teen boy lying on a couch watching television

“To the Bone” and Eating Disorder Treatment: Did Netflix Get it Right?

The Netflix movie To the Bone portrays a semi-autobiographical story about a 20-year-old girl named Ellen and part of her journey through recovery from an eating disorder, Anorexia Nervosa. To the Bone is based on the experiences of Marti Noxon, the film’s director and TV producer. The lead character, Ellen, is played by Lily Collins, who also has shared that she has struggled with anorexia nervosa in the past.

There has been much conversation regarding the movie and trailer and how it handles the eating disorder and recovery process. Overall, this movie seeks to raise awareness about something that doesn’t get enough discussion. But in doing so, it raises many questions.

Does it accurately represent eating disorders?

To the Bone shows different behaviors to represent how someone with an eating disorder may act and it uses several characters to portray a variety of eating disorder behaviors. Throughout the movie, Ellen wraps her hands around her bicep to see if she can get her fingers to touch. This is known as “body checking.” Other eating disorder symptoms accurately shown in the movie include: self-induced vomiting, over-exercising, bingeing, chewing and spitting, loss of menses, calorie counting, fear of gaining weight and food restriction.

Eating disorders come in all shapes and sizes. However, the movie uses a very thin, malnourished, white female to portray someone with an eating disorder. Someone can be considered malnourished and diagnosed with Anorexia Nervosa or another eating disorder even if he or she is not “to the bone” thin. While the movie attempts to show some diversity, it reinforces typical stereotypes. Eating disorders do not discriminate. Anyone, no matter age, size or ethnicity, can get one.

Can “To the Bone” be triggering to someone with an eating disorder?

A trigger is defined as a physical or emotional reaction to a particular action, process or situation. Many aspects of the movie and trailer could trigger individuals with eating disorders or eating concerns, causing them to feel anxious, uncomfortable or an increase in urges to take action in order to reduce negative feelings. Patients might mimic the behaviors they see or think that they are not “thin” enough or “sick” enough to have an eating disorder or get help. Someone without an eating disorder could believe these behaviors may help them lose weight. The movie does issue a brief warning that the material might be “challenging for some viewers.”

Is this what typical treatment looks like?

The movie represents an unconventional type of treatment after Ellen has failed five other treatments. Ellen and her peers are shown in a residential group home in which they have a lot of say in their treatment. This may not be a realistic portrayal. Patients are typically monitored by a physician, therapist, psychiatrist and dietitian. There is often an individualized meal plan, supervision to prevent behaviors from occurring, and structured meals and time. Residential treatment, the highest level of care, does require patients stay in a facility for a longer duration of time. Other levels of care, including outpatient, intensive outpatient and partial hospitalization, allow the patient to remain in his or her home while attending treatment anywhere from five days a week to once a week or every other week. Treatment should provide a safe, supportive environment in the least restrictive setting necessary.

Group therapy is common in treatment in higher levels of care. ”To the Bone” portrays a group of patients who form supportive relationships fairly quickly – something that is typically hard for someone with an active eating disorder. Ellen and a male patient develop an intimate relationship, which could be very difficult for someone with an eating concern. Near the end of the movie, we see Ellen find hope for what appears to be the first time. Many things preceded this, including a dream about her male peer. However, it is not common for patients to fully recover solely for someone else.

The movie also captures a family’s desperation when a loved one develops an eating disorder and their struggles throughout recovery. Ellen’s disorder affects the whole family and no matter how much they try to help, their efforts fail. They seek the cause and a solution and will do anything, including bottle-feeding their child. This treatment is not recommended as there is no evidence that it’s effective. The family is an ally, and should be used as a very important part of recovery. To the Bone misses an opportunity to empower families to be actively involved in treatment.

The cause of eating disorders is unknown and is often a mix of biological, social and psychological factors, but inding the cause is not necessary for a full recovery. In addition, treatment can occur and be successful even if the patient isn’t motivated for recovery.  Hitting “rock bottom,” as suggested in the movie, is also not necessary for a patient to get help.

How should I talk about the movie with my child and what should I do if someone I know is struggling?

It is important to have a conversation with your child about all mental health concerns. We recommend that parents consider how To the Bone might impact children before allowing them to watch it. If you decide to allow your child to watch, we recommend watching it with your child and asking the following questions:

  • “What is your take away from the movie?”
  • “Can you relate to Ellen or any of the characters? How so?
  • “Do you know anyone who struggles with eating issues?”
  • “Did you feel that the movie glamorized eating disorders?”

If your child has an active eating disorder, ask if they feel To the Bone accurately represents their experience and if they were affected by any parts of the movie. Discuss how this is one person’s story and talk about how other stories might look different.

To the Bone raises awareness of eating disorders and demonstrates the resistance to treatment one might experience. Eating disorders result in serious consequences if left untreated. If your child or someone you know is struggling with one, please reach out for help or encourage them to do so.

Call (614) 355-6300 to schedule an appointment with Nationwide Children’s Hospital’s Eating Disorder Program.

Kristen Armbrust, LISW-S
Kristen Armbrust is a licensed clinical social worker with experience working with children and families within Behavioral Health. Currently, she is the clinical lead supervisor of the Eating Disorder Program at Nationwide Children’s Hospital where she provides eating disorder treatment and clinical supervision to other clinicians. She also has experience working with adolescents with mood and anxiety disorders and is a clinician on the Dialectical Behavioral Therapy team. Her clinical interests include eating disorders and improving family-centered care.

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