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Pro-ana, murderous face of the Internet.

INTRODUCTION

Nowadays more and more people around the world have access to the Internet. It is impossible to estimate how strong an influence it has on communities and on each individual user. Information about all aspects of life can be found on the Internet. Materials related to medicine, including eating disorders, are available there. On many websites, information about pathogenesis, symptoms and treatment of anorexia nervosa can be found [2]. Unfortunately, apart from such useful pages, sites qualified as "pro-ana" pages also exist on the Web. Those are websites, forums and blogs promoting behaviors typical of people with eating disorders [3]. Pro-ana is an ideology whose adherents believe that anorexia is a "lifestyle" and not a disease, playing down its health consequences [1]. Pro-ana may also be considered as an informal, virtual community. However, we need to remember that it is created by living human beings, often ones who struggle with serious health problems. Pages created and run by pro-ana members, who call themselves "butterflies," contain different types of content that promotes radical and constant weight loss.

The aim of this study was to analyze the subject matter of websites, including the pro-ana content, to better understand the websites' significance in the pathogenesis, symptoms and treatment of anorexia.

MATERIALS AND METHODS

In the study, 50 pro-ana websites were analyzed. The material was evaluated for including content promoting behavior that is typical of eating disorders. The research was conducted in April 2012. The authors used the Google search engine using the phrase "pro-ana". Only websites promoting ANA were evaluated.

RESULTS

Among the assessed sites, 60% were blogs, 34% were forums, and 6% were informative pages. Access to 78% of them was unrestricted, 4% of the sites had content available to every Internet user as well as only to subscribers, and access to 18% of the sites was possible only after a positive evaluation of a request for access (Fig. 1, Fig. 2). A characteristic feature that can be found on 82% of pro-ana pages is "thinspiration." The word derives from a combination of two words, namely thin and inspiration, and together they mean an inspiration to be thin. These are usually pictures of famous, skinny celebrities, models, unknown skinny girls, and sometimes even people suffering from anorexia. Some of the members also add their own pictures. Thinspiration is not only pictures, but also songs with content compatible with the pro-ana ideology (20%), as well as videos of slim women (11%).

Another type of inspiration is so-called "reverse thinspiration," also referred to as "fatspiration," which was found on 13% of sites. These are photographs which show persons with morbid obesity. Their aim is to show how food may lead to such a situation (Fig.3). Butterflies also post photos of dissected human fat, which is meant to illustrate what happens with the calories (7%).

Authors of blogs and forums frequently post information about the diets and methods they use to lose weight. They also inform about their progress in losing weight or about any failures in achieving the desired goal, which is an extremely low body weight. Such types of data are published on 69% of the pages. Butterflies publish advice on how to lose weight on 78% of their blogs and forums.

This is often deemed very controversial because of the destructive character of such information. On 33% of the pages, readers can find information about very radical diets, such as the Ana Boot Camp diet. The Ana Boot Camp diet consists of reducing daily energy intake to an extremely low amount of calories - in the 0 to 800 kcal range. This diet has been described on 9% of the sites.

Furthermore, recipes for low calorie meals (9%) as well as the caloric value information on "light" products (7%) can be found there, together with nutritional value tables (38%). On 29% of such websites, people share information about supplements or drugs used for losing weight. The danger lies in the fact that they usually publish data about the effectiveness of their action, but used in excessive amounts, and of course without any health exams or consultations with a doctor. There is also a lack of information about the adverse effects of these substances. It is commonly known that in order to reduce body weight, it is the best to combine diet and physical activity. Such an observation, of course, could not go unnoticed by the pro-ana community. Therefore, 29% of the evaluated pages contain lots of information about the calories that can be burned during certain activities.

There are also sets of exercises available and so-called "fitspiration," which are images and films showing thin women practicing sport (Fig.4). Pro-ana pages usually contain characteristic features such as the butterfly's motto: "quod me nutrit me destruit"--"what nourishes me, destroys me" and the Decalogue (27%) containing the basic assumptions of pro-ana, often created by each of the members separately.

The Butterfly's Alphabet (9%) in which each letter is identified with some element of pro-ana, can be also found. Another characteristic feature is A Letter from Ana (7%), a friend of each butterfly. It is addressed to every single member and expresses a desire to help, support and a promise of gaining control over the body and life. These letters encourage internet users to become friends with Ana, which will make it easier to control their behavior. The dangerous thing is that this "friendship" hinders treatment, because it will be connected with rejection of the friendship. (Fig.5). For members of the pro-ana communities, their activities do not promote the disease. To confirm that thesis, they publish information about eating disorders such as anorexia nervosa and bulimia nervosa (11%). Some of the butterflies add statements on their websites showing what pro-ana means to them (16%).

DISCUSSION

The media has an incredibly strong influence on adolescent girls and young women, bombarding them with pictures of extremely thin models, who allegedly embody the ideal of female appearance. Most women fail to reach this idealized manuctured image, which leads to dissatisfaction with their body, lack of acceptance of their appearance and in the end, this can lead to eating disorders [4].

