Study Examines Pro-Anorexia and Pro-Bulimia Websites

Photo courtesy Forest Ray

A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health examines the content and messages presented by websites that appear to support or encourage eating disorders. These websites use images, text and interactive applications to further knowledge, attitudes and behaviors to achieve dangerously low body weights. The study is the largest and most rigorous analysis of pro-eating disorder websites and it is available online in advance of print in the June 17 edition of the American Journal of Public Health.

The internet offers messages and communities that sanction anorexia, bulimia and other eating disorders. Previous studies have shown the 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.

“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.”

Co-authors of the study “e-Ana and e-Mia: A Content Analysis of Pro-Eating Disorder Websites” include Summer Schenk, Jenny Wilson, and Rebecka Peebles. At the time of the study, Ms. Schenk was completing her MPH from the Bloomberg School of Public Health. Drs. Wilson and Peebles are from the Stanford University School of Medicine.

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