Promotion of anorexia
Promotion of anorexia is the promotion of behaviors related to the eating disorder anorexia nervosa. It is often referred to simply as pro-ana or ana. The lesser-used term pro-mia refers likewise to bulimia nervosa and is sometimes used interchangeably with pro-ana. Pro-ana groups differ widely in their stances. Most claim that they exist mainly as a non-judgmental environment for anorexics; a place to turn to, to discuss their illness, and to support those who choose to enter recovery. Others deny anorexia nervosa is a mental illness and claim instead that it is a lifestyle choice that should be respected by doctors and family.
Pro-ana sites often feature thinspiration (or thinspo): images or video montages of slim women, often celebrities, who may range anywhere from being naturally slim to emaciated with visibly protruding bones. The scientific community recognises anorexia nervosa as a serious illness. Some research suggests anorexia nervosa has the highest rate of mortality of any psychological disorder.
Culture.
Medical professionals treating eating disorders have long noted that patients in recovery programs often "symptom pool", banding closely together for emotional support and validation. In this context, people with anorexia may collectively normalize their condition, defending it not as an illness but as an accomplishment of self-control and an essential part of their identity, with some members of these online communities going as far as claiming that starving oneself is a lifestyle choice rather than an illness. These 'lifestyle' claims may be a symptom of anosognosia. Other community members band together for support in managing their illnesses, such as sharing harm reduction tips and having others to talk to about their experiences that are going through the same thing. Many individuals in pro-ana communities use the phrase "pro for myself, not anyone else" to indicate that they are only interested in furthering their own disorders, not encouraging anyone else to imitate their behavior.
Online presence.
Such advocacy has flourished on the Internet, mainly through tight-knit support groups centred on web forums and social network services such as Tumblr, Xanga, LiveJournal, Facebook and Myspace. These groups are typically small, vulnerable, partly hidden and characterized by frequent migrations. They also have a high female readership and are frequently the only means of support available to socially isolated anorexics.
Members of such support groups may:
Many have popular blogs and forums on which members seek companionship by posting about their daily lives or boasting about personal accomplishments of weight loss. The communities centred on such sites can be warmly welcoming (especially in recovery-friendly groups) or sometimes cliquish and openly suspicious of newcomers. In particular, hostility is often leveled at:
Thinspiration.
Pro-ana sites often (84%, in a 2010 survey) feature "thinspiration" (or "thinspo"): images or video montages of slim women, often celebrities, who may range anywhere from being naturally slim to emaciated with visibly protruding bones. Pro-ana bloggers, forum members and social networking groups likewise post thinspiration to motivate one another toward further weight loss. Conversely, "reverse thinspiration" features images of fatty food or overweight people intended to induce disgust. There exists significant controversy between supporters and opponents of thinspiration; some assert that thinspiration only "glorifies" eating disorders while some thinspiration bloggers argue that the purpose of thinspiration is to support a healthy level of weight loss.
Thinspirational clips circulate widely on video sharing sites, pro-ana blogs often post thinspirational entries, and many pro-ana forums have threads dedicated to sharing thinspiration. Thinspiration can also take the form of inspirational mantras, quotes or selections of lyrics from poetry or popular music (94% of sites in a 2003 survey).
Thinspiration often has a spiritual-ascetic flavour, referring to fasting through metaphors of bodily purity, food through allusions to sin and corruption, and thinness through imagery of angels and angelic flight. Exhortations like "Ana's Creed" and "The Thin Commandments" are also common.
Appeal.
Social researchers studying pro-ana have varied explanations for its popularity, with some characterizing it as a rejection of modern consumerism and others suggesting that pro-ana functions as a coping mechanism for those already emotionally stressed by eating disorders. However, most agree on two elements of pro-ana sites:
Fashion.
Red bracelets are popularly worn in pro-ana, both as a discreet way for anorexics to socially identify and as a tangible reminder to avoid eating. Pro-mia bracelets, likewise, are blue or purple. Most such bracelets are simple beaded items traded briskly on online auction sites.
Impact.
Proliferation.
Pro-ana has proliferated rapidly on the Internet, with some observers noting a first wave of pro-ana sites on free web hosting services in the late 1990s, and a second wave attributed to the recent rise of blogging and social networking services.
A survey by Internet security firm Optenet found a 470% increase in pro-ana and pro-mia sites from 2006 to 2007. A similar increase was also noted in a 2006 Maastricht University study investigating alternatives to censorship of pro-ana material. In the study, the Dutch blog host punt.nl began in October 2006 presenting visitors to pro-ana blogs on its service with a click-through warning containing a disparaging message and links to pro-recovery sites. Although the warnings were a deterrence (33.6% of the 530,000 unique visitors logged did not proceed past the warning), the number of such blogs actually increased tenfold, with their monthly traffic figures doubling on average by the end of the study.
Viewership.
In a 2009 survey by the Katholieke Universiteit Leuven of 711 Flemish high school students aged 13–17, 12.6% of girls and 5.9% of boys reported having visited pro-ana websites at least once. In another 2009 survey, by parental control software vendor CyberSentinel of 1500 female Internet users aged 6–15, one in three reported having searched online for dieting tips, while one in five reported having corresponded with others on social networking sites or in chat rooms for tips on dieting.
Visitors to pro-ana web sites also include a significant number of those already diagnosed with eating disorders: a 2006 survey of eating disorder patients at Stanford Medical School found that 35.5% had visited pro-ana web sites; of those, 96.0% learned new weight loss or purging methods from such sites (while 46.4% of viewers of pro-recovery sites learned new techniques).
Effect.
