Eating Disorders and the Internet

In America, it is clear that being thin is an ideal. The concept of ‘thin as beautiful’ is something that is omnipresent on television, in advertisements, in magazines, and on the internet. The message of ‘being thin’ is connected to the ongoing fight against obesity, which is currently one of the most prevalent health issues in America. Many argue that it is healthier to be thin than overweight; however, in this country, eating disorders, such as anorexia and bulimia, have emerged as some of the most significant mental disorders and they often lead to death. And what some may not realize is that those who have eating disorders are able to easily find internet communities that will support and encourage anorexia and or bulimia.

Web sites called Pro-Ana or Pro-ED (eating disorder) are often posted on servers such as Tumblr. These sites can range from simply glorifying thinness by showing pictures of incredibly thin models (labeled “thinspiration”), to actually promoting anorexia or bulimia as a lifestyle choice. Some of the most aggressive blogs will give tips on what food is easiest to throw up and how to hide an eating disorder from family members.

How should these websites be dealt with? Certainly it would be a violation of freedom of speech to attempt to completely ban Pro-Ana from the internet. Furthermore it would be extremely difficult. First, the internet is an incredibly powerful vehicle of communication that allows for all types of material to be posted, even items that could be considered harmful. In order to ban websites like Pro-Ana and Pro-ED, there would have to be proof that they are harmful in a way that distinguishes them from all other harmful content on the internet.

Furthermore, even if these websites could be banned, information on the sites could be reposted again. A study published in the American Journal of Public Health noted that this phenomenon occurred in 2001: “Yahoo and MSN agreed to shut down Web sites that were overtly pro-anorexia or pro-bulimia. This led to the remaining sites concealing their purposes or going underground, proving that Internet content is extremely difficult to regulate.”[1] So attempts at regulation, even if tried, can prove unsuccessful.

Even if these websites can’t be shut down, we must continue to view them as an ethical issue in public health because of their potential for causing harm. Studies have shown that the use of these sites can be harmful for people who already have eating disorders and can even cause feelings of body dissatisfaction for people who do not. [2]

Questions of decision-making capacity are quite complex for those with any mental health diagnosis, and eating disorders are no exception. A person with anorexia may or may not have the capacity to refuse treatment for the illness. If the anorectic person is so ill that she lacks decisional capacity, then it might be appropriate to intervene against her wishes, for instance by requiring treatment despite her objection. This question of decisional capacity is particularly pertinent in the case of adolescents, who are still under the authority of their parents. Adolescent girls have the highest rate of eating disorders and girls in their late teenage years are the predominant authors of pro-Ana blogs[3].

The idea that people suffering from eating disorders may not have decisional capacity relates to John Stuart Mill’s “harm principle.” The “harm principle” states that individuals should have the right to do whatever they choose so long as they are not harming other people. However, it has the proviso that people should not necessarily be able to do something that could harm them if they are not in the state of mind to be making these types of decisions, and he specifically refers to children when talking about this proviso.

The other part of the “harm principle” that is interesting to look at with respect to pro-Ana is the non-harming of others. Though the existence of these blogs does not directly cause eating disorders, they could potentially worsen an eating disorder of someone who looks at the site. Therefore, an argument could be made that these websites actually do harm others and the people who maintain these sites have an ethical responsibility to shut them down.

There is no clear path to lessening the power and prevalence of eating disorders and pro-eating disorder websites. However, going forward, further studies of the effects of the use of these sites and of the perceived harm from using these sites is very important. And better education about eating disorders, especially for parents, could potentially be helpful in diminishing the harm of eating disorders for adolescents.

Hannah Kronenberg is an intern at the Montefiore-Einstein Center for Bioethics. She is a rising junior in the Woodrow Wilson School at Princeton University pursuing certificates in Values and the Public Life and Statistics and Machine Learning.

[1]Borzekowski, Dina L. G., EdD, Summer Schenk, MPH, Jenny L. Wilson, MD, and Rebecca Peebles, MD. “E-Ana and E-Mia: A Content Analysis of Pro–Eating Disorder Web Sites.” American Journal of Public Health 100.8 (2010): 1526-534. Web
[2]Castillo, Michelle. “Despite Social Media Bans of “pro-ana” Websites, Pages Persist.”CBSNews. CBS Interactive, 28 Mar. 2012. Web. 12 Apr. 2013.
[3]Borzekowski, Dina L. G., EdD, Summer Schenk, MPH, Jenny L. Wilson, MD, and Rebecca Peebles, MD. “E-Ana and E-Mia: A Content Analysis of Pro–Eating Disorder Web Sites.” American Journal of Public Health 100.8 (2010): 1526-534. Web

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