1981's 'The Best Little Girl in the World' was the 1st-ever TV movie about anorexia. Experts grapple with its legacy today.

I will never forget the first pop culture depiction that I saw about an eating disorder: 1981's The Best Little Girl in the World, a high-drama, Emmy-nominated TV-movie starring 18-year-old Jennifer Jason Leigh as Casey, a high school student who develops anorexia.

It made a lasting mark on me, an impressionable preteen intrigued with magazines and diet culture, not only because of Jason Leigh's hauntingly stellar performance but because somehow, the film made the idea of anorexia seem less scary than intriguing, glamorous and darkly desirable.

On some confusing level, I envied Casey, a beautiful, thin, ballet-dancing perfectionist. And while my attempt to emulate luckily didn't go much past counting calories, eating SlimFast bars and asking my old-school ballet teacher for diet tips, I've been wondering what made the dramatization so triggering? And who else might've been spurred on by Casey's story?

A discussion of sorts on the topic was recently sparked on the Facebook page Brat Pack and ’80s Teen Movies, which posted to its 76,000 followers an image from the film showing Jason Leigh and co-stars, including Ally Sheedy, in a school-cafeteria scene. It prompted a slew of Gen X commenters to reminisce and, in some cases, blame the movie — and the novel of the same name that inspired it, by psychologist Steven Levenkron — for their own eating disorders, with at least one recalling how peers used it as a "how-to" guide.

"Ahhh … The book that helped create my eating disorder," Christine Hermes commented on the post, elaborating for Yahoo Life that she, too, was seduced by Casey's story.

"Honestly, it was the attention she received," Hermes says about what made becoming anorexic seem appealing. "I had a single mom who was an alcoholic and I suffered from depression and anxiety. If I drank, no one would notice or have cared, but you can't ignore a child who is slowly killing herself by starving."

Margo Maine, National Eating Disorders Association co-founder and clinical psychologist, tells Yahoo Life that, looking back at both the book and the movie version of The Best Little Girl in the World, one of the biggest problems was that "it sort of described the behaviors — but didn't describe the pain of the behaviors — so you just knew how to do it."

Maine, who has treated patients with eating disorders for 40 years and authored six books on the topic, says that she and other experts at the time found The Best Little Girl in the World to be "oversimplified… ego-driven…and very, very stereotypical," showing anorexia as a white, middle-class, girls-only issue. But the facts are that eating disorders do not discriminate, affecting people regardless of race or age or gender or sexual identity.

Further, both the book and movie "glamorized the eating disorder," which made it "dangerous for a lot of girls," Maine says, as the protagonist "gets a lot of attention and she's very attractive and she loses weight. It's very simplistic."

The risk for girls between about 11 and 18 who watched the movie was that "girls are really looking for an identity, a way to be special," she explains, adding that teen magazines at the time added to these types of aspirations. "It's looking for a way to define yourself and a way to be seen, and I think a movie like this is a great example of that," she says.

Adds Lucy Bassett, an associate professor of practice of public policy at the University of Virginia who has studied the media's depiction of eating disorders, Casey "is beautiful, and she suffered in this beautiful, poetic way," which can be viewed as alluring.

Watching it for the first time recently (on this fuzzy YouTube post, as the movie is currently unavailable on streaming services), Bassett, who has struggled with anorexia on and off, found it "horrifying" that the movie included characters basically "giving all these ideas" about "how to do [an eating disorder] better." She generally found it to be "sensational" and "triggering," though she does believe the film "was trying to show how bad this can be."

Levenkron, now 81 and still seeing patients, tells Yahoo Life that, after his book found an audience, his publisher at the time reached out to say, "'This has to be a movie for television because you'll reach more people.'" He says, "I didn't realize it was the only book on the subject, and [after it was published] I got deluged by mothers who wanted me to treat their daughters."

Levenkron quickly became known for his unconventional treatment approach, which involved "creating dependency" between himself and his patients. He went on to write more books and was sent on a speaking tour by his publisher, who told him, "You're going to become the country's expert on anorexia," though it was something Levenkron says he never set out to be.

As for the movie version of his book, which had an altered plot, "I didn't care for it," he says. "It ended on a silly note, with her in the hospital for two months and then eating ice cream with her therapist, when it would have been more like two years." Regarding claims that it may have triggered some of the women who would then become his patients, Levenkron says, "I didn't get those kinds of calls. They were desperate to get better, and nobody claimed — well, maybe a couple — that they got the idea from that."

Still, NEDA's director of education, Elizabeth Atunkara, tells Yahoo Life that this film and so many others can certainly tip someone into dangerous territory. "Messages in media, advertising, entertainment and in our society about dieting, and this pressure for thinness are internalized from a young age and can negatively affect every aspect of one's life leading to unnecessary feelings of shame and a distortion of one’s own body image, which triggers anxiety, self-consciousness and can contribute to a decline in mental and physical health," she says.

