Once again, a Netflix release sparks intense discussion about its depiction of a mental health issue. The feature film To The Bone, released July 14, is the story of Ellen, a 20-year-old girl who suffers from an eating disorder (ED) called Anorexia Nervosa.

As with their earlier release, 13 Reasons Why, a series about a fictional teen suicide, there is a fair amount of public outcry. This film, though far from perfect, does give some good information and also offers a message of hope for recovery.

If you, your teenager, or someone you or your teenager knows struggles with issues around eating or excessive exercise, you might be interested in watching this movie. Please be cognizant of where you are in your recovery before you choose to watch it; some scenes could be quite triggering.

As always, I would recommend that parents watch with their teenagers, rather than letting them watch the show alone. If your teen is in therapy, please consult with the therapist first about the best approach to take regarding this film. Keep in mind that forbidding a teenager to see something is rarely effective.

The first thing you probably want to know is,

How Accurate is the Portrayal of the Eating Disorders in this Film?

In some ways the portrayals are quite accurate, and in other ways they fall short.

The movie is a dramatization of one person’s experience, and is not necessarily representative of an average experience of EDs or ED recovery, especially as it pertains to the treatment center depicted in the movie.

Mostly this movie explains the mindset of the ED sufferer more than the actual pain.

The mindset of the person with an ED can be difficult to understand for someone with no experience of this personally, and the movie did show some of the typical examples of distorted thinking. This can be tremendously helpful for confused friends and family as they try to understand what is happening with their loved one.

Here are some examples from the movie of typical disordered thinking in EDs:

The patients in the treatment center referred to the dining room as “the torture chamber”, and there are several scenes showing the distorted thinking about eating, and how difficult it is for the patients both to eat and to watch others eating. They cut paper-thin slices of breading off of the chicken, and know the calorie count of every item by heart.

The weigh-in scenes show how difficult it is for the patients to see the scale climb up, even to normal weight. Even when they are pregnant.

And, of course, there is the feeding tube. It was clear that a fairly regular occurrence in treatment was a patient being unable to eat, even when they knew they would have to endure the uncomfortable and humiliating experience of the feeding tube. The discomfort and the humiliation were not nearly as well-depicted as the disordered thinking that lead to that moment.

What was noticeably missing from the movie was any meaningful discussion of why Ellen, or any of the other patients, had an ED in the first place.

The emphasis was on food and weight, and not on the personal meaning of the disease to any of the individual patients. There was some depiction of Ellen’s dysfunctional family dynamic, but the meaning of this dynamic for Ellen was never developed. Family therapy is almost always integral to recovery in eating disorders, and in this movie, the doctor gave up after just one session.

The movie doesn’t show how recovery occurs, but it does offer hope.

Though the movie does not show us how this actually happens, the message is hopeful overall. It does show us the reality that recovery is a complicated process, with both forward and backward movement. It shows us that Ellen did eventually re-connect with her mother and her stepmother, and she did choose to go back to the treatment center, clearly with more of a buy-in than the first time.

People do experience full recovery from eating disorders. Though the movie didn’t show this specifically, it did show that when Ellen experienced what many would call “rock bottom”, she was able to find her way back to treatment, and through music and cinematography the filmmaker conveys the message that this time things will be better, if not easier.

Some People Say That Eating Disorders are Glamorized in To The Bone.

This is a matter of some debate. The protagonist in the movie, Ellen, is played by the beautiful doe-eyed Lily Collins. She goes to a lovely treatment center in a custom Craftsman home and is treated by the handsome Keanu Reeves. A cute boy falls in love with her in treatment. None of these is typical in real life.

Except that, in real life, the beautiful doe-eyed Lily Collins DID have an eating disorder. And she has spoken about it in the media, and in her recent book, Unfiltered. Will this inspire impressionable young women to imitate her disordered eating behavior? Maybe.

Collins speaks to Access Hollywood about how she suffered from an ED as a teenager, and how she hopes this movie will build awareness of eating disorders. What she does not talk about with Access Hollywood is how incredibly painful it was to have an ED, and what a long, long haul it is to recover.

Whether or not you think this movie glamorized EDs may be largely based on your own emotional response to it.

Your emotional response depends not only on the filmmaker’s skill, but also on your own experience and relationship to EDs. Did the emotions of the patients in the treatment center, or of the family, speak to you personally, or was it just an interesting way to learn about the experience of people who have eating disorders?

There were definitely some poignant moments. Lily Collins has spoken about the scene where her stepmom took a picture of her naked back, and then showed it to her on her phone. Ms. Collins didn’t realize the actress was going to actually take a picture to show her. Her shock is real.

The treatment center in the movie, however, is a fairly “glamorous” version of ED treatment. Treatment centers like these do exist, but they are not accessible to the average person.

How Typical is the Treatment Center in To The Bone?

The treatment center in the film is not typical. They excuse this in the film by having Dr. Beckham explain that his methods are unconventional.

In most treatment centers, the patients will not be allowed to choose what they eat. In most treatment centers, the patients will not be allowed to “date”. And in most treatment centers, the doctor is not Keanu Reeves.

To The Bone does not depict the diversity of ED sufferers in the population in general. Of the seven patients in the recovery center, six are white and only one is a woman of color. Only one is a male. All but one of the patients is there for anorexia or bulimia– one woman is there for binge eating without purging. There is no mention of other EDs such as pica or rumination.

In real life, eating disorders occur in all parts of our population– all ages, all races, all ethnicities, all socio-economic groups. 30 million people will suffer from an ED in their lifetime.  The fastest-growing demographic of people with eating disorders is middle-aged women. In fact, 1 in 8 women over age 50 engages in disordered eating behaviors. 

