Faithful to Ana

WARNING: THIS PAGE CONtains graphic material. Do you still wish to enter?" The advisory isn't for a pornographic website. Instead it warns off Web-surfers who don't wish to see "bone pictures"-photos of women who have starved themselves skeletal. What follows are eight pages of women posing, often proudly, with sunken eyes, jutting clavicles, cage-like torsos, and arms so thin they look like chicken drumsticks with the flesh gone.

This is the world of "pro ana/pro mia," the term used by young women (and some men) who embrace eating disorders (ED) as a lifestyle. Historically, ED victims have suffered alone, slowly starving themselves in secret. But the Internet has provided a meeting place where "pro anorexia" and "pro bulimia" people trade tips and encourage each other to "stay faithful to 'Ana,'" the personified name for anorexia nervosa.

Eating-disorder experts say the sites can delay or deny recovery for ED sufferers seeking a way out. At worst, they may prove fatal.

Eight million Americans suffer from eating disorders, according to the National Association of Anorexia Nervosa and Associated Disorders (NAANAD). The most common are anorexia nervosa and bulimia nervosa, in which victims, often driven by dungeon-low self-worth and an obsessive-compulsive need for control, slash their food intake in an ill-conceived quest for physical perfection. Anorexics essentially starve themselves thin. Bulimics eat, often "bingeing," then induce vomiting to "purge" food before it can turn into weight gain.

The physiological toll of such disorders includes severe heart, kidney, and liver damage, as well as malnutrition, intestinal ulcers, ruptured stomach, and, in an estimated 6 percent of cases, death. The ED fatality rate is the highest of any psychiatric illness.

Mimi Ward was 16 when she began to binge and purge. Now 35, she has considered herself fully recovered for four years. But she had not recovered when she first came across pro-ana websites on the Internet. "They scared me to death," she remembers. Ms. Ward, now a merchandiser living in Chicago, knew her bulimia was something she needed to escape. "People enter these sites looking for help, but instead find people ... encouraging them to do their [eating disorder] behaviors."

Encouragement comes in the form of advice on how to conceal an ED from loved ones, which foods are best for throwing up, and how to "safely" use laxatives and diuretics to promote weight loss. One site includes a "Letter to Ana" which includes a pledge "to fear food, and to see obese images in the mirror. I will worship you and pledge to be a faithful servant until death does us part. If I cheat on you [with fast food] ... I will kneel over my toilet and thrust my fingers deep in my throat and pray for your forgiveness."

While that pledge shimmers with instability, the same site uses more rational-seeming language to explain pro-ana thinking: "Pro Ana is a movement of empowerment among females and males that have an eating disorder and do not want to recover.... The people of Pro Ana do not encourage other girl[s] or boys to get an eating disorder."

Holly Hoff disagrees. Ms. Hoff, executive director of the National Eating Disorders Association (NEDA), said pro-ana sites by default encourage young people "to experiment with dangerous behaviors."

Although it is a nonsectarian group, NEDA's philosophy reflects the scriptural teaching that a person's interior-not her external appearance-is of paramount importance: "We want girls to stop weighing their self-worth in pounds on a scale."

Ms. Hoff first heard about pro-ana sites three years ago from an ED sufferer who'd been looking online for help, found pictures on a pro-ana website, and wound up feeling worse. In the summer of 2001, NEDA contacted the Internet service provider (ISP) and search-engine giant Yahoo. The firm agreed that some pro-ana sites violated Web-hosting rules that prohibit harmful content, particularly content harmful to minors. Yahoo and other ISP/search-engines pulled the plug on numerous pro-ana sites.

But that didn't end the problem. Although NEDA's campaign made it more difficult for pro-ana site creators to find a Web home, WORLD had no trouble finding rogue outposts. Meanwhile, pro-ana groups are creating chat rooms embedded in other sites, making them more difficult to track.

NEDA is combating both by strengthening its own website (nationaleatingdisorders.org) as an information and referral source. "We want people to understand that eating disorders are not a lifestyle choice," Ms. Hoff said. "They're a disease."