Some health officials feel the nation is now facing an epidemic of anorexia and bulimia. Many sufferers, primarily young women, starve or purge in an effort to be extremely thin. Doctors are campaigning to raise awareness about the dangers of eating disorders. But even as that is happening, there are still sites on the Internet promoting what many call a lifestyle choice.
It doesn't take much to get a group of teenage girls to talk about the pressures they face to be thin. At a recent track practice at Mayo High School in Rochester, a group of teenage girls talked about their own body issues.
"I will go running and I'll puke when I'm running so I don't have to do it at home," says Annie Loomis, a petite and slim 16-year-old. "I'll eat, but afterwards I'll just feel so fat and bloated; sometimes I've gone to bed and I've ate and I can't let myself fall asleep because I feel so fat so I'll do sit ups or something just to feel like I burned off something."
Some of the girls say thin people get positive attention at school. Ally Holmquist and Lisa Hanson complain about pressure at home from their parents to lose weight.
"My parents tell me I'm fat," Holmquist says.
"I have the same problem at home," adds Hanson. "My dad makes fun of me all the time because he thinks I'm so big. He always goes, 'jeez, Lisa, why don't you run more in track? Why don't you lose some more weight? Why don't you get down to your sister's size?' and he makes me feel really bad."
While the pressure from family and peers may be to just lose weight, on the Web there are sites that take it to an extreme. Some sites encourage people to embrace anorexia or bulimia.
For example, when Web surfers visit the Anorexic Nation site, they're greeted by a shocking image - a torso of a malnourished girl with protruding ribs and a concaved stomach. Click on it and the same skin and bones figure appears wearing a t-shirt promoting perfection, starvation, emaciation.
There are bulletin boards where visitors can exchange tips. One teen writes into a pro-anorexia message board, Help me reach my goal of 85 pounds. Another asks, is there any way to stop my stomach from grumbling?
Web sites promoting eating disorders have popped up all over the Web in the last couple years with names like Dying To Be Thin and You Are What You Eat. The Web forums are run by individuals who call their habits lifestyle choices rather than disorders.
A 20-year-old woman from Florida who identifies herself as Mrs. Slim has created a Web site called Starving for Perfection. She refuses to have her voice recorded for this story. She says she doesn't want her husband to hear about her lifestyle choice. However, she did answer questions over the phone and via e-mail (Read interview).
Her site had more than 4,000 "hits" in April. On it a visitor will find diet pill reviews, fasting and exercise tips, and the body mass index and weight of several skinny celebrities.
Calista Flockhart, for example is a favorite on the Web. She's 5'6", weighs 97 pounds and has a BMI of 15.6. Many of the sites say 95 pounds is considered the ideal weight.
Mrs. Slim says, "Our Web sites are not aimed at drawing in innocent girls to kill themselves. We want control, power and something all our own."
A different kind of eating disorder resource is also on the Web. Amy Medina and her husband run somethingfishy.org. It's a recovery Web site based in New York. Medina, 32, says she's recovered from anorexia. She's trying to counter the pro-anorexia/pro-bulimia sites. She says they're very damaging.
"It's just like an alcoholic who hangs around with other alcoholics or a drug addict who goes and sees his drug dealer. His drug dealer's not going to say, 'this is bad for you.' He's going to sell him drugs. And all the people he hangs with that do drugs aren't going to encourage him to recover. They're going to encourage him to do drugs," Medina says.
"It's just like an alcoholic who hangs around with other alcoholics or a drug addict who goes and sees his drug dealer."
- Amy Medina
Something Fishy has more than 15,000 members. Medina and her husband monitor the chat room to make sure visitors abide by the rules. For example, no one is allowed to discuss their weight.
Many pro-anorexia sites, like Mrs. Slim's Starving for Perfection, have disclaimers that read something like this:
This site contains sensitive material that some may find disturbing. Also, if you are in recovery or do not believe in the pro-anorexia lifestyle, please leave now!
Something Fishy's Amy Medina says the disclaimers are legal cop outs. "I've been on the Web long enough to know: #1, people don't read disclaimers. #2, when I was headlong into my own anorexia, nobody could have ever told me what I was doing was wrong. I had to come to that decision on my own. And had I come to one of those Web sites, that would have allowed me the opportunity to compete with others and justify my illness, no disclaimer would have kept me out," she says.
Medina says eating disorders are about control - control over food in an attempt to control life and emotions.
"One of things we lost sight of is the fact that bodies are genetically predisposed to be all different sizes and shapes," says Kathy Kater, a psychotherapist based in St. Paul, who has specialized in the treatment of eating disorders for more than 20 years. "We want to believe it's more of a personal failing."
Kater says eating disorders should not be confused with diets. Someone with an eating disorder is willing to hurt themselves to be thin.
Kater says 75 percent of all teenage girls struggle with some degree of feeling dissatisfied about their bodies. She says fewer than 8 percent have a full-blown eating disorder. And a smaller percentage of teenage boys have anorexia or bulimia.
Kater worries about teens getting lured into a group on the Web that says this behavior is OK. "The most dangerous aspect of it is that those young people or adults - especially young people, I think - are susceptible to becoming part of a group those people who have not developed a full-blown eating disorder. If they log onto those sites, they can get caught up in very skewed and very dangerous ways of thinking. It's certainly very alarming," Kater says.
Rochester teens Elaine Edgewood and Annie Loomis say they don't go to the Web sites, but it's difficult to avoid other pressures such as the images in magazines and on TV.
"If the ideal image is still Barbie, that's what girls are going to work for for the rest of their lives," Edgewood says.
"TV and magazines - everybody looks like this: no hips - nothing - big boobs. They show Britney Spears and stuff like that to little girls and they think that's how they're supposed to be and they want to be her.
Several months ago a national movement fighting eating disorders put pressure on the Internet search engine Yahoo! to remove the Web sites that promote anorexia and bulimia. So, many have been shut down but several have just relocated to other servers.More from MPR