Mixed Messages

The study found that eating-disorder patients can get new, often harmful ideas from pro-ana and pro-mia sites. Researchers report that 96 percent of respondents who visited pro-eating-disorder sites said they learned new weight-loss or purging techniques; so did 46 percent of respondents who visited pro-recovery sites. Seven out of 10 users of pro-eating-disorder sites said they used the new techniques they learned; a third used new diet pills, supplements or laxatives. Parents had little knowledge of their teens' visits to these sites.

To conduct the study, Stanford researchers sent anonymous surveys to 698 families of patients, ages 10 to 22, treated for an eating disorder by the Adolescent Medicine Division at Stanford between 1997 and 2004. Respondents included 76 patients and 106 parents. Of the patients, 35.5 percent reported visiting pro-eating-disorder sites, defined in the study as "communities of individuals who engage in disordered eating and use the internet to discuss their activities." Also, 41 percent said they went to pro-recovery sites, which the study describe as having "a recovery-oriented perspective." And 25 percent visited both ,while 48.7 percent visited neither. It's not surprising that anorexics may visit both pro-eating-disorder and pro-recovery sites, says Peebles. "Part of them wants to get better and part wants to stay sick."

Pro-ana and pro-mia sites deny being harmful, saying they provide a community for those with eating disorders. (The term "pro-ana" is widely used and sites vary.) "Most people that come to our Web site already have an eating disorder, and they're looking for support from other people with eating disorders," says Anna Robbins, a 23-year-old mother of two who owns proana.us, a large pro-anorexia Web site. "It's impossible to get one [an eating disorder] from a Web site." She says she is not promoting anorexia and notes that her site includes a psychiatrist. "We don't want anyone going into the hospital and needing a feeding tube," she says. "I do not show nudity or disgusting images such as emaciated people. I think that would be a trigger to someone who may be thinking about recovery."

Robbins, who carries 89 pounds on her 5-foot frame, thinks "thinspiration" photos of celebrities (and others) are fine. "They see celebrities are just as normal as we are, they suffer the same things we do," she says. After "American Idol" contestant Katharine McPhee said she was bulimic, "a lot of people felt a lot better about themselves—they felt normal," she says. Her site helps girls, she says. "A lot of these girls come out here, and they want to kill themselves. We offer them support, saying it will be OK. Continue going to your doctor, we're still here, we'll talk to you." As a result of her disease, Robbins says she suffers from low blood pressure, a heart murmur and an irregular heartbeat. She also always feels cold and thinks constantly about food.

The sites may show pictures of singer Karen Carpenter and note that she died of anorexia. But in general, they don't focus on bad news—such as the Nov. 14 death of Brazilian model Ana Carolina Reston, 21, who suffered from organ failure brought on by anorexia. At 5-foot-7 and 88 pounds, Reston—who had modeled for Giorgio Armani—reportedly subsisted on tomatoes and apples. And this August another model, Luisel Ramos, 22, of Uruguay, who reportedly consumed little more than lettuce and diet soda, died from heart failure. (Anorexia nervosa patients can suffer from an abnormally low heart rate, dry skin, anemia, kidney dysfunction, cardiovascular problems, changes in brain structure and osteoporosis.) "They don't highlight the negative," says Dina Borzeko, a professor of health communication at Johns Hopkins University. She is studying how to present healthy messages about nutrition and physical activity through the Internet.

Many feature thinspirational photos (from shots of Audrey Hepburn to disturbing pictures of rib-protruding unknowns) and "tips and tricks" for eating less or vomiting. Often the message seems to be that Web-site visitors are in good company. Anorexics.net—which bills itself as a "friendly community" rather than a recovery or pro-ana site—features celebrity photos of luminaries like psychoanalyst Anna Freud ("documented that she struggled with anorexia"), poet Anne Sexton ("has struggled with anorexia and depression"), actress Audrey Hepburn ("103 lbs. at 5'7"), Princess Diana of Wales ("suffered from bulimia for years") and others.