Pro-ana

Medical professionals treating eating disorders have long noted that patients in recovery programs often "symptom pool", banding closely together for emotional support and validation.{{citation|title=The winner dies|work=Salon.com|first=Janelle|last=Brown|date=2001-07-23|access-date=2009-04-25|url=http://dir.salon.com/mwt/feature/2001/07/23/pro_ana |archive-url=https://web.archive.org/web/20100920234343/http://dir.salon.com/mwt/feature/2001/07/23/pro_ana|archive-date=2010-09-20|url-status=dead}} In this context, people with anorexia may collectively normalize their condition, defending it not as an illness but as an accomplishment of self-control and an essential part of their identity, with some members of these online communities going as far as claiming that starving oneself is a lifestyle choice rather than an illness.{{citation|title=Anatomy of Anorexia|author= Levenkron, Steven|isbn=978-0-393-32101-2|year=2001|publisher=W. W. Norton|author-link=Steven Levenkron}} These 'lifestyle' claims may be a symptom of anosognosia. Other community members band together for support in managing their illnesses, such as sharing harm reduction tips and having others to talk to about their experiences that are going through the same thing. Many individuals in pro-ana communities use the phrase "pro for myself, not anyone else" to indicate that they are only interested in furthering their own disorders, not encouraging anyone else to imitate their behavior.{{citation needed|date=July 2024}}

Such advocacy has flourished on the Internet, mainly through tight-knit support groups centred on web forums and social network services such as Tumblr, Xanga,{{citation|url=http://www.kitschmag.com/index.php?option=com_content&task=view&id=154&Itemid=27|title=I reside in skinny|last=Ensign|first=Rachel|issue=Fall 2006|magazine =Kitsch Magazine|date=July 2021 }} LiveJournal, Facebook and Myspace.{{citation|title=Before Spring Break, the Anorexic Challenge|url=https://www.nytimes.com/2006/04/02/fashion/sundaystyles/02BREAK.html|first=Alex|last=Williams|date=2006-04-02|access-date=2007-11-11|newspaper=New York Times}} These groups are typically small, vulnerable, partly hidden and characterized by frequent migrations.{{citation|title=Studying Eating Disorders in the Social Web. New methods, new questions |publisher=Institute of Social Psychology, London School of Economics and Political Science|first=Antonio A|last=Casilli|date=May 2011 |url=http://www.bodyspacesociety.eu/2010/05/12/studying-pro-ana-communities-in-the-social-web-lse-seminar }} They also have a high female readership and are frequently the only means of support available to socially isolated anorexics.{{citation|title=A Disturbing Growth Industry: Web Sites That Espouse Anorexia|first=Bonnie Rothman|last=Morris|newspaper=New York Times|date=2002-06-23|access-date=2009-04-21|url=https://query.nytimes.com/gst/fullpage.html?res=9F00E4DB123CF930A15755C0A9649C8B63&sec=&spon=}}

Members of such support groups may:

• Endorse anorexia and/or bulimia as desirable (84% and 64% respectively in a 2010 survey{{citation|journal=American Journal of Public Health|year=2010 |volume=100|issue=8|pages=1526–1534|first1=Dina|last1=Borzekowski|pmid=20558807|first2=Summer|last2=Schenk|first3=Jenny|last3=Wilson|first4=Rebecka|last4=Peebles |doi=10.2105/AJPH.2009.172700|title=e-Ana and e-Mia: A Content Analysis of Pro–Eating Disorder Web Sites|pmc=2901299}}).
• Share crash dieting techniques and recipes (67% of sites in a 2006 survey,{{citation|title=Ana and the internet: A review of pro-anorexia websites|first1=Mark L|last1=Norris|first2=Katherine M|last2=Boydell|first3=Leora|last3=Pinhas|first4=Debra K|last4=Katzman|journal=The International Journal of Eating Disorders|volume=39|pages=443–447|year= 2006|pmid=16721839|issue=6|doi=10.1002/eat.20305|s2cid=29355957 }} rising to 83% in a 2010 survey).
• Coach each other on using socially acceptable pretexts for refusing food, such as veganism{{citation|title=When Veganism Is an Eating Disorder|first=Danielle|last=Friedman|date=2010-07-22|access-date=2010-07-30|publisher=The Daily Beast|url=http://www.thedailybeast.com/blogs-and-stories/2010-07-22/when-veganism-is-an-eating-disorder}} (which is notably more prevalent in the eating-disordered in general{{citation|doi=10.1016/j.jada.2008.12.014|title=Adolescent and Young Adult Vegetarianism: Better Dietary Intake and Weight Outcomes but Increased Risk of Disordered Eating Behaviors|first1=Ramona|last1=Robinson-O'Brien|first2=Cheryl L|last2=Perry|first3=Melanie|last3=Wall|author3-link=Melanie Wall|pmid=19328260|first4=Mary|last4=Story|first5=Dianne|last5=Neumark-Sztainer|journal=Journal of the American Dietetic Association|volume=109|issue=4|year=2009|pages=648–655}}).
• 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.{{citation|title=Craving Community: The Phenomenon of Pro-Anorexia Sites |url=http://angelingo.usc.edu/vol04issue02/articles.php?section=tech&article=ProAna&page=all |journal=AngeLingo |publisher=USC College of Letters Arts and Sciences |first=Marjorie |last=Slater |date=April 2006 |volume=4 |issue=2 |url-status=dead |archive-url=https://web.archive.org/web/20070503192149/http://angelingo.usc.edu/vol04issue02/articles.php?section=tech&article=ProAna&page=all |archive-date=May 3, 2007}}{{citation|first1=Jenni|last1=Harshbarger|first2=Carolyn|last2=Ahlers-Schmidt|first3=Laura|last3=Mayans|first4=David|last4=Mayans|first5=Joseph|last5=Hawkins|title=Pro-anorexia websites: What a clinician should know|journal=International Journal of Eating Disorders|volume=42|pages=367–370|year=2008|doi=10.1002/eat.20608|issue=4|pmid=19040264}}
• Share information on reducing the side-effects of anorexia.{{citation|title=Pro-anorexia, weight-loss drugs and the internet: an "anti-recovery" explanatory model of anorexia|last1=Fox|first1=N|last2=Ward|first2=K|last3=O'Rourke|first3=A|journal=Sociology of Health & Illness|volume=27|pages=944–971|year=2005 |doi=10.1111/j.1467-9566.2005.00465.x|issue=7|pmid=16313524|url=http://eprints.whiterose.ac.uk/76886/7/WRRO_76886.pdf|doi-access=free}}
• Post their weight, body measurements, details of their dietary regimen or pictures of themselves to solicit acceptance and affirmation.
• Suggest ways to ignore or suppress hunger pangs.

