'Thinspiration' Packages Eating Disorders as a Lifestyle Choice

Rachel Cowey calls her illness "Ursula." It helped to picture an enemy, the witch in The Little Mermaid who manipulates Ariel into giving up her voice.

The eating disorder had ravaged her body, leaving her with osteoporosis at 19. Cowey stares into the shaky camera in her bedroom. “I am not anorexia. I am Rachel,” she declares, as if staring Ursula square in the eye.

She’s broadcasting on the Team Recovery YouTube channel, where Cowey and cofounders Sarah Robertson and Ali McPherson discuss the lows of battling an eating disorder and the highs of recovering from one.

The three women conceptualized Team Recovery after confronting the overwhelming mountain of online content that worships extreme thinness.

In recent years, the web has exploded with images, blogs and microsites that glorify dangerous weight loss at any cost. Photos of emaciated girls tagged with #thinspiration and #thinspo saturate Twitter feeds and Tumblrs. Waist-down shots picture girls in gym gear that hangs off their shrinking bodies. Pinterest photos depict women with #thighgap; they're so thin that, even with feet together, their thighs don’t touch, a genetic impossibility in most, but one that can occur in the dangerously thin.

In a sense, the phenomenon is nothing new. Similar photos have been online since the late '90s. But their volume and accessibility is unprecedented. One survey shows that between 2006 and 2008 alone, the number of such sites had increased by 470%. At the same time, dieters are getting younger. According to NEDA, 40-60% of girls aged 6-12 are concerned about their weight or about becoming too fat.

Yet for Cowey, the Internet was the only option for positive outreach.

Pro-anorexia and pro-bulimia sites have existed since the dawn of the Internet. Experts use the terms "pro-ana" and "pro-mia" to describe the type of online content that glorifies treacherously thin bodies, implies eating disorders or, in some cases, even directly advocates starving or purging.

In the mid-2000s these sites were vilified for their content: photos of emaciated bodies and tips on how to achieve them. The images were and continue to be particularly dangerous. If you’re at risk of an eating disorder, they can trigger and fuel a devastating psychological illness that manifests in body and mind.

Today’s social media has upped the stakes. With blogging platforms like Tumblr, web users no longer require coding knowledge to publish a website. With micro-blogging, sharing images is easier than ever.

“It’s taken on a whole new life,” says Claire Mysko, project consultant for the National Eating Disorder Association (NEDA). “Now they’re everywhere you turn. There are entire sites and hashtags devoted to these types of images.”

Thinspiration bears similarities to early pro-ana sites. At its core it celebrates extreme thinness. But unlike the first sites, thinspiration is couched with motivational quotes, like “Keep Calm and Thighgap On,” alongside faux-nutritional advice.

In this way, thinspiration has mirrored a cultural evolution. As society became more interested in health and fitness, pro-ana messages latched onto the trend like a parasite to its host.

Don't miss the underlying message, though: "Being emaciated will make you happy."

It isn't entirely the Internet's fault. “I don’t want to blame thinspiration for the epidemic, because we were already in it,” says Margo Maine, Ph.D., who’s been treating eating disorders for almost 35 years. “In our culture for women, being thin is still seen as pinnacle as success,” says Maine. She points out the irony: We stigmatize the extremes like anorexia and bulimia, but “they are just one step ahead of us.”

Early pro-ana forums were explicit in their goal: weight loss at all costs. But today’s thinspiration messages are blurred, which experts believe makes them all the more dangerous.

Maine explains, "Instead of looking at eating disorder habits as a pathology, thinspiration treats them as a lifestyle choice.”

Posts about self-harm, depression and even suicide frequently show up on thinspiration feeds. “It’s characterized as this dark world, which it is,” says Mysko. “But it’s posted by people who are really struggling. They’re not villains; they’re people who are in a really bad place and need help.”

“To think that 10 years ago it was only some web forums, and now it’s just everywhere, is really scary,” says Cowey via Skype, from her home in Northern England. .

Cowey logged on to pro-ana forums from 10 p.m. until 4 a.m. “With an eating disorder your body stays awake longer because it’s searching for food, so I used to be awake until about four in the morning on the pro-ana websites,” she says.

She used a pro-ana quote as her MSN tagline: “We turn skeletons into goddess so that they might teach us not to need.” She saved pictures of emaciated girls on her computer, including one of model Kate Moss with jutting ribs.

“If I ever wanted to eat, I’d look at these pictures and remind myself what I wanted to look like,” says Cowey.

