The press has recently highlighted that many online users are turning to sites which offer ‘thinspiration.’ Many of these sites make use of terms such as ‘pro-ana’ and ‘pro-mia.’ On the surface, this community looks to provide encouragement to eating disorder sufferers to continue with eating disorder behaviours and beliefs, but are there any positives that can be taken from it? What can be done to really help eating disorder sufferers on the road to recovery?
Priory has sought to address these questions and recently spoke with a recovered anorexic, a recovered bulimic, a nutritional expert and the administrator of a pro-ana site. Dr Alex Yellowlees, Medical Director and Consultant Psychiatrist at Priory Hospital Glasgow and an eating disorder specialist also comment on the issue.
What is ‘thinspiration’?
‘Thinspiration’ is a term coined to describe images and other media material intended to provide inspiration and encouragement to lose weight. In the majority of cases ‘thinspiration’ appeals to those who suffer from an eating disorder such as anorexia nervosa, as it presents images of thin men and women.
What is pro-ana/mia?
Pro-ana and pro-mia translate simply to pro-anorexia and pro-bulimia. The terms often refer to promoting these eating disorders as lifestyle choices rather than viewing them as illnesses. These terms are usually followed by tips, tricks, diets and words of encouragement from others in the ‘community’, in order to achieve the maximum potential of weightlessness.
Pro-ana/mia as defined by the community
One popular pro-ana site which consists of discussion forums, blogs and thinspirational galleries, has a different view on these issues. When we discussed the negativity of the terminology with the administrator of the site, he told us he does not believe his site conforms to the literal translation of ‘pro’ meaning ‘promoting’, or ‘for.’ Instead he sees it as a support network for “like-minded people.” He continued to tell us that “some may find ‘support’ in seeking help with their diet. For others it may seem to provide emotional support. And some it may be support towards recovery." All of this, he says, is ‘pro-ana’.
Debbie Francis, a recovered bulimic who suffered for 30 years, pointed out that if you produce an image of a person ‘in recovery’, someone with an eating disorder may see them as ‘big’. As these sites attract those with eating disorders, it is important to learn a different way of looking at such content. “It’s not all about the weight. Anorexia won’t give up on you unless you are in a coffin. You will never be thin enough to the voice in your head. It’s about learning to change that voice.”
A secret community
It seems that for many, the sense of community and friendship is what draws them. Dr Emily Troscianko is currently a junior research fellow in modern languages at St John’s College, Oxford. She has recovered from anorexia and now uses her experience to help others on her blog.
Both Debbie and Dr Troscianko note that eating disorders are very private, secretive illnesses. Debbie says: “you spend a lot of time locked away; most kids now have access to something where they can connect to the internet.” She continues: “if there is a community there that knows what you’re going though and supports you for all the wrong reasons, it could be very addictive for people to get stuck in that little world, as it is a bubble that you are stuck in anyway.”
An unhealthy level of competition exists between users competing (albeit subconsciously) to be skinnier or eat less than the last user that posted. Dr Troscianko highlights an interesting point - without the online element, competitiveness can only be implemented against the sufferer themselves. This competitiveness can turn outward in social situations, e.g. eating less or more slowly than others, or unfortunately, in eating disorder clinic situations between patients.
Dr Troscianko suggests that as this competition is now accessible from your bedroom 24/7, this dynamic can make the competitive element more acute and urgent, i.e. feeling that “I have to beat not only myself but all these other people now.” She notes that “If it's true that one's harshest critic is always oneself, then this new trend could conceivably be a good thing, drawing out the internal warfare and diffusing it by making the opponent other people rather than oneself, but I think this is highly unlikely: the profound mental and physical changes that accompany weight loss make restrictive eating disorders inevitably self-orientated, whatever else they may also be.”
The mentally intrusive nature of the condition makes a sufferer’s response harder to predict. She continues: “an additive rather than a replacement effect is, I think, much more likely to occur”, which would only make things worse. “Overall, then this is an extremely potent mixture of partially conflicting motivations, all of them pushing participants to engage ever more deeply in these profoundly unhealthy cognitive patterns and behaviours.”
As with anything online, there is an element of danger if users are not wary of whom they are interacting with. Many users are as young as 12, using pro-ana or mia sites in order to meet a ‘buddy.’ A buddy is someone who’s your supporter, who can help you to realise your goals, whether they are healthy or not. Revealing personal information such as phone numbers online obviously has its own dangers. Another concern highlighted by the research is that many of the owners of these sites seem to be older males with no eating disorder themselves. Though it is hard to pinpoint their intentions, many of these sites seem to be a cover for pushing diet products on vulnerable people. Where it may be true that many sites are not created with a damaging impact in mind, users must be wary of whom they are sharing personal details with and taking advice from.