Many have popular blogs and forums on which members seek companionship by posting about their daily lives or boasting about personal accomplishments of weight loss. The communities centred on such sites can be warmly welcoming (especially in recovery-friendly groups) or sometimes cliquish and openly suspicious of newcomers.{{citation|title=Constructing identities in cyberspace: The case of eating disorders|first=David|last=Giles|journal=British Journal of Social Psychology|volume=45|pages=463–477|url=http://www.brown.uk.com/eatingdisorders/giles2.pdf|year=2006|access-date=2009-04-29|pmid=16984715|issue=3|doi=10.1348/014466605X53596|s2cid=16799553 }}{{citation|title=Inside the" Pro-ana" Community: A Covert Online Participant Observation|year=2007|first1=Sarah|last1=Brotsky|first2=David|last2=Giles|journal=The Journal of Treatment and Prevention|volume=15|pages=93–109|doi=10.1080/10640260701190600|issue=2|pmid=17454069|s2cid=6615625}} In particular, hostility is often leveled at:

• The non-eating disordered who express disapproval, including the spouses, relatives and friends of members who appear on-site to post threats and warnings.
• Casual dieters who join, believing that inducing eating disorders will cause them to lose weight more effectively. Such people are often derisively referred to as "wannabes" or "wannarexics".{{cite web|url=http://digitalyouth.ischool.berkeley.edu/node/69|archive-url=https://web.archive.org/web/20070729020522/http://digitalyouth.ischool.berkeley.edu/node/69|url-status=dead|archive-date=July 29, 2007|title=No Wannarexics Allowed: An Analysis of Online Eating Disorder Communities|work=Digital Youth Project|access-date=2007-08-06|last=Pascoe|first=C J|publisher=University of California, Berkeley}}

{{for|the film alternatively titled Thinspiration|Starving in Suburbia}}

Pro-ana sites often (84%, in a 2010 survey) feature thinspiration (or thinspo): images or video montages of slim women, often celebrities, who may range anywhere from being naturally slim to emaciated with visibly protruding bones.{{citation|title=Narrow Minded|first=Virginia|last=Heffernan|date=2008-05-23 |magazine=New York Times Magazine |access-date=2008-12-30 |url=https://nytimes.com/2008/05/25/magazine/25wwln-medium-t.html}} Pro-ana bloggers, forum members and social networking groups likewise post thinspiration to motivate one another toward further weight loss.{{cite news|title=Seeking "thinspiration"|url=http://news.bbc.co.uk/1/hi/magazine/6935768.stm |first=Jacqueline|last=Head|publisher=BBC News|date=2007-09-08|access-date=2007-11-06}} Conversely, reverse thinspiration features images of fatty food or overweight people intended to induce disgust. There exists significant controversy between supporters and opponents of thinspiration; some assert that thinspiration only "glorifies" eating disorders{{cite web |url=https://vancouversun.com/mobile/health/women/Dangerous+online+culture+glorifies+eating+disorders/6379943/story.html |title=Dangerous online culture glorifies eating disorders |last=Auxier |first=Brooke |date=29 March 2012 |work=The Vancouver Sun |access-date=16 May 2012}}{{dead link|date=April 2018 |bot=InternetArchiveBot |fix-attempted=yes }} while some thinspiration bloggers argue that the purpose of thinspiration is to support a healthy level of weight loss.{{cite web|url=http://proana.info/pro-ana-and-thinspiration-under-attack/|title=Pro Ana and Thinspiration Under Attack|date=10 April 2012|publisher=ProAna.info|access-date=16 May 2012 |archive-url=https://web.archive.org/web/20120412192548/http://proana.info/pro-ana-and-thinspiration-under-attack |archive-date=2012-04-12}}

Thinspirational clips circulate widely on video sharing sites,{{citation|url=http://www2.canada.com/edmontonjournal/news/story.html?id=8e8d21e0-c8da-4af1-b05c-01422ab6136d|title=Online anorexia videos prompt call for website restrictions|date=2007-09-15|access-date=2009-04-21|first=Misty|last=Harris|newspaper=Edmonton Journal|url-status=dead |archive-url=https://web.archive.org/web/20110721180010/http://www2.canada.com/edmontonjournal/news/story.html?id=8e8d21e0-c8da-4af1-b05c-01422ab6136d|archive-date=2011-07-21 }} 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{{citation|title=Learning to Love Anorexia? Pro-Ana Web Sites Flourish|url=http://www.observer.com/node/47063|archive-url=https://web.archive.org/web/20071014042912/http://www.observer.com/node/47063|url-status=dead|archive-date=2007-10-14|first=Diedre|last=Dolan|date=2003-02-02|newspaper=New York Observer|access-date=2007-11-06}} (94% of sites in a 2003 survey{{citation|title=Pro or con? Anorexia nervosa and the internet|last1=Chesley|first1=E B|last2=Alberts|first2=J D|last3=Klein|first3=J D|last4=Kreipe|first4=R E|journal=Journal of Adolescent Health|volume= 32|pages=123–124|year=2003|doi=10.1016/S1054-139X(02)00615-8|issue=2}}).

Thinspiration often has a spiritual-ascetic flavour, referring to fasting through metaphors of bodily purity, food through allusions to sin and corruption, and thinness through imagery of angels and angelic flight. Exhortations like "Ana's Creed" and "The Thin Commandments" are also common.{{citation|last=Maloney|first=Patricia |date=2008-07-31|title=Quod Me Nutrit, Me Destruit: The Pro-Anorexia Movement and Religion|journal=American Sociological Association Annual Meeting 2008|url=http://www.allacademic.com//meta/p_mla_apa_research_citation/2/4/2/4/0/pages242403/p242403-1.php}}

Social researchers studying pro-ana have varied explanations for its popularity, with some characterizing it as a rejection of modern consumerism{{citation|title=The dangers and draw of online communication: Pro-anorexia websites and their implications for users, practitioners, and researchers|last=Tierney|first=Stephanie|journal=Eating Disorders|volume=14|pages=181–190|year=2006|doi=10.1080/10640260600638865|issue=3|pmid=16807213|s2cid=30908135}} and others suggesting that pro-ana functions as a coping mechanism for those already emotionally stressed by eating disorders.{{citation|title=An interpretative phenomenological analysis of participation in a pro-anorexia internet site and its relationship with disordered eating|last1=Mulveen|first1=Ruaidhri|first2=Julie|last2=Hepworth|journal=Journal of Health Psychology|volume=11|year=2006 |doi=10.1177/1359105306061187|issue=2|pmid=16464925|pages=283–96|s2cid=6120698}} However, most agree on two elements of pro-ana sites:

• Initially, pro-ana sites attract both the non-eating disordered (who first visit seeking tips and techniques for losing weight) and the eating-disordered (who seek advice on hiding their disordered behaviors or minimizing the physical damage caused by over-exercising and severe calorie restriction).
• Pro-ana sites give their members a strong sense of community and common identity.{{citation|url=http://www.wesleyan.edu/psyc/mindmatters/volume03/article05.pdf |title=Pro-Anorexia Websites: Content, Impact, and Explanations of Popularity |first=Grace |last=Overbeke |year=2008 |journal=The Wesleyan Journal of Psychology |volume=3 |pages=49–62 |url-status=dead |archive-url=https://web.archive.org/web/20120714075859/http://www.wesleyan.edu/psyc/mindmatters/volume03/article05.pdf |archive-date=2012-07-14 }}

