The dangers of the rabbit hole: Reflections on social media as a portal into a distorted world of edited bodies and eating disorder risk and the role of algorithms

Social media and body image: Relationships between social media appearance preoccupation, self-objectification, and body image

Nearly 85 % of emerging adults report using at least one social media site. Research suggests that viewing and internalizing unrealistic body ideals often displayed online may pose harmful effects on young people's body image. However, studies on the relationships between social media usage and body image have predominantly focused on women's drive for thinness. We sought to explore the relationships between social media appearance-related preoccupation (SMARP), body shame and surveillance, and drives for leanness, muscularity, and thinness, specifically examining the moderating role of gender within these relationships. Data from 939 undergraduate students (n = 240 men) were analyzed using multigroup structural equation modeling. Surveillance significantly mediated the positive associations between SMARP and drive for leanness for women and men. For SMARP and drive for muscularity, surveillance was a mediator for men only. Shame emerged as a significant mediator of the positive association between SMARP and drive for thinness for women and men. Moderated mediation was supported, such that the indirect effect of SMARP on drive for thinness was significantly stronger for women. These results suggest that for men in particular, SMARP is not necessarily associated with increased drives for leanness and muscularity unless men are also engaging in body surveillance.

Mitigating Harms of Social Media for Adolescent Body Image and Eating Disorders: A Review

Social media has negative effects on adolescent body image and disordered eating behaviors, yet adolescents are unlikely to discontinue engaging with these platforms. Thus, it is important to identify strategies that can reduce the harms of social media on adolescent mental health. This article reviews research on social media and adolescent body image, and discusses strategies to reduce risks associated with social media use. Topics covered include interventions aimed at mitigating social media's negative impacts, the body-positivity movement, and policies regulating adolescents' social media use. Overall, this review highlights specific factors (such as staffing, duration, modality, facilitator training, and cultural sensitivity) to consider when designing and implementing social media interventions targeting adolescents. This review also discusses psychosocial outcomes associated with body positivity on social media. Finally, policy efforts to reduce the negative impact of social media on adolescents' body image and eating behaviors are described. In sum, there is a strong need to conduct further research identifying optimal approaches to reduce the harms of social media for adolescent body image and eating behavior.

An exploration of having social media influencers deliver a first-line digital intervention to improve body image among adolescent girls: A qualitative study

Social media influencers are popular among adolescents and could offer a unique way to reach young people at scale with body image interventions. This study explored girls' and influencers' views on having influencers deliver body image interventions through vlogs (video blogs) and to gain insight into their preferred format, content, and views on factors that encourage engagement with vlogs. Twenty-one UK based participants were recruited. Three online focus groups were conducted with adolescent girls (n = 16) aged 14-18 years and one with influencers (n = 5) aged 24-33 years, who had a collective following of over 1.5 million subscribers across social media platforms. Data were analysed using reflexive thematic analysis and four themes were generated: Choosing an influencer whose messages and core values are aligned with the topic of body image; the importance of influencer authenticity and personal experience; collaborating on content creation with mental health professionals; and the need for long-form (i.e., 10-20 min) content to address serious topics. Findings suggest having influencers deliver body image interventions to young people could be a useful approach. Results highlight the need to engage with end users from the outset of intervention development to increase the likelihood of intervention effectiveness and engagement.

The Impact of Health Literacy on Trust in Online Plastic Surgery Content: A Nationwide Analysis

INTRODUCTION

On most online platforms, just about anyone can disseminate plastic surgery (PS) content regardless of their educational or professional background. This study examines the general public's perceptions of the accuracy of online PS content and the factors that contribute to the discernment of credible information.

METHODS

The Amazon Mechanical Turk crowdsourcing platform was used to survey adults in the United States. The survey assessed respondent demographics, health literacy (HL), and perceptions of online PS content accuracy. T-tests, Chi-square tests, and post hoc analyses with Bonferroni corrections assessed differences between HL groups. Multivariate linear regressions assessed associations between sociodemographic variables and perceptions of online content.

