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Here's some advice to give parents who have a daughter with an eating disorder: monitor her internet activities. The World Wide Web includes a number of interactive sites that actively promote anorexia and bulimia. In a study published electronically in Pediatrics last month, researchers found that patients at an eating disorder clinic at Stanford University often visited these sites, picking up so-called thinspiration images of obviously (to the pediatricians' eye, certainly) anorexic and indeed cachetic women modeling the latest fashions, performing as ballet dancers and gymnasts, offering themselves as role models to eating disordered teens seeking validation of their way of life. (Wilson JL, Peebles R, Hardy K et al: Surfing for thinness: A pilot study of pro-eating disorder Web site usage in adolescents with eating disorders. Pediatrics 2006;118:316355). These pro-eating disorder sites are, in the authors' words, "communities of individuals who engage in disordered eating and use the internet to discuss and reinforce their activities." The teens get more than validation: Almost all (96%) of the respondents to an anonymous survey reported learning new weight loss and purging techniques from the sites. (Samples from the Tips and Tricks portion of a randomly chosen site: "When you get hunger pains, curl up in a ball. It helps them go away," "Go into the kitchen and open and close the refrigerator, so your parents will think you're getting a snack," "Drink some vinegar before a meal. It tastes terrible, but it makes you less hungry.")

Interestingly, the researchers also found that so-called pro-recovery sites, ostensibly intended to help teens who want to get over their disorder, are also a potent source of information on how to keep from eating or induce vomiting. Almost half the respondents reported learning new techniques from such sites. Parents of these respondents weren't clued in to where their daughters were finding support: More than half of the parents who participated in the survey did not know their daughters were visiting pro-eating disorder or recovery sites.

Pro-eating disorder sites are not hard to find. Google "thinspiration," and you'll find plenty of them. Your parent education on this subject should warn of these internet enablers.

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