An Overview of Pro-Ana Websites

The Internet is like a river of information flowing in two directions. It is an invaluable source of health information for adolescents, but it can also provide dangerous medical misinformation. A good example of this is the case of pro-anorexia, or “pro-ana,” websites. These sites promote anorexia nervosa through misinformation, use of religious and inspirational themes, stories of individuals, poetry, and seemingly supportive suggestions.

A team of eating disorders experts recently tracked down and analyzed the 20 most popular pro-ana websites (Int J Eat Disord 2006;39:443). Mark L. Norris, MD and colleagues used interviews and focus groups to determine how best to review Internet websites. They then used three search engines, Google, Yahoo, and MSN, to visit and evaluate 60 pro-ana websites, and selected the final 20 because of multiple listings and links. Half of the websites reviewed were hosted by one of two free home page providers.

What was on the websites

Disclaimers and warning. Warnings and/or disclaimers before entry into the web pages were posted on 58% of the websites. These disclaimers including messages asking non-eating-disordered persons to leave the website, making clear that the website supported the pro-ana movement, and stating that persons under 18 years of age could not enter the website without prior parental consent. Although information on purging was supposedly not allowed by any web hosts, two-thirds of the sites offered information on laxatives and other ways of purging.

Lifestyle choice versus medical disease. Only one of the websites stated that it viewed anorexia nervosa as a lifestyle choice. Almost half of the website creators noted that their websites were a means of supporting individuals with eating disorders. About two-thirds of the webmaster/creators were listed, and all of these were female; 4 were younger than 18. Two gave histories of self-harm and/or suicidal attempts.

Information on the website. More than 90% of the websites had “thinspirational” content, or visual images and motivational quotes promoting thinness (for example, “nothing tastes as good as thin feels..”) They also featured photographs of extremely thin celebrities, and a few offered sexually explicit photos and cartoons.

Two-thirds of the websites offered “tips and tricks” for losing weight. These ranged from using laxatives and diet pills to use of cleansing enemas. Some included slight warnings about excess weight loss but others provided potentially hazardous information about starvation, fasting, and alternative medicine. Other tricks included methods of hiding weight loss and creative ways to “avoid calories.”

More than half of the websites included calculations of body mass index, basal metabolic rate, and the number of calories burned per activity. It was also common to see stories and poems sent by viewers; the themes usually were weight, self-image, and emotions. Many sites offered “ana” accessories, including a red “ana bracelet.”

Religious metaphors were common

More than two-thirds of the sites included religious metaphors, most commonly the Ana Psalm and Creed. In a few cases, according to the authors, viewers were encouraged to make a pact with Ana and to sign it in blood. “A Letter from ANA” could also be found on most personal websites. The content in this letter included phrases such as “I expect a lot from you. You are not allowed to eat much. I will expect you to drop your caloric intake and increase your exercise.I will push you to the limit. You must take it because you cannot defy me. Pretty soon, I am with you always.”

The “tips and tricks” sections contained the most serious and risky suggestions, especially though promotion of fasts, laxatives, and alternative medical procedures for weight loss. The tricks and tips often were framed in a way to promote the “safe management” of extremely dangerous behaviors.

Awareness can help counteract these sites

The authors stressed the importance of clinicians being aware of and knowing the content of these websites so they, parents, and caregivers can help counteract the information. They also noted that web providers hosted half of the websites at no cost, and each of the free websites disregarded the provider’s outlined terms of use, raising the question of how well such websites are being monitoredif the guidelines were enforced, half of the websites selected for study would have been taken off the Internet, according to the authors.