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Natural Born Dieters

Izzy Moore explores the role of the internet and media in shaping our understanding of eating disorders

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This article contains sensitive material which some might find upsetting or triggering. If you are struggling with an eating disorder, or someone you know is, help is available. Contact BEAT on 0808 801 0811 or Nightline 01904 323735.

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It doesn't start how you'd expect. It's a slow burn. You don't see the quote "Nothing tastes as good as skinny feels" and decide not to eat lunch. It takes much more than a quote to trigger an eating disorder. However, quotes like these are the fuel for online communities and shape how eating disorders are perceived. It is sometimes claimed the age of the 'pro ana' website is over, there peak be- ing during the early and mid 2000s.Yet, Kate Moss' infamous quote was not a product of this era, nor was it spoken during the 'heroin chic' phase of the 1990s. No, it was said in 2009.

Since then there's been increased expo- sure for the body positivity movement, and much less glamorisation of lithe figures in the fashion industry. In Italy and Spain fashion models need to reach a minimum BMI in order to walk the catwalk. France too has regulations; the requirement to meet a mini- mum BMI was removed due to backlash from designers. Similarly, while the public prefer- ence for skin and bone has lessened, there is a continuing focus on image and weight. Presently, we champion fitness models, but the only difference is the shape of our ideal body; the level of obsession and exposure is the same. While we've moved away from 'heroin chic' in the mainstream, there are remnants on Tumblr and Instagram, and 'pro ana' forums still exist. Use the right hashtag or follow the right account and you'll find an abundance of images promoting gauntness and quotes which echo Moss' sentiment that less is best.

One such website claims it is "dedicated to the support or recovery of those suffering from eating disorders or body dysmorphic disorders" followed by a request for sensitivity when creating an account and making contributions to the forum. While the URL would suggest the sole topic is anorexia, the sub topics cover a range of eating disorders including binge eating disorder, orthorexia, pica and bulimia. Other top- ics include exercise, fasting, dealing with a disordered parent and coping with abuse. The usership is not just teenage girls either, there are specific forums for the over-forties, men, and if you are pregnant. Despite this diversity the dominant topics are 'General' and 'Anorexia'. At the time of publication category 'General' included 226 488 topics with 3 851 514 replies, with 'Anorexia' at 188 073 topics and 2 936 325 replies. These two were by far the most active groups.

The website may seem extreme and unique, but there are clear parallels with the main- stream website and app My Fitness Pal, which also has a forum where weight loss tips are exchanged, calorie counting encouraged, and before and after photos posted. The latter is significantly less extreme; the majority of users are not aiming to become unhealthily thin, but the parallels remain. Notably too, while My Fitness Pal has the claim of being healthy, the users on the forum are under no pretence that they are.However, it isn't hard to see how one could begin using My Fitness Pal and end up on more extreme websites. It's worth pointing out too that there's over- lap in use. Many users of the forum use My Fitness Pal as a tool to count calories and more effectively restrict their energy intake. It is unlikely these websites cause eating disorders, as most users come from long histories of disordered eating - as stated on the introductions page. However, both forums enable disordered behaviour.

If we're going to blame pro ana forums then the media also has a lot to answer for. The
recent release To the Bone was particularly jarring and discussed at length on the forum. Users complained the film was unrepresentative and encouraged restrictive behaviour. To the Bone is based on the experiences of director Marti Noxon, and here lies the broader problem with depicting eating disorders on screen. Noxon's film is a highly individualistic account, which retells her eating disorder. Maybe it is unfair to expect filmmakers to represent each and every manifestation of disordered eating, but, I would argue the director has a responsibility to their audience. The users of the forum argued it was unrealistic, and it is films and characters like these which define how eating disorders are understood by the general public. They create a cultural understanding of what eat- ing disorders look like and which behaviours are associated with them. In some ways To the Bone did showcase a diverse array of who could have an eating disorder, what disorder they could have and that anorexia is not manifested as one set of behaviours. The fact that a mainstream release included a character with binge eating disorder is groundbreaking. Nevertheless, it was not their story. Instead the film focussed on the white female with anorexia, which only contributes to the misconception that this is the only group who have disordered eating and their only illness is anorexia.

