The following warning appears on the front page of a popular pro-anorexia internet discussion group, Hard Core Anorexic (Name changed).

"For girls who are hardcore about being skinny.

But on the contrary,

We are not in anyway trying to encourage ED!

But, we ARE Pro-Ana/Mia.

If you are trying to/ are recover/recovered, don't join"

On this site and countless others, women separated by geography, age and lifestyle log in to share their struggles, goals, triumphs and failures in living a "pro-ana" lifestyle.  Anorexia, long the staple of after-school specials and public service announcements, may have fallen off the national radar screen, edged out by public panic about obesity.  Nevertheless with increasing access to new media, those with (or claiming to have) eating disorders have congregated outside of hospitals and clinics, crafting a thriving pro-eating disorder community on the internet.  While some of those with eating disorders seek and develop recovery oriented spaces online, others, such as the members of Hard Core Anorexic, specifically cultivate "pro-ana" communities. ⁱ

It is estimated that as many as one in four adolescents are worried about their weight and they are either contemplating a diet or actually dieting.  The predominant majority of these teens are female, but males are also included in lesser numbers.  Many of these teens are preoccupied with shaping their bodies to match the anorexic looking figures that the fashion and advertising industries launch with authority.  The result is a thriving online subculture characterized by specific symbols, rituals and the identity of the wannarexic.

A wannarexic could be your daughter or son.  THE URBAN DICTIONARY defines wannarexic as, “Someone who wishes or pretends they have an eating disorder or deliberately goes out of their way to make it look like they have anorexia.”ⁱⁱ

The prevalence of fashion and media pressure to be thin produces a result that means that there is better than a ten percent chance that if your child is an adolescent girl she binges or purges.ⁱⁱⁱ  While these activities don’t necessarily mean the person exhibiting these conditions has as anorexia nervosa or bulimia nervosa, it does mean she/he is undertaking activities that can be harmful and lead to chronic and life threatening eating disorders.  Just a few unwanted results can include rotten teeth, and in adolescent females the interruption of menstrual cycles.

In an effort to meet her frequently unhealthy and unrealistically weight goal,  the wannarexic will go online to learn what laxatives, diuretics, extreme diets or other unhealthy advice she can use to force her body to conform to the pressures of the body image with which the fashion and advertising industry constantly bombard her with.  The wannarexic may even learn online what intestinal parasites are considered safe to take to lose weight.^iv

Indicators that the wannarexic has or is becoming a sufferer of anorexia nervosa or bulimia nervosa include the following:

Being extremely thin is not necessarily an indication a child may be suffering from an eating disorder.

In fact, a downward and unexplained weight loss over a period of time could be a sign of other health problems.

If a child or teen has an unexplained downward loss of weight one should consider making appointment with the child’s medical doctor for a complete physical examination.  Also prior to the examination the parents should be on the lookout for other signs of eating disorders. 

There are a range of symptoms and activities that the sufferer of eating disorders will exhibit.   Symptoms. Not all victims display all symptoms Abnormal weight lossRefusal to eat, except for tiny portionsBinge eatingVomitingAbuse of laxatives, diuretics, emetics, diet pills, and other over the counter and prescription medications.

Denial of hungerExcessive exerciseDistorted body image: see themselves as fat even though they may be so thin they are emaciatedDepressionPreoccupation with foodAbsent or irregular menstruation in womenRotted teeth from vomiting.

Many times the sufferer will deny she has a problem and attempt to disguise the symptoms.

It is not unexpected sufferers learn how to hide their symptoms or weight loss online.   

For example, the web site Tricks (name changed) provides 40 tips on anorexic and bulimic behavior, another 15 suggestions on how to hide one’s anorexic or bulimic behavior, how to erase history of the sites one has visited on the Internet, and more.

The parent(s) who is/are worried about her/his child’s weight should be concerned about the information the child may be getting from the Internet.  The parent should be aware of the likely places the child will receive dangerous information on how to lose weight.  Many parents are surprised to learn that there are Internet web sites and social networking communities, groups, and forums that support anorexia nervosa, bulimia nervosa and associated disorders.  These parents are unaware that the Internet supports web sites, communities, groups and forums that espouse anorexia, bulimia and other eating disorders as a way of life.

The findings of a pilot study which was published in the Journal of Pediatrics investigated “the awareness and usage of pro-eating disorder web sites among adolescents with eating disorders and their parents and explored associates with health and quality of life.  The conclusion of this pilot study was that pro-eating disorder site usage was prevalent among adolescents with eating disorders, yet parents had little knowledge of this.  Usage may have a negative impact on quality of life and result in adolescents’ learning about and adopting disordered eating behaviors.”^vi

These sites and communities are so prevalent on the Internet they even have their own definitions. For example the web site www.About.com defines:

“Pro ana Definition: An abbreviated form of "pro-anorexia." A pro-ana web site is one which promotes anorexia nervosa as noble and beneficial.

