Representation of Eating Disorders in To the Bone

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Symptoms and Warning Signs[edit]

Anorexia Nervosa[edit]

Representation of Causes[edit]

Populations with Eating Disorders[edit]

The main protagonist of the movie is Ellen (Eli), who is a white and young women in her 20s. Other characters in the movie who have eating disorders were mostly white young females as well, such as the girl in the waiting room at a clinic that Ellen and her step mother visited in the beginning of the movie and the girls in the in-patient home such as Anna, Pearl, and Tracy. However, there were other characters who did not conform to the young white girl stereotype such as Megan, an older woman in her 30s who was expecting, Luke, a man was anorexic, and Kendra, who was bulimic/ had binge eating disorder? Despite including individuals of different backgrounds, most of the people who have eating disorders were predominantly young, white females, which can reinforce the image that only white women are affected by eating disorders. This is common within the media, as other studies have examined that the media mostly portrays a victim of an eating disorder as a white young woman. Although there are a limited number of studies that examines eating disorders in minority groups, some studies show that minorities experience eating disorders at a similar rate to that of whites. In the movie, there was one individual who was noticeable a person of color. Moreover, the individuals in the movie with eating disorders were disportionately female. This can reflect the current situation, in that there is a higher occurrence of eating disorders among females than among males. However, this film can illustrate that males are less affected by including only one male or acknowledges the fact that males can have eating disorders, but just not as often as females. There is ambiguity with this interpretation. In addition, the movie includes a slightly older woman who was pregnant, Megan. Studies have shown that pregnant women can have eating disorders; however such populations are not typically represented in the media. However, in general, despite their attempts to include different individuals, they typically play into the common eating disorder stereotypes. Therefore, the movie does a poor job including a diverse population to represent individuals with eating disorders.



Cognitive behavioral therapy (CBT) is effective in treating eating disorders.[1] Family based treatment is shown to be effective in maintaining remission of eating disorders.[2]Family involvement is important in treating severe anorexia nervosa, especially with improving health and maintaining recovery.[3]Self-guided CBT therapy has shown to be an effective treatment in treating patients with bulimia and binge eating disorder.[4]The average stay in an inpatient facility for anorexia nervosa is around 26 days[5]. It is considered to be shorter than what is needed to gain weight healthily[5]. The length and cost of inpatient treatment can vary by country[6].


Inpatient treatment facilities are recommended as a standard for the treatment of anorexia nervosa[5]. It is recommended because it is able to ensure that patients can undergo medical monitoring and are able to gain weight safely[5]. Hospitalization also serves to provide as a means to treat any other co-occurring medical or psychiatric illnesses[5].


Costs of a facility are reliant on the length of stay. Inpatient facilities cost more than outpatient treatment[5]. Inpatient costs constitute the expensive part of treatment.[6] Costs for anorexia nervosa are higher than that of bulimia nervosa and non specified eating disorders due to the need for a longer stay[5]. There is no difference in cost based on gender. The costs of eating disorders are similar to those of schizophrenia, but are less than those of obsessive compulsive disorder. This is due to eating disorders leading to other co-occurring medical issues, many of which may require medical interventions.[5]Patient body mass index (BMI) can affect hospitalization cost[6]. Cost can decrease for small increases in BMI[6]. If the BMI is higher at admission, it means less time needed for rehabilitation and weight gain. The younger a patient is, the lower the hospitalization cost will be. Having a younger age also increases the length of inpatient stay, since the body is still undergoing growth and development while also having to restore to a normal weight[6].

Resistance to Treatment[edit]

Resistance to treatment is known to occur. In the film, Ellen is shown to have received treatment from several treatment facilities prior to joining Beckham's inpatient facility, including one in which she was tube fed. Involuntary feeding is done at a last resort in facilities[1]. As seen in the film, Ellen continues to lose weight despite being in the facility, and this leads her to be near the requirement to be tube fed. Another character, Pearl, is shown to be undergoing a tube feeding when Ellen arrives at the facility.

Gender Differences in Treatment[edit]

Males, compared to females, are less likely to seek treatment, and those who do receive less treatment.[5]Majority of individuals in treatment facilities are female[6]. In the film, this is evident in Luke being the only male present in the facility.

  1. 1.0 1.1 Wilson, G. T., PhD, & Shafran, R., PhD. (2005). Eating disorders guidelines from NICE. The Lancet, 365(9453), 79-81. doi:
  2. 10.1002/eat.22042
  4. doi: 10.1177/1359105311402244
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Striegel-Moore, R. H. (05/2000). The international journal of eating disorders: One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: Evidence from a national database of health insurance claims John Wiley & Sons Inc. doi:10.1002/(SICI)1098-108X(200005)27:4<381::AID-EAT2>3.0.CO;2-U
  6. 6.0 6.1 6.2 6.3 6.4 6.5 Toulany, A. (04/2015). CMAJ open: Cost analysis of inpatient treatment of anorexia nervosa in adolescents: Hospital and caregiver perspectives. Canadian Medical Association. doi:10.9778/cmajo.20140086