Red bracelets are popularly worn in pro-ana, both as a discreet way for anorexics to socially identify and as a tangible reminder to avoid eating. Pro-mia bracelets, likewise, are blue or purple.{{citation|title=A sick trade|first=Judy|last=Skatssoon|newspaper=The Age|date=2004-09-07|access-date=2009-04-21|url=http://www.theage.com.au/articles/2004/08/06/1091732078038.html?oneclick=true | location=Melbourne}}{{citation|title=Blood red bangle fosters cult of secret self-starving|url=http://www.independent.ie/national-news/blood-red-bangle-fosters-cult-of-secret-selfstarving-470064.html|first=Barbara|last=McCormack|date=2005-07-10|access-date=2009-04-21|newspaper=Irish Independent}} Most such bracelets are simple beaded items traded briskly on online auction sites.{{cite web|title=Bracelets Worn As Anorexic Status Symbol |url=http://www.kcra.com/news/4428694/detail.html |date=2005-04-28 |access-date=2009-04-21 |publisher=KCRA |url-status=dead |archive-url=https://web.archive.org/web/20110514000703/http://www.kcra.com/news/4428694/detail.html |archive-date=2011-05-14 }}{{cite web|title=Woman Makes, Sells Pro-Eating Disorder Bracelets |url=http://www.kcra.com/news/4433172/detail.html |date=2005-04-29 |access-date=2009-04-21 |publisher=KCRA |url-status=dead |archive-url=https://web.archive.org/web/20110514000712/http://www.kcra.com/news/4433172/detail.html |archive-date=2011-05-14 }}

Pro-ana has proliferated rapidly on the Internet, with some observers noting a first wave of pro-ana sites on free web hosting services in the late 1990s, and a second wave attributed to the recent rise of blogging and social networking services.{{cite web|url=http://www.canada.com/topics/technology/story.html?id=e63f0b6c-eafd-4971-8d59-f8b777c31e0f |publisher=Canwest |date=2008-06-03 |title=Eating disorders rampant on social networking sites |url-status=dead |archive-url=https://web.archive.org/web/20160105142153/http://www.canada.com/topics/technology/story.html?id=e63f0b6c-eafd-4971-8d59-f8b777c31e0f |archive-date=2016-01-05 }}

A survey by Internet security firm Optenet found a 470% increase in pro-ana and pro-mia sites from 2006 to 2007.{{citation|title=2008 International Internet Trends Study|publisher=Optenet|url=http://www.optenet.com/mailing/pdfs/TrendReport.pdf|access-date=2009-04-10|date=2008-09-24|archive-date=2009-04-19|archive-url=https://web.archive.org/web/20090419203122/http://www.optenet.com/mailing/pdfs/TrendReport.pdf|url-status=dead}} A similar increase was also noted in a 2006 Maastricht University study investigating alternatives to censorship of pro-ana material. In the study, the Dutch blog host punt.nl began in October 2006 presenting visitors to pro-ana blogs on its service with a click-through warning{{citation|title=Waarschuwing|url=http://waarschuwingstekst.punt.nl|publisher=punt.nl|access-date=2009-04-01}} containing a disparaging message and links to pro-recovery sites. Although the warnings were a deterrence (33.6% of the 530,000 unique visitors logged did not proceed past the warning), the number of such blogs actually increased tenfold, with their monthly traffic figures doubling on average by the end of the study.{{citation|title=Minder bezoeken aan pro-ana-sites bij waarschuwing|url=http://www.trouw.nl/nieuws/nederland/article2059453.ece/Minder_bezoeken_aan_pro-ana-sites_bij_waarschuwing.html|newspaper=Trouw|date=2009-03-20|access-date=2009-04-01|language=nl}}{{citation|doi=10.1002/eat.20598|first1=Carolien|last1=Martijn|first2=Elke|last2=Smeets|first3=Anita|last3=Jansen|first4=Nancy|last4=Hoeymans|first5=Casper|last5=Schoemaker|title=Don't get the message: The effect of a warning text before visiting a proanorexia website|journal=International Journal of Eating Disorders|volume=42|pages=139–145|year=2009|issue=2|pmid=18949766|citeseerx=10.1.1.620.9300}}

In a 2009 survey by the Katholieke Universiteit Leuven of 711 Flemish high school students aged 13–17, 12.6% of girls and 5.9% of boys reported having visited pro-ana websites at least once.{{citation|title=Viewership of pro-anorexia websites in seventh, ninth and eleventh graders|doi=10.1002/erv.910|first1=Kathleen|last1=Custers|first2=Jan|last2=Van den Bulck|year=2009|journal=European Eating Disorders Review|volume=17|issue=3|pmid=19142974|pages=214–219}} In another 2009 survey, by parental control software vendor CyberSentinel of 1500 female Internet users aged 6–15, one in three reported having searched online for dieting tips, while one in five reported having corresponded with others on social networking sites or in chat rooms for tips on dieting.{{cite news|title=Skinny celebrities drive one in five 11-year-olds to diet|url=https://www.telegraph.co.uk/health/children_shealth/5193807/Skinny-celebrities-drive-one-in-five-11-year-olds-to-diet.html|archive-url=https://web.archive.org/web/20090425185903/http://www.telegraph.co.uk/health/children_shealth/5193807/Skinny-celebrities-drive-one-in-five-11-year-olds-to-diet.html|url-status=dead|archive-date=2009-04-25|date=2009-04-21|access-date=2009-04-29|work=Daily Telegraph |location=London}}

Visitors to pro-ana web sites also 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 pro-recovery sites learned new techniques).{{Citation|last1=Wilson|first1=Jenny|last2=Peebles|first2=Rebecka|date=December 2006|title=Surfing for thinness: A pilot study of pro-eating disorder web site usage in adolescents with eating disorders|journal=Pediatrics|volume=118|issue=6|pages=e1635–e1643|doi=10.1542/peds.2006-1133|pmid=17142493|last3=Hardy|first3=KK|last4=Litt|first4=IF|last5=Wilson |first5=J L|s2cid=22277352}}

Pro-ana sites can negatively impact the eating behavior of people with and without eating disorders. One study of individuals without eating disorders demonstrated that 84% of participants decreased caloric intake by an average of 2,470 calories (301 min -7851 max) per week after viewing pro-ED (eating disorder) websites.{{cite journal |author1=Jett S. |author2=LaPorte D. J. |author3=Wanchisn J. |year=2010 |title=Impact of exposure to pro-eating disorder websites on eating behaviour in college women |journal=European Eating Disorders Review |volume=18 |issue=5|pages=410–416 |doi=10.1002/erv.1009|pmid=20572210 }} Only 56% of participants actually perceived the reduction in their intake. Three weeks after the experiment, 24% of participants reported continuing weight control strategies from pro-ana websites, though they did not continue to visit those sites. Controls viewing health and travel websites did not decrease caloric intake at a significant level. Other studies have found that women with varying levels of eating disorder symptomatology were more likely to engage in image comparison and exercise after viewing pro-ana websites versus control websites.{{citation|last1=Bardone-Cone|first1=A M|last2=Cass|first2=K M|year=2007|title=What does viewing a pro-anorexia website do? An experimental examination of website exposure and moderating effects|journal=International Journal of Eating Disorders|volume=40|issue=6|pages=537–548|doi=10.1002/eat.20396|pmid=17525952|citeseerx=10.1.1.455.8714}}{{citation|last1=Bardone-Cone|first1=A M|last2=Cass|first2=K M|year=2006|title=Investigating the impact of pro-anorexia websites: A pilot study|journal=European Eating Disorders Review|volume=14|issue=4|pages=256–262|doi=10.1002/erv.714|s2cid=49361069 }}

