Online communities that portray eating disorders as a 'lifestyle choice' can have devastating consequences. Social media must pull together to promote a positive body image, writes Frances Lockie.

Online pro-anorexia, or pro-ana, communities have been around for almost as long as the Internet, but now it seems they are more accessible than ever.

The visual and interactive format of sites like Tumblr, Pinterest and Instagram are particularly effective at sharing thinspiration (also known as 'thinspo') tips and images, and the proliferation of content promoting eating disorders is an ongoing issue for these sites.

Encouraging people with eating disorders to continue with unhealthy behaviours can have terrible consequences. In 2012, it was estimated that almost one million Australians had an eating disorder. Anorexia has one of the highest death rates (between 10 and 20% in 20 years) of all mental illnesses. Survivors are at risk of physical damage such as osteoporosis, infertility, and kidney failure. Young women are particularly at risk; approximately 90% of people with anorexia and bulimia are female, with anorexia commonly appearing between the ages of 13 and 18. Anecdotally, and unsurprisingly, it is young women that make up the bulk of the pro-ana spaces.

Popular social networking sites have attempted to respond to the growing presence of pro-ana communities. In February 2012, Tumblr announced that it would shut down blogs hosted on its site which "actively promote or glorify self harm", including eating disorders. One month later, Pinterest amended its acceptable use policy to ban similar content. Instagram followed closely behind announcing on their blog that the service will not allow accounts, images, or hashtags that promote of self-harm. Each service now provides a content advisory warning on search terms commonly associated with pro-ana. In addition, Pinterest and Instagram provide a link to the National Eating Disorders Association (NEDA), an American non-profit organisation, and Tumblr provides a list of counseling providers across the world.

In spite of this, social networking sites have been unsuccessful at eliminating pro-ana and thinspo. A massive amount of prohibited content can still be found on each of the above sites. In the case of Instagram, users easily worked around the ban on pro-ana terms, such as using #thinspoooo and #thinspogram in place of the banned hashtags #thinspo or #thinspiration.

(It should be noted Instagram recently lifted its ban on #thinspo for no discernible reason. #thinspiration continues to return no results.)

The sites are reluctant to enforce the bans with an iron fist as it may stifle free and open discussion of eating disorders. Tumblr has stated that, while it will not allow the promotion of self-harm, “We absolutely want Tumblr to be a place where people struggling with [conditions like anorexia and bulimia] can find solace, community, dialog, understanding, and hope.” Instagram has made a similar statement in their Community Guidelines, stating that “We believe that communication regarding these behaviors in order to create awareness, come together for support and to facilitate recovery is important”. Eating disorders are incredibly isolating diseases, and it is recognised that posting in pro-ana spaces can help people struggling feel less alone.

A study by Daphna Yeshua-Katz and Nicole Martins of Indiana University discovered exactly that: in addition to the negative effects of pro-ana, such as encouragement of disordered eating, bloggers also found their involvement in the community was a way to gain social support. According to Martins, "From the outside looking in, this looks like a really disturbing community, but I think that the fact that these women are able to find support from one another and find a place where someone understands what they're going through is a really good thing.”

Organisations are beginning to respond to this need for community amongst people with eating disorders by proving positive online support. Sites like Proud2bme have launched in the Netherlands and the US and promote positive body image and encourage healthy attitudes about food and weight. But until more viable alternatives to the acceptance provided by pro-ana communities are found, decreasing their online presence will be an uphill struggle.

Frances Lockie is a Sydney-based writer who spends way too much time on the Internet.

If you need support or information about an eating disorder, please call the Butterfly Foundation on 1800 ED HOPE (1800 33 4673) or email support@thebutterflyfoundation.org.au.