Chicago, USA - They call her "Ana." She is a role model to some, a goddess to others — the subject of drawings, prayers and even a creed. She tells them what to eat and mocks them when they don't lose weight. And yet, while she is a very real presence in the lives of many of her followers, she exists only in their minds.
Ana is short for anorexia, and — to the alarm of experts — many who suffer from the potentially fatal eating disorder are part of an underground movement that promotes self-starvation and, in some cases, has an almost cult-like appeal.
Followers include young women and teens who wear red Ana bracelets and offer one another encouraging words of "thinspiration" on Web pages and blogs.
They share tips for shedding pounds and faithfully report their "cw" and "gw" — current weight and goal weight, which often falls into the double digits. They also post pictures of celebrity role models, including teen stars Lindsay Lohan and Mary-Kate Olsen, who last year set aside the acting career and merchandising empire she shares with her twin sister to seek help for her own eating disorder.
"Put on your Ana bracelet and raise your skinny fist in solidarity!" one "pro-Ana" blogger wrote shortly after Olsen entered treatment.
The movement has flourished on the Web and eating disorder experts say that, despite attempts to limit Ana's online presence, it has now grown to include followers — many of them young — in many parts of the world.
No one knows just how many of the estimated 8 million to 11 million Americans afflicted with eating disorders have been influenced by the pro-Ana movement. But experts fear its reach is fairly wide. A preliminary survey of teens who've been diagnosed with eating disorders at the Lucile Packard Children's Hospital at Stanford University, for instance, found that 40 percent had visited Web sites that promote eating disorders.
"The more they feel like we — 'the others' — are trying to shut them down, the more united they stand," says Alison Tarlow, a licensed psychologist and supervisor of clinical training at the Renfrew Center in Coconut Creek, Fla., a residential facility that focuses on eating disorders.
Experts say the Ana movement also plays on the tendency people with eating disorders have toward "all or nothing thinking."
"When they do something, they tend to pursue it to the fullest extent. In that respect, Ana may almost become a religion for them," says Carmen Mikhail, director of the eating disorders clinic at Texas Children's Hospital in Houston.
She and others point to the "Ana creed," a litany of beliefs about control and starvation, that appears on many Web sites and blogs. At least one site encourages followers to make a vow to Ana and sign it in blood.
People with eating disorders who've been involved in the movement confirm its cult-like feel.
"People pray to Ana to make them skinny," says Sara, a 17-year-old in Columbus, Ohio, who was an avid organizer of Ana followers until she recently entered treatment for her eating disorder. She spoke on the condition that her last name not be used.
Among other things, Sara was the self-proclaimed president of Beta Sigma Kappa, dubbed the official Ana sorority and "the most talked about, nearly illegal group" on a popular blog hosting service that Sara still uses to communicate with friends. She also had an online Ana "boot camp" and told girls what they could and couldn't eat.
"I guess I was attention-starved," she now says of her motivation. "I really liked being the girl that everyone looked up to and the one they saw as their 'thinspiration.'
"But then I realized I was helping girls kill themselves."
For others, Ana is a person — a voice that directs their every move when it comes to food and exercise.
"She's someone who's perfect. It's different for everyone — but for me, she's someone who looks totally opposite to the way I do," says Kasey Brixius, a 19-year-old college student from Hot Springs, S.D.
To Brixius — athletic with brown hair and brown eyes — Ana is a wispy, blue-eyed blonde.
"I know I could never be that," she says, "but she keeps telling me that if I work hard enough, I CAN be that."
Dr. Mae Sokol often treats young patients in her Omaha, Neb., practice who personify their eating disorder beyond just Ana. To them, bulimia is "Mia." And an eating disorder often becomes "Ed."
"A lot of times they're lonely and they don't have a lot of friends. So Ana or Mia become their friend. Or Ed becomes their boyfriend," says Sokol, who is director of the eating disorders program run by Children's Hospital and Creighton University.
In the end, treatment can include writing "goodbye" letters to Ana, Mia and Ed in order to gain control over them.
But it often takes a long time to get to that point — and experts agree that, until someone with an eating disorder wants to help themselves, treatment often fails.
Tarlow, at the Renfrew Center, says it's also easy for patients to fall back into the online world of Ana after they leave treatment. "Unfortunately," she says, "with all people who are in recovery, it's so much about who you surround yourself with."
Some patients, including Brixius, the 19-year-old South Dakotan, have had trouble finding counselors who truly understand their struggle with Ana.
"I'd tell them about Ana and how she's a real person to me. And they'd just look at me like I'm nuts," Brixius says of the counselors she's seen at college and in her hometown. "They wouldn't address her ever again, so it got very frustrating.
"Half the time I'm, like, 'You know what? I give up.'"
Other days, she's more hopeful.
"I gotta snap out of this eventually if I want to have kids and get a job. One day, I'll get to that point," she says, pausing. "But I'll always obsess about food."