Dr Linda Bacon is a professor, researcher, internationally-recognised authority on nutrition and the author of Health at Every Size: The Surprising Truth About your Weight. She discussed the effect of diets popularised by online communities for example, the Ana Boot Camp diet (ABC). This is an extreme, low-calorie diet which normally lasts 50 days. It also includes five fast days in which the dieter cannot consume any calories whatsoever. The rest of the days allow between a 100 to 800 intake of calories.
Dr Bacon states the issues with encouraging this kind of dieting. “On a short -erm basis, people who follow restrictive diet plans like this will have nutrient deficiencies (which may not be immediately noticeable) and will weaken their immune system. The damage to the immune system may show up as increased vulnerability to viruses like colds. They may also experience concerns related to low energy, like irritability, impaired concentration, lethargy, and preoccupation with food. And when it doesn’t result in sustained weight loss, it may lower their self-esteem; make them feel like a failure. It also reinforces their bad feelings about their body.”
Similarly, talk of appetite suppressants and those encouraging each other to fast or restrict are potentially causing themselves a lot of harm. “Hunger is a good thing.” Dr Bacon went on: “It lets us know that our body needs nourishment. If you don’t trust and respond to hunger, after a while the self-regulatory set point mechanism that controls your fat stores breaks down. You weaken your innate ability to hear your hunger and fullness signals. When this happens, most people actually gain weight over the long-term.”
Is censorship the way forward?
Dr Yellowlees is a practising consultant specialising in the treatment of eating disorders. He believes that these online communities seeming to offer ‘advice’ on eating disorders can end up promoting eating disorder behaviours and beliefs causing the user more harm than good. He commented: “Fuelling the pursuit of thinness can reinforce the false beliefs which suggest that happiness and peace of mind and self-worth and body satisfaction can be found in starvation, thinness and self-harm.” Dr Yellowlees knows that many other health professionals and those affected by eating disorders are concerned and believe that sites with such dysfunctional messages should be censored.
However, the administrator of the popular pro-ana site we spoke to does not believe censorship will improve the situation. He stated that the community “is always one step ahead” and will find a way around banned hashtags and search terms, by misspelling keywords or using completely unrelated terms. This has proven to be the case with major social-networking sites such as Instagram. He does not believe that censorship will address the root of the problem. Debbie somewhat agrees with this point; however she believes banning or censorship of such sites would be a step forward. On the other hand, she is also wary that something else will take their place, as that is the nature of the internet. She makes the point that it’s about “the bigger picture of changing what’s important.”
Dr Troscianko considers approaches such as censorship idealistic; a longer-term strategy must be in place to have effect, for example countering pro-ana posts with a more positive message. This “is probably the only thing that's ever going to really work, by altering the foundations of how young people think of themselves, bit by bit over months and years (such as this). For a more immediate and combative approach, though, I also quite like various instances of directly subversive attacks on the offending images themselves, like these.”
She went on to explain that “Furthermore, it's worth remembering that this recent troubling phenomenon isn't the whole story when it comes to eating disorders online; there are also many genuinely helpful blogs and websites out there which provide informed accounts of relevant scientific research and honest first-person testimony about illness and recovery. We shouldn't let these valuable resources be eclipsed in public debate by the downsides of how the internet and eating disorders interact.”
The bigger picture
The administrator of the pro-ana site makes a valid point, that popular culture and the wider media are also responsible. There is truth in the fact that imagery in magazines and on TV etc. can have a damaging effect on people’s minds. Debbie has a daughter and points out that many fictional characters aimed at children are stick-thin. “I think catching it early is better as it’s so strong when it catches hold.” She explained: “[my daughter] has her head screwed on the right way; it is all about spirituality and who you are as a person. It’s important to demonstrate this to people very young as it is such an imagery related world.” She offered us a final word on the debate: “I think it’s about learning to give people something else to look at rather than just a body shape.”
The road to recovery
Dr Troscianko is aware that a restrictive eating disorder can develop and become self-sustaining, and that after a certain point there does not need to be any valid or explicit reason to continue weight loss itself. She explained her personal experience. “It becomes the end in itself, rather than a means to anything else. This makes change extremely hard to contemplate, though that doesn't mean it's impossible. I was deeply sceptical about whether eating more could really change anything, and frightened of regaining weight, frightened of change in general. But a certain core of conviction was there, and it made my journey back to health possible. You, and only you, can ‘choose life’.”
Debbie makes a strong point which struck her whilst reading a book: “If you were at the end of your life and looking back, what would you wish you’d done? I suddenly thought I’ve spent so many years wasted, tied up in an illness that held me back from doing the things I want to do. If you put that sort of perspective on things it does make you want to do something different with your life.”
Dr Yellowlees' view is that these online communities are indicative of a much larger eating disorder problem. The most important point to note is that eating disorders are serious illnesses with a very high mortality rate and should not be viewed as lifestyle choices. Encouragingly, with the right support and treatment, recovery is possible.