To the Bone: What’s Fact and What’s Fiction

This week marks the annual National Eating Disorder Awareness Week (#NEDAwareness).  Wow, this year has gone fast. (Here is last year’s blog). This year’s theme is “Let’s Get Real”, with the hopes of expanding the conversation about people’s (often complicated) relationships with food, exercise, and body image. Like many mental health illnesses, the stigma and stereotypes about eating disorders run deep. What better way to get conversations flowing than by portraying eating disorders in a movie, right? RIGHT! Well ready or not, that’s what keeps happening.

Netflix is always keeping me on my toes.  First, it was 13 Reasons Why that my patients kept asking about (it’s still being asked about 1 year later).  Now, it’s the Netflix original movie To the Bone that is frequently mentioned.  You may have seen ads for this movie while looking through Netflix, starring Lily Collins, Keanu Reeves (Ted had a way better movie career than Bill did, didn’t he?), and Carrie Preston. It’s about a young woman with anorexia nervosa who goes to an “unconventional treatment facility” and her interactions with the other roommates, providers, and family. It’ loosely based on the writer/director’s own experiences with anorexia. The film has other characters that have different eating disorders, like bulimia nervosa and binge eating disorder, but the focus is on anorexia (as is the case with most movies about eating disorders). I had heard a lot of different opinions and controversy about this film and was not sure how accurate this movie was at portraying anorexia, but the constant ads and curiosity got to me, so I watched it.

Just from an entertainment standpoint, I thought the movie had some great acting. Ironically (and with some questionable judgement, IMO), lead actress Lily Collins (who had struggled with her own eating disorder) lost weight in a dangerous manner to portray her character.  Now, I’m all for method acting, but this seems a little over-the-top.  Eating disorder recovery is a slippery slope. I always cringe when I hear of movie stars doing extreme things to gain or lose weight for a part – I’m not sure it sends the right message to the fans.

Like 13 Reasons Why, this movie should come with a trigger warning. If you want to watch this movie to get a glimpse into what one person’s individual viewpoint and experience of anorexia, that may be ok. If you want to watch this film with your family to get a conversation started about eating disorders, that may not be a bad idea. But, if you want to watch this movie to learn how anorexia or eating disorders are usually diagnosed and treated, that IS likely not a great idea.

(Spoilers ahead)

In this movie, the main character goes to live in a facility where there are no requirements for eating and patients/roommates are more or less left to their own devices. There is no real emphasis on nutrition, and that is not usually how treatment for eating disorder usually goes (at least, not when one is medically or psychologically unstable). In other words, this is not an accurate portrayal of treatment, which usually involves a team of providers and hard work.

I feel that the movie further perpetuates certain eating disorder stereotypes, like the fragile female from a privileged family who became obsessed with body image after staring at too many beauty magazines. The development of eating disorders is way more complicated than that. Any eating disorders are equal opportunity –they impact all genders, races, sexual orientations, and socioeconomic statuses. There is also concern that this movie glamorizes anorexia by having multiple extended and graphic scenes. For example, images of the characters may be used by someone struggling with body image issues as “thinspiration” (or “thinspo,” a common feature on pro-eating disorder blogs). And, after a near death experience, the lead character finally decides that she’s ready to tackle treatment of her eating disorder.  She’s lucky that her experience was only near-death; many people aren’t that lucky (and anorexia has the highest death rate of any psychiatric disorder).

I would definitely take caution in watching this movie if you are not mentally ready for it. If you have struggled with an eating disorder  or body image issue before, or if you are currently struggling with one, this movie might be triggering. If you are concerned about your ability to watch this film safely, I would suggest for you not to watch this film.

If you or someone you know is showing feelings or signs of an eating disorder, please look for help in the many resources out there. You can contact your health care provider or call the National Eating Disorders Helpline at (800) 931-2237. You can also text “NEDA” to 741741, or go to to chat with a trained Helpline volunteer.