Netflix’s ‘To the Bone’ Is Streaming Now—Here’s What an Eating Disorder Expert Thinks

To the Bone, Netflix’s highly anticipated and
controversial film about a young woman with anorexia, began streaming
this morning. Buzz has been building for months about the
movie, starring Lily Collins, and it’s received both praise and
criticism (based on advanced screenings and the
trailer
, released last month) for its portrayal of such a
sensitive topic.

For people with real-life experience with eating disorders,
reaction to the movie has also been mixed. A writer for In
Style
who recently completed a treatment program herself
applauded the movie for touching on some of the most important
(and frustrating) things about recovery
that often don’t get any screen time
. Meanwhile, an
article in The Guardian, also written by someone with a
history of disordered eating, calls To the Bone
shallow,
sexist, and sick
.”

The movie revolves around 20-year-old Ellen and her experience
in an in-patient recovery program. To find out what someone who
treats patients for eating disorders thinks of the film—and
suggestions that it
glamorizes anorexia
, or could be triggering for vulnerable
viewers—Health spoke with Bonnie Brennan, a licensed
professional counselor and senior clinical director of adult
services at Eating Recovery Center in Denver. Here’s what she
thinks the movie got right and wrong, and what people should
know before watching.

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The film does a lot of things well

Brennan, who has worked with disordered eating patients in
outpatient, residential, and inpatient settings, says To the
Bone
is a “really touching, powerful, and honest attempt to
portray eating disorders.” And while she does take issue with a
few things in the film, she says that overall, “I thought the
artists did a great job, and I applaud them for their efforts.”

She was pleased to see diversity in the cast; along with Ellen
and a few other young white women, the residents of the
treatment center include a 20-something male, an
African-American woman, and a pregnant woman. “Of course, more
diversity could still be represented, because eating disorders
come in all shapes and sizes and across all ages,” says
Brennan. “But I’m glad they didn’t just stick with the version
of a typical anorexic most people are used to.”

The movie also does a good job portraying a lot of the
behaviors that people with eating disorders partake in, says
Brennan, including ones that people unfamiliar with the topic
may know nothing about. Ellen, for example, is obsessed with
counting calories and measuring her arm circumference, and she
does sit-ups so frequently that her back is chronically
bruised.

“They highlight how the exercise Ellen is compelled to do is
not enjoyable,” says Brennan. “You can see the real difference
between someone who exercises for health and well-being and
someone who’s doing it for painful, obsessive reasons.”

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Yes, it can be triggering

“There’s no doubt that, for folks who have been affected by
eating disorders, they’re going to see some stuff that’s hard
to watch,” says Brennan. That’s true of the characters’
physical appearances, as well as their behaviors around food.
“One thing to know about eating disorders is that there’s this
competitive side of wanting to be the sickest and the
thinnest,” she adds, “and those things probably will bring up,
for some folks, the lure of the illness.”

That doesn’t mean the movie will cause people to relapse,
however, and it doesn’t mean that anyone who’s struggling
automatically shouldn’t watch it.

“I recommend that if you are affected by eating disorders in
any way, that you watch this with a support person you can
trust,” says Brennan. It can also help for people to make a
note of specific things in the movie that bother them, she
says, and have a conversation afterward with a counselor or
someone they can trust.

The film’s casting of Collins—who
struggled with anorexia and bulimia
in her teens—has also
been heavily criticized by some. Brennan acknowledges that the
actress’s decision to participate in the film “must have been
incredibly hard and painful, and I’m going to assume it came
from a place of love and purpose.” Collins and the film’s
director have also
spoken out about that decision
, and the steps they took to
make sure she lost (and regained) weight for the role in a
healthy manner.

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It highlights the role of families

When To the Bone isn’t focused on Ellen’s life in the
treatment center, it’s exploring her relationship with her
family—including a stepmother who doesn’t understand her, an
absentee father, and a sister who admits she’s angry that Ellen
won’t “just eat” and get better.

“Often families don’t know what to do when a loved one is
suffering; they feel like they’re doing everything wrong,” says
Brennan. While Ellen’s stepmom says and does a lot of
questionable things, “she was willing to step up and be there
for the hard stuff, like getting her into treatment,” Brennan
says.

Brennan does think that the fact that Ellen’s dad was too busy
working to attend family therapy or make it home for dinner was
one stereotype the movie didn’t need. (He never once appears on
screen.) “As a clinician who’s worked with families for many
years, I will say that our dads really are showing up to
support their sons and daughters in treatment.”

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The film’s version of therapy is very
unconventional

People should not watch this film expecting to learn what
typical treatment for an eating disorder is like. The program
is referred to as inpatient, but when Ellen shows up she is
surprised to find a large residential house. “Inpatient
facilities are usually more like hospitals,” says Brennan.

 

Some of the program’s “rules” will likely raise eyebrows, as
well. “The way the meals are done, with the residents sitting
around the table without any staff, getting to decide what they
want to eat or not eat—that is very atypical of eating-disorder
care,” says Brennan.

 

And while some of Ellen’s housemates have been at the facility
for quite some time—six months, in one case—that’s generally
not the case for people in inpatient care. “That’s pretty
luxurious, and most folks don’t have the resources or the
benefits from third-party providers to support that long of a
stay,” says Brennan.

Still, Brennan says, the message that the program’s doctor
(played by Keanu Reeves) tries to get across rings true. “He
has a statement in there that is very aligned with our center’s
mission: He asks the character how she wants to live her life
moving forward,” she says. “We believe that a key to recovery
is finding a meaningful life that’s worth being in your body
and eating food and making the right choices 356 days a year.”

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It’s not perfect, but it’s a good start

For people with an advanced understanding of eating
disorders—their own or a loved one’s—To the Bone will
probably feel oversimplified and stereotypical, says Brennan.
“But for families or people who just want to understand this
issue a little better, I think we need to start simple and
build from there,” she says. “In an hour and 40 minutes, I
think they cover a lot of territory.”

Brennan says it’s important that the film makes the point that
treatment isn’t easy. “It does a good job showing that this is
a painful process and that it’s hard to face this thing and
manage all these thoughts and emotions.”

Overall, Brennan says that any film that shines a light on what
living with an eating disorder is really like—the pain, the
frustration, the unusual behaviors, and yes, even the dark
humor—has the potential to do a lot of good. “We like to say
that eating disorders thrive in secrecy and isolation,” she
says, “and this film does a great job of exposing some of that
stuff.”

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