Cowey was 16 when her eating disorder began to develop. At one time, she’d been the smartest kid in class; now she felt out of her own league. A group of friends bullied her, and another boy would call her “ugly” and “dog.”

“It’s not that I wanted to be skinny. I wanted to be invisible so that they’d stop picking on me,” she says. “The irony is that when you’re anorexic people notice you more.”

Initially, she wanted to lose a few pounds, “but you so easily get taken over by an eating disorder.” Cowey would stay out after school so her mother wouldn’t make her eat at home. She became more withdrawn, isolating herself from friends and losing weight quickly.

In February her mom discovered she’d been hiding food and confronted her. Cowey insisted she didn’t have an eating disorder, even after being admitted to the children’s hospital, even after a prognosis that she had weeks to live if she didn’t put on weight.

“I didn’t think I was as bad as other anorexics,” she remembers.

Even then Cowey saw “a really fat, horrible, ugly person” when she looked in the mirror. People at her school would tell her she looked like a mannequin in a shop window. A few times students came up and hugged her, in order to measure how skinny she was. “My mom said my dad was afraid to touch me because he thought I was going to break. By that point my legs were so skinny that it didn’t look as though I could hold myself up,” she says. Her elbows stuck out so much that “my mom used to joke I had a dangerous weapon, that I could poke somebody’s eye out.”

According to NEDA, 20 million American women and 10 million American men suffer from a “clinically significant eating disorder” at some stage in their lives â€" and many cases go unreported. As well as anorexia nervosa and bulimia nervosa, people suffer from binge eating disorder and EDNOS (Eating Disorder Not Otherwise Specified), in which sufferers might show symptoms of anorexia and/or bulimia but are considered to be within a normal weight range.

“We have this idea, this picture in mind of what an eating disorder looks like,” says Mysko. “You can’t tell by looking at someone what they’re dealing with, in many cases.”

Maine explains that eating disorders are caused by a complicated combination of biological, psychological and social factors, and the last two are most powerful. In other words, much of the epidemic is man-made, thus, reversible.

Fijian culture is a perfect example. By 1998 â€" only three years after the introduction of Western TV shows, featuring skinny girls whose bodies looked different from the strong, powerful frames typical of Fijian women â€" eating disorders, which had virtually never existed, became alarmingly prevalent. “Eleven percent used self-induced vomiting, 29% were at risk of an eating disorder and 74% felt too fat.” This is just one example detailed in Maine’s book.

An eating disorder can happen at any time in someone's life, but people are at most risk when they are 13-19. In the early teenage years people are transitioning out of childhood and learning to adopt the values of the wider world. Later there are pressures to succeed and attend a good college. “At that age you’re very vulnerable,” says Maine. If society glorifies thinness and those are the values you hone in on, “it’s a runaway train.”

Marissa (last name withheld) began to develop anorexic tendencies in 2002, and bulimia in 2003. Shortly after, she found Facebook.

“My eating disorder took off like a rocket,” she says. Marissa, 27, would log on as soon as she woke up and take a quick scan of her News Feed. Among the typical high school posts, she found images of girls so thin their bones stuck out, status updates that read “going back to treatment,” wall posts detailing number of pounds lost and number of pounds gained. Once or twice she even caught an image of a girl in a hospital bed, a feeding tube in her mouth.

Maine explains, “Eating disorders have always been a competitive sport, but social media just increases the number of people you are competing with.” This is especially true of anorexia. Marissa says, “A very big part of the eating disorder is competition of ‘who’s the thinnest, who’s the best at it, who’s the sickest.'”

With Facebook, “you had competition at your fingertips all the time,” she says.

She explains that in analog world if you were anorexic you might have been in competition with four other girls at school, whose bodies and damaged health you would have seen with your own eyes. Online, however, there's no way of knowing what’s doctored and what’s real.

There was no respite. At midday Marissa would log on to Facebook again. Much in the same way you’d check in on your favorite blog, she carried a mental list of friends she’d met in treatment. She would scour their profiles for new photos.

“I was obsessive,” Marissa says. “I wanted to see if I was thinner than them. If I was, that was great. If I wasn’t, that was a catastrophe,” one that led her to restrict her food and lose even more weight.

After meeting people at treatment centers, they’d form Facebook groups. People would share information about recent visits to the hospital and numbers from their latest weigh-ins.

“It developed into an eating disorder culture," she says, "where it not only seemed normal, but it was kind of a community of people who were not getting well.”