Pro-ana sites can negatively impact cognition and affect. Women who viewed a pro-ana site, but not control sites focused on fashion or home décor, experienced an increase in negative affect and decreases in self-esteem, appearance self-efficacy, and perceived attractiveness. They also reported feeling heavier and being more likely to think about their weight. The effects of perfectionism, BMI, internalization of the thin ideal, and pre-existing ED symptomatology as moderators of negative affect were comparable to chance, suggesting that pro-ana websites can affect a broad spectrum of individuals, not simply those with ED characteristics.

A 2007 survey by the University of South Florida of 1575 girls and young women found that those who had a history of viewing pro-ana websites did not differ from those who viewed only pro-recovery websites on any of the survey's measures, including body mass index, negative body image, appearance dissatisfaction, level of disturbance, and dietary restriction. Those who had viewed pro-ana websites were, however, moderately more likely to have a negative body image than those who did not.{{citation|title=Viewership of pro-eating disorder websites: Association with body image and eating disturbances|first1=Kelley|last1=Harper|first2=Steffanie|last2=Sperry|first3=J Kevin|last3=Thompson|journal=International Journal of Eating Disorders|volume=41|pages=92–95|year=2008|doi=10.1002/eat.20408|issue=1|pmid=17634964|first4=J L|last4=Wilson|doi-access=free}}

Similarly, girls in the 2009 Leuven survey who viewed pro-ana websites were more likely to have a negative body image and be dissatisfied with their body shape.

A 2012 report by Deloitte Access Economics, commissioned by Australian non-profit The Butterfly Foundation, estimated that eating disorders resulted in productivity losses totaling just over $AUD15 billion, with 1828 (515 males and 1313 females) dying that year from eating disorder-related complications.{{citation|url=http://thebutterflyfoundation.org.au/wp-content/uploads/2012/12/Butterfly_Report.pdf |title=Paying The Price: The economic and social impact of eating disorders in Australia |date=2012-11-29 |publisher=Butterfly Foundation |url-status=dead |archive-url=https://web.archive.org/web/20130409071511/http://thebutterflyfoundation.org.au/wp-content/uploads/2012/12/Butterfly_Report.pdf |archive-date=2013-04-09 }}

Unlike pro-ana sites, pro-recovery sites are designed to encourage development and maintenance of healthy behaviors and cognitions. A study of pro-ana and pro-recovery website use among adolescents with eating disorders found that adolescents used both types of websites to further eating disordered behaviors.{{citation|first1=Jenny L|last1=Wilson |first2=Rebecka|last2=Peebles|first3=Kristina K|last3=Hardy|first4=Iris F|last4=Litt|title=Surfing for thinness: A pilot study of pro-eating disorder web site usage in adolescents with eating disorders|journal=Pediatrics|year=2006|volume=118|issue=6|pages=e1635–e1643|url=http://pediatrics.aappublications.org/content/118/6/e1635.full |doi=10.1542/peds.2006-1133|pmid=17142493|s2cid=22277352 }} Those who viewed pro-ana sites were comparable to those who viewed pro-recovery sites with respect to appearance dissatisfaction, restriction, and bulimic behaviors. Over half of parents were unaware of any ED website usage.

People who use pro-ana sites report lower social support than controls and seek to fill this deficit by use of pro-ana sites.{{citation|first1=Danielle C|last1=Ransom|first2=Jennifer G|last2=La Guardia|first3=Erik Z|last3=Woody|first4=Jennifer L|last4=Boyd|title=Interpersonal interactions on online forums addressing eating concerns|journal=International Journal of Eating Disorders|volume=43|issue=2|pages=161–170|year=2010|doi=10.1002/eat.20629|pmid=19308991|s2cid=31581815 }} While pro-ana site users in this study perceived greater support from online communities than offline relationships, they also reported being encouraged to continue eating disorder behaviors. Users of pro-ana sites (n=60) cited a sense of belonging (77%), social support (75%), and support for the choice to continue current eating disorder behaviors (54%) as reasons for joining a pro-ana site. Reasons for continuing to use a pro-ana site included general support for stress (84%), meeting others with eating disorders (50%), and finding triggers for eating disorder behaviors (37%). Finally, behaviors first learned after visiting a pro-ana site include using thinspiration (63%), hiding eating disorder behaviors (60%), fasting (57%), using diuretics and laxatives (45%), vomiting (23%), using alcohol or other drugs to inhibit appetite (22%), and self-harm (22%).

Some studies, however, claim that the link between pro-ana websites and increased incidence of eating disorders are not strongly linked; instead, these communities have just increased the visibility of those affected.Davis, Jennifer. “Pro‐anorexia sites – a patient’s perspective.” Child and Adolescent Mental Health, vol. 13, no. 2, 7 Apr. 2008, pp. 97–97, https://doi.org/10.1111/j.1475-3588.2008.00489_3.x.Lyons, Elizabeth J., et al. “Pro-Anorexics and Recovering Anorexics Differ in Their Linguistic Internet Self-Presentation.” Journal of Psychosomatic Research, vol. 60, no. 3, Mar. 2006, pp. 253–256, https://doi.org/10.1016/j.jpsychores.2005.07.017.Mulveen, Ruaidhri, and Julie Hepworth. “An Interpretative Phenomenological Analysis of Participation in a Pro-Anorexia Internet Site and Its Relationship with Disordered Eating.” Journal of Health Psychology, vol. 11, no. 2, 1 Mar. 2006, pp. 283–296, pubmed.ncbi.nlm.nih.gov/16464925/, https://doi.org/10.1177/1359105306061187Eichenberg, Christiane, et al. “Pro-Ana-Foren Im Internet.” Psychotherapeut, vol. 56, no. 6, 11 Sept. 2011, pp. 492–500, https://doi.org/10.1007/s00278-011-0861-0. [link to this source's abstract in English https://www.researchgate.net/publication/225548662_Pro-Ana-Foren_im_Internet] It's possible that health professionals and academics are eager to place blame on these communities because of this increased visibility and being an "easy target" for understanding the complex problem of root causes of eating disorders.Blodgett Salafia, Elizabeth H., et al. “Perceptions of the Causes of Eating Disorders: A Comparison of Individuals with and without Eating Disorders.” Journal of Eating Disorders, vol. 3, no. 1, 15 Sept. 2015, jeatdisord.biomedcentral.com/articles/10.1186/s40337-015-0069-8, https://doi.org/10.1186/s40337-015-0069-8.

