‘To The Bone’: Final thoughts from eating disorder experts

After watching Netflix’s newest original movie, To the Bone, we were surprised by the realism of some aspects, yet disappointed by the lack of accuracy when it comes to some major aspects of eating disorder treatment and recovery.

One of our biggest disappointments about treatment is the lack of meal plans given to those in recovery. Eating disorders aren’t all about food, and establishing healthy nutrition is essential for recovery. We were shocked when the therapist tells Ellen, “Eat what you want.” It’s a total disregard of the neurobiological nature of Anorexia Nervosa, and an overemphasis on will power. Research indicates that brain receptor activity is more impaired in anorexia patients than in schizophrenia. Can you imagine an individual with schizophrenia who hears a voice in her head to kill herself (and maybe others) getting treatment from a psychiatrist who says “Meh, take your medicine if you like. It’s up to you.”

Some parts of the brain aren’t working well in those with Anorexia Nervosa, causing individuals to feel extreme anxiety and distress every time they try to eat. To recover, individuals need a lot of support and encouragement to push through that anxiety and eat what their bodies need. While readiness and inner strength are one part of recovery, it’s not helpful to leave it entirely up to volition. 

Additionally, we don’t believe it’s helpful to wait until someone reaches “rock bottom”. Many would die if this was the case. Once a patient nourishes her brain, that’s when her will to live will strengthen.

We were also frustrated that there didn’t appear to be any skill training in therapy. If eating disorders help individuals avoid emotional pain, what happens when they stop relying on the eating disorder? They need to build skills for coping with emotions more effectively – but this movie showed none of that.

Additionally, we were disappointed by the lack of evidence-based treatment and the slight toward The Renfrew Center and the Maudsley approach at the beginning of the movie, which are evidence-based programs. The treatment center that Ellen is admitted to is not an inpatient treatment center – those occur in hospital units. The film is more reticent of a residential treatment center. Highly regarded treatment centers use evidence-based treatments, such as Cognitive Behavioral Therapy and Dialectical Behavior Therapy to teach skills to regulate emotions and cope with urges for eating disorder behaviors. At the beginning of the movie, the characters reference the Maudsley approach, but allude to it being ineffective and undesired. In reality, it's a treatment for adolescents with anorexia, and Family Based Therapy, which is the gold standard, is highly regarded by treatment providers and is the only evidence-based treatment method for adolescents.

Despite our frustrations, there were things shown in this movie that were accurate about those suffering from an eating disorder. For example, the psychiatrist in this movie, Dr. Beckham, points out that eating disorders can’t be linked to one cause; they have multiple causes. While Ellen’s father blames himself for her eating disorder, it’s important to note that no parent is to blame for a child’s eating disorder. We feel it’s important for family to be a part of their loved one’s recovery, especially since they need to learn how to be supportive with this illogical illness. The individual suffering from the eating disorder isn’t the only one who needs treatment and education.

To the Bone is by no means a glamorization of eating disorders, but it does provide viewers opportunity to see the glamour in hope, healing and human connection.

Anorexia kills more people than any other psychiatric disease, including depression. Most of those deaths are suicides. And 25 percent of those who battle these demons will die. If you or someone you love is suffering from an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.