Public health implications of the Internet-based pro-anorexia movement

Background: Pro-anorexia (“pro-ana”) is a thriving Internet-based movement defining anorexia as a lifestyle choice rather than a disease. These websites exalt extreme thinness and applaud weight loss. As many as 40% of teen anorexics visit these sites. Parents, teachers and health care workers commonly are unaware of these websites, which number over 400, some claiming as many as 350,000 hits. Objective: Create an informational pamphlet to increase community awareness about the warning signs of anorexia and the potential public health implications of the pro-ana movement. Methods and Results: We accessed representative sites via Google and Yahoo search engine inquiries for “pro-anorexia” to determine content. These sites commonly contain: (1)weight loss strategies and starvation techniques; (2)a re-definition of normalcy (“anorexia is a choice, not a disease”); (3)“thinspiration” (images of emaciated models to inspire weight loss); (4)strategies to conceal extreme thinness from parents and physicians; (5)interactive chatrooms and message boards; (6)and methods to create password-only websites to escape surveillance. Pro-ana supporters claim these websites create an anonymous, supportive and non-judgmental community for anorexics who otherwise feel persecuted or misunderstood. Conclusion: Pro-ana websites are pervasive, easily accessible and potentially harmful. Commonly, these sites advocate self-destructive advice on dieting and weight loss techniques, and contradict recommendations made by health professionals. Raising community awareness of the pro-ana movement will promote health-enhancing interventions.