There are multiple factors involved in the aetiology of eating disorders. Logging into social media accounts daily, or in many cases even hourly, is now considered the norm in our society. Exposure to these social feeds and messages is regarded as a contributing factor to the development of body image issues and eating disorder development. Other traditional media platforms such as magazines and television have been researched in their influence on eating disorder risk, however social media influence has not yet received as much review and examination. This article evaluates the current research and topics involved with social media influence and eating disorders in girls and women.
Eating disorders (ED) are complex and include a large spectrum of abnormal behavioural and mental attitudes towards body weight and food intake. Common presentations of ED include bulimia nervosa (BN), anorexia nervosa (AN) and binge eating disorder (BED).
AN is primarily characterised by restricted caloric intake alongside fear of weight gain and body image distortion.[5,6] BN is characterised by episodes of binge eating, followed by a form of compensatory behavior such as use of laxatives, exercise or purging, and may also involve food restriction.[5,6] BED involves episodes of high caloric intake and experiencing lack of control.[6,7]
Orthorexia nervosa (ON) is characterised by an obsession of healthy eating through attainment ‘pure’ diet which may then become pathological. Other specified feeding and eating disorder (OSFED), previously known as EDNOS, are eating disorders that do not fit the criteria of the other eating disorder categories.
The emergence of social media has been useful in providing easy access to health information and social support, but has also become a platform for promoting dangerous behaviours. People who are considering or actively participating in certain behaviours such as smoking, self-harm or extreme dieting, might shy away from discussing these behaviours with their friend and family circles, out of fear of judgement. This can result in social media being a primary source of emotional and informational support.
The influence and utilisation of social media networking online over the last 10 years has increased the capacity for people to share and find content with other like-minded individuals around the world. Health-related content encompassing fitness and diet is among one of the leading trends on social media and has widespread popularity. In response to these trends, research is now being conducted to explore health-related information on social media platforms, and the outcomes associated with engagement and exposure to this content.
Research has shown that social media use is correlated with disordered eating, depressive symptoms, internalisation of body ideals and body weight dissatisfaction. Pro-muscularity and pro-eating disorder platforms are among some the communities that have emerged through social media. These platforms are easy to access and give rise to potentially disturbing information that promotes disordered eating behaviours.
One study assessed a group of girls aged 12 to 19 years old. They were asked to participate in a survey providing information on television and internet habits, as well as the type of shows they watch. They were asked to compete a questionnaire looking at their outlook on eating, physical satisfaction or dissatisfaction, approach to slimming and their view of empowerment. The results indicated that increased social media use resulted in higher incidence of negative approaches to eating and urge to be on a weight loss program, negative self-image, physical dissatisfaction and suffering of AN and BN.
Another study examined the association between social media use and eating concerns. In this study, 1765 participants aged from 19 to 32 years were randomly selected. Social media use, including Reddit, Snapchat, Vine, Tumblr, Pinterest, Instagram, LinkedIn, Youtube, Google+, Twitter and Facebook, were assessed in relation to frequency per week and volume per day. Participants found in the highest quartile compared with the lowest quartile for social media frequency and volume had significantly greater likelihood of eating concerns. The study showed a consistent and strong relationship between social media usage and disordered eating.
Growing evidence is assessing the nature of pro-eating disorder platforms. Qualitative studies of this online content show recurring themes associated with AN. These themes position the condition as a lifestyle choice striving for body perfection and control. Pro-anorexia platforms encourage solidarity and share hazardous advice in the form of “tricks and tips” that promote the hiding of the disordered behaviour. A meta-analyses of outcomes linked to pro-eating disorder content showed that even short exposure to these social media themes was associated with reduced caloric intake, compensatory behaviour, low self-esteem and body image issues.
Beyond these groups giving advice, these trends have also evolved into “healthy living” content, which further perpetuates disordered eating behaviours. “Thinspsiration” is content characterised by promotion of restrictive eating habits and slim bodies. “Fitspiration”, on the other hand, is content that spreads messages of exercise and healthy eating through strength and empowerment. Despite the positive juxtaposition to thinspiration, fitspiration still promotes narrow body ideals and primarily focuses on, and promotes the sharing of, physique and appearance.
Another study assesses how content celebrating and defending AN as a lifestyle are distributed to individuals who use social media, and looks at the characteristics that encourage the propagation of these messages. Content assessed was acquired over one month from social media platform Tumblr, which is a blog commonly used to discuss eating disorders. A large 35,432 posts were collected and assessed using coding on the highest propagated posts to identify message characteristics. They found that characteristics most likely to be propagated included posts with a narrative or testimony positively associated with their own or another person’s experience with AN, posts with an affective tone toward AN and posts showing underweight bodies or high exposure.
Social media influence on eating disorders among girls and women is a topic with many avenues to explore. Such avenues include early exposure of social media to children and adolescents, emerging social media trends and hash-tags specifically in the health and wellness industries, certain platforms used to celebrate hazardous behaviours and disordered eating, general influence of social media on self-worth and self-esteem, and social media as a primary resource for health related advice.
The use of social media will continue to grow and expand. However, while useful at times, the social media addiction society is facing needs to be considered. On-going research should examine more specific characteristics of social media including context and content being viewed by specific populations and groups.
Social media use assessment is something for practitioners to consider. Questions could relate to what social media platforms the client uses, frequency of visits on a daily or weekly basis, time spent online, specific times of the day and favourite types of content to view. Exploring social media use in clients may assist practitioners in developing the full client picture and lead to more effective client outcomes.
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- Parra-Fernandez ML, Rodriguez-Cano T, Onieva-Zafra MD, et al. Adaptation and validation of the Spanish version of the ORTO-15 questionnaire for diagnosis of orthorexia nervosa. PLoS One 2018:13:S1-S14.[Abstract]