Some Web sites encourage eating disorders

August 2005

A growing number of teenagers with eating disorders are visiting Web sites that promote anorexia and bulimia as a lifestyle choice and not a disease.

These sites offer visitors tips on how to lose weight, to purge and to hide food. They also suggest avoidance tactics to hide their eating disorders from family and friends, according to researchers at Stanford School of Medicine and Lucile Packard Children’s Hospital (LPCH).

“This is the first study that begins to examine the health effects of frequenting these sites, which outnumber those dedicated to recovery by five to one,” said researcher Jenny Wilson, a Stanford medical student who presented the findings, along with Rebecka Peebles, MD, at the 2005 Annual Meeting of the Pediatric Academic Societies, held in Washington.

Teenagers who use these sites are spending less time on schoolwork than their peers and are hospitalized more than those who do not use the sites, according to Wilson. She and her colleagues also suspect that many teenagers and young adults with eating disorders design and maintain these sites. Adolescents may use these Web sites as their personal “educational” resource.

“These Web sites are founded on the mistaken belief that eating disorders are not a disease, but a way of life,” said Peebles, co-researcher and LPCH adolescent medicine specialist. “[The Web sites] are well designed and alluring, often with a gateway emphasizing the danger of the site that can be attractive to teenagers.”

The research is the culmination of an anonymous survey of medical histories and Internet use that researchers sent to the families of adolescents diagnosed with an eating disorder at LPCH since 1997.

Web sites’ influence

Researchers used a cross-sectional design and sent surveys to the caretakers of 678 patients treated for an eating disorder by the adolescent medicine division at Stanford and their parents. Then, researchers asked patients and parents to fill out separate forms documenting their struggles with an eating disorder and Internet usage.

Fifty-two adolescents and 77 parents participated in the study. Patients’ age varied from 10 to 22. Ninety-four percent were girls and 89% were white. Fifty percent were currently in treatment for an eating disorder, according to the abstract.

The researchers found that 40% of adolescents who responded had visited Web sites promoting eating disorders, 34% had visited sites dedicated to eating disorder recovery, 24% frequented both types of sites and 50% had visited neither.

Although teenagers who visited pro-eating disorder sites reported spending less time on schoolwork and more time in the hospital, they did not differ from those who did not visit these sites in a number of other health measures.

“There does not appear to be a difference in major health indicators — percentage of ideal body weight, number of missed menstrual periods, presence of osteoporosis or osteopenia — between users of pro-eating disorder Web sites and those that did not use these sites,” Wilson said.

Furthermore, Wilson and colleagues found that parents of pro-eating disorder Web site users were more likely to know about the sites, to have visited the sites, to have discussed them with their children and to be concerned about the information their children accessed online than parents of nonusers.

The researchers also found that 29% of teenagers visiting eating disorder recovery sites learned about and tried new weight loss techniques or diet aids as a result of their visit, according to the abstract.

“Adolescents with eating disorders may also use these sites as a place to find information about eating disorders, for the purpose of continuing their disorder,” Wilson said. “We found that 67% of users of pro-eating disorder Web sites used new weight loss or purging techniques as a result of visiting these sites.”

While the sites provide ideas in the form of pictures, body weight goal charts, exercises and low- calorie recipes, they do not uniformly flaunt the perceived advantages of eating disorders.

“There is a profound ambivalence that embodies the pro-eating disorder sites,” Peebles said. “There are discussions in chat rooms and on bulletin boards about how much the disorder pains sufferers, cautioning others against trying too hard to lose weight.”

“Pro-eating disorder Web sites offer information to increase the severity and risk behaviors of an eating disorder,” the researchers concluded in their abstract.

The researchers’ study underscores how dependent adolescents are on the Internet for health information and peer support. Teenagers typically use the sites promoting eating disorders as a forum to express their innermost thoughts and feelings, the researchers said.

Perhaps as a result, adolescents visiting pro-eating disorder sites were more likely to describe themselves as recovering from their disorder than their peers who did not visit the sites.

“It’s such a dichotomy,” said Peebles. “Teenagers enter the sites promoting eating disorders possibly to gain solidarity and to express their pride in and publicize what they see as a lifestyle choice. At the same time they are cautioning others not to follow in their footsteps. Teenagers in the midst of an eating disorder need to voice what they want: to continue to lose weight. While many people believe the Web sites should be shut down, it could be a very isolating experience for the users.”

The researchers caution that the results of this study are preliminary.

Wake-up call

They plan a larger, prospective study designed to more closely follow health outcomes in newly diagnosed eating disorder patients who visit pro-eating disorder sites. In the meantime, they hope their results will serve as a wake-up call for physicians treating adolescents with eating disorders, who may underestimate the influence pro-eating disorder Web sites may be having on their patients.

Wilson advises physicians to ask patients and their parents if these sites are being used and be aware that they may impact the quality of life and health of patients with eating disorders.

“Medical professionals need to recognize the important role the Internet is playing in the education and miseducation of their patients,” said LPCH adolescent medicine specialist Iris Litt, MD, also senior advisor for the work. “These Web sites offer peer group support, which can be used for good or for evil.”

For more information:

• Wilson JW, Peebles R, Hardy K, et al. Pro-eating disorder Web site usage and health outcomes in an eating disordered population. Abstract #1823. Presented at the 2005 Annual Meeting of the Pediatric Academic Societies. May 14-17, 2005. Washington.

• For more information about Lucile Packard Children’s Hospital, visit www.lpch.org.