Can filmmakers portray eating disorders in a way that raises awareness without contributing to the problem?
A new film from Netflix, “To the Bone,” has courted controversy with its portrayal of a young woman’s struggle with anorexia.
Some experts and advocates welcome the attention the film is bringing to eating disorders.
But many have also raised concerns about the film’s graphic depictions of emaciated bodies and eating disorder behaviors.
“As an eating disorder treatment provider and a professional who works with many courageous and inspiring individuals and families each day, watching ‘To the Bone’ left me feeling disappointed,” Dr. Stuart Koman, president and chief executive officer of Walden Behavioral Care, said in a statement issued earlier this month.
“While it does cast much-needed awareness about eating disorders, which have the highest mortality rate of any mental illness, it is triggering and reinforces many stereotypes about eating disorders and recovery,” he added.
Robyn Cruze, the national recovery advocate for Eating Recovery Center Denver, shares some of Koman’s concerns.
But she also welcomes the platform the film has provided for constructive dialogue.
“Some people who are in early recovery will be triggered by the film, and as an advocate and someone who has been through recovery, I completely empathize with them,” she told Healthline.
“If you’re further along in recovery and don’t agree with the film,” she continued, “consider what you would have liked to see differently, and use the platform the film has provided to bring further awareness about recovery. Use the film’s platform to contribute to the message that there is help, and recovery is so very possible.”
Graphic on-screen depictions
“To the Bone” focuses on the experiences of Eli, a young woman with anorexia nervosa. It also features characters with bulimia nervosa and binge eating disorder.
Many experts and eating disorder survivors have warned that some of the film’s scenes can evoke painful emotional responses.
“I think this film is going to be triggering for people who have been affected by eating disorders, whether you’re a family member or friend or someone who’s struggled with it yourself,” Bonnie Brennan, MA, LPC, CEDS, senior clinical director of adult services at Eating Recovery Center Denver, told Healthline.
Brennan highlighted the film’s graphic depictions of extreme thinness, which may be challenging for some viewers to see.
Its on-screen portrayals of eating disorder behaviors, such as calorie counting and excessive exercise, may also pose risks.
In fact, the National Eating Disorder Association warns that well-intentioned depictions of emaciated bodies and eating disorder behaviors can not only trigger painful emotions. They can also serve as inspiration or how-to guides for people with eating disorders.
“As advocates, we often talk about sharing our story responsibly,” Cruze said. “We talk about keeping numbers out, keeping weight out, keeping calorie counts out. They utilized those things, and I would have liked not to see that.”
Social support and values-focused treatment
Although Brennan and Cruze expressed concerns about some of the film’s contents, they also appreciated its focus on social support as a factor that influences recovery.
“It’s not just an illness that the main character was struggling with alone,” Brennan said. “You see the pain of her parents who are trying to connect with her, the pain of her sister who is fearful that she might die, and all the different ways that people are trying to help this person.”
“The film shows how the family might not get it perfectly and might not be able to completely understand, but that doesn’t mean that they can’t be helpful in recovery,” she added.
Eli’s stepmother and stepsister encourage her to attend an in-patient treatment center.
The care she receives there is in some ways atypical, Brennan noted.
For example, compared to the film’s portrayal, treatment centers often provide more supervision and grant patients less freedom in choosing what they eat.
“The standard treatment is to provide a variety of food groups and encourage completion of meals, rather than just let patients pick and choose what they want,” Brennan explained.
On the upside, Brennan said she liked how the psychiatrist in the film asked individuals how they wanted to live their lives moving forward and who they wanted to be.
“That’s much in alignment with the Eating Recovery Center, where we have a values-focused approach. We believe that recovery is near impossible without that higher purpose or without that context of why you’re doing this hard work every day,” she said.
Recovery is possible
For those with a history of eating disorders, Koman advised against watching the Netflix film.
But Brennan and Cruze suggested that some people might be able to use it as a tool for reflection in their recovery process, with support from their treatment team.
“Meet with your treatment team and ask: Am I ready to watch it? Am I at a point in my recovery where I can take that story back to my treatment team and use it as a discussion for moving forward? When the answer is yes, go ahead and watch the movie. If not, work on your own recovery tools first,” Cruze said.
If you suspect that you or someone you love may have an eating disorder, it’s important to reach out for professional help, the experts added.
“You don’t have to wait until you’re as sick as you can be to reach out for help,” Brennan emphasized. “Actually, you’re much more likely to recover if you get treatment early on and quickly.”
Although the film focuses on a stereotypically thin and young white woman with anorexia, eating disorders can affect people of all ages, genders, backgrounds, and body types.