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Pro-anorexia websites pose public health challenge : The Lancet

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The Lancet, Volume 379, Issue 9811, Page 110, 14 January 2012

doi:10.1016/S0140-6736(12)60048-8

Pro-anorexia websites pose public health challenge


Mario Christodoulou In recent years, websites that promote anorexia and advise people on how to maintain the disorder have appeared on the web. Mario Christodoulou examines the health risks of such sites. Peer through the window of any western high street fashion retailer and your eyes will be caught by images of very thin models. The fashion industry and media have faced much criticism for perpetuating a distorted idea of beauty. Most recently the clothing retailer H&M was lambasted for using computer generated models to advertise their clothing. The prevailing aesthetic of extreme thinness is certainly part of the cultural influence to which some people are particularly vulnerable, observes Susan Ringwood, chief executive of UK charity Beating Eating Disorders. People with anorexia nervosa are particularly vulnerable to this type of media influence. Pro-anorexia (pro-ana) websites, which draw on the thin ideal generated by the media, have materialised across the web to promote and advise on anorexia in recent years. Pro-ana websites are online communities of individuals who believe that anorexia is not a serious psychiatric condition that requires treatment, but rather it's a lifestyle choice, says Helen Sharpe from the Section of Eating Disorders, Institute of Psychiatry, London, UK. So typically what you see on these websites are tips and tricks on how to lose weight, how to hide that weight loss from others, and what's called thinspiration. This so-called thinspiration consists of photographs of emaciated models, who supposedly provide inspiration for weight loss. The tips and tricks are particularly shocking (eg, purge in the shower! It covers up the sound, smell, and washes out the evidence). The content of these sites poses a potentially serious health risk. About a third of patients with eating disorders have used these websites. When it comes to the dangers of these sites, there are two big things that we need to think about: one is that these sites might induce an eating disorder [in vulnerable people] or maybe if you already have an eating disorder, these sites make it difficult to recover, warns Sharpe. We know that people with anorexia are often terrified of being made to give up their anorexia, and are therefore reluctant or at least ambivalent about recovery or accepting help. Pro-ana sites exploit this ambivalence, adds Ulrike Schmidt head of the eating disorders section at South London and Maudsley NHS Foundation Trust, London, UK. Censorship of pro-ana sites might seem to be the most logical step, but many barriers to this approach exist. There is no internationally enforceable legislation that could be effective in this area. The internet is a global phenomenon, and much of its operation is beyond the scope of legislators. User generated contentyoung people running pro-ana sites from their own bedroomscannot easily be legislated against, as there is no corporate entity or legal owner. We are not sure what purpose it would serve to make people affected by a serious mental illness

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Pro-anorexia websites pose public health challenge : The Lancet

criminals too, says Ringwood. Although many young people with eating disorders are aware of pro-ana websites, their parents and many health professionals, might be unaware. Health professionals working in eating disorders will be aware of pro-ana sites and of the associated tips and tricks and how to deal with them, but other health professionals likely to come into contact with patients with eating disorders such as GPs [general practitioners], nurses, dietitians, and other doctors I suspect are less aware of these issues, suggests Schmidt. Since censorship is impractical and could marginalise people with anorexia, educating the public about the dangers of these sites is the most effective alternative. However, traditional methods for raising public awareness, such as media campaigns, could have counter productive effects by drawing attention to these sites. In a 2009 position paper on pro-ana websites, the UK's Royal College of Psychiatrists called on the media not to make pro-ana websites into headline news, not to report their content in a sensationalised way and not to report how to access them, as this may lead to increased use of such sites. Meanwhile, the UK's Body Confidence Campaign has pledged to improve the media's knowledge about eating disorders and the National Eating Disorders Association has launched Proud2Bme, an online community that provides support and advice, while promoting a positive body image and encouraging healthy attitudes about food and weight. Although these efforts will help reduce the number of people visiting pro-ana sites, they will not completely solve the problem. People with anorexia are attracted to these sites because they provide a virtual refuge where they can freely express themselves, without fear of judgment. We believe the answer lies in providing that same sense of acceptance and support throughout society, so that a pro-ana site is no longer the only refuge a person feels they can seek. We would therefore not try to promote awareness of the pro-anorexia sites, but rather promote compassionate understanding of eating disorders in general, concludes Ringwood.

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