ALEX COHEN, host:
From the studios of NPR West, this is Day to Day. I'm Alex Cohen.
MADELEINE BRAND, host:
I'm Madeleine Brand. Coming up, has it begun, the slide toward bank nationalization? The Treasury Department announced today that it is increasing its ownership of Citigroup to nearly 40 percent. We'll have more on that in a moment.
COHEN: But first, this week is National Eating Disorders Awareness Week, an opportunity for us to look at a phenomenon known as pro-ana. Pro-ana refers to the idea of promoting anorexia nervosa; a similar term, pro-mia, refers much the same way to bulimia.
BRAND: In recent years, pro-ana and pro-mia Web sites have proliferated. They are, in their unsettling way, support communities. These sites feature photographs and videos of extremely thin women and girls, many of them celebrities. There are tips for crash dieting, for fasting and for forced vomiting, and playlists featuring so-called "thinspirational" songs like this one. It's called "A Beautiful Lie."
(Soundbite of song "A Beautiful Lie")
30 SECONDS TO MARS: (Singing) Lie awake in bed at night And think about your life. Do you want to be different...
COHEN: There are also chat rooms and discussion boards. Here is a sample of posts that recently appeared online.
Unidentified Woman #1: Hey, skinny girlies. Am I going to gain weight if I just drink, like, eight cups of tea a day? I don't put anything in them usually, but sometimes a bit of no-cal sweetener. Drinking just tea, remember, no food at all.
(Soundbite of song "A Beautiful Lie")
30 SECONDS TO MARS: (Singing) It's a beautiful lie...
Unidentified Woman #2: I forgot to delete the history on my Internet, and my mom saw what I had been on, Ana Boot Camp, Anorexic Queen, et cetera. Now she's watching me like a hawk. I'm only on now because she's out at the pub. It was my 100-calorie diet today, and I did fine until dinner. She shoved a white roll down my throat and a bunch of chicken, probably like 300 calories. Ugh, I can feel myself getting fatter. I need tips on how to get her off my back.
(Soundbite of song "A Beautiful Lie")
30 SECONDS TO MARS: (Singing) It's time to forget about the past To wash away what happened last...
Unidentified Woman #3: I can't sleep. I spent all night binging, and I haven't had one in over a month and a half. I screwed up bad, and I now I need to fast all day. I was still eating up until 7 a.m. I'm destroying everything for myself, and I skipped the gym for the first time in five weeks and stopped taking my diet pills the whole day. What's wrong with me?
(Soundbite of song "A Beautiful Lie")
Ms. MELISSA COX (Creator, Ana Death): As a human, if you learn to live off of water and air, there's something very special about you.
BRAND: Most of those were anonymous blog posts read by our staff members, but the last person you heard was Melissa Cox. She used to visit pro-ana sites regularly.
Ms. COX: And it just kind of made me feel like I had found some sort of secret society that I could belong to whenever I didn't feel like I belonged anywhere else in the world, and that's really what got me, I guess, addicted to them.
BRAND: We'll hear from Melissa in just a few minutes. First, though, let's go to Rebecka Peebles. She's a doctor who specializes in eating disorders and adolescent medicine at the Lucile Packard Children's Hospital at Stanford University.
COHEN: Dr. Peebles studies how teens with eating disorders use both pro-ana sites as well as sites dedicated to overcoming eating disorders. These are known as pro-recovery sites.
Dr. REBECKA PEEBLES (Pediatrics and Adolescent Medicine, Stanford University School of Medicine; Eating Disorder Specialist): We surveyed a number of our patients and basically found that a little over a third had visited pro-eating disorder Web sites and that nearly an equal number had visited pro-recovery Web sites. And we found that users of both types of sites were hospitalized more frequently than users of neither type of site. So, that was sort of our major finding. We also found that that 96 percent of people who visited pro-eating disorder Web sites had learned new weight-loss or purging techniques off of those sites. However, one thing that sort of surprised us was that the users of pro-recovery sites, almost half of them had also learned new weight-loss or purging techniques on even pro-recovery sites. So, it sort of opened our eyes as to that there's a lot of overlapping content to these different types of sites, and that when you put this information out there on the Internet, no matter how well-intentioned it might be, the interpretation to the user may be different than you intended.
COHEN: I think most people, when they hear about these sites, would envision primarily women using them, and primarily younger women. What were you able to find in terms of which sorts of people were going to these sites?
Dr. PEEBLES: In our studies, most users are female. However, there certainly are some sites that are geared towards males, just like there are sites that are geared toward groups of different ethnicities and different backgrounds, and I would not say that all the users are females at all. In terms of ages, most of our users are adolescent or, in fact, more commonly, young adults. I think the oldest age that we had of anyone that responded was 54 years of age. But there certainly is a wide range of ages of people who respond.
COHEN: You have been studying these sites for many years now; they've been around for some time, and it doesn't seem like the Internet is going away anytime soon. And what do you see as the future of pro-ana?
