The vast majority of websites that appear to support or endorse eating disorders provide "overt suggestions" on engaging in eating-disordered behaviours, according to a new study.
U.S. researchers conducted an in-depth examination of 180 websites and the messages that users may be exposed to online.
They initially found the sites using Yahoo or Google search engines through keying in various terms including Proana, Promia, Pro-Bulimia and Pro-Eating disorder.
Researchers included sites, forums, journals and blogs characterized by a main focus on or promotion of eating disorders. Medical reference pages, medical journals, news articles and professional or medical organization sites focusing on eating disorders were excluded.
According to the findings published Thursday in the online edition of the American Journal of Public Health, researchers found that 40 per cent of the sites had a section "overtly labelled" as containing tips for practising eating disorder behaviours. An additional 43 per cent offered such tips throughout the site without designating a particular area.
Tips ranged from simple suggestions like sitting up straight to burn more calories, to more potentially life-threatening ones, such as a how-to on purging.
Lead author Dina Borzekowski of Johns Hopkins University's Bloomberg School of Public Health, said many of these sites are support networks for people suffering from eating disorders.
"Now, whether or not the person really realizes that they're suffering or they have this disorder is still unknown, but they are supporting these behaviours and thoughts," said Borzekowksi, who co-authored the study with master's graduate Summer Schenk and Dr. Rebecka Peebles of Stanford University.
"One of the interesting things is that people who suffer from eating disorders are often isolated, so it's not too surprising that they're going online to find a network of people who are like-minded and engaging in the same types of behaviours."
Valarie Bittner, clinical director of the Westwind Eating Disorder Recovery Centre in Brandon, Man., said many individuals with eating disorders tend to socially isolate themselves.
Many of the clients she deals with find it much easier to engage socially through networking sites like Facebook as opposed to having to see someone and deal with the social anxiety, she said.
Bittner said it is often the goal of some of the women she works with in recovery to learn how to disengage from public material that might pull them back into negative habits, like pro-Ana sites or magazines.
"A lot of women in recovery that I've met, that's a big struggle," she said. "When they're feeling really down about their bodies and negative, that's where they go to, and it just fuels the self-criticism."
"Thinspiration" material - images or prose intended to inspire weight loss - appeared in 85 per cent of the sites reviewed.
One of the findings researchers describe as "somewhat surprising" was that nearly one-third of the sites had a recovery-oriented focus. They wrote this could reflect a "duality of purpose" for pro-eating disorder site visitors who may feel pulled simultaneously towards both eating disorder behaviours and recovery.
Merryl Bear, director of the National Eating Disorder Information Centre, said she feels pro-eating disorder sites deepen behaviours and attitudes that are harmful for people who already have food and weight preoccupations and can encourage those not yet committed to eating disorder behaviours to engage in them.
That said, she believes it's important not just to try to shut the sites down but to get at the root of what's driving individuals to both create and view them.
"I think it's really important to understand the motivation of the individuals who both create and use these sites, to better understand the needs, the fears and the compulsions of individuals who engage in them so that as health providers we can better understand the experience of individuals who are at risk of an eating disorder or who are engaged in eating disorder behaviours."
Borzekowski said her research team has studies currently under review looking at people who use these websites, which involved interviewing young people in treatment for eating disorders.
As for the current study, she said the take-home message for caregivers and educators is the need to be aware of the content available to and potentially reaching vulnerable youth.
"There are websites that promote equally unhealthy behaviours such as self-injury and suicide. So as a parent, as an educator, as a health provider, knowing that these websites are out there and supporting very dangerous behaviours is critical."
According to a 2002 survey, 1.5 per cent of Canadian women aged 15-24 years had an eating disorder.
- Government of Canada. (2006). The Human Face of Mental Health and Mental Illness in Canada 2006.
Lifetime prevalence rates for anorexia nervosa (AN) and bulimia nervosa (BN), and Binge Eating Disorder (BED) tend to be higher among women than in men.
° Lifetime prevalence of AN: 0.9 per cent in women and 0.3 per cent in men
° Lifetime prevalence of BN: 1.5 per cent in women and 0.5 per cent in men
° Lifetime prevalence of BED found to be 3.5 per cent in women and 2.0 per cent in men
The average lifetime duration of BN is found to be approximately 8.3 years.
- Hudson, J. I., Hiripi, E., Pope, H. G. & Kessler, R. C. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348-358.
AN has the highest mortality rate of any psychiatric illness - it is estimated that 10 per cent of individuals with AN will die within 10 years of the onset of the disorder.
- Sullivan, P. (2002). Course and outcome of anorexia nervosa and bulimia nervosa. In Fairburn, C. G. & Brownell, K. D. (Eds.). Eating Disorders and Obesity (pp. 226-232). New York, New York: Guilford.
- Source: National Eating Disorder Information Centre, nedic.ca