The other big problem with To the Bone was the reckless decision to allow Lily Collins to become severely underweight for the role. Perhaps it is no different to other transformations which actors undergo in order to play a character more convincingly, Christian Bale being an obvious example. However, Collins has a history with anorexia and, as users noted, in any other context this would be classed as a relapse. To put your main actress in the same headspace which she has recovered from, to potentially reignite her mental illness, that Collins may have thought it was necessary, was wrong. She placed herself in a position where the long-term effects of anorexia could have resurfaced, or worsened. In some cases it can take years for a damaged body to recover from amenorrhea and osteopenia. The other problem with this choice is that it strengthens the strong association between eating disorders and an emaciated appearance. Naturally, the two should be linked. However, this shouldn't be the only visual associated with disordered eating. In the real world this false expectation means a lot of people go under the radar. Friends and family don't clock on as they believe an eating disorder is only present if the individual is visibly underweight. If someone gains weight, or the weight loss isn't significant then the possibility wouldn't even cross their mind. Meanwhile, the person with the illness doesn't see themselves but as a fake. It's only "real" if you also look skeletal.

To the Bone is just one example of how the media shapes pub- lic understanding. There are further examples; Skins is an obvious one. Cassie is another character who has anorexia and has supplied quotes that are tweet- ed, reblogged, and idolised. She additionally sets expectations for how a disordered person acts; "I didn't eat for three days so I could be lovely." Organisations such as BEAT and NICE have since produced media guidelines, so that less harmful material is produced. Citing specific weights or calories is particularly discouraged. These numbers could easily become goals to aim for, or another measure in which to judge how 'valid' your eating disorder is. The scene with Cassie and Sid in the canteen where Cassie explains how to avoid eating lunch is a clear example of what shouldn't be included. She is essentially teaching the viewer how to skip meals. Mainstream media has an important role in humanising eating disorders, and has the potential to challenge stereotypes. However, characters like Cassie and Ellen reinforce "misconceptions and are damaging to those with existing conditions.

Instagram is also influential. If the individual desires, the app has an unlimited sup- ply of "Thinspiration". A less obvious use of the app however is searching for the inspiration and advice on recovering from an eating disorder. There are several recovery communities of users who post and discuss the pro- cess of recovering from an eating disorder. These topics are alien to the uninitiated. It is known that an anorexic has to regain weight, but there is little to no awareness in the general population of the emotional and physical stress recovery can involve. Recovering individuals are at risk of 'refeeding syndrome'; if the number of calories are increased too quickly, heart failure can occur. The process of weight gain is concentrated around the stomach to protect the internal organs. Eventually the weight will redistribute across the body, but the individual may become too un- comfortable and anxious over their bloated appearance and relapse. These communities provide reassurance to each other that their recovery process is normal.

There are generally two levels of users. Those who use the app as an online private diary posting photos of meals, opening up about their feeling, and seeking support from others who are also recovering. The other group of users are those who have large followings and are essentially the equivalent of Instagram influencers. They advise followers on methods of recovery and may have more detailed resources such as eBooks. One example is Kayla Rose (also known as Damn the Diets) who has 11.1k followers. Unlike the typical Instagram influencer she describes herself as "anti-diet" and champions body acceptance. Kayla is unique as for ten years she was a fitness model. Now she directly criticises the "fitspo" culture as she argues it promotes compulsive exercise, restrictive dieting and poor body image. Usually "fitspo" shows a lean body with tips on how to achieve this figure, but Kayla deconstructs these photos and captions them with the various health problems she experienced in order to maintain her low body fat percentage. Heart problems, constipation, depression, and binge eating, all as a result of compulsive dieting. She successfully challenges the belief that visible extreme fitness is the ultimate sign of health.

Kayla is one of the many within the recovery community who argue that each individual
has a set body weight, determined by their genetics. Largely this is used to comfort those going through weight restoration who may experience the phenomenon of "extreme hunger". This term which refers to the larger amount of calories physically and mentally desired and required by someone after a period of restrictive eating. The body needs this higher level of energy in order to adequately repair damaged parts of the body such as muscle, bone and for women the re- productive system. After looking at the recovery forum it's clear that there's an enormous amount of anxiety over eating too much food compared to 'normal people', that they will continue to eat upwards of 5000 to 10000 calories a day, that they will become obese, or they have developed binge eating disorder. There are countless videos on YouTube by Kayla and others, like Tabitha Farrar, arguing that this is a normal and necessary process. Patterns of restrictive eating and habits such as calorie counting or dividing food into "safe" and "forbidden" foods can only be overcome by embracing the hunger you body feels and allow yourself to become your predetermined weight. By highlighting this 'set weight' theory these influencers emphasise to their followers that this is a temporary process and once your set point is reached the intensity of hunger will subside and the individual will be able to eat more typical portion sizes and feel satisfied.