Dr. PEEBLES: People with eating disorders have a lot of very complex thoughts and emotions. I think they often feel shut down in common health-care settings and therapeutic settings, in that if they express a lot of their thoughts and feelings and what they're struggling with in a very open and candid way, they may be told that they're being triggering to other people or that it's not appropriate to express those things. So, I think then they go to the Internet and express these feelings online in the same way that, when the Internet wasn't around, they might have written down these feelings in a diary. So, I think probably pro-ana is going to evolve in the same way that these thoughts and feelings evolve, and the real issue is what the social media will be that portrays it. So, for example, now we are seeing more YouTube pro-ana or Facebook pro-ana, and that's different than even just a couple of years ago what we were seeing.
COHEN: As parents and loved ones of those who may be using these sites are listening now, I'm sure that many of them are very concerned. What advice will you give to a parent, a friend, a family member, if they're worried about someone logging on to pro-ana or pro-mia sites?
Dr. PEEBLES: When you are trying to prevent risky eating behaviors and curiosity surrounding these in your children, and risky Internet use behaviors, I think it's always helpful to talk to your children. So, that would be the first thing. The other thing is I would perceive - I would think of the Web as a social media, and I try to explain to parents that if they wouldn't feel comfortable with their child going out of their home at 11 o'clock at night and meeting people that their parents have never met in the middle of the night, that they may want to think about whether or not their child should have access to the Internet late at night in their room alone, and that that may be something that they want to do together for a while and introduce them to it in a graded way. But that requires a significant amount of Internet savviness on the part of parents, and I think that many parents are sort catching up to their kids on this.
COHEN: Dr. Rebecka Peebles specializes in eating disorders at Stanford University. Thank you, Rebecka.
Dr. PEEBLES: Thank you.
Ms. COX: My mom was watching "Oprah," and they were talking about pro-ana sites, and they had a young girl on there, and she talked about how much they helped her, and without listening any more of the interview that was going on, I went into the computer room and jumped on the sites.
BRAND: From that day on, Melissa Cox visited pro-ana Web sites regularly for years. She was a teenager then; she had already been struggling with food and weight issues. Five feet seven inches tall, at one point, Melissa weighed just 78 pounds.
COHEN: She's now 22. She's at a healthy weight and living in South Carolina. Melissa now runs a Web site called Ana Death, dedicated to those like her looking for an out from the pro-ana movement. Thinking back to when she did visit pro-ana sites, Melissa says their lure was strong.
Ms. COX: I had never met anyone with an eating disorder before. So, I kind of felt like maybe I had found somewhere that I would be understood.
COHEN: One of the components of some of these Web sites is that people think of "ana" as a person, as a spirit, and you say you used to do that. Can you explain what that experience is like?
Ms. COX: Sure. An eating disorder is a very isolating disease. A way to justify your disease is to kind of make Ana this person, your best friend, and to make your disease your best friend. And it was comforting, and I didn't feel alone, and it was kind of my own world. No one around me knew what was going on, and it was kind of something I felt like we had together.
COHEN: Melissa, how did you wind up making the choice to go into recovery for your eating disorder?
Ms. COX: I didn't make the choice very willingly at first, I guess. I had a heart attack at 17. There was no option if I was going to treatment or not going to treatment. And at first, I didn't want to get help, but as I was in the hospital for a few days and thought about what this disease had done to my body and my family and everything around me, I really started realizing that I needed help and that I wanted a lot of the secrets to stop. And I really just wanted to feel happiness and excitement about life like other people around me.
COHEN: What role has the Internet played in terms of your recovery?
Ms. COX: It used to be toxic and disastrous for me, but now, it's something that is really motivational for me, because I've found another network of friends who are also in recovery. And with my Web page, I talk to girls every day about how wonderful life can be. It's really something that kind of keeps me going now, and to be able to go on and talk to people who can understand how tough it is to recover from this disease is really helpful.
COHEN: Your site, in some ways, seems almost like a mirror reflection of what you find on some of the pro-ana sites. There are things like quotes and motivation. And one of the sections there is the religion section. Can you talk a little bit about what that section's about?
Ms. COX: Sure. One of the big things that pro-ana sites have is the religion section. They talk about the ana creed and the prayer to ana and actually make anorexia, I guess, a sort of religion. I went under and kind of made it more of like a self-affirmation-type thing, a creed, basically.
COHEN: So, for example, the pro-ana sites, you know, one of their rules might be that food makes you fat, and you counter that by saying food makes you healthy, not fat.
Ms. COX: Exactly, exactly, healthy and to feel good and to be able to live life.
COHEN: Sometimes people are going to these pro-ana sites and they're also looking at very legitimate pro-recovery sites, and sometimes they might still also motivate them not to eat. Do you ever worry about that at all? You know, is there ever concern that maybe your site might do more harm than good to some people?
Ms. COX: I have worried about that. My main concern is always for that young girl out there like me that didn't know about pro-ana sites to come across my page and say, oh, well, I need to go visit the pro-ana sites. But I really feel like I try to be very encouraging and to urge people towards recovery. So, all I can do is kind of put it out there, put my experience out there, and hope that it's being helpful.
COHEN: Melissa Cox is founder of the Web site Ana Death. She spoke to us from Charleston, South Carolina. Thank you, Melissa.
Ms. COX: You're welcome.
(Soundbite of music)
COHEN: Stay with us on Day to Day from NPR News.
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