RESULTS

In total, 428 (92.0%) of 465 complete responses were analyzed. The median age of respondents was 32 y (interquartile range: 29-40). Online sources were predominantly perceived to have a high degree of accuracy, with mean scores of various platforms ranging from 3.8 to 4.5 (1 = not accurate at all; 5 = extremely accurate). The low HL group perceived social media sites and review sites to be more accurate than the high HL respondents, particularly for Reddit (P = 0.004), Pinterest (P = 0.040), and Snapchat (P = 0.002).

CONCLUSIONS

There is a concerning relationship between low HL and the perceptions of the accuracy of online PS sources. This study underscores the need for education campaigns, the development of trustworthy online resources, and initiatives to improve HL. By fostering a more informed public, individuals seeking PS can make better informed decisions.

Social media use by patients with hypermobile Ehlers-Danlos syndrome

BACKGROUND

Patients with uncommon genetic conditions often face limited in-person resources for social and informational support. Hypermobile Ehlers-Danlos syndrome (hEDS) is a rare or underdiagnosed hereditary disorder of the connective tissue, and like those with similar diseases, patients with hEDS have begun to turn to social media in search of care and community. The aims of our study were to understand the usage habits and perceptions of utility of social media use for patients with hEDS in order to formulate suggestions for how clinicians may best engage these and similar patient populations about this topic.

METHODS

We conducted both a quantitative survey and qualitative interviews with patients who had received a robust clinical diagnosis of hEDS.

RESULTS

Twenty-four individuals completed the initial survey, and a subset of 21 of those participants completed an interview. Through thematic analysis, we identified four primary themes related to their experience with social media: (1) befriending others with their disease, (2) seeking and vetting information, (3) the risks and downsides of social media use, and (4) the desire for clinicians to discuss this topic with them.

CONCLUSION

We conclude by proposing five suggestions that emerge empirically from our data. These proposals will help clinicians engage their patients regarding social media use in order to promote its potential benefits and circumvent its potential harms as they pursue support for their hereditary condition.

#WhatIEatInADay: The effects of viewing food diary TikTok videos on young adults' body image and intent to diet

The rise of short-form video content has prompted research into its impact on body image; however, little remains known regarding the effects of exposure to food-related content of this type. The present study aimed to fill this gap in the literature by conducting a between-subjects experiment (N = 316) examining the effects of exposure to low-calorie versus high-calorie "What I Eat in A Day" food diary TikTok videos on young adults' body appreciation, body dissatisfaction, and diet intentions. Additionally, this study sought to explore how social comparison and mood might affect participants' responses to these videos. Results indicate that social comparison mediated the relationship between video type (low- vs high- calorie) and positive mood, such that low-calorie videos increased upward social comparison and decreased positive mood, and high-calorie videos increased downward social comparison and increased positive mood. Positive direct effects of positive mood on body appreciation and diet intentions occurred, and a negative direct effect on body dissatisfaction was found. Additionally, positive mood mediated the path from social comparison to diet intentions. These findings highlight the importance of further research into the nuanced impacts of food diary social media content on young adults' body image and behaviors.

Physical attributes of workout instructors and appearance-related messaging in a sample of home workout videos on YouTube: A content analysis

Given the popularity of home workouts and effects of exposure to media messaging regarding appearance ideals, the purpose of this analysis was to examine the content of YouTube home workout videos. A sample of 298 YouTube home workout videos was coded for demographic factors and body shape of instructors and the presence of body positivity messaging, appearance-related messaging, and other relevant themes. All videos in the sample included detailed instructions and demonstrations of the exercises by instructors. The majority of the videos depicted young White women with low body fat and thin/athletic bodies with visible muscles. Instructors often focused on burning fat/calories but also emphasized body functionality, exercising for fun/enjoyment, and the importance of taking care of one's body. Overall, findings demonstrate that workout instructors on YouTube conformed to unrealistic, narrowly defined appearance ideals present in Western culture, but the messaging in the videos contained many positive and affirming qualities.