The anonymity of the web lets people suffering from an already private illness keep their binging, purging or starving hidden from family and friends, all the while experiencing validation from anonymous users online.

Marissa looked at these wall-to-wall photos in private. Cocooning herself in her room with her laptop made for a more intimate yet lonely experience.

“Nobody knew I was doing it. I didn’t tell anyone. I didn’t even tell my therapist,” she says. If you're with a friend and thinspiration-worthy images come up in a magazine or on TV, there’s a strong chance they’ll jump and comment that you can't be that weight and be healthy. But on pro-ana sites, where the majority of users have disordered eating â€" otherwise they wouldn’t be there â€" few offer a voice of reason.

It was only when Marissa went away to a residential unit for a year and a half, where she couldn't go online without a counselor, and Facebook use was forbidden entirely, that she was able to sustain a period of recovery. By the time she got home, the cycle was broken and she'd developed goals beyond calorie-consumption.

Facebook employs stringent community guidelines regarding pro-ed content. If someone posts images or text that suggests self-abuse, users are expected to report the activity. Facebook employees then review every piece of content and decide whether it should be removed. Sometimes Facebook may also take extra steps to get in touch with users who are showing extreme behavior and need help.

Pinterest also prohibits posts promoting self-harm. The company has worked with NEDA to develop a list of search terms that prompt a warning and include help resources. Generally, moderators don't ban topics altogether, because someone searching for "warning signs," "help," "support groups" or "recovery stories" may include the term in his or her searches. It’s a similar story for Tumblr.

“You have to view the Internet as a neutral tool that can be used either for positive or negative purposes,” says Sharon Hodgson, who founded one of the earliest pro-recovery forums, We Bite Back.

Hodgson says banning websites is pointless and misguided; it misses what these sites, feeds and Pinterest boards really amount to. “It’s not a website, it’s not a hashtag. It’s a community,” she says. “You’ll have people finding each other through the hashtags just as they’ve used many other mechanisms to do so in the last two decades.”

“There weren’t any support websites that I could find. So although pro-anorexia sites are dangerous, in a way they were the only place I had someone to talk to, to understand what I was going through,” says Cowey.

And pro-recovery sites and forums tended to have a lower profile or be less prevalent in search terms.

Before founding We Bite Back, Sharon Hodgson was a moderator on a pro-ana site in the early 2000s. She’d put in eight-hour stints online and had practically more posts than anyone on there. Hodgson was partly drawn to pro-ana sites because of her personal connection with the other users. “You find people that are like that too,” she says “and you aren't alone any more.”

Back then, she had a pro-ana “buddy” who was around the same height (between 5'8" and 5'11"), weight and body type. They kept each other on target, eating under a designated number of calories and avoiding certain foods. “We'd just sort of check in with each other,” says Hodgson. “Like somebody in AA might say to a buddy, 'So you still not drinking? How are you doing today?’ But instead of alcohol, it would be about food.” As a result, they both supported and reinforced the demands of their respective eating disorders.

Her online community was close, but a series of tragic events â€" a member committed suicide and another was diagnosed with osteoporosis aged 19 â€" hit them hard. Together, they started to reconsider what they were doing to their bodies and move toward recovery.

Hodgson explains that in the same way pro-ana sites had helped her become a “good anorexic,” she could set up an online community that would help her recover.

She stayed up all week building We Bite Back. As a web developer, she knew the tricks of the trade and targeted key search terms, such as “thinspiration,” “pro-ana recipes,” “how do I lose 10 pounds” and “pro-anorexia,” so her pro-recovery site could cut through the mass of pro-ana disorder results.

The response was overwhelmingly positive. “I had all these people follow me, from 80 countries from around the world,” she says.

They kept the buddy system model throughout the recovery process. “Instead of saying, ‘Did you manage to stay under 500 cal?’ it would be like, 'So did you eat three meals today?'” says Hodgson. “We'd be continuously putting ideas in front of each other to make things better for ourselves.”

The web may contain more pro-ana content than ever before, but it's also welcomed a huge pro-recovery community.

“We hear all about these big, bad, terrible pro-ana and thinspiration sites,” says Mysko. “But there are also a lot of great sites started by people who are in recovery and who are actively combating this stuff.”

Mysko oversees one such site, called Proud2Bme. It looks like a standard platform aimed at teens and young adults, all bright colors and snappy blog posts, but all the content, from health to beauty, is viewed through a pro-recovery lens. Users can also chat with mentors who have themselves recovered from eating disorders.

