Pro-anorexia and pro-bulimia websites - a cultural cage match for really thin girls

A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health has examined the content and messages presented by websites that appear to support or encourage eating disorders, using images, text and interactive applications to further knowledge, attitudes and behaviors to achieve (dangerously) low body weights.

The study is the largest (yes, there has been more than one) analysis of pro-eating disorder websites and will be published in the American Journal of Public Health.

The Internet, being a bastion of freedom of expression, offers messages and even communities that sanction anorexia, bulimia and other eating disorders. Previous studies have shown that adolescents exposed to such pro-eating disorder websites have higher levels of body dissatisfaction compared to adolescents that have not been exposed. In addition, young people who have visited these sites are also known to engage in more and intense eating disordered behaviors. Of course, they may be visiting the sites because they are already vomiting after meals.

"Some of the reviewed sites present very dangerous ideas and disturbing material that serve to inform and motivate users to continue behaviors in line with disordered eating and exercise behaviors," said Dina L.G. Borzekowski, EdD, lead author of the study and associate professor in the Bloomberg School's Department of Health, Behavior and Society. "Others sites seemed less harmful; they offered links to support recovery from these disorders and gave users venues for artistic expression."

For the study, Borzekowski and colleagues conducted a systemic content analysis of 180 active pro-anorexia (pro-ana) and pro-bulimia (pro-mia) websites. This involved creating a valid and generalizable sample and a reliable coding scheme. In addition to objectively counting site logistics and features, researchers devised a perceived harm scale for the analyzed sites.

According to the study, more than 91 percent of the websites were open to the public, and more than 79 percent had interactive features, such calorie and body-mass index (BMI) calculators. Eighty-four percent of the sites surveyed offered pro-anorexia content, while 64 percent provided pro-bulimia content. "Thinspiration" material appeared on 85 percent of the sites; this included photographs of extremely thin models and celebrities. About 83 percent provided overt suggestions on eating disordered behaviors, including ways to engage in extreme exercise, go on a several-day fast, purge after meals, and hide rapid weight loss from concerned family and friends.

On the other hand, thirty-eight percent of the sites included recovery-oriented information or links. Nearly half (42 percent) provided the maintainers and users a place where they could post art work and poetry.

"Knowing the messages that vulnerable populations encounter is critical," said Borzekowski. "To better understand how media messages can potentially harm, first we must be aware of what messages are out there."

Source: Johns Hopkins University Bloomberg School of Public Health