Searching for Thinspiration : The Nature of Internet Searches for Pro-Eating Disorder Websites

Introduction

Growing attention is being paid to the nature of potentially harmful material on the Internet and the risks this may have for individuals who access it.^1,2 Of particular interest has been the content of pro-eating disorder (pro-ED) Websites, which encourage eating disorder behaviors (e.g., food restriction, extreme dieting). Several studies have formally examined the content of pro-ED Websites.^1,3–7 However, the extent to which these Websites are sought by Internet users and which search terms may be used to retrieve these Websites in online search engines remains unclear. Knowing how pro-ED Websites are found, how often specific search terms are used, and where in the world these searches most often occur may lead to efforts that involve the provision of helpful, healthy, and safe resources in Internet search engines used to find more pernicious Websites. This study was the first that (a) determines the types of search terms related to pro-ED sites that are sought globally, (b) identifies the most common terms used to retrieve these Websites, (c) identifies countries in which these searches occur, and (d) examines whether certain search terms correspond with potentially harmful material.

The nature of pro-eating disorder Websites represents an important public health issue given the potential risks associated with their content.^1,3–7 These Websites typically provide suggestions for engaging in eating disorder behaviours (e.g., tips for dieting/purging), and many contain an interactive component (e.g., message board). Also common on these Websites are references to thinspiration, a blend of thin and inspiration (sometimes referred to as thinspo for short), which involves sharing photos/prose intended to inspire eating disorder behaviors. Some pro-ED Websites also provide recovery-oriented information (e.g., links to treatment programs) in addition to pro-ED content. One risk of pro-ED Websites is that many operate under the pretext of a supportive forum (i.e., peer-support in which recovery is, in theory, encouraged by the community) but largely function as a means for users to support engaging in eating disordered behaviors. Thus, other major risks include encouraging and reinforcing eating disordered behaviors in the form of sharing ‘tips and tricks’ to lose weight and a perceived competition among Website visitors to gain an extreme level of thinness. Finally, pro-ED Websites may dissuade individuals from recovery and professional help-seeking behavior. ⁷

Among adolescents and young adults, social groups have been found to exhibit similar eating behaviors (including dieting and eating disorders), body mass indices, and body-image. ⁸ Studies suggest that the content of pro-ED Websites (i.e., the techniques, encouragement of eating disorder behaviors) may have a contagion-like effect on individuals who are experimenting with eating disorder behaviors without fully committing to them.^1,9 Furthermore, among adolescents, the use of pro-ED Websites is associated with a longer duration of eating disorder illnesses and greater hospitalization rates, indicating that pro-ED Websites may contribute to the perpetuation of eating disorder behaviors. ⁶

In 2001, Yahoo! shut down several pro-ED Websites—a movement believed to be propelled by the media, clinicians, and professional organizations offering support and advocacy for eating disorders.^10,11 Although access to these Websites was temporarily thwarted, many sites re-emerged and new ones surfaced. Indeed, shutting down pro-ED Websites does not solve the problem. One possible way to address the issue of pro-ED content on the Internet is to provide individuals who search for pro-ED material online with helpful resources at the point of their Internet search. Similar initiatives have already started for web-searches about suicide. For example, in the United States, ¹² and more recently in the United Kingdom, ¹³ individuals who search for terms associated with suicide (e.g., suicide methods) in Google are presented with helpful resources at the top of the search page. Since Google represents not just the most popular search engine on the Internet, but the Website garnering the most traffic worldwide, ¹⁴ similar initiatives for pro-ED Websites may be beneficial.

The current study used the Google AdWords Keywords ¹⁵ program to examine the nature of online Google searches for pro-eating disorder content. This program (described below) allows users to determine the nature of actual search queries used in Google's search engine. Identifying which terms are used, how often they are used, and the regions in which these terms are most frequently sought may help spur efforts to present individuals with helpful eating disorder resources in Google search results—similar to the efforts undertaken for suicide-related searches that have just been mentioned. No study has examined the nature of searches for pro-ED content online. Google AdWords Keywords ¹⁵ represents a useful tool in this regard as it permits users to determine the nature of actual search terms used by Internet users, how often each search term is sought over the course of a year, and the geographic regions associated with each search term. It also provides the corresponding Google search results (i.e., Websites) for each search term produced by the program. The current study used this program and is the first to formally examine the nature and scope of online pro-ED searches on Google.

