Lily Collins: Eating Disorder Expert Says She's Doing Better Than Feared

Months before Netflix released the provocative film To The Bone, people were worrying about Lily Collins, the star actress who lost a significant amount of weight to portray a struggling young anorexic. For someone like Collins, a former anorexic herself, losing weight sounds like a recovering alcoholic having a drink: certain relapse and ill health, if not death.

One LA eating disorder therapist who should know isn’t all that worried about Collins. That’d be Carolyn Costin, who has treated the likes of Portia de Rossi, Katharine McPhee, among other eating-disordered actresses.

What this therapist to the stars knows about Collins comes from extensive conversations she had with the actress and director Marti Noxon in preparing for a panel discussion at a special screening of To The Bone. Of course, Costin has also examined the same photographic evidence the world has examined of the 28-year-old actress restoring herself on an Italian beach, looking fabulous like she’s restored her weight, too.

I know Costin professionally, so I expected this renowned therapist and founder of a highly-acclaimed treatment program had good reason for suggesting we all stop worrying about Collins’ weight and well-being. But this enquiring mind needed to know why. Plus, I wanted Costin’s professional take on the actress, the film and the ongoing hysteria about both.

As an eating disorder therapist myself, I’ve got my own take, but knowing what I know about this esteemed colleague and out-of-the-box thinker, I expected her considered opinion would go a long way toward quieting worries, if not challenging assumptions and broadening perspectives.

Long story short, I interviewed Costin via email. What follows is an edited version of that interview. To read the full interview, click here.

Q. Tell me about your meeting with Lily Collins and Marti Noxon.

A. Prior to a panel I moderated at a film screening sponsored by the nonprofit eating disorder organization Project Heal, I spoke for almost three hours with Lily and Marti. I was struck by Lily’s vitality and resilience. I asked her if she was back to where she was prior to losing the weight, and she said yes. Of course, I can’t prove that, I have no record of her weight. But, as a therapist, I value my instincts, and Lily is fine. Not only did she not relapse, she found the entire experience [of portraying an anorexic] insightful and therapeutic.

Q. You’re aware of Collins’ decade-long struggle with anorexia and bulimia, and yet you’re the rare therapist who doesn’t seem to have a problem with her losing weight for the film. Why is that?

A. When I first heard about [Lily’s weight loss], I felt very concerned. But after talking with Lily and Marti, I learned about the care and thinking that went into her decision, including the medical and nutritional monitoring that took place. I would [never] recommend [anyone with an eating disorder history lose weight], but people make their own choices. We all have to accept that this happened, and, so far, everyone’s worst fears, including my own, have turned out not to be true.

Q. You say that “Lily is fine,” and yet, as someone who’s personally struggled with anorexia and professionally counseled countless anorexics, you know better than most that people with eating disorders are incredibly skilled at acting as if everything’s fine. Given that Collins is both a skilled actress and a former anorexic, how would you know how she’s really doing?

A. The truth is, I don’t know. In fact, with eating disorders you often cannot know. There is no blood test or urine screen like you can give someone with a chemical dependency. You can see if the person with an eating disorder seems to have a healthy weight. The photos of Lily after a swim in Italy certainly don’t show an emaciated girl. But eating disorders come in all shapes and sizes, and Lily is an actress. So I can’t say with certainty exactly how fine Lily is. What I can say is that I took Lily at her word.

Q. You also say that casting a recovered anorexic willing to lose weight (vs. an actress currently suffering with anorexia or a normal weight actress) was the best of all casting alternatives. Please explain.

A. I actually said that any of the alternatives would have brought criticism from the eating disorder community, and that I haven’t seen anyone propose a better alternative. This is not a story about any eating-disordered person, it’s the story of director Marti Noxon’s personal experience with anorexia. The reality of her illness is that she was extremely thin. A different movie could have been made about a person with an eating disorder who is normal weight, but that wasn’t Marti’s story. That wasn’t this movie.

Q. Collins describes the film as a “therapeutic experience.” And yet, it wouldn’t be the least bit surprising if the experience of portraying an anorexic ends up triggering a relapse or the onset of another destructive habit. Your thoughts?

A. I am a firm, ardent and vocal believer that one can be recovered from an eating disorder. I am recovered for over 42 years now, and I don’t think there is anything that would cause me to relapse…. No one can tell if someone is not really recovered, and no one can predict if he or she is going to engage in this or that behavior. It’s not possible; it’s not fair, and it’s not right.

Q. In your professional opinion, who should see To The Bone and why?

A. Anyone who sees the film will learn a few things, see some realistic portrayals of patients, and will [end up with more questions than answers]. But that is exactly what Marti had in mind. Her hope is to promote a conversation about an illness that is still not well understood by the public.

Those with an eating disorder history don’t need to see this film because they’re already [well enough informed], and the potential risk of being triggered is probably not worth it.

Jean Fain is a Harvard Medical School-affiliated psychotherapist specializing in eating issues, and the author of “The Self-Compassion Diet.” For more information about Jean’s self-compassionate approach and her next Self-Compassion-Based Eating Awareness Training, go to

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