Even pro-anorexia Web sites know they're wrong

In a Google search for "bulimia side effects" the second Web site to come up was "How to Avoid Bulimia Side Effects." Here a former bulimic writes that while she doesn't recommend bulimia to anyone, "The best way to slow down the erosion of your tooth enamel is to brush your teeth rigorously with a whitening toothpaste immediately after vomiting."

An ad for Crest 3D White products (strips, toothpaste, rinse) accompanies this site, which goes on to address the bulimic's other concerns. Such as:

"To keep facial puffiness to a minimum, cut back on the number of times you vomit throughout the day. Keep in mind that you have three hours to vomit after a meal. Throwing up every hour is unnecessary."

In other words, if you're going to do it, here's how.

This tack turns out to be common. Researchers at Stanford and Johns Hopkins medical schools recently conducted the first large-scale analysis of pro-eating disorder Web sites, and found that most of these sites recognize eating disorders as a disease. Their findings are published in the June 17 issue of the American Journal of Public Health.http://med.stanford.edu/121/2010/peebles.html

They focused on 180 Web sites using search terms such as "Pro-Ana," "Pro-Anorexia," "Pro-Bulimia" and "Thin and Support." As "Bulimia Side Effects" shows, however, you don't have to use positive terminology to get "how-to" suggestions.

The researchers rated each site's themes, format and information, and gave each a score based on how harmful it would be to users. Here are some of their findings:

* Nearly 80 percent of the sites had interactive features, so that users can encourage each other to lose weight and share techniques.

* 85 percent displayed "thinspiration" materials (such as photos of very thin models or celebrities)

* 83 percent offered suggestions on how to engage in disordered eating behaviors.

And yet, the majority of the pro-eating disorders 180 sites acknowledged the harm in eating disorders. More than a third included recovery information. Huh?

An explanation of this mixed message comes from Stanford's Rebecka Peebles, MD, senior author of the new study. She told the Stanford University School of Medicine News Service. "Although pro-eating-disorder Web sites are often portrayed in a black-and-white manner, most of them exist on a continuum. Many people with disordered eating behaviors have days when they want to get better, and days they have no interest in getting better. The Web sites reflect the individual characters of the people visiting them."

There's an ick factor to these sites, but family members and clinicians who treat eating disorders should know about them.

Peebles said, "If these sites make us uncomfortable, the focus at the public health level should be asking how we can reach and treat more people struggling with disordered eating, and how we as providers can become more comfortable with the difficult feelings that people with eating disorders feel. Right now, many patients are going to the Web to express those feelings, instead of handling them through traditional models of care, such as psychotherapy."

Just look at "How to Avoid Bulimia Side Effects." After reading that concealer helps hide eye circles and Tums ease heartburn, we get to the even-more obvious, if confused, advice:

"Bulimia side effects can be avoided altogether if you just stop being bulimic! I know by experience how hard it is to stop. Bulimia is more of a psychological disease than a physical one. In a desperate attempt to be thin you believe that not eating will make you lose weight. This is not true. The only way to lose weight is to diet and exercise."

What's true about pro-eating disorders Web sites, and those that purport to help, is that they aren't rational. But then, neither are eating disorders.