Dying to Be Thin

Just one click of the mouse grants you immediate access to the disturbing and deadly domain of the women who are literally starving to be thin. Welcome to the world of "pro-ana, "an online community dedicated not to offering support and advice for anyone battling life-threatening eating disorders such as anorexia but to preventing their recovery.

These 1,000 or so sites feature "thin-spiration galleries" -- picture after picture of skinny celebrities such as Victoria Beckham and images of emaciated women with their ribs on show and close to death. These cyber-galleries and chatrooms, which claim that "being thin is more important than being healthy," were yesterday condemned by experts who say they deliberately encourage users to compete against each other to lose weight. Ministers have already held talks with internet providers to find ways of clamping down on them.

However, some clinicians say young women are turning to these websites because of a lack of proper support elsewhere and a postcode lottery in treatment for eating disorders. They blame the fact that adolescents and children are being fed conflicting messages about diet and health.

On one hand, they are the focus of anti-obesity campaigns, but then only have to switch on the television to be bombarded with images of junk food or read magazines featuring images of impossibly thin women.

The Eating Disorders Association says the focus on obesity takes the attention away from anorexia and bulimia, which are all about excessive weight loss and represent the flipside of a negative relationship with food.

"Not only does it take funding away but it means government messages are focusing on diet and exercise, which is what these people want to do to extinction," said Susan Ringwood, the charity's chief executive.

The fashion industry has also been singled out for criticism. Psychiatrists say that while the use by designers of size 0 models -- such as Lily Cole and Erin O'Connor -- on the catwalk does not trigger eating disorders in an impressionable teenager, they can prolong the time it takes for them to recover.

This is backed up by new findings published last week. The first major study into female attitudes to thin fashion models has found that their images can lower levels of self-esteem and lead to higher levels of depression. Published in the journal, The Psychology of Women Quarterly, the research found that exposure to "thin-ideal" advertisements increased body dissatisfaction.

Eating disorders now affect more than one girl in every 100. Although 90 per cent of cases are female, boys are not immune. Increasing numbers of male patients who have an unhealthy relationship with food are being referred by doctors for treatment.

The deadly compulsion to starve or purge to stay thin also no longer respects class or race. Once anorexia and bulimia only afflicted well-educated and white, middle-class women. Now Asian and black people are seeking help, as well as those from working-class backgrounds.

Anorexia nervosa, in which sufferers restrict their food intake or starve themselves, is the third most common chronic illness of adolescence. Bulimia nervosa is even more common, but the secretive nature of the disorder coupled with the reluctance of sufferers to seek help means that it can go undetected.

And now experts have identified a new type of bulimia, unheard of 10 years ago. A third of patients seen by psychiatrists in eating disorder clinics are "multi-impulsive," which means not only do they binge on food then purge themselves, but they also express their inner despair by cutting, overdosing and abusing alcohol. Sane, the mental health charity, has picked up on this worrying new trend. Its helpline staff report a rise in callers suffering from eating disorders who are also self-harming.

The effects of acute eating disorders can be hugely damaging. Acid in the food brought up from the stomach damages the oesophagus and may cause bleeding and also erodes tooth enamel. In chronic cases it can cause kidney failure.

The nation's abnormal relationship with food is just as worrying at the less acute end of the eating disorder scale. An estimated 11 million Britons have psychological issues or problems connected to food, with young people between the ages of 15 and 24 particularly at risk. A survey by the Priory found that people are resorting to disordered eating, in which they comfort themselves with sweets and junk food in a desperate attempt to cover up deeper psychological issues such as negative feelings and low self-esteem.

Professor Hubert Lacey, a leading expert on eating disorders, said that society's "preoccupation" with thinness and body size has contributed to the increase in severity of eating disorders. He also warns that a lack of specialist services means that many women are not getting the help they need in the form of therapy.

"The preoccupation with weight and shape is ubiquitous because of the judgement on women," said Mr Lacey, a professor of psychiatry at St George's Hospital, London. "One of the increasing problems women face is that desired body shapes change according to a woman's role, but the fact is they cannot change their bodies."

In 2004, the NHS watchdog, the National Institute for Clinical Excellence (Nice), issued new guidance to doctors in which it said that a holistic approach was needed in caring for those suffering from anorexia nervosa, bulimia nervosa and conditions such as binge eating.

Nice recommended that people with eating disorders should have prompt access to a range of psychological therapies including so-called talking treatments, which help to boost self-esteem and overcome negative feelings. Families and siblings of children and adolescents with eating disorders, said the guidance, should all be included in learning about the condition because they can also be affected.

However, experts warn that, two years on, a postcode treatment lottery exists, with some parts of the country still without the specialist teams needed to help patients recover. The result is that some trusts are sending them to private clinics miles away from their homes and families and at great expense to the NHS.

South London and Maudsley NHS Trust in London treats around 200 anorexics a year and has a total of 30 hospital and residential beds which are always full. Its clinic says that it has a problem getting NHS funding and that waiting lists for out-patient treatment are getting longer.

Lisa Lewer, a nurse consultant at the Ellern Mede Centre in north London, warns of a "shortage within a shortage" of specialists. The age range of her patients is from eight to 18, and staff receive people from as far away as Sheffield because of the demand. "We try to get young people in within two to three weeks, but there are waiting lists," she said. "There is a shortage of adolescent mental health beds anyway within the NHS and this is just another shortage within the shortage."

There is still a degree of stigma surrounding eating disorders. This, coupled with the lack of trained specialists, has led some experts to warn that increasing numbers of young people will turn to websites for support.

A report published this month by researchers at the University of Manchester on pro-anorexia websites says these sites are regarded by sufferers as a form of "self-management."

There is some evidence that more people are searching the internet for pro-anorexia websites. Research carried out by Hitwise UK, which analyses internet traffic, has found that one pro-ana site has gone up in popularity ranking from the 350,000th most visited site a year ago to the current frequency of 40,000th.

But Dr Ulrike Schmidt, an expert on eating disorders, says that patients, especially anorexics, who surround themselves with "pro-ana porn" are delaying their recovery.

"People with anorexia see it as virtuous and a good thing, and that it has a meaning," said the professor of eating disorders at Kings College, London. "But if you surround yourself with this pro-ana porn it could keep you ill."

Additional reporting by Lauren Veevers

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