Many medical professionals and some anorexics view pro-ana as a glamorization of a serious illness.{{cite web|title=Pro-Anorexia Web Sites: The Thin Web Line|url=http://www.webmd.com/a-to-z-guides/features/pro-anorexia-web-sites-thin-web-line|publisher=WebMD|first=Charlotte Grayson|last=Mathis|access-date=2007-11-06}} Pro-ana began to attract attention from the mainstream press when The Oprah Winfrey Show aired a special episode in October 2001 focusing on pro-ana.{{cite web|title=Archives: Girls Who Don't Eat|url=http://www.oprah.com/tows/pastshows/tows_past_20011004.jhtml|date=2001-10-04|access-date=2007-11-11|work=The Oprah Winfrey Show|publisher=Harpo Productions|url-status=dead|archive-url=https://web.archive.org/web/20071119112200/http://www.oprah.com/tows/pastshows/tows_past_20011004.jhtml|archive-date=2007-11-19}} Pressure from the public and pro-recovery organizations led to Yahoo and GeoCities shutting down pro-ana sites.{{citation|title=Nurturing an Anorexia Obsession|url=https://www.latimes.com/archives/la-xpm-2002-feb-12-lv-proana12-story.html|first=Lynell|last=George|date=2002-02-12|access-date=2009-05-02|newspaper=Los Angeles Times}} In response, many groups now take steps to conceal themselves,{{citation|title=Weborexics: The Ethical Issues Surrounding Pro-Ana Websites|first=Leslie Regan|last=Shade|journal=ACM SIGCAS|volume=33|year=2003|publisher=Association for Computing Machinery|archive-date=2009-04-08|archive-url=https://web.archive.org/web/20090408031344/http://artsandscience1.concordia.ca/comm/shade/word/Weborexics.pdf|url=http://artsandscience1.concordia.ca/comm/shade/word/Weborexics.pdf|issue=4}} disclaim their intentions as neutral and recovery-supportive (58% of sites in a 2006 survey), or interview members to screen out the non-eating disordered.{{citation|title=Not Pro-Ana: The Online Sisterhood of Eating Disorders |access-date=2010-12-10 |date=2010-12-01 |url=http://www.longislandpress.com/2010/12/01/the-online-sisterhood-of-eating-disorders/ |first=Jaclyn |last=Gallucci |publisher=Long Island Press |url-status=dead |archive-url=https://web.archive.org/web/20101206183944/http://www.longislandpress.com/2010/12/01/the-online-sisterhood-of-eating-disorders/ |archive-date=2010-12-06 }}

{{prose|section|date=September 2015}}

Health care professionals and medical associations have generally negative views of pro-ana groups and the information they disseminate:{{cite news|url=http://news.bbc.co.uk/1/hi/health/7259143.stm|publisher=BBC News|title=Pro-anorexia site clampdown urged|date=2008-02-24|access-date=2008-02-25}}

• The National Association of Anorexia Nervosa and Associated Disorders (ANAD) states that Pro-Ana sites "can pose a serious threat to some individuals, not simply because they promote eating disorder behaviors, but because they build a sense of community that is unhealthy. They lure the impressionable and persuade them that the Pro-Ana community is providing caring and nurturing advice."{{cite web|title=Eating Disorders and the Internet |url=http://www.anad.org/get-information/eating-disorders-and-the-internet/ |publisher=National Association of Anorexia Nervosa and Associated Disorders |access-date=2010-09-07 |url-status=dead |archive-url=https://web.archive.org/web/20101019032231/http://www.anad.org/get-information/eating-disorders-and-the-internet/ |archive-date=2010-10-19 }}
• The Academy for Eating Disorders (AED) stated 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."{{cite web|title=Position Statement on Pro-Anorexia Web Sites |url=http://aedweb.org/policy/pro-anorexia_sites.cfm |access-date=2007-11-06 |publisher=Academy for Eating Disorders |archive-url=https://archive.today/20071014045846/http://aedweb.org/policy/pro-anorexia_sites.cfm |archive-date=2007-10-14 |url-status=dead }} However, one of its board members, Eric van Furth, has noted that pro-ana sites have relatively few visitors and advises against legal sanction of such sites, claiming instead that popular media play the more important role in establishing ideals of female thinness.{{citation|last=Esser|first=Luuk|title=Anorexia-sites weinig bezocht|newspaper=de Volkskrant|date=2008-04-17|page=3|url=http://www.volkskrant.nl/binnenland/article527915.ece/Anorexia-sites_weinig_bezocht|access-date=2008-07-03|language=nl}}
• Bodywhys (the Eating Disorders Association of Ireland) notes that pro-ana sites "might initially help people to feel less isolated, but the community that they create is an unhealthy community that encourages obsessiveness and minimization of the seriousness of these potentially deadly disorders."{{citation|title=Statement On Pro-anorexia Websites|url=http://www.bodywhys.ie/news.php?id=34|publisher=Eating Disorders Association of Ireland|date=May 2005|access-date=2009-05-01 |archive-url=https://web.archive.org/web/20071119011838/http://www.bodywhys.ie/news.php?id=34 |archive-date=November 19, 2007}}
• B-eat (the Eating Disorders Association of the UK) has remarked that those who seek out pro-ana sites do so "to find support, understanding and acceptance. We don't call for the sites to be banned, but rather for everyone else to consider how they can also provide that understanding and acceptance so that these sites don't become the only refuge for someone."{{cite web|title=Pro-ana and Social Networking Websites |url=http://www.b-eat.co.uk/PressMediaInformation/ProAnaandSocialNetworkingWebsites |date=2007-11-29 |access-date=2007-11-30 |publisher=Eating Disorders Association of the UK |url-status=dead |archive-url=https://web.archive.org/web/20090412034752/http://www.b-eat.co.uk/PressMediaInformation/ProAnaandSocialNetworkingWebsites |archive-date=2009-04-12 }}
• The UK Royal College of Psychiatrists has called for the Council of Child Internet Safety—a UK government advisory body—to expand its definition of harmful online content to include pro-ana sites, and to inform parents and teachers of the dangers of pro-ana, arguing that "the broader societal context in which pro-ana and pro-mia sites thrive is one where young women are constantly bombarded with toxic images of supposed female perfection that are impossible to achieve, make women feel bad about themselves and significantly increase their risk of eating disorders."{{citation|url=http://news.bbc.co.uk/2/hi/health/8261268.stm|publisher=BBC|access-date=2010-07-15|date=2009-09-17|title=Call to get tough on eating sites}}{{citation|title=Psychiatrists urge action to tackle 'pro-ana' websites danger|access-date=2010-07-15|date=2009-09-18|url=http://www.rcpsych.ac.uk/press/pressreleases2009/proanawebsites.aspx|first=Deborah|last=Hart|publisher=Royal College of Psychiatrists}}
• The National Eating Disorders Association (NEDA) "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."{{cite web|title=Position Paper: Pro-Anorexia and Pro-Bulimia Websites|url=http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=779|publisher=National Eating Disorders Association|access-date=2007-11-06 |archive-url=https://web.archive.org/web/20070429190429/http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=779 |archive-date=April 29, 2007}} NEDA has also warned that journalists often glamorize anorexia by associating anorexia with personal self-control and that media coverage of pro-ana often triggers the already-anorexic by mentioning weights and calorie counts and by showing photographs of thin people.{{citation|title=Tips for Responsible Media Coverage |publisher=National Eating Disorders Association |year=2004 |url=http://www.nationaleatingdisorders.org/uploads/file/News%20Releases/Tips%20for%20Responsible%20Media%20Coverage.pdf |access-date=2010-07-15 |url-status=dead |archive-url=https://web.archive.org/web/20100704173906/http://www.nationaleatingdisorders.org/uploads/file/News%20Releases/Tips%20for%20Responsible%20Media%20Coverage.pdf |archive-date=2010-07-04 }}

