Should Netflix be 'starting conversations' about eating disorders? A psychologist weighs in.

Content warning: This post deals with eating disorders, and may be triggering for some readers.

When streaming service Netflix announced the impending release of To The Bone earlier this week, it was met with two things: excitement and panic.

While the film, which will dramatise the struggle and recovery of an anorexic 20-year-old, is set to premiere on the streaming service on July 14, its two-minute trailer has already been met with backlash from some experts.

Starring British-born actress Lily Collins as the deeply unwell protagonist Ellen, and Keanu Reeves as her mentor and doctor, Dr William Beckham, the trailer for the film alone depicts calorie counting, imagery of protruding bones and food restriction.

Watch the trailer for To The Bone below. (Warning: triggering content)

Australian youth mental health body, Headspace, has issued a warning about To The Bone. CEO Jason Trethowan is concerned the movie will act like a “how to” guide for adolescents who may be at risk.

“We don’t want any representation or discussion in the media, on TV, or anywhere else, that has the potential to place young people at risk,” he says of the show whose trailer is already appearing on “thinspiration” sites.

For clinical psychologist Louise Adams, an eating disorder therapist from Treat Yourself Well in Sydney, the movie goes beyond being purely educational, to being dangerously instructive.

Speaking to Mamamia, Adams said she wouldn’t let her own daughters watch To The Bone as research shows “it is triggering to watch other people displaying eating disorder behaviours – even if it’s a story about recovery.”

With over one million Australians suffering from disordered eating – a number that has doubled since 2005 – Adams said we are in “the midst of an epidemic”; an epidemic that cannot be aided by depictions of a beautiful young woman reciting how many calories are in a bread roll.

“Even if the entire production is blasted with trigger warnings, if it goes through actual behaviours to avoid eating, that’s very dangerous messaging,” Adams said.

With this comes a gentle reminder from Adams: A skinny body is not what all eating disorders look like.

An emaciated body might be the easiest to glamourise, but Ellen’s tiny frame does not represent those who suffer disordered eating the most.

“Eating disorders also come in fat bodies,” Adams, who has almost 20 years experience in the field, said.

“The face of eating disorders is not a thin female. People with eating disorders come in all shapes and sizes, and we need to show that.”

Listen: Is food a friend or foe? The Well discuss…

Further muddying the streaming giant’s selection of Lily Collins as Ellen, is the actress’ lengthy history with eating disorders herself.

In her memoir Unfiltered: No Shame, No Regrets, Just Me, the 28-year-old dedicated an entire chapter to her battle with anorexia and bulimia, where she wrote: “I didn’t go into treatment, I didn’t seek out professional help. . . . I kind of just figured it out on my own.”

Being cast into the role of Ellen required Collins to once more shrink into the body of a starving woman. Meaning, effectively, a woman with a history of disordered eating had to lose weight, which brings with it the risk of collapsing back into her anorexia.

Still, Collins insists “we did it in the most healthy way possible”, with the assistance of a nutritionist.

“That is ethically horrendous if it is true,” Adams said of the claim. “I know actors starve themselves for roles, but if someone has had an eating disorder in the past it beggars belief that a professional would aide that sort of weight loss again.

“This is all very, very messed up.”

Netflix chose not to comment on the concerns raised by Adams, but to instead give background on how To The Bone was created, as well as press notes from a Q&A segment with script writer and director, Marti Noxon.

“Because of my own long battle with eating disorders, I’d always wanted to write a film that dealt with the topic from an insider’s perspective,” Noxon was quoted in the document provided to Mamamia.

“I was kind of appalled that there wasn’t more mainstream entertainment that dealt with such a common problem.”

Noxon went on to say that “if we can lift some of the shame around [eating disorders], there is hope for a great life and full recovery.”

Indeed, in light of smash teen series 13 Reasons Why, this seems to be Netflix’s party line: that any conversation about a tough topic is inherently good, worthwhile and productive conversation.

Whether that's the truth - or a simplistic way of looking at a very complex topic - is a matter of opinion. After all, conversation about mental health is one thing. Ignoring research and guidelines about reporting on mental health is another.

According to MindFrame's research, presenting eating disorders as an entertainment story, detailing specific behaviours, or using imagery of people with extreme weights or shapes is counterproductive in curbing the epidemic. In fact, evidence shows doing any of these things is linked to "greater body dissatisfaction and eating disorder behaviour".

Meaning To The Bone is increasing conversation while also increasing the risk of viewers developing eating disorders.

“I’m going to see an increase in the number of my patients," Adams said. "Teenagers follow this stuff and when people display unhealthy eating behaviours, we know they follow suit."

While Netflix consulted 'Project HEAL', a small US charity that aims to "provide grant funding for people with eating disorders who cannot afford treatment", in the making of To The Bone, Netflix didn't seek guidance from the USA's National Eating Disorders Association (NEDA).

According to Project HEAL's website, its three staff members are not qualified to give guidance on matters of eating disorder psychology, and its two founders, while having battled eating disorders in the past, lack clinical training.

Regardless of intention, this could be quite the mistake.

“We need to start thinking ethically about this, about the stuff that’s killing our kids," Adams said.

Because if the three main concerns of teenagers are bullying, suicide, and eating disorders, you might ask whether Netflix is determined to capitalise on each in 2017.

If you or a loved one is suffering with an eating disorder, Mamamia urges you to contact The Butterfly Foundation. 

To sign a petition asking for the makers of To The Bone to have a content review by professionals, click here.