Even limited exposure to pro-anorexia websites can lead teenagers to reduce their calorie consumption considerably and to increase disordered eating behaviour, new research says.
Indeed, these websites create an environment in which striving to be severely underweight is not only normal but a sign of success, according to Dr Emma Bond, of University Campus Suffolk. And site users often seek solace by competing with each other.
"Not only is anorexia viewed as a lifestyle choice, but those who embrace it are praised for the desirable qualities involved in being a 'successful' anorexic: control over oneself, self-discipline and the denial of pleasure and nourishment," Bond says.
In partnership with eating disorder charity Beat, Bond examined 126 pro-anorexia websites and social networking groups, looking at the effects they had on their users. She estimates that the sites in her study make up about a quarter of all pro-eating disorder websites.
'Starving for perfection'
Recent reports have shown that girls as young as 5 are already concerned about their weight. And by the time girls are 15, one in every 150 is likely to have developed anorexia. One in every 1,000 15-year-old boys is also affected. The numbers do not improve with age: one in 100 women between the ages of 15 and 30 suffers from anorexia.
A 2011 online study revealed that one in 10 pupils between the ages of 9 and 16 had visited a pro-anorexia website. A Belgian study of 711 secondary pupils showed similar results.
One quarter of the sites studied by Bond included disclaimers on the front page, such as: "This is a pro-ana website. It is not anti-recovery, but if you are recovering from an eating disorder, then you should leave now."
Many of the websites also carried the tag line "starving for perfection". "It is not that the sites claim that anorexia or bulimia are glamorous and desirable lifestyle choices," Bond says. Instead, the prevailing message is: "Yes, these are diseases which are dangerous to your physical and mental health. But, bearing that in mind, here is the inspiration to carry on, if you want to, or feel you have to."
Yet the websites also carry images of very thin bodies, often those of celebrities, intended as "thinspiration". Nearly 90 per cent of the sites included such thinspiration material; emaciated, almost skeletal figures. Some websites also included pictures of obese people as "reverse thinspiration".
"One image, tagged 'emaciated', was accompanied by text claiming that the subject intended to lose another 15lb (6.8kg)," Bond says. "Research suggests that the viewing of these images has a negative impact on mood and self-esteem, and participants... felt worse about their body image as a result, which overall discouraged them from seeking recovery."
More than 80 per cent of sites also included information on how to engage in disordered eating behaviour and offered advice on dieting, exercise and purging.
Regimes cited by Bond include the Ana Boot Camp diet, which recommends no more than 400-500 calories per day, as well as occasional fasts. One website author advocates her own diet, including minimal food, lots of water and diet fizzy drinks, plus coffee, cigarettes and diet pills.
"Striving to be thin is of paramount importance in users' lives," Bond says. "While users appear to understand the damaging nature of certain activities, this does not restrict their... dangerous behaviours to lose weight."
Site users create and maintain an identity as a successful or failing "ana" by detailing their diet activities. This is a way of proving their worth within the pro-anorexia community. When one blogger posted her decision to undertake a three-day fast to "gain control", 36 of her followers pledged to fast for three days in support.
The users' shared interest in weight loss offers them a supportive community. But, at the same time, there is often significant competition between them. "These activities actually nurture each other's harmful behaviour," Bond says. "Engaging with pro-anorexia sites reinforces an existing eating-disordered identity.
"People with eating disorders often have both positive and negative emotions about the anorexia itself and the idea of recovery. They also view the sites as enabling them to receive support to maintain restricted eating ... and to obtain valuable emotional support."
Feeling misunderstood by family and friends, people with eating disorders often seek sanctuary and support from other sources. The anonymous nature of the internet may also enable them to open up to others more easily.
"Pro-anorexic sites are, therefore, appealing," Bond says. "The participants have issues in common and develop positive supportive relationships with each other." But this very sense of belonging prevents individuals from seeking help. In fact, they may instead take more extreme steps to maintain their anorexia.
Bond believes it is vital to provide pupils with lessons in media literacy, so that they can judge more critically the images and text they see on these websites. "The pro-anorexia phenomenon should be taken seriously, in order to develop a more sophisticated approach," she concludes.
Bond, E. Virtually Anorexic - Where's the Harm? A research study on the risks of pro-anorexia websites (2012).
Emma Bond, senior lecturer in applied social sciences, University Campus Suffolk.
Beat, an eating disorder charity.