Since the release of the film To The Bone a week ago on Netflix, there has been much discussion within the eating disorders community – among treatment professionals, patients, parents and families, and advocates – about the film’s portrayal of eating disorders and some of the associated concerns. As a hospital system that specializes in the treatment of eating disorders, we have heard from many families who have questions and concerns about how to address the film with their children or other loved ones who are currently in treatment – and whether or not watching the film could be helpful or problematic in their recovery. Our goal is to provide our perspectives on both the positive aspects of the film, as well as our concerns, so that you can determine whether or not viewing or discussing the film is the right choice for you or your loved one.
First and foremost, it is important to recognize that the film portrays the story of one woman’s struggle with an eating disorder illness. It is likely that there may be some aspects of Ellen’s (the main character) experience that are similar to your own, and others that are very different from your eating disorder experience. It is also possible that watching someone else’s story and struggle, whether similar to or different from yours, could be challenging or even triggering. The remaining elements of the film discussed below should all be considered in the context of this key point.
Image Courtesy of IMDB
Positive Aspects of the Film
There are a few things that this film does well in portraying eating disorders and treatment that could lead to helpful discussions about the downsides and realities of eating disorder illnesses.
- The movie attempts to depict the severity of eating disorder illnesses and their consequences. In doing so, the movie also avoids glamorizing eating disorders. Several characters in the film are shown experiencing significant physical consequences as a result of their eating disorder that have a major impact on their lives. A variety of medical complications, interpersonal challenges, life plans interrupted – almost all of the characters present to us some way that their life was affected for the worse by their eating disorder and helps remind the audience that these illnesses are serious.
- The movie makes an effort to portray the impact of eating disorder illnesses and treatment on the whole family. One of the highlights of the movie is the relationship between Ellen and her sister. Siblings are often in a unique and challenging position when a brother or sister is in need of treatment, and the film gives an honest portrayal of how this might be experienced. Relatedly, an eating disorder illness can be stressful on all members of a family, and we see Ellen’s family members all impacted in different ways, as well as seeing Ellen herself impacted by her illness.
- The movie highlights the potential dangers of social media influence. There are several references throughout the movie to how Ellen’s artwork was displayed online and seen and used by others in the midst of their own illnesses. Families viewing the film together are presented with a great opportunity to discuss other ways that social media may influence eating disorders and what cautions or supports might be helpful in order to safely engage with social media.
Concerning Aspects of the Film
There are also several aspects of the film that raise concerns, and should be thoroughly considered before deciding if watching the film might be helpful or harmful at this point in your recovery journey.
- The film includes explicit discussion of calories, weights, sizes, and numbers as well as graphic depictions of eating disorder behaviors. The characters in the film are seen and heard discussing numbers frequently, while restriction, food manipulation, purging, chewing and spitting, body checking, excessive exercise, and other behaviors are shown throughout. Eating disorders can be competitive illnesses, and viewing others engaging in eating disorder behaviors or discussing calories and weights could be triggering for someone who is struggling with their own eating disorder. Individuals watching this movie are encouraged to be mindful or their own reactions, and should talk with their team about the potential triggers the film might present for them.
- The film’s portrayal of treatment is not reflective of current evidence-informed practices. In fact, I am not completely sure that it can really be called treatment. A central component of any eating disorder treatment is medical and physical restoration and healing, which for most individuals with eating disorders will include specific nutritional intervention from a registered dietitian, which is sadly absent from this film. The patients in this movie are left to their own devices when it comes to eating – instructed to eat what they want with the only specified goal being to make weight progress. This is counter to what is recommended in treatment, and downplays the essential importance of food in recovery. The patients are also without support and supervision for much of their time in treatment, and the portrayal of therapy is essentially non-existent. The film does include characters who are minors and young adults who live with or are supported by their parents, yet does not include any real family involvement in treatment, which is particularly problematic given what we know about the important role of family members in treatment. For patients and families watching this film, it is important to recognize where the treatment depicted deviates from the treatment you may be participating in or have had recommended for you and to discuss any questions or concerns with your treatment providers.
- The psychological components of eating disorder illnesses and treatment are largely ignored, and even misrepresented. As stated above, there is no real psychological treatment portrayed in the film. While we do witness a family therapy session and a brief individual session, these are not reflective of what we know the psychological work of recovery to involve. At one point in the film, Ellen’s doctor states that he cannot treat her unless she wants to live. Moreover, he later states that hitting rock bottom might be necessary before she can get better. This is inherently problematic because, as anyone who has been in treatment or has provided treatment can attest to, the desire to recover is simply not always present until recovery is well underway, and waiting for things to get worse before they can get better is a dangerous direction to go. There is a great deal of psychological work that happens between a patient, their family, and their providers to help them move toward increased motivation. This work can take place even when patients are not completely sure they are ready for it, and certainly can take place well before they hit “bottom”. There are many evidence based treatments for eating disorders, including both family and individual approaches, that are not portrayed in this film and unfortunately leave the viewer to conclude that getting better might just be as simple as “wanting it”. If you are currently in treatment or struggling with an eating disorder, talk with your family and treatment providers about your own motivation or ambivalence about recovery. If you are a family member of a loved one with an eating disorder, please know that your loved one’s recovery is not as simple as “wanting to live”.
- The film perpetuates the myth that families cause eating disorders. A great deal of time is spent highlighting Ellen’s family’s shortcomings and how these have impacted her. While the film does not outright state that Ellen’s family caused her eating disorder, it is heavily suggested throughout that they influenced its development and are impacting her recovery. The fact is, we know that parents and families are the number one resource and support in treatment for someone with an eating disorder, and almost all treatment settings today will involve family members in one form or another in order to help their loved one recover. It is important for viewers to identify places where this myth is portrayed and work to challenge similar beliefs in their work with their own family.
- Eating disorders are presented as choices. In light of the above described concerns, the viewer is ultimately left with the notion that an eating disorder, and perhaps recovery, is simply a choice. We know that nothing could be farther from the truth, and that eating disorders are serious and complex psychological and biologically influenced illnesses that require specialized treatment and support to recover from. While the film does depict the seriousness of these illnesses in many ways, it still unfortunately supports the myth of choice.
Overall, we cannot say that To The Bone was either a “good” or “bad” movie; it is simply a movie that portrays some parts of one woman’s experience with her eating disorder. We also cannot say that it will be helpful or harmful for individuals to watch this film, as that will depend entirely on the individual. In deciding for yourselves whether you or your family members should watch this film, we encourage you to review the above points and consider the potential impact for your recovery.
Talk with your treatment team about specific areas of concern, and discuss the potential pros and cons of watching the film.
We encourage individuals who are in treatment or recovery and who choose to watch the film to do so with other supportive individuals in their life with whom they can have a recovery minded dialogue about the film while watching; parents should watch with their children, and adults should identify someone in their community of support to watch with them.
We recognize that beyond the concerns above, this film is shining light on the eating disorder community and helping increase awareness of the challenges faced by individuals who are struggling with eating disorders. To further accurate education about the realities of eating disorder illnesses, we encourage you to watch and share the “Nine Truths About Eating Disorders” PSA that was recorded by the film’s cast, as these are the messages that we want the world to truly know and understand about eating disorders. You may also read the Nine Truths here.
Written by Sara Hofmeier, MS, LPCS, CEDS
Executive Director, Child and Adolescent Program, North Carolina