Disordered eating in a digital age: Eating behaviors, health, and quality of life in users of websites with pro-eating disorder content

Rebecka Peebles, Jenny L. Wilson, Iris F. Litt, Kristina K. Hardy, James D. Lock, Julia R. Mann, Dina L.G. Borzekowski

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


Background: Much concern has been raised over pro-eating disorder (pro-ED) website communities, but little quantitative research has been conducted on these websites and their users. Objective: To examine associations between levels of pro-ED website usage, disordered eating behaviors, and quality of life. Methods: We conducted a cross-sectional, Internet-based survey of adult pro-ED website users. Main outcomes were Eating Disorder Examination Questionnaire (EDE-Q) and Eating Disorder Quality of Life (EDQOL) scores. Results: We included responses from 1291 participants; 1254 (97.13%) participants were female. Participants had an average age of 22.0 years and a mean body mass index of 22.1 kg/m2; 24.83% (296/1192) were underweight; 20.89% (249/1192) were overweight or obese. Over 70% of participants had purged, binged, or used laxatives to control their weight; only 12.91% (163/1263) were in treatment. Mean EDE-Q scores were above the 90th percentile and mean EDQOL scores were in the severely impaired range. When compared with moderate and light usage, heavy pro-ED website usage was associated with higher EDE-Q global (4.89 vs 4.56 for medium and 4.0 for light usage, P < .001) and EDQOL total scores (1.64 vs 1.45 for medium and 1.25 for light usage, P < .001), and more extreme weight loss behaviors and harmful post-website usage activities. In a multivariate model, the level of pro-ED website usage remained a significant predictor of EDE-Q scores. Conclusions: Pro-ED website visitors reported many disordered eating behaviors, although few had been treated. Heavy users reported poorer quality of life and more disordered eating behaviors.

Original languageEnglish (US)
Article numbere148
JournalJournal of medical Internet research
Issue number5
StatePublished - 2012
Externally publishedYes


  • Anorexia nervosa
  • Bulimia nervosa
  • Eating disorder
  • Pro-ED
  • Pro-ana
  • Pro-anorexia website
  • Pro-bulimia website
  • Pro-eating disorder website
  • Pro-mia
  • Social network

ASJC Scopus subject areas

  • Health Informatics


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