Can you make a movie about eating disorders without glamorising them?

Lily Collins stars in Netflix’s new film about anorexia, but critics have suggested it promotes an irresponsible view of eating disorders

Weight expectations: Lily Collins in ‘To the Bone’ (Netflix)

Part drama, part dark comedy, To the Bone stars Lily Collins as Ellen, a young woman who, after multiple stays in inpatient treatment programmes, grudgingly agrees to live in a group home run by an unconventional doctor (Keanu Reeves). It premiered to generally positive reviews at this year’s Sundance Film Festival, where Netflix purchased the global rights for a reported $8m (£6.2m).

Netflix posted the trailer on 20 June, prompting an intense Twitter debate around whether the film glamorises anorexia and whether it could be harmful or a trigger for those with eating disorders. The company sparked a similar conversation in April after releasing the drama series 13 Reasons Why, which caused concern for its graphic depiction of a teenager’s suicide.

Director Marti Noxon and supporters of the film say it’s an authentic departure from the slew of made-for-TV movies and TV show subplots that have made eating disorders look like trends instead of life-threatening illnesses. But the trailer shows elements of the film – Ellen ticking off calorie counts for the items on her dinner plate, a close-up of her extremely thin frame – that highlight the challenge of portraying eating disorders on-screen in a responsible way.

Critics have zeroed in on the film’s protagonist: a young, thin, white woman with anorexia, a prevailing narrative in pop culture despite the fact that eating disorders vary (binge-eating disorder is actually the most common eating disorder in the United States) and affect people of all backgrounds.

“It reinforces stereotypes about what an eating disorder is and looks like,” one survivor told Teen Vogue. “That imagery is everywhere, and it is actually celebrated in our culture.”

Noxon, the veteran writer-producer behind Girlfriends’ Guide to Divorce, Unreal and later episodes of Buffy the Vampire Slayer, based the film on her own battle with anorexia and bulimia, which began in her early teens.

She was aware of the film’s potential to be a trigger for some people and, as a result, tried to be “really conscientious in the way we approached how [Ellen] looked, how often we showed her body and in what context”.

“You want to help other people understand and have compassion for something they’ve never experienced, but you also want people who have experienced it to feel understood and seen and to give people hope,” she added. “At the same time we want it to be entertaining, so we were balancing a lot.”

Noxon wanted to avoid one trope in particular, “this idea that the perfectionist quality of anorexics is their most defining trait,” she said. It’s something she saw in a character with anorexia (played by To the Bone actress Ciara Bravo) in Fox’s short-lived dramedy Red Band Society.

“I appreciated their attempt to incorporate that as a real problem and a real illness,” said Noxon, who watched the series with her now 12-year-old daughter. But, she added, “it didn’t necessarily feel that the person writing it had really been through it.”

Noxon wrote To the Bone a few years ago, inspired by another project (an early draft for the film adaptation of The Glass Castle) that required her to think a lot about her childhood.

“It really came back to me that I was still myself,” Noxon said. “I think if you’ve recovered from a traumatic illness, mental or otherwise, sometimes you just think of yourself as being sick. But I remembered that I still had my personality. I still had a lot of humour to me.”

That realisation gave Noxon a clear idea of how she wanted to approach the film, which she wrote in just six weeks. “The character was going to have life to her. She wasn’t just one-dimensional,” Noxon said. “It wasn’t just about a sick person. It’s about a person struggling with her real demons.”

While To the Bone focuses mainly on Ellen’s recovery, it features a woman of colour battling an eating disorder and a male character with anorexia. Cynthia Bulik, founding director of the UNC Centre of Excellence for Eating Disorders, has not yet seen the film, but said those inclusions are encouraging because Hollywood and news outlets often fail to show that eating disorders also affect people outside of the stereotype.

“Those people are less likely to seek treatment, they are less likely to be accurately diagnosed, because they don’t fall within the stereotypical presentation that their physician might expect,” Bulik said.

Bulik was among the collaborators on a document titled Nine Truths About Eating Disorders, which inspired last year’s public service announcement featuring the cast and crew of To the Bone. “Eating disorders affect people of all genders, ages, races, ethnicities, body shapes, weights, sexual orientation and socioeconomic status,” Noxon says in the video.

It caught the attention of Liana Rosenman and Kristina Saffran, who met as teenagers while receiving treatment for anorexia. They co-founded Project Heal, an organisation geared toward helping eating disorder sufferers afford treatment.

Project Heal recently hosted screenings of To the Bone in New York and Los Angeles, but it has faced sharp criticism from members of their community on social media for supporting the film amid the trailer debate.

Rosenman and Saffran continue to stand by it. “I thought it was very powerful,” Rosenman said. “There is a sense of humour and wittiness in it as well as just understanding what it’s like to have an eating disorder.”

Saffran doesn’t think the film glamorises eating disorders, but rather “captures how serious these illnesses are”. (Anorexia has the highest mortality rate of any mental illness, according to the National Institute of Mental Health.)

Still, the backlash prompted Project Heal to compile a list of “Frequently Asked Questions” that recommend “carefully evaluating where you are in recovery before deciding to view this film”.

“Triggers are everywhere in eating disorder recovery,” Saffran said. “In many ways, it would have been impossible to make any sort of film that didn’t have the potential to trigger somebody who is struggling.”

Another concern around the film is that Collins, who has been open about her own struggle with eating disorders, lost weight for the role, which experts say can lead to relapse for those with a history of disordered eating. For her part, Collins has described the film as a cathartic experience.

“It was a new form of recovery for me,” the actress told Shape magazine. “I was terrified that doing the movie would take me backward, but I had to remind myself that they hired me to tell a story, not to be a certain weight. In the end, it was a gift to be able to step back into shoes I had once worn but from a more mature place.”

Claire Mysko, chief executive of the National Eating Disorders Association (Neda), said she is encouraged by the dialogue sparked by the trailer.

“Thirty million Americans struggle with eating disorders at some point in their lives,” Mysko said. “This is something that needs to be talked about, and we need for people to understand that this isn’t a silly fad or something that people choose.”

Mysko hasn’t yet seen To the Bone, but said she hopes Netflix will provide resources for viewers who may be vulnerable. Neda has reached out to the company asking that the film link to its help line and text line. A representative for Netflix did not respond to an email inquiry about whether the film will include a link to treatment resources.

Asked if she might have benefited from seeing a film like To the Bone when she was struggling with her eating disorder, Noxon paused.

“Yeah,” she said. “If I had seen where it leads, that no matter what you’re going through and however you’re externalising your anger and your sadness, ultimately it becomes a question of ‘how do you want to live?’ The thing that my doctor did for me that so few people were doing was frame it not as a problem I had with food or my body, but a problem I had with my soul.”

To the Bone begins streaming on Netflix on July 14

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