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 July 2002, the Baltimore City Paper published an investigative report into pro-ana on the web.{{cite news|title=Misery Loves Company – Introducing the Pro-Anorexia Web, Where the Ultimate Control Freaks Find Friendship |work=Baltimore City Paper |last=Davis |first=Natalie |date=2002-07-24 |url=http://www.citypaper.com/news/story.asp?id=3413 |access-date=2009-01-10 |url-status=dead |archive-url=https://web.archive.org/web/20110721190501/http://www2.citypaper.com/news/story.asp?id=3413 |archive-date=2011-07-21 }}

"Growing up Online", a January 2008 episode of the PBS Frontline television program, also featured a brief discussion of pro-ana.{{cite web|title=Growing up online|work=Frontline|publisher=Public Broadcasting Service|date=2008-01-22|access-date=2008-04-04|url=https://www.pbs.org/wgbh/pages/frontline/kidsonline}}

The 2009 novel Wintergirls features a protagonist with anorexia, who at one point in the novel seeks support from a pro-ana forum, referring to the people there as “her sisters” and “the only people that understand”.

In April 2009, The Truth about Online Anorexia, an investigative documentary about pro-ana on the Internet, aired on ITV1 in the UK presented by BBC Radio 1 DJ Fearne Cotton.{{citation needed|date=February 2020}}

In April 2012 speech at Harvard University, Vogue Italia editor Franca Sozzani conceded that the fashion industry may be a cause of the recent rise in eating disorders, but that the industry was being unfairly singled out for blame: "How can all this be possibly caused by fashion? And how come that Twiggy, who would be surely considered an anorexic today, did not arise controversy in the Sixties and did not produce a string of anorexia followers?" According to Sozzani, pro-ana sites were more effective at promoting eating disorders, and obesity was the more pressing public health problem that food industry was not being likewise attacked for exacerbating.{{citation|url=http://www.vogue.it/en/magazine/editor-s-blog/2012/04/april-3rd|date=2012-04-02|publisher=Vogue Italia|title=My Harvard Speech|first=Franca|last=Sozzani|access-date=2019-01-11|archive-url=https://web.archive.org/web/20170603103847/http://www.vogue.it/en/magazine/editor-s-blog/2012/04/april-3rd|archive-date=2017-06-03|url-status=dead}}

The existence of pro-ana blogs and forums was featured in the 2014 Lifetime film Starving in Suburbia, which starred Polish actress Izabella Miko as "ButterflyAna", a beautiful model and moderator on the internet who promotes anorexia religiously to the followers of her blog. This entices teenager Hannah (Laura Wiggins) to become severely anorexic; this was also the first Lifetime film to address the subject matter of anorexia among men and boys, when Hannah's brother, Leo, is revealed to suffer from anorexia and later dies due to health complications from the disorder.{{cite web |last1=Gilbert |first1=Sophie |title=To the Bone: The Trouble With Anorexia on Film |url=https://www.theatlantic.com/entertainment/archive/2017/07/to-the-bone-review-netflix/533517/ |website=www.theatlantic.com |date=14 July 2017 |publisher=The Atlantic |access-date=25 July 2022}}{{cite web |last1=Vaid |first1=Shana |title=Starving in Suburbia: Review |url=https://www.thepennmoviegoer.com/movie-review/starving-in-suburbia-review |website=www.thepennmoviegoer.com |publisher=Penn Moviegoer |access-date=25 July 2022}}

File:thirty-two kilos (5).jpg

Thirty-two kilos, an exhibition by photographer Ivonne Thein, went on display at the Berlin Postfuhramt art exhibition center in May 2008{{cite web|title=Ivonne Thein and Heide Häusler: Thirty-Two Kilos |first=Tom |last=Felber |access-date=2009-04-23 |work=Creative Face Magazine |url=http://creativeface.net/berlin_co-berlin_10021-0 |url-status=dead |archive-url=https://web.archive.org/web/20090502150157/http://creativeface.net/berlin_co-berlin_10021-0 |archive-date=2009-05-02 }} and the Washington Goethe-Institut in January 2009, featuring photographs of young women digitally manipulated to appear skeletally thin. Thein said that the photographs were intended as a mocking and satirical take on pro-ana. However, many images from the exhibition were nevertheless later shared online as thinspiration.{{citation|title=Thirty-Two Kilos: A Stark Look at Anorexia|newspaper=Washington Post|first=Rachel|last=Beckman|date=2009-01-08|access-date=2009-04-23|url=https://www.washingtonpost.com/wp-dyn/content/article/2009/01/07/AR2009010703387.html}}

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.{{citation|last=Holahan|first=Catherine|date=2001-09-04|title=Yahoo Removes Pro-Eating Disorder Internet Sites|newspaper=Boston Globe}}{{citation|title=Anorexia Goes High Tech|first=Jessica|last=Reaves|url=http://www.time.com/time/health/article/0,8599,169660,00.html |archive-url=https://web.archive.org/web/20010805161211/http://www.time.com/time/health/article/0,8599,169660,00.html |url-status=dead |archive-date=August 5, 2001 |magazine=Time|date=2001-07-31|access-date=2007-11-11}}

LiveJournal has not made a position statement on pro-ana. In August 2007, however, a staff member declined to act on an abuse report filed against a pro-ana community hosted on its network, stating that:

{{blockquote|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.{{cite web |title=LiveJournal forum thread |url=http://community.livejournal.com/lj_biz/241428.html?thread=12329748#t12329748|date=2007-09-07|access-date=2007-11-11 |author=thevelvetsun}}

}}

Facebook staff seek out and regularly delete pro-ana related groups. A spokesperson for the online service has stated that such pages violate the site's terms of service agreement by promoting self-harm in others.{{citation|title=Out of the Shadows|first=Tina|last=Peng|access-date=2008-12-19|date=2008-11-23|magazine=Newsweek |url=http://www.newsweek.com/id/170528/output/print}}

MySpace does not ban pro-ana material and has stated that {{blockquote|"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 banner advertisements for pro-recovery organizations through pro-ana members' profiles.