In January 2012, 29 members of the proana society were examined in France. All of them reported a high level of disordered eating [5]. Internet users are mainly young people, it is used by 90% of those aged 16-24 years [6], and this age group is the main target of pro-ana pages. In 2009, in Belgium, a survey among 13-, 15- and 17-year-olds was conducted assessing their presence on pro-anorexic websites. The researchers found that 12.6% of girls and 5.9% of boys have visited these sites. For girls, visiting such websites was associated with a higher motivation to be thin, worse perception of own appearance, and greater perfectionism [7]. It cannot be ignored that nowadays children are more and more active online. Research shows than children as young as 5 are aware of their bodies and even at such a young age the desire to be thinner may appear [4].

The main reasons for joining the pro-ana community are to receive guidance on weight loss and to gain support in achieving this aim [5]. The investigated groups and communities are focused on social interactions [8]. They are created by and for people who want to share their experiences of eating disorders in a friendly and supportive environment [9]. Pro-ana members are reluctant to reveal their membership in the real world [10] and such psychological factors such as social isolation, depression and compulsive behaviors may predispose them to new Internet-related diseases [11]. Even if pro-ana members claim that they do not promote anorexia, their websites undoubtedly include content that impedes treatment [12].

CONCLUSIONS

Pro-ana websites include lots of content which can promote behaviors characteristic of eating disorders. Blogs and forums are the most common websites, where followers of the pro-ana movement share information, advice, as well as weight loss successes and failures. Access to most pro-ana websites was unrestricted, which makes it possible for any interested person to review their content.

Conflict of interest

We have no commercial, financial, or other associations that could pose a conflict of interest in connection with our submitted article.

REFERENCES

[1.] Stochel M, Janas-Kozik M. [Friends of virtual Ana--the phenomenon of pro-anorexia in the Internet]. Psychiatr Pol. 2010 Sep-Oct; 44(5): 693-702.

[2.] Abbate Daga G, Gramaglia C, Piero A, Fassino S. Eating disorders and the Internet: cure and curse. Eat Weight Disord. 2006 Jun; 11(2): e68-71.

[3.] Mule A, Sideli L. Eating disorders on the web: risks and resources. Stud Health Technol Inform. 2009; 144:8-12.

[4.] Andrist LC. Media images, body dissatisfaction, and disordered eating in adolescent women. MCN Am J Matern Child Nurs. 2003 Mar-Apr; 28(2): 119-23.

[5.] Rodgers RF, Skowron S, Chabrol H. Disordered eating and group membership among members of a pro-anorexic online community. Eur Eat Disord Rev. 2012 Jan; 20(1): 9-12.

[6.] Polski Internet 2008/2009--raport Gemius.pl. [Internet]. [cited 2010 Jan 23]. ttp://www.slideshare.net/szakatak/polskiinternet-20082009-raport-gemiuspl.

[7.] Custers K, Van den Bulck J. Viewership of pro-anorexia websites in seventh, ninth and eleventh graders. Eur Eat Disord Rev. 2009 May; 17(3): 214-9.

[8.] Juarascio AS, Shoaib A, Timko CA. Pro-eating disorder communities on social networking sites: a content analysis. Eat Disord. 2010 Oct; 18(5): 393-407.

[9.] Giles D. Constructing identities in cyberspace: the case of eating disorders. Br J Soc Psychol. 2006 Sep; 45 (Pt 3):463-77.

[10.] Gavin J, Rodham K, Poyer H. The presentation of "pro-anorexia" in online group interactions. Qual Health Res. 2008 Mar; 18(3): 325-33.

[11.] Kryspin-Exner I, Felnhofer A, Kothgassner OD. [Pandora's digital box: mental disorders in cyberspace]. Neuropsychiatr. 2011; 25 (4): 172-82.

[12.] Fox N, Ward K, O'Rourke A. Pro-anorexia, weight-loss drugs and the internet: an "anti-recovery" explanatory model of anorexia. Sociol Health Illn. 2005 Nov; 27(7): 944-71.

Gwizdek A.*, Gwizdek K., Koszowska A.

Medical University of Silesia, Katowice, Poland

* Corresponding author:

ul. Kolorowa 20c/18

42-606 Tarnowskie Gory, Poland

Tel: +48664464567

E-mail: anngwi@poczta.onet.pl (Anna Gwizdek)

Received: 15.04.2012

Accepted: 4.06.2012
Fig. 1. Types of pro-ana web sites.

Blogs               60%
Forums              34%
Information pages    6%

Note: Table made from pie chart.

Fig. 2. Access to pro-ana web sites.

unlimited access          78%
limited access            18%
partly limited access      4%

Note: Table made from pie chart.

Fig. 3. Pro-ana inspirations.

Thispiration photos   82%
Thinspiration songs   20%
Thispiration films    11%
Fatspiration          13%

Note: Table made from bar graph.

Fig. 4. Losing weight advices.

Advices                             78%
Diets                               33%
ABC diet                             9%
Nutritional value tables            38%
Recipes                              9%
"Light" products calories            7%
Supplements, stimulants and drugs   29%
Physical activity                   29%

Note: Table made from bar graph.

Fig. 5. Pro-ana characteristic elements.

Decalogue          27%
Ana Alphabet        9%
Letter from Ana     7%

Note: Table made from bar graph.
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Article Details
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Title Annotation:anorexia nervosa
Author:Gwizdek A.; Gwizdek K.; Koszowska A.
Publication:Progress in Health Sciences
Article Type:Report
Geographic Code:4EXPO
Date:Jun 1, 2012
Words:1810
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