These mentors go largely unnoticed on Instagram and hardly contribute to public perceptions of eating disorders. Body positivity is perhaps the main point of overlap between these private communities and the mainstream. It's hard to say whether the fairly underground nature of these communities is for the best. The arguments made by Tabitha Farrar especially would seem fairly radical to normal eaters. Her suggestion that in recovery you need to eat as much as you want, whenever you want, and whatever you want, could appear to encourage obesity. However, she is talking to a specific group of people who need to hear these kinds of encouragements. A good majority of the videos she posts deal with listening to your body, allowing yourself to eat when you feel hungry. She is not advocating overeating but overcoming restrictive eating. For a normal eater eating until you are completely full would not trigger such anxiety that you had to google whether this was normal. The anti-diet message is also directed at clean eating. This may seem surprising, as clean eating is celebrated on Instagram as the ultimate lifestyle for health and happiness. Yet, as Kayla discusses, taking any kind of diet to the extreme will be eventually damaging to your health and clean eating can quickly lead to orthorexia. These online personalities and their resources show that the relationship between the internet and mental health is not as obvious as some might assume. Typically we class social media as detrimental to mental health, promoting certain body types and life- styles over all others. Should we assume this when social media also provides networks of support?

I reached out to both Tabitha Farrar and Kayla Rose and asked their thoughts on the effect of the web. Tabitha Farrar explained eating disorders are "very competitive" making pro ana sites "destructive", while sites with a pro-recovery focus, if moderated, can be helpful "people can push each other to eat more and gain weight etc in a healthy way." Kayla Rose added: "Without these pro- recovery pro-body positive communities, we would be left with only the communities that got us all into the mess in the first place [...] which then leaves the consumer or follower feeling less than, because they're comparing to something that isn't their reality, that can't be their reality and is too unrealistic or unattainable - healthfully or naturally." She highlighted the importance of communities, as going alone is hard and "If one cannot find support locally within their direct community, the internet is the next best thing to find the support you need. It was vital in my recovery and is crucial for a lot of my clients as well."

I also reached out to users of the recovery forum asking their thoughts on the links between the internet and their eating disorders. Generally responses claimed the forum and Instagram had made them both better and worse. The resources available can teach
you how to be get better, but also how to 'be better' at restricting. These communities
can provide solidarity and act as online support groups. However, by providing advice on
losing weight more rapidly and effectively, it creates an environment which normalises weight loss. When disordered behaviours such as fasting or purging are discussed and joked about, they become acceptable. One user stated: "well hey, they're do-
ing it and they're okay, so I guess I'm fine too." There was a consensus that the website provided an outlet for discussing taboo top- ics. Eating disorders still carry a stigma, never mind the extreme that would be completely taboo in person, never mind discussing the use of laxatives and diet pills or binge eating.

What is clear from the responses is that these users are largely self-aware. They understand that they are ill, despite no formal diagnosis. They sometimes don't want to be this way, but they aren't ready to stop. It's not easy to stop. These are ritualistic patterns of behaviour. These are coping mechanisms. It may be a method to express inadequacy or insecurity. Restricting or deliberately overeating may be a way of punishing yourself. These patterns become entrenched and when things go wrong, however minor, the conclusion is 'I am not good enough as I am, and I need to change.' It's impossible to just wake up and be normal again. This is their normal. If you've been restricting over the long term there's the fear you will be judged if you put on weight. This is an area in which the media has a lot to answer for. The media constantly criticises celebrities for 'letting themselves go' and demonises larger bodies, making recovery even harder.

These are vulnerable people who are being manipulated by the media, people who are conned into thinking weight loss is the only path to happiness. Mental illness is never a choice, but the negative thoughts are intensified by these influences. People turn to the internet because something is profoundly wrong in their lives, because offline no one quite understands. We can try and overcome that. More research is required, better education is needed. There are lessons to be learned. The ability to eat without anxiety or second- guessing should never be taken for granted. We need greater awareness of eating disorders beyond what's shown in film and television. We need to break down the taboos, so people aren't isolated to the extent that this is their only outlet. It isn't good enough that mental health is a buzz word, educate yourself.

There's so much more to discuss than what's been discussed in this article. All I can say is that these users do care about each other, even if it's expressed in foreign ways. I hope each and every one of those users can one day step away from the screen. These people have futures beyond their disorder. They are not their fasting or compulsive exercise, or calories, or rules. Fat is not a feeling, although I know it seems that way. They deserve so much more. They will be enough. They are already enough. I have to believe that. I have to.

With thanks to Kayla Rose and Tabitha Farrar. For more information on eating disorder recovery https://tabithafarrar.com/ https:// amzn.to/2sLQ8hD Help and advice is available through BEAT at https://www.beateatingdisorders.org.uk/

If you are worried about yourself or someone you know you can contact Nightline on 01904 323735 or BEAT on 0808 801 0811.


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