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.{{cite web|title=Nueva ofensiva contra páginas pro anorexia y bulimia|language=es|url=http://www.iqua.net/?go=S3iJ27PQ09INywzsO3FyalSoH3yDxSSX+1VQGEz7ZjalkPdWyhbnGEcwa7kvOKg=|publisher=La Agencia de Calidad de Internet (IQUA)|access-date=2007-11-30|date=2007-11-21}} A Microsoft spokesperson stated that such sites "infringe all the rules on content created by users and visible on our sites".{{citation|title=Online anorexia sites shut down amid claims they glorify starvation|url=http://timesonline.co.uk/tol/life_and_style/health/article2916356.ece|archive-url=https://web.archive.org/web/20080517040953/http://www.timesonline.co.uk/tol/life_and_style/health/article2916356.ece|url-status=dead|archive-date=May 17, 2008|first=Thomas|last=Catan|date=2007-11-22|access-date=2007-11-30|newspaper=The Times |location=London}}

In September 2008, San Sebastián-based Spanish-language web portal {{ill|Hispavista|es|vertical-align=sup}} removed its pro-ana forums at the request of the provincial prosecutor for Guipúzcoa and the {{ill|Children's Ombudsman of Madrid|es|Defensor del menor de la Comunidad de Madrid|vertical-align=sup}}, who stated that "while not illegal, the harmful and false information in such forums being disseminated to minors will impair their proper development."{{citation|first=Guillermo|last=Abril|newspaper=El País|url=http://www.elpais.com/articulo/sociedad/Ana/princesas/Internet/elpepusoc/20090404elpepusoc_1/Tes|date=2009-04-04|access-date=2009-04-21|title=Ana y Mia, princesas de Internet}}

In February 2012, after consulting with NEDA,{{citation|url=http://blisstree.com/look/pinterest-terms-of-service-bans-thinspiration-787/|title=Pinterest Bans Thinspiration And Pro-Ana Content…But That Doesn't Mean That It's Going Away|date=2012-03-27|access-date=2012-04-04|first=Hanna Brooks|last=Olsen|publisher=Blisstree|archive-url=https://web.archive.org/web/20120621192733/http://blisstree.com/look/pinterest-terms-of-service-bans-thinspiration-787/|archive-date=2012-06-21|url-status=dead}} the blog-hosting service Tumblr announced that it would shut down blogs hosted on its microblogging service which "actively promote or glorify self harm," including eating disorders,{{cite news|newspaper=Tumblr|url=http://staff.tumblr.com/post/18132624829/self-harm-blogs|date=2012-02-23|access-date=2012-04-04|title=A New Policy Against Self-Harm Blogs}} and display warnings with names of organizations that can help facilitate recovery in people affected by eating disorders, on searches for common pro-eating disorder terms.{{citation|newspaper=Tumblr |url=http://staff.tumblr.com/post/18563255291/follow-up-tumblrs-new-policy-against-pro-self-harm|title=Follow-up: Tumblr's New Policy Against Pro-Self-Harm Blogs|date=2012-03-01|access-date=2012-11-14}} Despite this, Tumblr remains a large hub for pro-ana microblogging.{{cite web|url=http://www.foxnews.com/fncu/current-interns/blog/2012/04/06/heavy-price-thinspiration|title=The Heavy Price of Thinspiration|last=Quinn|first=Melissa|date=6 April 2012|publisher=Fox News|access-date=16 May 2012|archive-url=https://web.archive.org/web/20120510173520/http://www.foxnews.com/fncu/current-interns/blog/2012/04/06/heavy-price-thinspiration|archive-date=2012-05-10|url-status=dead}} Pinterest, a social photo-sharing site, similarly amended its TOS{{cite web|title=Pinterest: Terms & Privacy|access-date=2012-04-04|publisher=Pinterest|url=http://pinterest.com/about/use/}} in March 2012 to ban pro-ana content, but was similarly unsuccessful.{{cite web|url=http://nwhn.org/2012/04/30/pinterest-or-thinterest|title=Pinterest or Thinterest?|last=Murphy|first=Sarah|date=30 April 2012|publisher=National Women's Health Network|access-date=16 May 2012|url-status=dead|archive-url=https://web.archive.org/web/20120524231945/http://nwhn.org/2012/04/30/pinterest-or-thinterest|archive-date=24 May 2012}} Instagram followed suit and announced in April 2012 that it would summarily disable any accounts on its photo-sharing service with pro-ana specific hashtags on images.{{cite web|publisher=Instagram|access-date=2012-04-30|date=2012-04-20|url=http://blog.instagram.com/post/21454597658|title=Instagram's New Guidelines Against Self-Harm Images & Accounts}}{{Dead link|date=September 2023 |bot=InternetArchiveBot |fix-attempted=yes }}

TikTok's algorithm has been criticized for amplifying pro-ana content.{{cite news |last1=Muldowney |first1=Decca |title=TikTok Slammed for 'Doing Nothing' Over Pro-Anorexia Content |url=https://www.thedailybeast.com/tiktok-slammed-for-doing-nothing-over-pro-anorexia-content-by-center-for-countering-digital-hate |website=The Daily Beast |date=3 March 2023 |access-date=16 June 2023}}

In the United Kingdom, 40 MPs signed an early day motion tabled in February 2008 by the then Liberal Democrats member for Cheadle, Mark Hunter, urging government action against pro-ana sites.{{citation|title=EDM 659 Anorexia Web Sites|publisher=UK Parliament|date=3 February 2009|access-date=16 December 2009|url=http://edmi.parliament.uk/EDMi/EDMDetails.aspx?EDMID=37710|archive-url=https://web.archive.org/web/20170407054935/http://edmi.parliament.uk/EDMi/EDMDetails.aspx?EDMID=37710|url-status=dead|archive-date=7 April 2017}} The motion was timed to coincide with the UK National Eating Disorder Awareness Week.{{cite web|url=http://www.channel4.com/news/articles/science_technology/call%20to%20check%20proanorexia%20webpages/1644752|title=Call to check pro-anorexia webpages|date=2008-02-25|access-date=2008-03-14|work=Channel 4 News|publisher=Channel 4}}{{cite news |title=Eating disorder sites 'despicable' |first=Brian |last=Lashley |date=2008-02-25 |access-date=2008-03-13 |newspaper=Manchester Evening News |url=http://www.manchestereveningnews.co.uk/news/s/1037998_eating_disorder_sites_despicable }}

In the United Kingdom, Jo Swinson, the Liberal Democrat member for East Dunbartonshire, called for advertisers to voluntarily adopt similar disclaimers in an adjournment debate in October 2009, and later in an early day motion tabled in February 2010. She has stated that such "photos can lead people to believe in realities that, very often, do not exist," and that "when teenagers and women look at these pictures in magazines, they end up feeling unhappy with themselves."{{citation|url=https://www.nytimes.com/2009/09/28/business/media/28brush.html|title=A Move to Curb Digitally Altered Photos in Ads|first=Eric|last=Pfanner|date=2009-09-27|access-date=2010-02-09|work=The New York Times}}

