People with anorexia have a distorted body image, are typically severely underweight and are terrified of gaining an ounce, often restricting calories to the point of near starvation. Individuals with bulimia may not be underweight, but engage in a dangerous cycle of binge eating and purging. Both of these eating disorders can wreak havoc on the body, causing heart failure and death. For anyone who has suffered from an eating disorder and is in recovery, or for parents who have witnessed their children become emaciated, pro-anorexia websites seem like the cruelest joke. Anorexia is not a lifestyle, it is a serious psychiatric disorder with the highest mortality rate of any mental illness.1 Studies show individuals with anorexia have more than five times the risk of dying as the rest of the population. Moreover, 15- to 34-year-old women with anorexia nervosa are 18 times more likely to die by suicide, compared to females in that same age range in the general population.2 Tragically, at least one person loses their life as a direct result of an eating disorder, every 62 minutes.1 Pro-Ana Websites Starting around 2010, the words \u201cpro ana thinspiration\u201d and \u201cthinspo\u201d were trending on social media, supposedly as motivation for heathy weight loss. Back then, social media was in its infancy, with just a few options for young people, most notably Facebook and MySpace. Since then, a proliferation of websites, blogs, forums and Instagram posts provide an explicit, 24\/7 step-by-step guide to becoming anorexic. The truth is, these sites are far more likely to propagate body image problems in vulnerable teens than promote healthy lifestyles. In these dark and private spaces, anorexia is celebrated and embraced as a lifestyle, with \u201cfake news\u201d pitched to incredibly impressionable individuals seeking acceptance.2 How can pro-ana websites survive and thrive and what philosophies do they preach? Consider one website, run by Jade, a 24-year-old British woman who calls herself an \u201cana veteran.\u201d At the top of the home page is a red banner reading, \u201cAnorexia is a lifestyle, not a disease.\u201d The goal of Jade\u2019s website is to provide \u201ctips, tricks and information\u201d to facilitate living with an eating disorder. Jade said these are \u201cgirls who are desperate in their anorexia and willing to do anything to lose weight. They are sick, but they don\u2019t see it as an illness. I\u2019ve been anorexic for 10 years and I know this is the way I want to live.\u201d Jade helps and encourages readers to embrace their eating disorder, writing, \u201cI eat three meals a day but make sure I never take in more than 50 calories,\u201d and \u201cI\u2019ve reached a point where I can go without food for three or four days. You can do it too, but it will take discipline and hard work.\u201d3 Limited Research on Pro-Ana Websites Hospitalizations for eating disorders increased by 24% in the U.S. from 1999 to 2009 and nearly doubled in the U.K. from 2010 to 2013. It is nearly impossible to draw a conclusive connection between these websites and rising anorexia prevalence due to their ever-evolving nature and the many complex factors involved in the disease. A few studies have indicated evidence of a link. A 2010 study published in the European Eating Disorders Review showed when healthy weight female college students were exposed to pro-ana websites for just 1.5 hours, their food intake decreased the following week by almost 2,500 calories.3 A different 2010 study conducted by researchers at Johns Hopkins Bloomberg School of Public Health on 180 active pro-anorexia (pro-ana) and pro-bulimia (pro-mia) websites revealed alarming findings. An estimated 84% of the sites surveyed offered pro-anorexia content, while 64% provided pro-bulimia content. About 83% provided obvious suggestions on eating disordered behaviors, such as how to engage in extreme exercise, go on a multiple-day fasts, purge after meals and conceal rapid weight loss from concerned family and friends. The vast majority posted \u201cthinspiration\u201d photos of extremely thin models and celebrities, sending a dangerous message that anorexia is not only acceptable but laudable.4 Virtually Anorexic\u2014Where\u2019s the Harm?, a 2012 report on pro-anorexic websites by an associate professor at England\u2019s University Campus Suffolk, discusses the chain reaction that occurs when people with eating disorders discover these sites. As their social isolation increases, the more they rely on these sites to support their obsessions, which leads to increasing depression. Some of these pro-ana blogs and websites imply anorexia is an act of extraordinary willpower and unique opportunity to find oneself. They appeal to people with anorexia because they defend and even celebrate the pride and exultation many feel but hide about their emaciated figures, growling stomachs and protruding bones.2 A recent study on anorexia and bulimic individuals who were followed over the course of 20 to 25 years challenges the notion that eating disorders are a life sentence. The evaluation at the end of the first decade (average nine years) revealed 31.4% of individuals with anorexia had recovered, while 68.2% of those with bulimia achieved recovery. After 22 years, these percentages increased to 62.8% and 68.2% respectively, for anorexia and bulimia.5 Current research indicates early intervention improves the likelihood of long-term recovery. If your daughter or son is struggling with an eating disorder, be vigilant about their activities and seek prompt professional help. \tEating Disorder Statistics. National Association of Anorexia Nervosa and Associated Disorders website. http:\/\/www.anad.org\/get-information\/about-eating-disorders\/eating-disorders-statistics \/ Accessed May 20, 2017. \tMariani M. How Pro-Anorexia Websites Exacerbate the Eating Disorder Epidemic. Newsweek. June 23, 2016. http:\/\/www.newsweek.com\/2016\/07\/01\/pro-ana-websites-anorexia-nervosa-473433.html Accessed May 20, 2017. \t\u2018Anorexia is a lifestyle, not a disease\u2019: An investigation into harrowing online forums promoting extreme dieting. National Post website. http:\/\/news.nationalpost.com\/news\/anorexia-is-a-lifestyle-not-a-disease-an-investigation-into-harrowing-online-forums-promoting-extreme-dieting Published February 25, 2014. Accessed May 20, 2017. \tStudy Examines Pro-Anorexia and Pro-Bulimia Websites. Johns Hopkins Bloomberg School of Public Health website. http:\/\/www.jhsph.edu\/news\/news-releases\/2010\/borzekowski-e-ana-websites.html Published June 17, 2010. Accessed May 20, 2017. \tGiven time, most women with anorexia or bulimia will recover. Science Daily website. https:\/\/www.sciencedaily.com\/releases\/2016\/12\/161220140917.htm Published December 20, 2016. Accessed May 20, 2017.