Pro-ana refers to the rejection of the idea that anorexia nervosa is an eating disorder. It is often referred to simply as "ana" and is sometimes affectionately personified by anorexics as a girl named Ana.

Pro-ana is a loosely descriptive term rather than an organized social movement, and as such encompasses a wide range of views. Many pro-ana organizations state that they do not promote anorexia and acknowledge that anorexia is a real medical disorder, and that they exist mainly to give anorexics a place to turn to discuss their illness in a non-judgmental environment: some promote recovery while still supporting those who choose to defer or refuse medical or psychological treatment. Others go further, disputing the prevailing psychological and medical consensus that treats anorexia nervosa as a mental illness rather than a "lifestyle choice" that should be respected by doctors and family. One study defines pro-anorexia as "a way of coping and a damage limitation that rejects recovery as a simplistic solution to a symptom that leaves the underlying pain and hurt unresolved."

The lesser-used term pro-mia refers likewise to bulimia nervosa and is sometimes used interchangeably with pro-ana.

Online groups

Most pro-ana material is disseminated over the Internet, through tight-knit support groups centred around web forums and, more recently, social networking sites such as Xanga, LiveJournal, Facebook and Myspace. These sites typically have an overwhelmingly female readership and are frequently the only means of support available to socially-isolated anorexics.

Members of these support groups may:

• Share crash dieting techniques and recipes (67% of sites in a 2006 study)
• Compete with each other at losing weight, or fast together in displays of solidarity
• Commiserate with one another after breaking fast or binging
• Advise on how to best induce vomiting, and on using laxatives and emetics
• Give tips on hiding weight loss from parents and doctors
• Share information on maximizing the safety of anorexia.
• Affirm the attractiveness and acceptability of other members' current weight.

As an encouragement to further lose weight, members often exchange thinspiration (or thinspo): image or video montages of slim women, often celebrities, who may be anything from naturally slim to emaciated with visibly-protruding bones. Conversely, reverse thinspiration may be photographs of fatty food, overweight or obese people intended to induce disgust and motivate further weight loss. 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 pro-ana websites have this type of content.

Impact

Visitors to pro-ana web sites 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 anti-anorexia sites learned new techniques).

A 2006 experimental study at the University of Missouri on 235 female undergraduates found that those subjected to a single viewing of a pro-ana site created by the study designers reported lower self-esteem and were more likely to become preoccupied with exercise and weight loss, as compared to control groups. A greater likelihood to exercise and a reduced likelihood to overeat or self-induce vomiting was also reported by the group viewing the pro-ana site. The study was limited by reliance on self-reports, possible non-generalizability of the results beyond viewing in a laboratory setting, and the assessment of only immediate effects. A larger study by the University of South Florida of 1575 girls and young women in 2007 found that those who had a history of viewing pro-ana websites did not differ from those who viewed only professional anorexia websites on any of the study's measures, including body mass index, negative body image, appearance dissatisfaction, level of disturbance, and restriction. Those who had viewed pro-ana websites were, however, moderately more likely to have a negative body image than those who had viewed no websites on anorexia. It was not clear whether a causal relationship existed.

Criticism and controversy

In pro-ana

Pro-ana has attracted teenage girls who believe that inducing eating disorders will cause them to lose weight more effectively. Such people are often unwelcome in pro-ana groups and derisively referred to as wannarexics. Some medical professionals and anorexics also take affront to wannarexia as they believe it glamorizes a serious illness.

From the medical profession

Health care professionals and medical associations have taken generally negative views of pro-ana groups and the information they disseminate:

• NEDA (The National Eating Disorders Association) "actively speaks out against pro-anorexia and pro-bulimia websites. These sites provide no useful information on treatment but instead encourage and falsely support those who, sadly, are ill but do not seek help.
• The Academy for Eating Disorders takes the position that "websites that glorify anorexia as a lifestyle choice play directly to the psychology of its victims", expressing concern that sites dedicated to the promotion of anorexia as a desirable "lifestyle choice" "provide support and encouragement to engage in health threatening behaviors, and neglect the serious consequences of starvation.
• ANAD (The National Association of Anorexia Nervosa and Associated Disorders) states that "pro-ana and pro-mia web sites and communities create the opportunity to compare to more and more dangerous methods of weight loss, and increase the drive and interest, and increase the severity and frequency of eating disorder behaviors.
• Eric van Furth, a board member of the AED (the international Academy of Eating Disorders), notes that pro-ana sites have relatively few visitors and advises against sanction of such sites, claiming instead that popular media play the more important role in establishing ideals of female thinness.

In the 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 February 2002, the television series Boston Public aired an episode that centered around a teacher becoming upset at a student's eating disorder and discovered that another student was running a pro-ana website.

Growing up online, a January 2008 episode of the PBS Frontline television program, also featured a brief discussion of pro-ana.

From Internet service providers

In July 2001, Yahoo--after receiving a letter of complaint from ANAD--began removing pro-ana sites from its Yahoo Clubs (now Yahoo Groups) service, stating that such sites endorsing self-harm were violations of its terms of service agreement.

LiveJournal has not made a position statement regarding pro-ana. In August 2007, however, a staff member declined to respond to an abuse report filed against a pro-ana community hosted on its network, stating that: "Suspending pro-anorexia communities will not make anyone suffering from the disorder become healthy again. Allowing them to exist, however, has several benefits. It reassures those who join them that they are not alone in the way they feel about their bodies. It increases the chance that the friends and loved ones of the individuals in the community will discover their disorders and assist them in seeking professional help.

In November 2007, Microsoft shut down four pro-ana sites on the Spanish-language version of its Spaces social networking service at the behest of IQUA, the Internet regulatory body for Catalonia. A Microsoft spokesperson stated that such sites "infringe all the rules on content created by users and visible on our sites".

Facebook has stated that it will not close pro-ana groups on its service; when pressed for comment by the BBC in February 2008, a spokesperson said that "many Facebook groups relate to controversial topics; this alone is not a reason to disable a group." Similarly, MySpace does not ban pro-ana material and has stated that "it's often very tricky to distinguish between support groups for users who are suffering from eating disorders and groups that might be termed as 'pro' anorexia or bulimia. Rather than censor these groups, we are working to create partnerships with organisations like b-eat." MySpace has chosen instead to cycle b-eat banner advertisements through pro-ana members' profiles.

Legality

In the United Kingdom, 40 MPs signed an early day motion tabled in February 2008 by the LibDem member for Cheadle, Mark Hunter, urging government action against pro-ana sites. The motion was timed to coincide with the UK National Eating Disorder Awareness Week.

In April 2008, a bill outlawing material which "provokes a person to seek excessive thinness by encouraging prolonged restriction of nourishment" was tabled in the French National Assembly by UMP MP Valérie Boyer. It imposes a fine of €30,000 and two years imprisonment (rising to €45,000 and three years if there was a resulting death) on offenders. Health minister Roselyne Bachelot, arguing for the bill, stated that "giving young girls advice about how to lie to their doctors, telling them what kinds of food are easiest to vomit, encouraging them to torture themselves whenever they take any kind of food is not part of liberty of expression.

Any legislation to shut down pro-ana or pro-mia websites in the United States (where many are hosted) would be prima facie unconstitutional, as only incitement to imminent lawless action and the utterance of fighting words (breaching the peace) are criminally actionable under U.S. law. (For more information, see the First Amendment to the United States Constitution.) U.S. companies hosting pro-ana and pro-mia websites may speak freely as well - and can refuse to host sites as they choose.

References