Anorexia nervosa is a mental illness characterised by a distorted body image, an extremely low body weight, and a fear of gaining weight. While anorexia affects all people, it is significantly more prevalent among women. Even though it is relatively rare, its effects are devastating.

Anorexia is notoriously difficult to treat. Across all mental illnesses, it has the highest rate of mortality, so research in this area is crucial.

It is not possible to determine a single cause of anorexia. Nevertheless, risk factors associated with the disease are well known. These include genetics, psychological predisposition, and social or cultural factors.

Increasingly, our social and cultural interactions take place online. It is, therefore, not surprising that online interactions intersect with mental illnesses generally, and anorexia specifically. This is particularly when taking into account that the average person who suffers from anorexia tends to be relatively young.

“Pro-ana” websites endorse anorexia as a positive choice, as opposed to a mental illness. Other variants include “pro-mia” websites, which endorse bulimia. These sites predominantly target women.

They promote a very thin body as the type that women must have. They give advice about how to become anorexic, how to hide an eating disorder from others and how to diet. The websites contain images of extremely thin women, which are sometimes altered to make the women appear thinner.

These websites have a long history. In 2001, Time Magazine noted the existence of 400 such sites. Efforts to eradicate these sites are just as old. AOL and Yahoo tried to ban pro-ana material that same year.

These attempts have not been successful. Rather, the “survival” of such networks has required adaptation.

In practice, this involves these networks “turning inwards”, as “subgroups of ana-mia bloggers will exchange messages, links and images among themselves and exclude other information sources”. Present estimates suggest there may be millions of pro-ana websites.

Like other online interactions, pro-ana websites have become integrated with social media.

The present legal framework

In Australia, there is little regulation of pro-ana material. There are general criminal offences that relate to causing bodily harm. This includes causing a person to have a disease or disorder. It follows that anorexia, while a mental illness, might nevertheless constitute bodily harm.

However, it is not likely that these offences will criminalise the publication of pro-ana material. The causes of anorexia are complex and multifaceted. Criminal prosecution usually requires proof that an action caused a particular outcome. Where many complex factors contribute to an outcome, it is difficult to prove causation in a criminal court.

Some jurisdictions have offences of “hastening death”. These provisions criminalise making a “substantial contribution” to a death. Where it can be shown that pro-ana material contributed to death, by accelerating the progression of anorexia for example, criminal liability may follow. However, prosecution in such a case remains very difficult.

The French legislation

France has been an international leader in laws that relate to body image. In 2015, the French government modified its Public Health Code to include an article that states:

[c]ausing a person to seek excessive leanness by encouraging prolonged food restrictions which result in exposing the person to life-threatening danger or in directly compromising their health, is punishable by one year in prison and a fine of €10,000.

The French MPs who proposed the law, Maud Olivier and Catherine Coutelle, stated that “certain sites known as pro-ana can push people into a vicious circle of anorexia and authorities cannot do anything about it”.

Other countries have also proposed similar bans. In Australia, former federal MP Anna Burke has advocated following France’s lead and banning such websites in Australia.

Issues with criminalisation

Pro-ana websites are commonly interactive. The line between a consumer and a producer of social media is blurry. Laws to prohibit pro-ana material would likely also capture the behaviour of visitors to these sites who interact with them.

A considerable proportion of women who seek out pro-ana websites report suffering from an eating disorder. Visitors to these websites commonly report that they are seeking support in relation to those disorders, often after traditional therapies have been unsuccessful.

Similarly, most publishers of pro-ana websites are women who themselves suffer from the illness. If creating pro-ana websites is criminalised, then it could make it more difficult for the creators to seek the help that they need to recover.

Much of the content of pro-ana websites is shocking. Telling readers to “stop eating until they take you to the hospital” is disturbing. This line might be hyperbole. It might be evidence of the disordered thinking typical of anorexia. In either case it evokes a strong reaction.

Yet, similar material is found elsewhere in the public space. The common pro-ana motto, “nothing tastes as good as skinny feels”, is attributed to supermodel Kate Moss. That line, and variations on it, are used in marketing material by clothing retailers.

Images used by pro-ana websites are most often taken from other sources. They include photos from fashion and women’s magazines, celebrities and well-known models. These images – shocking in the context of pro-ana websites – are ubiquitous in the public space.

Public comment advocating extreme thinness in women is also common. Radio shock-jock Kyle Sandilands used his nationally syndicated show to tell a woman: “I like the starving look … 60kgs is pushing it.”

Internationally syndicated celebrity MD Dr Oz’s show is broadcast on free-to-air TV in Australia. It featured Camille Hugh’s book, The Thigh Gap Hack. That book promised women “the shortcut to slimmer, feminine thighs every woman secretly desires” by techniques such as the trademarked “hunger training”. This technique encourages women to skip meals and instead “listen” to their body for signals of “true” hunger.

Proposals to criminalise pro-ana websites would make it an offence to collect and collate images, slogans and “tips” that are commonly used to market to women. These laws would criminalise this behaviour when done by women in a pro-ana context, but not when done to women. This seems deeply problematic.

Alternatives to criminalisation

The alternative to criminalisation is to use online platforms to deliver health information. For example, searching “pro-ana” on social media site tumblr returns the following page:

from www.tumblr.com

Research on internet search habits found that explicit reference to a celebrity’s eating disorder in traditional media reports decreased the rate at which people searched for material relating to anorexia. This suggests that alternative messaging, rather than criminalisation, may have merit.

Another possible alternative is to add some sort of warning on these pages about the dangerous content and the harm that may come from viewing them.

If you, or anyone you know, is suffering from an eating disorder, you can contact the Butterfly Foundation for assistance by calling 1800 334 673.