Healthy Living

As An Eating Disorder Therapist, I'm Worried After Seeing Netflix's 'To The Bone'

It plays out a lot of tired old stereotypes about people with eating disorders.

Netflix’s new movie “To The Bone” opens with a warning that reads, “The film was created by and with individuals who have struggled with eating disorders, and it includes realistic depictions that may be challenging for some viewers.”

While it’s partly true that some of the more realistic elements of the film could be incredibly triggering for those who are struggling with eating disorders (as well as for individuals who have the underlying genetics to develop an eating disorder), there’s also so much about this film that actually just perpetuates dangerous myths about eating disorders and recovery.

The movie, which was written and directed by Marti Noxon and stars Lily Collins and Keanu Reeves, depicts a young woman’s battle with anorexia. It has been met with a lot of controversy, especially within the eating disorder recovery and treatment community.

I think the creation of this film was well-intentioned. The director and lead actress both shared that they have personally struggled with eating disorders in the past and that their aim was to raise awareness and to diminish shame and secrecy.

Raising awareness of eating disorders and decreasing shame and stigma surrounding seeking help is crucial. One of the positive aspects about the film is that it is opening a larger conversation about eating disorders and seeking treatment.

However, as an eating disorder therapist in private practice in Rockville, Maryland, I have some major concerns about the way anorexia is being depicted in this movie and the impact that this can have on individuals.

Concerns About The Movie

As an eating disorder specialist, I know that often people with eating disorders struggle with the thought of “not being sick enough to need treatment.” This is a common eating disorder thought, and the problem with the depiction of eating disorders in this film is that it perpetuates the myth that people with anorexia always appear visibly emaciated.

The film also goes out of its way to highlight Ellen’s frail appearance, with close-up shots of her spine and a scene where she takes her clothes off to reveal an emaciated frame. Therefore, I’m afraid people might view this film and think because they don’t appear “as thin” as Ellen they do not deserve to seek treatment.

It also worries me that this movie is educating the general public along these same lines as well. For instance, so many people with eating disorders have experienced friends, family and treatment professionals saying incredibly damaging things such as, “You don’t look like you have anorexia.”

It’s important to note that eating disorders (including anorexia) can impact people of all different shapes and sizes. You can be considered “normal weight” or “overweight” (I dislike these terms but use them to make my point) and intensely struggle with an eating disorder.

You cannot tell who is struggling with an eating disorder by looking at them. Eating disorders are one of the few mental illnesses where we judge someone’s level of suffering based on their physical appearance. No matter what your body looks like, you deserve to seek treatment and support.

“Eating disorders are one of the few mental illnesses where we judge someone’s level of suffering based on their physical appearance.”

The movie does depict a woman in a larger body; however, she of course struggles with binge eating disorder. Again, this is perpetuating the myth that you can tell what kind of eating disorder someone struggles with based on their body size, which is blatantly false.

Does The Movie Glamorize Anorexia?

I have a lot of compassion for the director and producer of the film, as it’s very difficult to make a movie about anorexia without glamorizing the illness.

However, the issue here is that the lead character, Ellen, is super likable, glamorous, and “cool” as she is struggling with this deadly disease. Anorexia is not Lily Collins with a perfectly done smokey eye, staring sullenly out of the window, cracking funny/sarcastic one-liners, and enjoying fun escapades with friends and family.

Anorexia is often feeling too depressed to want to leave your house. It’s isolating yourself from friends and family because you are afraid to be around food. It’s constant thoughts about food 24/7 and intense anxiety. For some, it’s hair falling out, low heart rate and osteopenia (however, even if you have no medical complications, you still deserve to seek treatment). It is a voice in your head that’s constantly yelling at you. It is feeling completely trapped. It’s not being able to find pleasure in things. It’s becoming a shell of your former self.

While the movie attempts to show some of these complications, it’s easy to see how for those with the underlying genetics, temperamental, and psychological factors, this could easily become “aspirational.”

“Anorexia is not Lily Collins with a perfectly done smokey eye, staring sullenly out of the window, cracking funny/sarcastic one-liners, and enjoying fun escapades with friends and family.”

Eating disorders are not glamorous, they are miserable and can be deadly. If you are struggling, you deserve to seek treatment and support.

The Movie’s Depiction Of Treatment And Recovery

I think the makers of the movie tried to highlight that anorexia is not simply about “wanting to be thin” and that it can have a devastating impact on family members, which was great.

However, the movie missed the opportunity to dive deep and provide any real insight into the underlying causes of the illness (not once did they mention genetics) as well as how to effectively treat eating disorders.

Further, the treatment approach shown in the movie is not at all realistic of eating disorder treatment. For instance, the woman with binge eating disorder randomly eats jars of peanut butter at every meal. Patients are allowed to choose their own food, and there appears to be little staff monitoring. Additionally, little is shown of the actual therapy component or of Ellen’s recovery journey. This aspect would actually have been helpful to highlight, as this depiction only serves to promote misconceptions about treatment and recovery.

While hardly any of the actual treatment and recovery process is highlighted, specific eating disorder behaviors and “tricks” that people use in treatment are highlighted in abundance. Specific calorie counts are referenced, as are “lowest weights,” and a variety of detailed eating disorder behaviors that I will not reference here due to my desire to not unnecessary trigger anyone.

We know that this kind of content can be highly triggering to people with the underlying genetics for an eating disorder and for this aspect alone, i’m highly concerned about the impact that it will have.

“While hardly any of the actual treatment and recovery process is highlighted, specific eating disorder behaviors and 'tricks' that people use in treatment are highlighted in abundance.”

Further, the doctor at one point advises Ellen’s family to “let her hit bottom” (terrible advice, and how are we determining “bottom” here, exactly?!) and tells Ellen that he doesn’t want to treat her if she isn’t interested in getting well. If many people with eating disorders waited until they “wanted to get better” to seek treatment, they would never seek treatment. Part of the illness is often an inability to see how “ill” that you actually are.

Also, the movie doesn’t provide any resources for people who watch it and wish to seek help. It would have been easy for them to have a message at the end referencing The National Eating Disorder Association helpline; however, they chose not to do so.

I was expecting to be riveted by the film, especially given that working with people with eating disorders is my passion. However, I didn’t actually even find it that interesting. It plays out a lot of tired old stereotypes about people with eating disorders, and while the main character is likable, I felt that the storyline overall fell flat.

Ultimately, while I’m thankful that it’s prompted a larger discussion about eating disorders and raised awareness, I don’t think that it added anything new or helpful to the conversation.

The Bottom Line

If you or someone you know thinks that they might be struggling with an eating disorder, it’s so important to reach out for help from a professional.

Seeking help when you are struggling is a sign of true strength, not weakness. No one should have to struggle with an eating disorder alone.

With access to treatment and support, individuals with anorexia can recover and go on to lead meaningful and purpose-driven lives. Full recovery is possible!

Jennifer Rollin, MSW, LCSW-C: is an eating disorder therapist in private practice in Rockville, Maryland. Jennifer specializes in helping teens and adults struggling with anorexia, binge eating disorder, bulimia, compulsive exercise, and body image issues. Jennifer provides eating disorder therapy in Rockville, MD. Connect with Jennifer through her website: www.jenniferrollin.com

If you’re struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.