“Something that’s really important in the solution of this, is that people that really get it, and have maybe even been on these sites themselves, for them to step up as the leaders,” says Mysko.

Furthermore, hundreds of pro-recovery bloggers chime in to such communities. Much like Cowey and Team Recovery, Rae Smith set up The Love Yourself Challenge on Tumblr, Pinterest, YouTube and Facebook, after a six-year battle with anorexia. She also tags pro-recovery messages with pro-ana hashtags, so if someone searches for thinspiration on Pinterest or Tumblr, Smith's body-positive messages will infiltrate negative search results. “This is a fairly typical strategy,” explains Mysko.

The Internet also provides new opportunities to treat eating disorders. Eric van Furth is a professor of eating disorders at Leiden University in the Netherlands and cofounded the original version of Proud2Bme in Holland. He is convinced that e-mental health can significantly improve the efficiency with which people get treated. He's currently piloting an experiment called Featback, an online self-monitoring program where 350 volunteers complete a questionnaire each week, after which they get a personalized analysis that compares how they coped in the previous week. Each volunteer then gets paired with a psychologist with whom they talk over Skype or via chat, in 20 minutes blocks.

Van Furth explains that through the Internet they’re able to communicate with people who wouldn't normally seek treatment, or who would only participate after many years with the disease, at which point treatment would be more extensive and expensive. Proud2Bme reports that, thanks to chat, they’re connecting with a much younger demographic. A massive 87% of people using chat to get in touch are under 18, as opposed to 50% of callers.

There's an album on the Team Recovery Facebook page called “This Is What Recovery Looks Like.” In it are photos of Cowey eating ice cream on the beach, or sipping cocktails with friends. Users leave comments: “You look amazing! Isn't recovery awesome!” and “You will always be an inspiration to me & many other people battling an ED. *hugs*.”

One image stands out: a tattoo on Cowey’s thigh reads “25th June 2004 Hope.” She calls it her “Being Alive Day,” and this year she celebrated its ninth anniversary. At the time, it felt like “the day my life ended. Because I literally couldn’t do anything, because of how ill I was.” Her blood tests showed she had a severe potassium deficiency, and a scan confirmed she had osteoporosis in her lower back. The hospital sent her home with instructions not to do anything, for fear she’d use all her energy. “At one point they only let me go up and down stairs four times a day. And that’s only because the bathroom was downstairs.”

In March 2005 her school told her she was en route to failing her A-Levels, the high school exams that would get her to college. “My mom knew it’d devastate me, because going to university had been my motivation for gaining weight,” says Cowey. “My mom said I should prove them wrong.”

That and the desire for independence and adulthood spurred her on. She gained a little weight, passed her exams and went to university near her home.

“[Anorexia] took three years of my life away from me,” says Cowey. “I wanted to actually achieve things.”

Gradually, her self-perception changed: “I started to try on party dresses and all I saw was a skeletal little girl.” As well as rigorous counselling, friends would come over at dinner time and cheer her on. ("One more fork, go on, one more,” they'd say.) When she had to eat on her own, she kept an “incentives list” in front of her as a reminder what was at stake in the battle against Ursula. It said things like:

• I want to begin my driving lessons again.

• I want to be independent.

• I want to be able to sleep over at a friend’s house and not have to leave early to come home for breakfast.

• I would like to see my nephews grow up.

• I don’t want my stepsister and younger cousin to be scared of me.

• I want to be a mother.

• I want to make a difference in the world.

Cowey reached her target weight in September 2006, but didn’t consider herself fully recovered until February 2011, at 24 years old. Recovery has let her live in France and Australia, swim with dolphins, go to New Zealand twice, fall in love and get a Master's degree. And gradually tick off the incentives on her list.

In one YouTube video, Cowey sits on her bed, reading “A Letter to My Low Self-Esteem.” It’s addressed to Ursula.

“Dear Ursula, you have underestimated me. You may cuss and shout at me every day and every hour and every minute, about how I’m not good enough, how I’m a horrible person and worthless. Yet I haven’t given up. I go out and achieve things.”

She signs off: “It is time for you to disappear, and you know what? I’m confident I can beat you. I’m not in this battle on my own. So be prepared, Ursula. You don’t belong here any more. â€" Rach.”

Editor's Note: If you or a loved one is suffering from an eating disorder, you're not alone. Organizations like the National Eating Disorder Association (U.S.), National Eating Disorder Information Centre (Canada), The Butterfly Foundation (Australia), BEAT (UK) and We Bite Back can help.

Illustrations: Angie Wang