to the editor: I enjoyed the article on the diagnosis of eating disorders¹ by Drs. Pritts and Susman and found it to be useful. However, I feel it's important for physicians who manage these patients to be aware of a recent phenomenon that further complicates their care. Many patients with eating disorders belong to the “Pro-Ana” movement, a subculture in which members believe that anorexia nervosa and other eating disorders are not disorders at all, but an alternative lifestyle that only needs support and encouragement. A quick Internet search of the term “Pro-Ana” will reveal a multitude of Web sites, bulletin boards, discussion groups, and chatrooms devoted to the movement. Most of these sites have disturbing and shocking content. Physicians who care for these patients would be well advised to spend some time exploring this world.