Methods

Results

Discussion

This is the first study that examines how pro-ED Websites may be found by individuals who search for them using Google—the world's most used search engine and Website. ¹⁴ Based on the 26 terms yielding at least 1,000 monthly searches, queries for pro-ED terms occur frequently and exceed 13 million searches annually. Although pro-ana was the most common search term identified, search terms including thinspiration and thinspo were also common and occurred more often than terms with an explicit reference to an eating disorder (i.e., terms including anorexia, ana, bulimia, or mia). This is somewhat surprising, as terms with these references are commonly used in research examining pro-ED Websites.^1,3–6 Since thinspiration content often includes images of slim or underweight young women,^1,5 and this material may promote body comparisons that exacerbate or encourage eating disorder behaviors, ¹ search results corresponding with thinspiration and thinspo may be particularly worrisome. Indeed, search terms with these references associate with more harmful content based on Websites in the first page of search results. Thus, efforts to prevent the effects of, and access to, Pro-ED Websites may need to pay particular attention to these terms.

The nature of Pro-ED related searches is also widespread and varies geographically. This may be due to a number of factors, including differences in the eating disorder culture across countries, and, in particular, the online pro-ED culture; however, future research is needed before conclusions can be made. The term with the highest number of searches, pro-ana, had high regional interest in many countries; however, it did not have high regional interest in all countries represented in the analyses—including the United States. This variability may indicate a need for different countries to develop uniquely tailored prevention and intervention efforts that reflect these regional differences. For example, in the United States, search terms with references to thinspiration (i.e., real thinspo, pro thinspo, pro ana thinspo, thinspiration tips) had higher regional interest compared with terms such as pro-ana, which suggests that the former may merit more attention in this region.

Limitations and Future Directions

Results from this study may not generalize to searches conducted on other search engines (e.g., Yahoo!, Bing). Nevertheless, our results may correspond to the most frequently sought out pro-ED terms as Google generates more traffic than any other Website online ¹⁴ and individuals likely use similar terms in various search engines. At the same time, the current findings pertain to searches conducted in English and future work should determine how searches are conducted in other languages. One limitation related to the nature of data generated is that the number of people searching for pro-ED content online is unknown, as frequency counts for each search term represent total searches and not the number of individuals conducting the search; thus, several searches likely reflect the same individuals conducting multiple searches.

Since the goal of this study was to conduct a preliminary analysis of the nature of online pro-ED search patterns, we only examined the first 10 search results (i.e., first search results page). Future work may need to examine the length of time spent conducting these searches and determine how many search results are examined until people's search needs are met. In addition to this, we do not know the motive behind people's online searches using pro-ED terms. It is surmised that the keywords identified represent searches for pro-ED Websites by individuals who have eating disorder difficulties, but this cannot be assumed and the rationale for the search may vary (e.g., some searches may reflect searches conducted by concerned parents, health professionals or researchers). Demographic data about those conducting the searches were also unavailable. Past research suggests that adolescent and young adult women primarily engage in pro-ED online activity^1,3,6 but more research will be needed to confirm whether this is the case for pro-ED online searches. Finally, since search term interest and search term results fluctuate temporally, it will be important to reexamine the nature of pro-ED searches via the Internet prospectively.

Implications and Conclusion

Past efforts have been made to take down pro-ED Websites, but this has led to a resurgence of the same Websites and the development of new ones.^10,11 This does not solve the problem, and it is important to find alternative methods to address this issue. The current study provides a possible place to intervene and redirect people who search for potentially pernicious pro-ED content before the point-of access—namely, in the search results. Indeed, by virtue of knowing what terms are used to find pro-ED content on the Internet, researchers and health professionals may be better equipped to redirect those who search for this material to helpful, recovery-focused and research-supported resources. Thus, similar to recent efforts to provide resources in the search results for suicide-related searches,^12,13 efforts can be made for pro-ED content as well. Efforts to provide suicide resources for potentially harmful suicide-related Google searches present resources (e.g., crisis lines) in the corresponding search results for queries such as suicide methods. Following this logic, efforts can be made to provide sponsored links to supportive and research-based eating disorder resources (e.g., how to seek help, from where to seek help) for individuals suffering from eating disorders when terms such as thinspiration and thinspo are used. Since the nature of online searches may change over time, it will be important to monitor these efforts and account for changes in search terms used and the nature of search results corresponding with these searches. Given the number of pro-ED search terms, the frequency with which they are sought, their widespread global interest, and the harmful material with which many terms associate, this may represent a critical step in preventing the effects that some pro-ED Websites may have on some vulnerable individuals–namely those who search for them online. To this end, it will be important to investigate the effectiveness of these types of initiatives and monitor this temporally, as search terms (and search results) may vary over time.