting their beliefs. They applaud one other for reaching low weights. Their message board conversations often turn to statistics: height, weight and measurements.
A site called Blue Dragon Fly sells red bracelets to encourage solidarity among pro-Anas. So you can go out into the world and not have to wonder, Is she or isnt she? . . . You see the red bracelet, and you know, the site explains.
But its the pro-eating disorder advice that many women say they seek on these sites. There are tips for the best foods to eat and vomit up later (remember if it is hard to swallow it will be hard to unswallow, one site says) and how to cover up your eating disorder (tell friends and family youre sick or have already eaten, tips another site).
A college sophomore from Alexandria, Virginia, diagnosed with bulimia and anorexia said tips from pro-eating disorder sites helped her go from 73kg to her current 33.5kg.
At times I did gain back the weight, but I would always make a plea for help on the pro-ana websites, she wrote in an e-mail responding to a reporters question.
She asked not to be identified by name, adding that although her family knows she has an eating disorder, they dont know about - and wouldnt approve of - her visiting these sites. She called the sites a tether to bring me back on track when I start to think about going into rehab or bingeing without purging.
Some internet service providers shut the sites down in 2001 after the nonprofit United Statess National Eating Disorders Association and other groups complained that the sites contained content that could harm minors. Many sites disappeared briefly, only to re-emerge later under different names and on different internet domains.
Creating awareness
Seattle-based NEDA has since changed strategies, opting to create increased awareness and education about eating disorders on the web and elsewhere.
Theres the whole free-speech issue in trying to have sites removed from the web, said NEDA chief executive officer Lynn Grefe. Unless sites encourage or reflect specific crimes, most internet service providers have been reluctant to shut them down.
America Online, which has about 23 million subscribers in the United States, has removed several pro-eating disorder websites in the past few years under its policy prohibiting material that defames, abuses, threatens, promotes or instigates physical harm or death to others, or oneself, according to company spokesman Andrew Weinstein.
Encouraging an eating disorder would fall into the category of promoting physical harm to others, Weinstein wrote in an e-mail.
Proactive role
Grefe said NEDA realised that its time was better spent getting the word out about eating disorders and treatments, rather than pushing to eliminate the sites. We cant rid the world of these sites . . . but we can be more proactive in trying to get real information out to the public, Grefe said.
NEDA sets up booths at schools to educate students about eating disorders and available treatments, and it runs a confidential telephone help line. It also offers eating disorder information on its website.
Health professionals said people who think they may have eating disorders should seek medical treatment, rather than surf the web for advice.
I would prefer that individuals not access that particular door (pro-eating disorder
