RESEARCH ARTICLE Viewership of Pro-Anorexia Websites in Seventh, Ninth and Eleventh Graders Kathleen Custers & Jan Van den Bulck * Leuven School for Mass Communication Research, Katholieke Universiteit Leuven, Parkstraat, Leuven, Belgium Abstract Objective: To examine the prevalence of visiting pro-anorexia websites by 13-, 15- and 17-year old adolescents and to explore correlates of visiting such websites and predictors of anorexia nervosa (AN). Method: Questionnaire in a sample of 711 secondary school children from the 7th, 9th and 11th grade in Flanders, Belgium. Results: 12.6% of the girls and 5.9% of the boys had visited such websites. In girls, visiting pro-anorexia websites was associated with a higher drive for thinness, worse perception of appearance and more perfectionism. Conclusion: The prevalence of visiting pro-anorexia sites is non-trivial and the significant correlations between viewership of pro-ana sites and predictors of AN suggest a potential for negative impact of exposure to pro-ana sites. We conclude with some speculative remarks on the potential threat of the existence of pro-ana sites to organized health care. Copyright # 2009 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords pro-anorexia websites; adolescents; internet; lifestyle  Correspondence Jan Van den Bulck, PhD, DSc, Leuven School for Mass Communication Research, Katholieke Universiteit Leuven, Parkstraat 45 Box 3603, 3000 Leuven, Belgium. Tel: þ3216323294. Fax: þ3216323312. Email: jan.vandenbulck@soc.kuleuven.be Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/erv.910 Introduction Young people surfing the internet today may come across what is commonly referred to as pro-anorexia or ‘pro-ana’ websites. These websites define and promote anorexia nervosa (AN) as a conscious choice and as a lifestyle (Bardone-Cone & Cass, 2006; Chelsey, Alberts, Klein, & Kreipe, 2003). There is a small, but rapidly growing body of research on this topic. A study from 2003 found over 500 of these sites (Chelsey et al., 2003). Content analyses have shown that they shared a number of characteristics (Dias, 2003; Norris, Boydell, Pinhas, & Katzman, 2006). Sites typically contained sections such as ‘thinspiration’ with inspiring texts and photos of very thin celebrities or even manipulated photos (Mulveen & Hepworth, 2006; Norris et al., 2006). A ‘tips and tricks’ section was usually present and offered information on the caloric value of foodstuffs, or on diuretics and drugs as well as suggestions on how to hide or mask dieting behaviour and an anorexic body shape (Norris et al., 2006). Three studies have looked at the relationship between viewing pro-anorexia websites and outcomes related to body image and eating disturbances. A survey of 76 patients suffering from eating disorders (ED) showed that 60.5% visited pro- eating disorder sites, although this included 25% who visited pro-recovery sites as well (Wilson, Peebles, Hardy, & Litt, 2006). A randomized experiment with 24 Eur. Eat. Disorders Rev. (2009) ß 2009 John Wiley & Sons, Ltd and Eating Disorders Association.