Mental health experts have said a Netflix trailer for a film about a teenage girl with anorexia could trigger psychological issues for sufferers and should come with a warning.

To the Bone, which is released next month, tells the story of 20-year-old Ellen, who struggles with anorexia and enters a group recovery home for help. But while its director says the film is intended as “a conversation starter about an issue that is too often clouded by secrecy and misconceptions”, critics say the film risks glamourising and trivialising anorexia.

Netflix recently found itself at the centre of controversy over its drama 13 Reasons Why, a portrayal of a teenager’s suicide that critics said could encourage young people to kill themselves. Samaritans said the show was “extremely concerning”.

Psychiatrists have levelled similar criticisms at To the Bone. Dasha Nicholls, chair of the eating disorders faculty at the Royal College of Psychiatrists, said: “It is potentially risky to two groups of people, including those who have not yet developed an eating disorder. There is always a risk of glamourising it [anorexia] and also slightly trivialising it.

“My anxiety is that because [the movie looks like] it has a happy ending and looks like such an enriching experience that it may seem to be an appealing way to address internal conflict. I am just providing a warning about that. We have a responsibility to protect young people and people who are vulnerable.”



Nicholls said it was hard to judge the entire film on the trailer, but said: “My main message for people who will be vulnerable to this is to consume with caution.” She said a trigger warning would be a “really sensible idea”, as well as a parental advisory note.

Psychologist Dr Carolyne Keenan said: “It is very possible that some viewers may find the material distressing and triggering, and both Netflix and viewers will need to take responsibility for what they do with that. I wonder if it might be helpful to have an advisory prior to the trailer, for example, stating what viewers are about to see so that they can make an informed choice about watching.”

The movie stars Lily Collins and Keanu Reeves. While the trailer does not explain the whole plot, experts said some of the images in it could trigger emotional distress in those with anorexia. In the trailer, Collins’s character counts calories and looks extremely thin.

Leading eating disorder charity Beat recommends that the media does not report on specific low weights. In its reporting guidelines, it says: “Images, especially photographs of certain emaciated body parts are triggering.”



Nicholls said: “There is quite a lot of concern about the use of imagery, mainly from patient and carer groups. We in the medical profession are used to looking at bodies objectively ... but people can be triggered by such images.”

Despite reservations, charities and psychologists said it was important that this issue was being addressed. Keenan described it as a sensitive topic, “but one that does need to be spoken about”.

Kennan said: “Both the director and the lead actress have struggled with anorexia nervosa and created the production in collaboration with related organisations. There is evidence that they have attempted to make this a useful, informative piece in order to invite discussion.”

A spokesperson for Beat said they were waiting to see the full film before commenting further. However, they said: “We very much support the media in raising awareness of eating disorders ... Equally, we know that when eating disorders are glamourised or trivialised by the media, this can trigger negative behaviours in people who are affected by these complex mental health issues.

About 1.6 million people in the UK are affected by an eating disorder, and 11% of these people are male. Additionally, about one in 100 women aged between 15 and 30 are affected by anorexia.



The trailer has received a mixed response online. The movie’s writer and director, Marti Noxon, who based the film on her own experiences, said: “My goal with the film was not to glamorise [eating disorders] but to serve as a conversation starter about an issue that is too often clouded by secrecy and misconceptions.”

Collins, who plays the lead character in To the Bone and has experienced eating disorders herself, said: “There never was a ‘goal’ weight, but I knew that hair and makeup and wardrobe could only do so much. And that to pay tribute to the girl that I was when I was younger, and also to the character, I wanted to do it in a way that really went there – but was also healthy. But, yeah, there’s always a fine line.”

Nina Martynchyk, who experienced anorexia and is a campaigner for eating disorders awareness, said: “When someone is making a movie, they want it to be something that is enjoyable for the audience to watch and thus not too depressing. Although, making a film that is enjoyable about something as serious and devastating as anorexia consequently has a great potential to minimise the seriousness of the issue.



“I will be watching the movie – albeit with a lot of scepticism – but I wouldn’t recommend that anyone who is still struggling with an eating disorder and/or is susceptible to being triggered sees it, as I am scared it has the potential to do them harm.”

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.