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.{{citation|url=https://www.pbs.org/frontlineworld/rough/2009/12/france.html|title=Outlawing Ana: French lawmakers battle eating disorders|first=Lucie|last=Schwartz|date=2009-12-22|publisher=PBS Frontline}}{{citation|url=http://www.theaustralian.news.com.au/story/0,25197,23515919-2703,00.html|title=French anorexia law targets websites|date=2008-04-10|first1=Charles|last1=Bremner|first2=Marie|last2=Tourres|access-date=2008-04-11|newspaper=The Australian|archive-url=https://web.archive.org/web/20080414122351/http://www.theaustralian.news.com.au/story/0,25197,23515919-2703,00.html|archive-date=2008-04-14|url-status=dead}}{{citation|first=Ségolène|last=de Larquier|title=L'apologie de l'anorexie sera réprimée, même sur le web|url=http://www.lepoint.fr/actualites-societe/l-apologie-de-l-anorexie-sera-reprimee-meme-sur-le-web/920/0/238381|access-date=2008-12-23|date=2008-04-15|newspaper=Le Point|language=fr|archive-url=https://web.archive.org/web/20081224014946/http://www.lepoint.fr/actualites-societe/l-apologie-de-l-anorexie-sera-reprimee-meme-sur-le-web/920/0/238381|archive-date=2008-12-24|url-status=dead}} 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."{{citation|url=https://www.reuters.com/article/technologyNews/idUSL1578685820080415?sp=true|title=France to crack down on "pro-anorexia" Web sites|first=James|last=MacKenzie|date=2008-04-15|access-date=2008-04-17|publisher=Reuters}} The bill passed the National Assembly,{{citation|url=http://www.assemblee-nationale.fr/13/ta/ta0132.asp|title=Texte adopté n° 132 – Proposition de loi visant à lutter contre les incitations à la recherche d'une maigreur extrême ou à l'anorexie|publisher=Assemblée nationale|date=2008-04-15|access-date=2009-03-30|language=fr}} but stalled in the Senate, where a June 2008 report by the Committee of Social Affairs emphatically recommended against such legislation and instead suggested early-screening programs by schools and physicians.{{citation|title=Proposition de loi visant à lutter contre les incitations à la recherche d'une maigreur extrême ou à l'anorexie|url=http://www.senat.fr/rap/l07-439/l07-439_mono.html|date=2008-07-02|access-date=2009-03-30|publisher=Assemblée nationale|language=fr}}

Boyer subsequently introduced another bill in September 2009 to mandate disclaimers on photographs in which body parts have been retouched, with the aim of reducing the impact of unrealism in photography on young girls and women.{{citation|title=Point, Shoot, Retouch and Label?|work=New York Times|first=Steven|last=Erlanger|date=2009-12-02|access-date=2010-02-09|url=https://nytimes.com/2009/12/03/fashion/03Boyer.html}} The bill was ostensibly targeted at advertising photography but could be broadly applicable to digitally manipulated photography in general, including thinspirational montages. It imposes a penalty of €37,500 per violation, with a possible rise to 50% of the cost of each advertisement.{{citation|title=Proposition de loi relative aux photographies d'images corporelles retouchées|url=http://www.assemblee-nationale.fr/13/propositions/pion1908.asp |date=2009-09-15|access-date=2010-02-09|publisher=Assemblée nationale|language=fr}} The bill did not pass its first reading and was relegated to the Committee of Social Affairs.{{citation|publisher=Assemblée nationale|url=http://www.assemblee-nationale.fr/13/dossiers/photos_images_retouchees.asp|title=Proposition de loi relative aux photographies d'images corporelles retouchées – 1ère lecture|date=2009-09-15|language=fr|access-date=2010-07-15}}

In April 2009, Dutch Minister for Youth and Family André Rouvoet called for click-through warnings to be added to all pro-ana sites on Dutch hosting services, citing a successful trial of such warnings by blog host punt.nl in 2006. The Dutch Hosting Provider Association, however, has stated that "the Internet is simply a reflection of a world with many undesirable things", and that its members cannot be held responsible for monitoring and disclaiming all hosted content.{{cite web|title=Hosters weigeren te waarschuwen voor anorexia-sites|language=nl|url=http://webwereld.nl/nieuws/57256/hosters-weigeren-te-waarschuwen-voor-anorexia-sites.html|date=2009-04-23|access-date=2009-04-29|first=Andreas Udo|last=de Haes|work=Webwereld|publisher=IDG}}

In March 2012, the Israeli Knesset passed a bill sponsored by Kadima MK Rachel Adato and Likud MK Danny Danon requiring advertisements which have been retouched to alter the body shape of models to fully disclose the fact. The bill, which applies to both foreign-produced and locally produced advertising, also sets a lower BMI limit for models featured in advertisements of 18.5 (the threshold of underweight under World Health Organization guidelines).{{citation|title=Knesset passes bill banning use of underweight models in advertising|first1=Jonathan|last1=Lis|first2=Sahar|last2=Shalev|newspaper=Haaretz |date=2012-03-20|access-date=2012-05-11|url=http://www.haaretz.com/print-edition/news/knesset-passes-bill-banning-use-of-underweight-models-in-advertising-1.419616}}{{citation|title=Knesset Passes New Anorexia Law|url=http://www.israelnationalnews.com/News/News.aspx/153937|first=Chana|last=Ya'ar|publisher=Israel National News|date=2012-03-20|access-date=2012-05-11}}{{citation|url=https://www.theatlantic.com/international/archive/2012/05/what-the-us-can-and-cant-learn-from-israels-ban-on-ultra-thin-models/256891/|title=What the U.S. Can—and Can't—Learn From Israel's Ban on Ultra-Thin Models|date=2012-05-09|access-date=2012-05-11|publisher=The Atlantic|first=Talya|last=Minsberg}}

In a November 2009 interview with Women's Wear Daily, model Kate Moss gave a popular thinspirational slogan as her motto: "Nothing tastes as good as skinny feels."{{citation|url=http://www.wwd.com/beauty-industry-news/kate-moss-the-waif-that-roared-2367932?full=true|title=Kate Moss: The Waif That Roared|first=Brid|last=Costello|date=2009-11-13|work=Women's Wear Daily|access-date=2009-12-10}} Moss came under widespread criticism—particularly by eating disorder recovery organizations—for endorsing pro-ana. Her agency, Storm, stated: "This was part of a longer answer Kate gave during a wider ranging interview which has unfortunately been taken out of context and misrepresented."{{citation|url=https://www.theguardian.com/lifeandstyle/2009/nov/20/kate-moss-motto-pro-anorexic|title=Kate Moss's motto gives comfort to 'pro-anorexic' community|first=Alexandra|last=Topping|date=2009-11-20|access-date=2009-12-10|work=The Guardian}} Still, Moss has been known in the fashion world to have helped popularize the "heroin chic" trend, which uses models with disheveled, ultra-skinny, and waif-like body types on the runway.{{citation|url=https://www.huffingtonpost.com/2012/10/31/kate-moss-heroin-johnny-depp-drugs-vanity-fair_n_2048793.html|title=Kate Moss Talks Heroin, Crying Over Johnny Depp & Lunches With Carla Bruni In Vanity Fair |first=Rebecca|last=Adams|date=2012-10-31|access-date=2013-04-11|work=Huffington Post}}

• Fat acceptance movement
• Inedia

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{{Digital media use and mental health}}

Category:Anorexia nervosa

Category:Culture-bound syndromes

Category:Body shape

Category:Self-harm