If you came here on a search for pro-anorexia or pro-bulimia websites please visit Getting Help for Anorexia and Bulimia at HealthyPlace.com instead (or at least first).

I’m happy to see that the American Journal of Public Health has published a study of eating disorder websites –the so-called “pro-Ana” and “pro-Mia” (as in anorexia and bulimia) sites that provide “thinspiration” or “thinspo” to their visitors. The article, reviewed on MedPage Today, includes a systematic assessment of 180 such sites.

From MedPage Today:

Although 85% provided “thinspiration,” 83% also offered overt suggestions on how to engage in eating disorders.

“The tips and techniques were suggestions and strategies to achieve rapid weight loss and even hide one’s eating disorder from concerned parents and friends,” [author Dina L.G.] Borozekowski said.

I’ve spent some time looking at pro-Ana/pro-Mia sites in the past, and Borozekowski’s words ring true. However, I wish she’d gone a bit farther in her comments to help pediatricians understand what they are up against. (Maybe she did in the AJPH article –but I don’t have access.) It’s not just “concerned parents and friends” who can be fooled.

As I reviewed the sites I noticed that some provide very specific instructions on how to hide eating disorders from one’s physician. I had informal follow-up discussions with a number of pediatricians. Few had heard of these pro-Ana and pro-Mia sites; they certainly hadn’t visited them to see what they are all about. Some pediatricians also talked about how the emphasis on obesity screening and prevention might make things worse. BMI screening focuses on finding patients who are too heavy, not too light. And the message that it’s bad to be too heavy resonates with the “thinspo” crowd.

If you’re a pediatrician or a parent of an adolescent girl (though boys can have eating disorders, too), try browsing some “thinspo” sites. You are likely to learn about how those with eating disorders try to evade you, and you might also develop some insights into the psychology of those with anorexia and bulimia.

In the past I’ve avoided linking to thinspo sites because I didn’t want to boost their popularity. But I’ve decided to abandon that policy in the name of getting more parents and peds to visit. I think it’s more likely they are the ones  reading my blog than thinspo fans.

• Here’s a summary of pro-Ana tips and tricks. They are quite repetitive –probably compiled from a number of separate lists. A couple examples:087. If you must eat at the table with the family do not pile food upward on your plate. Try to keep it close to the plate and spread out this way your plate looks full with lots of food, but isn’t.088. If you must eat at the table, talk a lot and take a drink with EVERY bite or every other bite to fill up and make you look active at the table.
• Here’s a fairly hard core one (Prothinspo) that includes a lot of tips on hiding anorexia from parents and doctors.Avoid going to the doctor at all costs.If you do have to visit the doctor and you are underweight, here are some things you can try: drink tons of water, if you know you are going to the doctor a few days in advance you can load op on salt; you can lose the water weight alot easier,Wear heavy clothes and clunky shoes, wear extra jewelry, paint your nails with extra layers ( every ounce counts, remember 16 ounces make a pound), if the doctors office isn’t too far from your house you can wash your hair right before going, layer the inside bottom of your shoes with coins, (I hate to say this) but don’t scrub your body for a few days and don’t shave your legs, when the doctor weighs you, say “hey, I lost some
  weight!” pay attention to your facial expressions upon saying this, when you are weighed, and when the doctor talks to you. If you are still underweight after all that and the doctor asks you about it just say you’ve been so busy and you too are unhappy with your weight loss, say it definitely wasn’t intentional, you can even say you haven’t felt well.

Some of the suggestions in the last paragraph seem absurd (painting nails with extra layers!) but it gives you a sense of the mentality.

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After I wrote this post it occurred to me to go on Twitter, which is a natural spot for thinspo behavior. Try searching #thinspo and #proana and you’ll find plenty of informative, disturbing posts and photos.