Contextualizing Eating Disorders

Just as 13 Reasons Why faced criticism for sensationalizing of suicide, Netflix’s new film To the Bone is stirring fears about how young viewers might perceive its depiction of eating disorders. The film follows a 20-year-old woman’s battle with anorexia as she enters an inpatient facility, meets residents struggling with similar addictions, and recognizes the strain her disease has on her family.

To the Bone has been praised by some for its portrayal of anorexia as an illness, rather than simply a desire to be thin, and for its hopeful-but-uncertain ending for Eli, the protagonist. But other elements of the film — dream sequences, indie-pop music, and a romantic subplot — have parents, educators, and health professionals worried that the movie glamorizes anorexia. And while movies and shows have been depicting eating disorders for decades, the internet has made it easy for kids to watch this content anywhere, anytime, and without parents nearby — or even aware.

We asked Josephine Kim, an educator, counselor, and faculty member at the Harvard Graduate School of Education, to share her thoughts on the risks the film poses for young people, and how educators can support young viewers and create a safe space to teach about eating disorders and mental health.

What are the risks of young people watching viral television shows and movies that portray difficult, even disturbing topics — To the Bone, 13 Reasons Why, etc. — without any external context or support?

Young people may have vivid imaginations, but it can be difficult for them to make helpful meaning of what they’re viewing because they are limited in life experience, maturity, and clinical knowledge. Without the support and guidance of a trusted adult who can contextualize complex mental health issues, they may attempt to mirror or simply distort what they see in the media.

In To the Bone, there is a valiant effort to portray thinness accurately, but the movie is still missing the realistic portrayal of “less-desirable” side-effects of eating disorders, such as hair thinning from anorexia or acid-eroded teeth from chronic vomiting. Anorexia displayed only as thin with stylish clothes and makeup may minimize the seriousness of the disorder and actually glorify it. Students may also intensely identify with the main character, who feels ill-fated and helpless, and believe that they are likewise destined for the same outcomes. And these types of shows and films rarely offer an evidence-based remedy.

Despite these negative effects, we know that teens are still going to watch the film. So what are a few ways that guidance counselors and teachers can acknowledge To the Bone and provide the context teens need to critically understand it?

The easiest yet most powerful way to acknowledge To the Bone in schools is to talk about it. Create spaces to discuss and unpack the societal, familial, and personal factors that were at play in Eli’s life, and allow students to discuss what resonates in their own lives. Give voice to Eli's self-harming attempts to control and make meaning of something that is beyond her control, and brainstorm with students about coping strategies.

To provide context, discuss the pressures to be thin and fit that society places not just on girls and women, but also boys and men, and how everyone is personally impacted on some level. Talk about mental health and how to maintain a healthy self-image, because those who are emotionally vulnerable will be impacted more than those who are not. Teach students about the full spectrum of eating disorders, their symptoms, and effective treatment methods, so that they have context to critically understand the film in a cognitive way.

I’d also suggest that educators actually bring the film into the school. What if a few carefully selected clips from To the Bone were watched together — teachers and parents with students within the confines of a safe space at school, so that authentic dialogue could take place in real time, facilitated by well-trained counselors?

More broadly, what are some ways school leaders can create safe spaces to talk about mental health?

School personnel are first responders and have the most access to students. Conversations about mental health should be routine, not a one-time discussion sparked by a horrible incident, so that mental health is destigmatized and normalized. Also, these discussions should not be isolated to the select few students whom adults deem to be needing such a space. Everyone, at one point or another, deals with mental health issues, and the best time to talk about mental health is now. Prevention is key. Homeroom check-ins, large classroom guidance lessons, lunch time discussions, PTO meetings, and parent-teacher conferences are all great opportunities to address issues that impact everyone, such as anger and stress management, coping strategies, societal pressures, self-esteem, and body image.