Netflix shocked viewers with “13 Reasons Why” this spring, but the streaming service recently released another controversial title: “To the Bone.”

The film’s trailer opens with Ellen — an attractive, young woman, played by Lily Collins — counting her dinner’s calories with sunken cheek bones.

The trailer later reveals Ellen receiving treatment from Dr. William Beckham, played by Keanu Reeves, for anorexia nervosa.

Like 13 Reasons Why, the film has been met with mixed reviews. Criticized for glamorizing eating disorders, triggering viewers and supporting sexist, patriarchal dynamics, the film has sparked discussion.

Project Heal, a nonprofit organization that provides grant funding to those who can’t afford treatment, worked closely with writer and director Marti Noxon to create the film. “To the Bone” is based on Noxon’s own struggles with anorexia. She received treatment in her early teens into her 20s and is currently in recovery.

“My goal with the film was not to glamorize (eating disorders) but to serve as a conversation starter about an issue that is too often clouded by secrecy and misconceptions,” Noxon said in a post on Twitter.

Noxon defended the film since its debut at the Sundance Film Festival in January despite repeated criticism from viewers and news publications.

According to Project Heal, eating disorders have the highest mortality rate of any mental illness. In the United States alone, one in ten people will suffer from an eating disorder at some point in their life.

Ninety percent of individuals suffering never receive treatment.  

Like Noxon, Collins revealed that she, too, struggled with anorexia and bulimia in her new book of essays —“Unfiltered: No Shame, No Regrets, Just Me.”

Collins has been criticized for losing weight for the role. In an interview with Refinery 29, Collins explained that her health was monitored by a nutritionist, who supplied her with nutritional supplements.  

Project Heal said in its FAQs that Collins’ weight loss was not condoned,and occurred before Project Heal was involved with the film’s production. Makeup and special effects were used to emphasize Ellen’s weight and physique.  

Sharon Tittl, a counselor at New Beginnings, an eating disorder treatment center in Fairlawn, Ohio, said Collins’ depiction of Ellen was predictable but still harmful.

“I wasn’t really surprised by it, I guess, definitely the actress’ body was very thin,” Tittl said.

Tiittl feared Ellen’s appearance would create a standard for comparison.

“I think it’s really easy to minimize (eating disorders) when you’re not underweight,” Tittl said. “(Those with eating disorders) may compare themselves because they need to be as sick as she was to get treated.”

Tittl said although anorexia and other eating disorders may result in weight loss, the side effects are not always physical.

“Binge eating and bulimia sufferers are often at what is considered to be average or above average weight,” Tittl said.

Project Heal wrote in an email that eating disorders may manifest in a variety of different body sizes and even lifestyles.

“Many people with eating disorders look healthy yet may be extremely ill,” Project Heal wrote.

National Eating Disorders Association describes eating disorders as being a biological, psychological and social disorder that may result in binging, purging, starvation or overeating.

Eating disorders may start with food, Tittl said, but the disorder and treatment go much deeper.

“An (eating disorder) would be a pattern unhealthy behaviors and eating behaviors brought on by a negative or distorted view of yourself,” Tittl said. “Food is just part of the recovery process, it’s also developing part of yourself and your identity.”

Despite Tittl’s concerns, she plans on watching the film for herself and to help her patients if necessary.

“I’m open to it, I have an open mind. They want to promote recovery, I think it could be beneficial to some,” Tittl said. “If people are suffering, I think it would be important to talk with their therapist about what was triggering.”

Tittl said viewers should view the film as less entertainment and more as a learning tool.

“I guess I would recommend using the movie as a platform for discussion,” Tittl said. “Watch it with other people and talk about what you thought about it.”

Despite concerns and criticism, Project Heal, Noxon and Collins have provided and promoted resources for help with eating disorders, including crisis hotlines and statistical data.

Since the announcement of the film in collaboration with Project Heal’s involvement, Project Heal noted, it has seen an increase in interest about disorders.

“We have seen an increase in inquiries about eating disorder resources and general questions about eating disorders,” Project Heal wrote in an email. “We have also had an increase in interest in our new peer support program and local volunteer opportunities for those in recovery.”

Tittl said she hopes the film may encourage viewers to take the next step toward treatment.

“The disorder wants you to avoid treatment,” Tittl said. “(Don’t) be afraid to talk to a friend or a professional, there’s no shame.”

If you or a loved one is suffering from an eating disorder, appointments can be scheduled with the university’s psychological services by calling 330-672-2487.

The NEDA Helpline is available Monday through Thursday from 9 a.m. to 9 p.m. EST, and Friday from 9 a.m. to 5 p.m. EST. You may reach the helpline at 800-31-2237. For crisis situations, text “NEDA” to 741-741 to connect with a trained volunteer at the 24-hour Crisis Text Line.

Isabel Kiefer is the dining, housing and DKS reporter, contact her at [email protected].