Pronunciation: PRO-AN-a

Also Known As: Pro-anorexia

Alternate Spellings: pro ana

Common Misspellings: pro-anna

Examples: Since recovery from her anorexia was so difficult, Katie was very drawn to the pro-ana web site.^vii

About dot com defines Pro Mia

Definition: An abbreviation of "pro-bulimia," a name applied to a philosophy that promotes bulimia as noble and desirable. Generally applied to certain web sites.

Pronunciation: PRO-MEE-ah

Examples: Noel decided that her bulimia was too important to her to give up; she started visiting pro-mia web sites.^viii

ANAD defines “Pro-ana, pro-mia and other sites and communities as online locations that share and dispense information to sufferers of eating disorders that glamorize eating disorders. These sites and communities also share information and photos relationg to:

• The deification of anorexia or bulimia
• Supporting those who are subsisting on a few hundred calories a day, exhorting them to be strong
• Misusing over-the-counter and prescription drugs such as laxatives and diuretics
• Self harm
• Purging
• Use of intestinal parasites
• Triggering photos of anorexic individuals that are used for inspiration
• Detailed information on extreme diets that are as low or lower than 400 calories a day

The creators of these web sites, or bogs, or forums, or groups encourage and support sufferers to continue these practices.

Anorexia kills. Despite this hard fact frequently the corporations that host pro eating disorder sites and social networking communities will hide behind freedom of speech as an excuse for allowing pro ana and pro mia Internet sites and communities to continue to exist. ANAD believes there is no excuse for corporations to host and harbor online pro-ana, pro-mia and other pro-eating disorder locations. ANAD believes these champions of misery to innocent children must be removed.                                                                     

ANAD along with Therapists, Treatment Centers, and eating disorder health care professionals everywhere all agree such information is at the very best unhealthy and at the very worst is deadly.  Vivian Hanson Meehan, D.Sc, and founder and president of ANAD writes “providing tips to anxiety ridden, prepubescent or pubescent individuals who want to adopt this lifestyle promotes life adjustment failures, shortened stature, osteoporosis, in female’s endangerment of the reproductive system, heart attacks and death.”                                                                                                                                        
Dr. Maria Rago, Eating Disorder Therapist, ANAD Board Member and parent reviewed a social networking group that claims to be the largest pro anorexia community on the Internet.   Dr. Rago’s observations about the content of the “World’s Largest Pro-anorexia Community” provide some very key insights in establishing whether or not the questionable Internet location is pro ana or pro mia and a potential danger to impressionable adolescents. Here is what she had to say about the location.                

“As a parent I am especially frightened of this site.  To imagine a young person coming across this site or pictures like this and being affected is an unnecessary danger.  We will need to work together to stop children and other vulnerable people from being exposed to this kind of propaganda. Viewing this site is disturbing, sad and frightening.  Anorexia and Bulimia are not fun ways to chat and get to know new people.  They are deadly illnesses rooted in depression, anxiety and starvation.  This site glamorizes and feeds into Anorexia and Bulimia Nervosa.The site’s very purpose is to support and strengthen the desires to starve and purge.  It also serves to promote new information about ways to use more and more dangerous methods to lose weight and avoid eating.  Anorexics and Bulimics naturally compare to each other as part of the disease.  This site creates the opportunity to compare to more and more dangerous methods of weight loss and increase the drive and interest, and to increase the severity and frequency of eating disorder behaviors.

I would compare this site to a pro-suicide site which would give depressed and suicidal people methods to kill themselves and feed into a negative, depressed and hopeless view on life.” 

Don’t be mislead by claims the location’s purpose and content are to help, or that those who are not anorexics should not enter. If anorexia nervosa or bulimia nervosa are glamorized, treated as deities or lifestyles and support is given to sufferers to maintain this deadly lifestyle, then despite claims to the contrary, the online location’s purpose is not to help anyone. Nor is it beneficial if the location provides increasingly dangerous methods to lose weight and avoid eating, the online location’s purpose is not to help anyone. 

If there are disparaging comments about how individuals and/or organizations such as ANAD are wrong in condemning pro ana, pro mia or similar sites, the online location’s purpose is unlikely to be positive. If you as a parent have bad feelings about the content and the information the online location provides its visitors then trust your instinct and question if the online location’s purpose is not to help anyone.

If you aren’t sure, review ANAD’s list of signs of pro ana and pro mia Internet locations that contain information that can kill. Here is a more complete lists of tale tell indicators that the onsite location could be dangerous or deadly to your child.

1. Glamorize, reinforce, anorexia nervosa and associated disorders as desired lifestyles.  

2. Focus on weights that are below the generally accepted standards of the medical profession body mass index (BMI).  

3. Provide instructions on how to obtain weight reduction goals through the explanation of diets that are so low in calories these diets are far under accepted standards of nutritionists and health officials.  

4. Reinforce behaviors that help eating disorders sufferers to reach weigh reduction goals that are harmful and possibly deadly.  

