Pro-ana

Pro-ana refers to the promotion of anorexia nervosa as a lifestyle choice rather than an eating disorder. Pro-mia, likewise, is the promotion of bulimia nervosa. They are often referred to simply as "ana" and "mia", and are sometimes affectionately personified as girls named Ana and Mia. Of the two, pro-ana is the more commonly-used as an umbrella term for the advocacy of eating disorders in general.

Pro-ana does not refer to any single organized social movement and as such, encompasses a wide range of views: many pro-ana organizations state that they do not promote eating disorders, and that they exist mainly to give anorexics and bulimics a non-judgmental environment in which they can safely discuss their illness; others promote recovery while still supporting those who choose to defer or refuse medical or psychological treatment. Some go further yet and dispute the prevailing psychological and medical consensus that treats anorexia nervosa as a mental illness rather than a conscious "lifestyle choice" that should be respected by doctors and family.

Online groups

An example of thinspiration.

Most pro-ana material is disseminated over the Internet, through tight-knit support groups centred around web forums and, more recently, social networking sites such as Xanga, LiveJournal, Facebook and Myspace. These sites typically have an overwhelmingly female readership and are frequently the only means of support available to socially-isolated anorexics.

Members of these support groups:

• Share crash dieting techniques and recipes
• 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

As an encouragement to further lose weight, members often exchange thinspiration (or thinspo): image or video montages of slim women, often celebrities, who may be anything from naturally slim to emaciated with visibly-protruding bones. Conversely, reverse thinspiration may be photographs of fatty food, overweight or obese people intended to induce disgust and motivate further weight loss. 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.

Impact

Visitors to pro-ana web sites 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. Another survey by the University of South Florida of 1500 girls and young women in 2007 found that those who viewed pro-ana sites were more likely to have eating disorders and a negative body image, compared those who only viewed pro-recovery sites or those who viewed neither.

Criticism and controversy

In pro-ana

Pro-ana has attracted teenage girls who believe that inducing eating disorders will cause them to lose weight more effectively. Such people are often unwelcome in pro-ana groups and derisively referred to as wannarexics. Some medical professionals and anorexics also take affront to wannarexia as they believe it glamorizes a serious illness.

From the medical profession

Health care professionals and medical associations have taken generally negative views of pro-ana groups and the information they disseminate:

• b-eat (the Eating Disorders Association of the UK) has stated that "anorexia and bulimia are dangerous activities and people can be encouraged to copy them," but acknowledged "that the main reason people access these sites is 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."

• NEDA (The National Eating Disorders Association) "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."

• The Academy for Eating Disorders takes the position 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."

• ANAD (The National Association of Anorexia Nervosa and Associated Disorders) states that "pro-ana and pro-mia web sites and communities create the opportunity to compare to more and more dangerous methods of weight loss, and increase the drive and interest, and increase the severity and frequency of eating disorder behaviors."

In the media

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.

Growing up online, a January 2008 episode of the PBS Frontline television program, also featured a brief discussion of pro-ana.

From Internet service providers

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.

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

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. A Microsoft spokesperson stated that such sites "infringe all the rules on content created by users and visible on our sites".

Facebook has stated that it will not close pro-ana groups on its service; when pressed for comment by the BBC in February 2008, a spokesperson said that "many Facebook groups relate to controversial topics; this alone is not a reason to disable a group." Similarly, MySpace does not ban pro-ana material and has stated that "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." March 2008}} MySpace has chosen instead to cycle b-eat banner advertisements through pro-ana members' profiles.

In politics

In the United Kingdom, 40 MPs signed an early day motion tabled in February 2008 by Mark Hunter—the LibDem member for Cheadle—urging government action against pro-ana sites. The motion was timed to coincide with the UK National Eating Disorder Awareness Week.