Gilles Mingasson/NetflixNetflix doesn't shy away from controversial material. Earlier this year, the original series 13 Reasons Why centered on a teenager's tragic suicide. The show's conceit—the girl who died posthumously orchestrates the action of the show by calling out 13 people who contributed to her decision—prompted concerns that it was glamorizing suicide.
On Friday Netflix premiered To The Bone, a dark dramedy about a young woman named Ellen, played by Lily Collins, and her battle with anorexia while seeking treatment under the unconventional guidance of Dr. William Beckham (Keanu Reeves).
The portrayal of eating disorders onscreen has been notoriously tricky for Hollywood, and despite some preventative efforts, To The Bone is facing some of the same criticism as its predecessors. There have been editorials accusing the movie of glamorizing anorexia, and there's a Change.org petition calling for Netflix to withdraw To The Bone from the public domain so as not to "exacerbate the stigma surrounding eating disorders" or "be triggering for those attempting to recover from an eating disorder."
That said, Collins, who has talked candidly about battling eating disorders in the past, and writer-director Marti Noxon, who based the film on her personal experiences, have been conscious of trying to "responsibly" cover the sensitive topic matter. During filming, the cast and crew took part in a PSA for World Eating Disorders Action Day and also consulted post-production with Project HEAL, a nonprofit aiming to prevent and treat eating disorders while promoting healthy body image.
As far as how right To The Bone got it, the answer still depends on who you ask. Claire Mysko, CEO of the National Eating Disorders Association, has mixed feelings about the movie. "I was disappointed that Netflix didn't include any resources with the film," she told E! News. "They did put a content warning on the film, but there were no resources or links to help."
Mysko was also concerned about some of To the Bone's "very graphic depictions of extreme thinness," she said, as well as its depiction of "eating disordered behavior which can be upsetting for people who are personally affected by eating disorders or at risk."
There were other aspects of the film, though, that Mysko found encouraging. "I was pleased to see the there was some diversity in the film as far as showing other people who struggle with eating disorders who don't necessarily fit the picture that we tend to see mostly in mainstream media of eating disorders," she said. "There was a young man in the treatment center, there was a woman of color... We don't typically see these depictions, so that was something I was pleased to see."
Dr. Cynthia Bulik, founding director of the University of North Carolina Center of Excellence for Eating Disorders, also emphasized the importance of showing diversity onscreen. "It's important [to note] that eating disorders don't discriminate," she says. "By stereotyping eating disorders we risk overlooking people who are suffering [but] who do not fit the stereotypical picture. The detection, referral, and treatment pipeline rests on the ability to identity people who are ill, and stereotypes blind us to the illness in those who do not fit some preconceived notion of what eating disorders look like."
Although Dr. Bulik had not yet seen To the Bone when she spoke with us, she did express some concern over Collins' weight loss for the role. The 28-year-old actress, who has spoken publicly about her struggles with anorexia and bulimia as a teen, made it clear it was her personal choice (not Noxon's) to lose weight for the film, and that she did so (and later gained it back) under the supervision of a trained nutritionist.
Collins told Access Hollywood losing weight was "something that I decided to do as an actor for a role," but it wasn't the kind of movie transformation that many medical professionals could stand behind. As Dr. Bulik said, "A parallel could be asking an actor with a history of serious drug abuse to get high repeatedly for a film."
Project HEAL wrote in an online FAQ that although they were consulted on other parts of To the Bone, they did not support Collins' decision to lose weight. NEDA's CEO was wary as well, telling E! News, "That's [Collins'] decision as an actress to do that, but I do think that there are serious risks involved with someone who's struggled with an eating disorder...I'm not a clinician, but as someone who has personally struggled with an eating disorder and who works with a lot of people and talks to a lot of people who have struggled, you know putting yourself back into an eating disordered, restrictive mindset can be really, really risky for someone who has got that history."
Others with a history of eating disorders might find it a good idea to avoid all things To the Bone—for now, at least. "There are some things in there that our organization [NEDA] recommends against in depictions of eating disorders," said Mysko. "There are a lot of scenes with body checking, there are calorie counts and numbers, so these are things that if you are struggling [you should] know that that's there...and if you think it's going to have a negative impact in your recovery, then you could choose not to watch it."
But why is it that certain imagery has the potential to "trigger" some people and not others? Every expert we talked to pointed out that eating disorders are complex biopsychosocial illnesses, and research indicates that some people have a genetic predisposition towards developing them. However, as Eating Disorder Hope CEO Jacquelyn Ekern told E! News, there are also a number of "environmental factors...including cultural and societal pressures and influences" that can contribute to an individual's development of the disease.
That's part of the reason why films like To the Bone have a responsibility not to oversimplify eating disorders or focus entirely on the weight loss aspect of this disease.
"...[As] a society, we seem to equate thinness with success, self-control, prosperity—you name it—as though [being thin is] the magic key," said Ekern. "Young people, particularly, I think buy into that...When they see a film about it and they're also equating thinness with all of these things that they probably long for in life that they think thinness is going to deliver, which is not accurate...that's where the correlation comes from that can be destructive."
Ekern acknowledged that while To the Bone "could be triggering for some," she was glad to see it raising awareness of eating disorders as a serious health concern. Mysko agreed, telling E! News she was "encouraged to see that there's a national platform for a discussion about eating disorders."
"I think that it's important for people to know that recovery is possible, and that eating disorders are treatable," said Mysko. "[To the Bone] already has sparked a conversation, but I hope that it encourages people to reach out for help too."
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