5. Provide information of the misuse of drugs in order to induce weight loss through vomiting or bowel movements.  

6. Use photos or videos of celebrities, fashion models, or other individuals as roll models who are identified as anorexia.

Most Internet guidelines for parents about internet safety are written from the point of view of protecting the child from pornography or child predators. Some of the general guidelines make equally good sense for protecting children from pro eating disorder sites. These suggestions include:
  
1.      Purchase good monitoring software. According to www.webmonitoringsoftwarereviews.org some of the features and benefits of child monitoring software include:

• For effective monitoring make sure the  program lets  you to see all web pages visited, read sent and received email, and see both sides of IM chats conversations of your child (children)
• Remote web access that allows you to keep an eye on things from anywhere (Imagine keeping an eye on the kids' Internet activity from your office for instance)    
• Stealthily be able to see what your child does when they think no one's looking, you need a program that's completely invisible
• Other features to look for are ability to block, the ability to filter data, and the ability to take screenshots^x

2.      Keep your child’s computer in a public room of your home so you can indiscreetly monitor activities when you pass by the computer work station.

3.      Set age appropriate rules and guidelines for computer use with your child.        

•  Discuss these rules with children and put a copy near the computer as a reminder.
•  A child or teenager’s excessive use of online services or bulletin boards, especially late at night, may be a clue that there might be a hidden problem.

4.      Don’t be afraid to learn more about the interests of the people with whom your child is chatting.

Unfortunately, too many people still believe anorexia nervosa and bulimia nervosa pose little threat and are primarily conditions that white middle class girls suffer from.

The truth is eating disorders know no socio-economic or ethnic or national borders.

The facts are eating disorders have the highest mortality rate of any mental illness and the mortality rate associated with anorexia nervosa is 12 times higher than for all causes of death for females 15-24 years of age.^xi                                                                                    

Eighty six percent of sufferers report the onset of illness by the age of 20. This is the demographic that goes to the Internet for information and to socialize. 

Once a sufferer has an eating disorder, she/he only has a fifty percent chance of being cured.

Those that are cured report suffering from their eating disorder from one to fifteen years, and it is estimated that between five and six percent of serious cases die. 
 
DURATION OF ILLNESS/MORTALITY: –        

• 77% report duration from one to fifteen years –       

• 30% report duration from one to five years –       

• 31% report duration from six to ten years –       

• 16% report duration from eleven to fifteen years –      

• It is estimated that between five and six percent of serious cases die

• Only 50% report being cured 

Treatment for anorexia nervosa and/or bulimia is often extremely expensive. For example cost of inpatient treatment can be $30,000 or more a month, and the cost of out patient treatment, including therapy and medical monitoring can be as much as $100,000 a year.           

In addition there are the thousands of dollars a sufferer and/or her/his family may lose from lost time at work, the cost of transportation, and other related costs.           

The mental hardship and anguish to the sufferer and friends and family is incalculable. Marriages are destroyed by eating disorders and families are damaged in ways that are irreparable.

Join ANAD and make your voice count. Enlist as an ANAD Internet Militia Member. Help us raise the alarm and to ·      

• Fight to get responsible corporations to police the pro ana and pro mia web sites, social networking communities, blogs, and forums

• Draw attention to those corporations who disregard the safety of your children by continuing to harbor online pro eating disorder locations

• Send emails to those corporations announcing your displeasure

• Send emails to the sponsors and to the advertisers found at those locations  

ⁱPascoe, C.J.. 2008. "You're Just Another Fatty: Creating a Pro-Ana Subculture Online."  Digital Youth Research http:// digitalyough.ischool.berkeley.edu/node/104.  January 22, 2008.

ⁱⁱhttp://www.urbandictionary.com/define.php?term=wannarexic

ⁱⁱⁱNeumark-Sztainer D. Hannan PJ.  Weight-related behaviors among adolescent girls and boys: results from a national survey.  Arch Pediatr Adolesc Med.  2000; 154: 569-577

^ivANAD opts to keep the reference to the web site that discusses the use of internal parasites confieential in order not to provide this source to wannarexics and those suffering from eating disorders.

^vhttp://www.anad.org22385/22427.html and http://www.anad.org/22385/22448.html

^vi PEDIATRICS Vol. 118 No. 6 December 206, pp. e1635-e1643 (doi: 10.1542/peds.2006-1133)

^viihttp://eatingdisorders.about.com/od/glossary/g/proana.htm

^viiihttp://eatingdisorders.about.com/od/glossary/g/promia.htm

^ixEmail from Dr. Maria Rago, Clinician and Therapist, Linden Oaks Hospital at Edward, IL

^xhttp://www.monitoringsoftwarereviews.org/?3=1&kw=monitoring+child+internet&s_kwcid=monitoring%20child%20internet59646515&gclid=CMP4v

^xihttp://www.state.sc.us/dmh/anorexia/statistics.htm