For three years, when Alison Devenny wanted weight-loss tips, she turned to the Internet. But she didn't look for typical dieting Web sites. The George Washington University sophomore visited Web sites that encourage visitors to embrace anorexia and bulimia as "lifestyle choices" and provide instruction on how to do so.
The sites provide "thinspirational" pictures of extremely underweight women, menu suggestions, discussion boards and tips on topics including ways to overcome hunger pangs, such as doing household chores and drinking lemon water.
Despite attempts to encourage Internet service providers to close down such sites, many continue to exist. A recent Google search using the term "pro-anorexia" yielded 30,000-plus results. Many were links to pages by health authorities warning about the pro-anorexia movement, while others were links to sites no longer in operation.
Tips on avoiding eating
Carol Day, director of health education services at Georgetown University and a member of the school's eating disorder treatment team, called the sites "dangerous and disturbing." Experts say the sites can reinforce unhealthy behaviors, slow the recovery process and discourage people from seeking help.
"I always kind of knew that what I was doing was stupid," said Devenny, now 19, who has since begun treatment for multiple eating disorders. She used to visit the sites about twice a week, she said, picking up tips on how to avoid eating and how to keep her illness a secret from her family.
The terms "Ana" and "Mia" _ short for anorexia (a condition characterized by eating so little that one's health and life are at risk) and bulimia (overeating and then purging by vomiting or taking laxatives) _ are often used by those with eating disorders who don't want treatment.
Frequent visitors to these sites refer to themselves as "anas" and "mias" and say the sites offer a safe haven where they can talk, share advice and commiserate away from the harsh criticism of family, friends and other "outsiders."
The sites' creators are typically teenagers and young adults who have eating disorders. Many are directed at women, who experience eating disorders more often than men.
According to the National Institute of Mental Health, about 0.5 to 3.7 percent of women suffer from anorexia in their lifetimes and about 1 percent to 4 percent are bulimic.
Eating disorders are often accompanied by depression, substance abuse and anxiety disorders. Common personality characteristics include excessive anxiety, perfectionism and low self-esteem. Treatments include hospitalization or outpatient treatment, as well as psychotherapy, nutritional counseling, cognitive therapy, behavioral therapy and antidepressant medication, according to the Harvard Eating Disorders Center.
Seeking solidarity and support
About half of people with anorexia or bulimia recover completely through treatment, according to the Harvard center. About 30 percent make a partial recovery, and 20 percent have no substantial improvement. The mortality rate for anorexia is less than 1 percent _ about 0.56 percent per year, according to NIMH. Cardiac arrest and suicide are common causes of death for anorexics.
But "Anas" and "Mias" say they are not sick, don't need to be "fixed" and don't want sympathy. They develop creeds and post poetry and online diaries reciting their beliefs. They applaud one other for reaching low weights. One sites sells red bracelets to encourage "solidarity" among pro-anas. "So you can go out into the world and not have to wonder, "Is she or isn't she?' . . . You see the red bracelet, and you know," the site explains.
But it's the pro-eating-disorder advice that many women say they seek on these sites. A college sophomore from Alexandria, Va., diagnosed with bulimia and anorexia said tips from pro-eating-disorder sites helped her go from 161 pounds to her current 74 pounds.
"At times I did gain back the weight, but I would always make a plea for help on the pro-ana" Web sites, she wrote in an e-mail responding to a reporter's question. She asked not to be identified by name, adding that although her family knows she has an eating disorder, they don't know _ and wouldn't approve of _ her visiting these sites.
Some Internet service providers shut down the sites in 2001 after the nonprofit National Eating Disorders Association and other groups complained that the sites contained content that could harm minors. Many sites disappeared briefly, only to re-emerge later under different names and on different Internet domains.
The NEDA in Seattle has since changed strategies, opting to create increased awareness and education about eating disorders on the Web and elsewhere.
"We can't rid the world of these sites . . . but we can be more proactive in trying to get real information out to the public," said the group's chief executive officer Lynn Grefe. Unless sites encourage or reflect specific crimes, most Internet service providers have been reluctant to shut them down.
America Online has removed several pro-eating-disorder Web sites in the past few years under its policy prohibiting "material that defames, abuses, threatens, promotes or instigates physical harm or death to others or oneself," according to company spokesman Andrew Weinstein.
Health professionals say people who think they may have eating disorders should seek medical treatment, rather than surf the Web for advice.
"I feel kind of bad for girls who go into it with a little less maturity and buy into everything they read," Devenny said.
"I think it's dangerous, especially in the wrong hands. . . . This is a life-and-death matter for a lot of people."
ON THE PHONE
To reach the National Eating Disorders Association's confidential help line, call toll-free 1-800-931-2237.
ON THE WEB
For more information about eating disorders and treatments, visit:
Alison Devenny, 19, visited pro-eating-disorder Web sites regularly until seeking treatment three months ago. An expert calls the sites "dangerous and disturbing."