Unfortunately, the movie may be realistic in its depiction of who might actually be a patient in a treatment center such as the one run by Dr. Beckham.

The truth is that many treatment centers are fabulously expensive, and people without health insurance can’t possibly afford them. Because of parity laws, mental health coverage is legally required to be included, but insurers are reluctant to cover treatment centers and if a patient doesn’t have the strength or knowledge to advocate vociferously for their rights, they might not get their needs met in this way.

In my opinion, it is a shame that the filmmakers missed a wonderful opportunity to explain to the public that there is help available to those who might not be able to afford a tony avant-garde treatment center.

Anyone with insurance should start with their general practitioner for a recommendation, or talk to their therapist if they already have one, about a treatment program. There are both residential treatment programs and out-patient programs, depending on the level of care indicated.

For people without health insurance, there are clinics that offer both groups and individual counseling as well as on-line groups. There is help available to anyone who reaches out, and the movie did nothing to further awareness of this fact.

Families and friends need to know how to help someone who might not be aware of the resources available.

To The Bone falls way short on this count. They do not list a hotline or any other resources at any point in the movie. There is no mention in the script that these resources exist. This is a glaring omission from the production, and I am surprised that the nonprofit Project HEAL that consulted with Netflix was not listed anywhere before or after the film. The cast of the movie did do a public service announcement about EDs, but there was no link to this either. 

There is a list of resources at the end of this article for anyone who has further questions or needs more help with eating disorders. Help is available, and I want to be sure you know where to find it!

How Were the Actors So Thin? Did They Actually Have Eating Disorders?

There is a fair amount of controversy surrounding Ms. Collins’ choice to lose weight for her role as Ellen. She stresses that her weight loss was supervised by a nutritionist (not a doctor) and she took supplements, so it was therefore a “healthy” weight loss. She lost over 20 pounds.

Additionally, Ms. Collins claims that it was safe for her to lose the weight because “none of the reasons that had kickstarted my disorder in the past applied any more.” This misses the point entirely. If losing weight is someone’s “go-to” response to stressors, new stressors can still elicit the same response.

I am not a doctor, and I don’t play one on the internet, so let’s just see what Project HEAL, the non-profit group that supports recovery from EDs and is associated with the film, has to say about this:

“There is strong research showing that getting into a state of negative energy balance and/or losing weight can make people who have struggled with anorexia nervosa much more prone to a relapse. The weight loss aspect is not something that Project HEAL supports.”

Unfortunately, Ms. Collins is sending a message that it is possible for it to be healthy to lose this much weight. Anyone who has the kind of disordered thinking that is typical of EDs and hears this, could be encouraged to lose weight to an extent that is not healthy for them.  

This, I believe, is one of the most damaging messages to come from the film and all the attendant press releases and interviews.

If you watch this film with your teenager, be sure to discuss this with them. Chances are your teen will be familiar with the debate about Lily Collins’ weight loss for the film. Don’t be afraid to bring it up.

There is no healthy way to become seriously underweight.

Eating disorders have the highest mortality rate of any mental illness; there can be grave health implications for someone with a history of anorexia to begin losing weight again.

Summary

The Netflix movie To The Bone can be helpful in that it opens a discussion about eating disorders, a topic that can be confusing and embarrassing for those that experience it, as well as to their friends and family.

The movie is based on only one person’s experience of an eating disorder and ED recovery. Some parts of this experience may be easy for you or your teenager to relate to, and some may not. There are many experiences of EDs that are not reflected in this film and may be more relevant to you. This is just a starting point for a meaningful discussion with your teenager.

The movie depicts some of the issues and the mindset of many ED sufferers, and can be useful in that way as well, although it does not do a particularly good job of depicting the deep pain experienced by ED sufferers, and the treatment center in the movie is certainly not typical.

Netflix is seriously remiss in not listing resources for viewers who have questions or need more help.

Lily Collins’ assertion that her weight loss for the movie was “healthy” because she was supervised by a nutritionist is dangerous and irresponsible.

Full recovery from EDs is difficult, but it is completely possible, and help is available in many forms.

If You Have More Questions Or Would Like Some Extra Help

You can call me at 323-999-1537 or email me at amy@thrivetherapyla.com for a free 20-minute consultation. Please don’t hesitate to call; I am happy to help you find a therapist or other resources in your area if you are not in Los Angeles.

RESOURCES

National Eating Disorder Hotline: 1-800-931-2237

Confidential and free support during business hours (EST). You can also IM with a volunteer at

For crisis situations, text "NEDA" to 741741 to be connected with a trained volunteer at Crisis Text Line

 ANAD– The National Association of Anorexia Nervosa and Associated Disorders

This is an excellent website with information about eating disorders, and also a great place to find all kinds of resources in your area like support groups, therapists, nutritionists, doctors, treatment centers, etc. They also offer online support groups.

For Those Who Are Supporting a Loved One:

Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T) –  An international organization of and for caregivers of eating disorder patients. F.E.A.S.T. serves families by providing information and mutual support, promoting evidence-based treatment, and advocating for research and education to reduce the suffering associated with eating disorders.  http://www.feast-ed.org/

Finding Treatment Centers

Eating Disorder Referral and Information Center – Offers a comprehensive search for eating disorder treatment centers across the country at edreferral.com.

The Alliance for Eating Disorders Awareness has a directory of over 200 treatment centers all over the country. https://www.findedhelp.com/

Body Image

Body Positive – Focuses on boosting body image at any weight. www.bodypositive.com