LOS ANGELES (AP) — Writer and director Marti Noxon struggled with anorexia and bulimia for 10 years. It's her story, albeit a fictionalized version, that she tells in "To The Bone," a feature film coming to Netflix on Friday about a 20-year-old artist whose eating disorder has reached a dire point. Lily Collins, who herself has a history with eating disorders, plays the main character Ellen.
"I didn't remember seeing a feature film that dealt with this," Noxon said recently in a joint interview with Collins. "I felt like it was high time there was a more authentic look at it, something that felt more genuine. There's still a lot of misunderstanding of it. People make the mistake of thinking it's all about vanity run amok."
The depiction of eating disorders, and specifically anorexia, in film and on television has a troubled history. In feature films, we've seen it fetishized as Natalie Portman's perfectionist ballerina coos over half of a grapefruit in "Black Swan," exploited as an emaciated patient wails that "74 pounds is the perfect weight" in "Girl, Interrupted," satirized with Barbie dolls in "Superstar: The Karen Carpenter Story" and played for comedic effect when in the black comedy "Drop Dead Gorgeous" a skeletal and wheelchair-bound beauty pageant contestant rolls out on stage to lip synch "Don't Cry Out Loud." On television, interpretations are usually of the maudlin and melodramatic variety — Lifetime films about broken homes and obsessive teenage girls where tears and death are a guarantee.
And most of the time, it's about a young, white, underweight female.
For these reasons and the sensitivities of those who have or are suffering from eating disorders, "To the Bone" has already provoked passionate responses. Critics latched on to a trailer and picked it apart for its potential to trigger and a worry that it could glamorize eating disorders or be used as "thinspiration." It was also lampooned for focusing on "another middle class white woman."
Its put Collins and Noxon in the position of having to be defensive before the film is even out. Both say they hope audiences respond to its more nuanced and complex portrait of the illness and the various ways in which it can manifest. For instance, there's a woman of color in the treatment center, as well as a man. As fellow survivors, they were extremely careful in just how they wanted to bring the story to life.
Noxon consulted with specialists who treat eating disorders during the script phase and, as a result, never includes mention of Ellen's weight or goal weight — in fact, numbers aren't discussed — and only once shows the character's full body. Numbers, she said, can stick in people's heads and become aspirational.
"We didn't want it to be gratuitous in any way," Collins said. "Neither Marti nor I having experienced this would ever set out to make a movie that fetishized, encouraged or glamourized this disorder."
Ellen, who is witty, vibrant and darkly funny, is also not the kind of tragic heroine you might recognize from other depictions.
While some 30 million Americans struggle with eating disorders at some point in their lives, according to the National Eating Disorder Association (NEDA), it remains an illness that is widely misunderstood.
"For us as an organization, we're very interested in raising the profile of eating disorders as a serious public health issue," said NEDA CEO Claire Mysko. "Having eating disorders discussed on a national platform like this is really important."
NEDA participated in a public service announcement "Nine Truths About Eating Disorders " with the "To the Bone" cast, but had no involvement in the actual film. Representatives have encouraged Netflix to include resources for help in its rollout.
An organization that has supported "To the Bone" is the eating disorder non-profit Project HEAL , which has hosted screenings and discussions of the film.
Project HEAL co-founders Kristina Saffran and Liana Rosenman hoped to help the filmmakers deliver a responsible message about eating disorders and provide accurate information and resources.
"It's pretty groundbreaking," Saffran said. "It's extremely hard to make a movie about eating disorders that really gets to the reality of the disorder and how serious and challenging and life-threatening these disorders can be without glamourizing them. 'To the Bone' does an amazing job of striking that balance."
For others, however, depiction itself can be the issue. Dr. Emily Fox-Kales has been a clinical psychologist for over 30 years specializing in the treatment of eating disorders. She also teaches film and gender studies and her 2011 book "Body Shots: Hollywood and the Culture of Eating Disorders" examined how movies and celebrity culture can influence the way real people feel, eat and live.
"The best way to understand it is genetics and your family and all that stuff load the gun and make you vulnerable, but I really think our culture pulls the trigger," said Fox-Kales.
Fox-Kales has also not seen "To the Bone," but worries that the imagery can often be more powerful than the message behind it. She said even attempts to talk about skinny celebrities with concern, like People Magazine's "How Thin is Too Thin" articles, can be harmful.
For her, the only film that has so far done the disease justice is the documentary "Thin," from Lauren Greenfield.
Noxon and Collins aren't shying away from the debate and discussions either and both urge those who feel like they might not be in a good place to watch the film to simply skip it. They also stress that it's a story of hope and recovery.
"This is just one story," Noxon said. "There are millions of stories like this."
"What's important to take away from the movie is that seeking help is never a weakness, it's a strength," Collins added. "It's meant to start a conversation."
Follow AP Film Writer Lindsey Bahr on Twitter: www.twitter.com/ldbahr .