Websites promoting anorexia and bulimia started popping up in the mid-1990s. By 2000 there were more than 500 “pro-ana” and “pro-mia” sites, and they continue to proliferate today. Physician Rebecka Peebles, an instructor in adolescent medicine, and third-year medical student Jenny Wilson, ’01, surveyed 54 adolescent eating-disorder patients and 91 parents, and found that young people who regularly visited the websites spent more time in the hospital and less time on homework than those who did not. There were no significant differences in body weight, number of missed menstrual periods or bone density between the two groups of patients.
Stanford: What do you find on pro-eating disorder websites?
Wilson: They give tips and techniques on how to purge better, or how to hide it from your parents. They also have “thinspirations,” which are images of anorexic women. And a lot of them have message boards. We found that two-thirds [of patients] learned about new weight-loss and purging techniques from the websites, and one-third learned about diet pills, laxatives and supplements. So there is an indication that they are learning about unhealthy behaviors that are impacting their health.
Peebles: And the websites offer a community where people feel like they can express whatever it is that they’re thinking. When someone says, “I’m going to a treatment program,” or “I’m tired of this, I want to quit,” she’ll get a “Good job” or “Good luck.” But people also say, “How can I lose weight before the prom?” And then there will be a lot of, “Well, these diet pills helped me,” and, “You can vomit without your parents hearing by being in the shower.” What web support means to patients suffering from [an eating disorder] is complicated.
Have there been many studies about the impact of these websites?
Peebles: The effects of the Internet on [eating disorders] is an emerging field. I think physicians are just starting to understand how much their adolescent patients are online, and what kinds of impacts that usage has.
As a physician, what are your concerns about eating disorders?
Peebles: The most pressing concern is the risk of death. Disordered eating does damage to almost every organ system—to the heart, hormonal system, kidneys, liver, brain. There’s a myriad of complications that occur.
Do young women understand how serious an eating disorder is?
Peebles: I think many patients do see how serious it is, and they ask for help. But there’s also a huge number of patients who are dragged in by their parents, and who are really not at all cognizant that this is a problem.
Do you spend time on websites yourself?
Peebles: I do because many of my patients give me their log-ins. They feel more comfortable expressing their feelings on a site.