Netflix is creating buzz with a controversial new movie about a young woman struggling with anorexia, an eating disorder driven by a desire to be thin.

“To the Bone,” a two-hour film released July 14, has raised concerns among critics who fear the fictional portrayal could glamorize a life-threatening disease, and could also negatively influence viewers who struggle with eating disorders and body dysmorphia.

Nancy Zucker, Ph.D., a child psychologist and director of the Duke Center for Eating Disorders, offered tips for parents on starting a dialogue with children who might be viewing the film or hearing about it from peers.

Q: How often does the public see characters with eating disorders in TV and film?
A: Not often. Now and then, there will be a character in a sitcom with an eating disorder, but they usually recover in the space of the 30-minute program. Rarely do you see a main character or program that delves into the daily struggles of dealing with this disease or one that portrays the extreme loneliness and complexity of the illness. It’s not a simple story. I do think it’s becoming more part of the mainstream conversation.

Q: What was your gut reaction hearing the buzz about this movie?
A: I had a sense of dread, mostly out of fear that this could be a film that glamorizes or that inaccurately portrays eating disorders in a one-dimensional manner. While one could critique any portrayal, this film had a number of strengths that could launch meaningful conversations for people struggling with the disease and their loved ones to help them better understand the experiences of people with eating disorders. 

Q: Could watching a film about anorexia trigger someone to develop the disease?
A: The idea that an eating disorder is “contagious” is fascinating, but little research has been done in this area. We know that vulnerable individuals are more susceptible to potential triggers in their environment, but we have a lot to learn about what exactly makes them vulnerable. The degree to which the behaviors and opinions of others influence how we feel about ourselves – and what we choose to do as a result – differs widely. Some people are impervious to those influences, they are going to “do their thing” no matter what others say. Some individuals struggling with anorexia appear more vulnerable to these influences, and there is some evidence to suggest that this vulnerability existed prior to their disorder.

Because of this vulnerability, the concept of triggering has long been a part of the eating disorder vernacular. For some, watching a film that highlights the challenges and behaviors associated with anorexia could add to a viewer’s own feelings of guilt and shame. That could increase the likelihood that a person already struggling with an eating disorder might do something self-destructive.

Q: What should parents consider if their pre-teen or teen wants to watch “To the Bone”?
A: Ideally, parents would watch the film first to make an informed decision on whether this is suitable for their child. Watching the film with the child can also allow parents to discuss the feelings that come up as a result. 

Parents should know that there are many aspects of the disease the film captures accurately, such as how lonely it can be to struggle with an eating disorder and how symptoms of the disease allow a person with the disease a temporary escape or distraction from other emotions they might be fearful of.

But the film also reveals some critical gaps in understanding. The main character never receives an empirically validated treatment, one that has been proven effective through controlled research. The parents are not a constructive source of support for the main character. And throughout the story, there is an emphasis on “choice” being central to the character’s recovery, but the film doesn’t fully explore the complexity of the disease and aspects of it that can influence her choices, including malnourishment and her environment.  

Q: Who should watch this film?
A: Parents who have a child with an eating disorder could gain greater understanding from this film – but they’ll have to ignore how parents are portrayed in the film, as it’s not a fair representation. If you are a young person with an eating disorder, it’s hard to articulate your experience. And as a parent, it’s very abstract to try and understand what’s going on in someone else’s mind. 

This might help them understand better what the child’s experience is, and even provoke discussion on the ways their child’s experiences have been similar or different. The greatest benefit this movie could offer is to provide an opportunity for parents to have those kinds of guided conversations. 

Q: What behaviors or symptoms should concern parents?
A: Children who are developing or struggling with an eating disorder may seem sad or distant and might increasingly isolate themselves from friends and family. They may look for excuses not to eat with others, skipping family meals or staying busy and telling family they don’t have time to eat.

Parents who observe these types of behaviors need more information, which they can gather by scheduling more times for family to eat together and be together. If a child is feeling more distant, there is a need for connection and time together. This way, parents can gather more insight on the child’s eating habits and general well-being -- both for the sake of strengthening important family relationships and to offer insight on whether the child could benefit from additional services. 

For immediate help, the National Eating Disorders Association offers support through text messaging, online chat and a phone hotline available five day a week (800) 931-2237.