Pro-ana sites can negatively impact the eating behavior of people with and without eating disorders. One study of individuals without eating disorders demonstrated that 84% of participants decreased caloric intake by an average of 2,470 calories (301 min -7851 max) per week after viewing pro-ED (eating disorder) websites. Only 56% of participants actually perceived the reduction in their intake. Three weeks after the experiment, 24% of participants reported continuing weight control strategies from pro-ana websites, though they did not continue to visit those sites. Controls viewing health and travel websites did not decrease caloric intake at a significant level. Other studies have found that women with varying levels of eating disorder symptomatology were more likely to engage in image comparison and exercise after viewing pro-ana websites versus control websites.
Pro-ana sites can negatively impact cognition and affect. Women who viewed a pro-ana site, but not control sites focused on fashion or home décor, experienced an increase in negative affect and decreases in self-esteem, appearance self-efficacy, and perceived attractiveness. They also reported feeling heavier and being more likely to think about their weight. The effects of perfectionism, BMI, internalization of the thin ideal, and pre-existing ED symptomatology as moderators of negative affect were comparable to chance, suggesting that pro-ana websites can affect a broad spectrum of individuals, not simply those with ED characteristics.
A 2007 survey by the University of South Florida of 1575 girls and young women found that those who had a history of viewing pro-ana websites did not differ from those who viewed only pro-recovery websites on any of the survey's measures, including body mass index, negative body image, appearance dissatisfaction, level of disturbance, and dietary restriction. Those who had viewed pro-ana websites were, however, moderately more likely to have a negative body image than those who did not.
Similarly, girls in the 2009 Leuven survey who viewed pro-ana websites were more likely to have a negative body image and be dissatisfied with their body shape.
A 2012 report by Deloitte Access Economics, commissioned by Australian non-profit The Butterfly Foundation, estimated that eating disorders resulted in productivity losses totaling just over $AUD15 billion, with 1828 (515 males and 1313 females) dying that year from eating disorder-related complications.
Social support vs. exacerbation of illness.
Unlike pro-ana sites, pro-recovery sites are designed to encourage development and maintenance of healthy behaviors and cognitions. A study of pro-ana and pro-recovery website use among adolescents with eating disorders found that adolescents used both types of websites to further eating disordered behaviors. Those who viewed pro-ana sites were comparable to those who viewed pro-recovery sites with respect to appearance dissatisfaction, restriction, and bulimic behaviors. Over half of parents were unaware of any ED website usage.
People who use pro-ana sites report lower social support than controls and seek to fill this deficit by use of pro-ana sites. While pro-ana site users in this study perceived greater support from online communities than offline relationships, they also reported being encouraged to continue eating disorder behaviors. Users of pro-ana sites (n=60) cited a sense of belonging (77%), social support (75%), and support for the choice to continue current eating disorder behaviors (54%) as reasons for joining a pro-ana site. Reasons for continuing to use a pro-ana site included general support for stress (84%), meeting others with eating disorders (50%), and finding triggers for eating disorder behaviors (37%). Finally, behaviors first learned after visiting a pro-ana site include using thinspiration (63%), hiding eating disorder behaviors (60%), fasting (57%), using diuretics and laxatives (45%), vomiting (23%), using alcohol or other drugs to inhibit appetite (22%), and self-harm (22%).
Some studies, however, claim that the link between pro-ana websites and increased incidence of eating disorders are not strongly linked; instead, these communities have just increased the visibility of those affected. It's possible that health professionals and academics are eager to place blame on these communities because of this increased visibility and being an "easy target" for understanding the complex problem of root causes of eating disorders.
Controversy and criticism.
Many medical professionals and some anorexics view pro-ana as a glamorization of a serious illness. Pro-ana began to attract attention from the mainstream press when "The Oprah Winfrey Show" aired a special episode in October 2001 focusing on pro-ana. Pressure from the public and pro-recovery organizations led to Yahoo and GeoCities shutting down pro-ana sites. In response, many groups now take steps to conceal themselves, disclaim their intentions as neutral and recovery-supportive (58% of sites in a 2006 survey), or interview members to screen out the non-eating disordered.
Medical profession.
Health care professionals and medical associations have generally negative views of pro-ana groups and the information they disseminate:
Media.
In October 2001, "The Oprah Winfrey Show" hosted a special on anorexia; the pro-ana movement was discussed briefly by the guest panel, who expressed alarm at the appearance of pro-ana websites and recommended the use of filtering software to bar access to them.
In July 2002, the "Baltimore City Paper" published an investigative report into pro-ana on the web.
"Growing up Online", a January 2008 episode of the PBS "Frontline" television program, also featured a brief discussion of pro-ana.
The 2009 novel Wintergirls features a protagonist with anorexia, who at one point in the novel seeks support from a pro-ana forum, referring to the people there as “her sisters” and “the only people that understand”.
In April 2009, "The Truth about Online Anorexia", an investigative documentary about pro-ana on the Internet, aired on ITV1 in the UK presented by BBC Radio 1 DJ Fearne Cotton.
In April 2012 speech at Harvard University, "Vogue Italia" editor Franca Sozzani conceded that the fashion industry may be a cause of the recent rise in eating disorders, but that the industry was being unfairly singled out for blame: "How can all this be possibly caused by fashion? And how come that Twiggy, who would be surely considered an anorexic today, did not arise controversy in the Sixties and did not produce a string of anorexia followers?" According to Sozzani, pro-ana sites were more effective at promoting eating disorders, and obesity was the more pressing public health problem that food industry was not being likewise attacked for exacerbating.
The existence of pro-ana blogs and forums was featured in the 2014 Lifetime film "Starving in Suburbia", which starred Polish actress Izabella Miko as "ButterflyAna", a beautiful model and moderator on the internet who promotes