How views of eating disorders have changed — and remained the same

The way Jason Leigh (whose manager did not respond to Yahoo Life's request for comment on this story) has spoken about The Best Little Girl in the World to the press over the decades has evolved with the public's understanding; early interviews had her getting into the triggering nitty-gritty of the role — how much she ate and how much weight she lost, to the point where her doctor placed a worried call to the studio.

But in 2015 to Interview, her focus shifted. "That role was important to me, because my best friend in middle school had anorexia, so I felt a deep connection to it. I really loved doing it," she said. "You know, the girl who was my [body] stand-in died shortly after doing the movie. And that was quite horrible. It was so sad, because you didn't know what responsibility we had in that. Did we make the movie glorify it for her in some way?"

How the film depicted Casey's treatment, Maine says, was also indicative of the times, reflective of how eating disorders were approached by clinicians throughout the 1980s and ’90s — "medicalized," "authoritative" and often sexist. In other words, she says, "a white man telling the girls what to do." regarding this approach in the TV movie, Bassett says "it's basically like, the therapist and doctor are men, and they kind of save her — it's not even her finding the inner strength to overcome."

Maine recalls going to eating disorder conferences in those days, and that "all the speakers on the stage were men and the audience was all women." She adds, "In general, mental health … was dominated by men, so women's voices took a while to be heard." Now, she says, the field of eating disorder treatment is "very, very diverse" and "full of women."

The current approach to treatment generally involves a psychological-behavioral combination of therapy on either an outpatient or inpatient basis, depending on severity; and cognitive behavioral therapy (CBT) is considered "first in line" treatment, with a team of experts, often including a nutritionist, psychiatrist and family therapist, providing collaborative care. (NEDA's website offers an interactive, regional guide to finding treatment.)

But back then, Maine says, "the standard was you took all their privileges away and [the patient] had to earn them back. And a lot of hospital-based programs didn't give therapy until you were a certain weight… We've come a long way in the understanding of eating disorders and treating people more like people," but adds that, unfortunately, "there's still a lot of focus on weight per se."

While Levenkron was not the only clinician successfully treating patients with anorexia at the time, Maine says, "In some ways, I think he was a pioneer, because he wrote about it," and, between the book and the movie, there was purpose, as "it was the first attempt to educate the public about eating disorders in a big way."

Unfortunately, the way in which the media has depicted and dramatized eating disorders has barely evolved in all the years since, both Maine and Bassett lament. Although recent examples — including Netflix's 2017 film To the Bone, Feed (directed by and starring Troian Bellisario, who struggled with an eating disorder), The Crown series, the film Spencer and the Apple+ series Physical — have inched closer to reality, they still have an "image problem," says Bassett.

"The main image problem is that the representation of eating disorders in the media doesn't reflect what it is in reality — who actually has eating disorders, whether we're talking about gender, race, age or size," says Bassett, who in 2022 compiled a dataset of nearly 100 characters with EDs on TV and in movies from the 1980s to the present day, comparing their demographics to those of reality. The result revealed an extreme lack of characters who were male, non-white, larger-bodied, older or LGBTQ.

A similar tracking project, by Miriam Haart when she was a virtual-reality instructor at Stanford University, had similar conclusions. "It seems that even when films do include men and women of color [like To The Bone], the storylines are heavily knotted with tropes and cliches," she wrote in her conclusions. "Are eating disorders such a minefield to comprehend that even those with direct experience have difficulty narrating them? Or perhaps the challenge for filmmakers lies in simultaneously striving for authenticity and commercial success."

Even though there's been some improvement over time regarding the early glorification of Casey, says Bassett, "it's still that the majority [portrayed in media] are young white females." And that matters, she explains, because the medical community might not recognize those who need help. "Or people might not recognize it in themselves, making it harder to ask for help," she says. "And because of these being disorders that often make people feel so isolated and secretive, the more recognition there is … the better it is for people getting treatment early," which improves chances of recovery.

As far as whether a perfectly representative, complex, responsible depiction of an eating disorder is possible? "I don't think we've gotten there yet. It's just so risky and so easy to sensationalize and glamorize," Maine says. "I think it could be depicted well, but it would be a very full story and there would be a lot of nuance to it and it might not end easily and happily… The Best Little Girl in the World ends with her agreeing to eat, and a twinkle in her eye. It's not always like that. It's usually a much longer journey."

If you or someone you know is struggling with an eating disorder, call the National Eating Disorders Association hotline at 1-800-931-2237.

Wellness, parenting, body image and more: Get to know the who behind the hoo with Yahoo Life's newsletter. Sign up here.