Social Media Effects Regarding Eating Disorders and Body Image in Young Adolescents

The following study investigates how eating problems and young people's body image are affected by social media. As social media becomes more pervasive, young teenagers are exposed to many pictures, messages, and influencers encouraging unachievable body and beauty ideals. The study investigates the link between social media usage and the development of binge eating disorder patterns and undesirable body image judgments. It also sheds light on the influence that so-called social media influencers and celebrities have on encouraging disordered eating patterns and forming negative body image perceptions. On websites like Instagram and TikTok, exposure to deliberately selected photographs of "ideal" body types encourages body dissatisfaction and poor self-worth. The research emphasizes social media's possible harm to this vulnerable group's physical and mental health by examining pertinent literature and empirical evidence. It also looks at potential safeguards and methods for fostering good mental and physical health in early adolescents during pervasive social networking site use. Promoting fad diets, weight-loss aids, and the exaltation of extreme thinness aids in the normalization of harmful behaviours. Social media's negative consequences on eating disorders and body image in young teenagers are highlighted by this study in its conclusion. As a critical developmental stage, early adolescence is vulnerable due to the effect of social media, which could normalize unhealthy behaviours and maintain negative body image and insecurities. The findings underscore the need for targeted interventions and educational programs to mitigate the adverse effects of eating problems and young people's body image in light of social media.

Association between engagement with appearance and eating related TikTok content and eating disorder symptoms via recommended content and appearance comparisons

OBJECTIVE

It is well-established that the use of appearance-focused social media is associated with eating disorder (ED) symptoms, due to the presence of idealized imagery. Of concern, social media exposure is increasingly influenced by algorithms, which recommend content based on an analysis of the users' previous patterns of engagement. However, the relationships between users' engagement with social media content based upon its centering of appearance and eating, the presence of these themes in content suggested to them, and their ED symptoms remains unknown. The current study aimed to examine these relationships in the context of TikTok, a video- and algorithm-based platform.

METHOD

Undergraduate students (N = 230; 78% female) completed self-report measures of ED symptoms, upwards social media appearance comparisons, as well as a novel measure of TikTok activity.

RESULTS

Serial mediation analyses provided support for indirect relationships between engagement with appearance/eating-related content and ED symptoms via higher proportions of appearance/eating-related recommended content and higher levels of upwards social media appearance comparisons, respectively. There was no association between average screen time, nor general tendency to actively engage with content, and either ED symptoms or upwards social media appearance comparisons.

DISCUSSION

Findings provide preliminary support for how engagement on TikTok is related to targeted exposure in ways that may contribute to perpetuating and exacerbating ED symptoms.

PUBLIC SIGNIFICANCE

Social media use has been consistently associated with greater eating disorder symptoms. However, the ways in which users' engagement with social media content may be related to targeted social media exposure, and in turn eating disorder symptoms, remains unknown. This research provided preliminary evidence for associations between users' engagement with, and targeted exposure to, TikTok content related to appearance and eating, and their eating disorder symptoms.

"Eat more protein, build more muscle": A grounded theory study of muscle-building behaviors among Canadian adolescents and young adults

Unique risk factors for the development of muscle dissatisfaction and engagement in muscle-building behaviors have been described by theoretical frameworks and supported by empirical research. What remains unknown are the unique processes, including catalysts and facilitators, which underpin engagement in muscle-building behaviors. Therefore, this study used a grounded theory methodology to elucidate the process of engagement in muscle-building behaviors. Thirty-three individual semi-structured interviews with Canadian adolescents and young adults ages 16-30 years were conducted. Transcripts were analyzed using initial and focused coding to identify themes that explained the grounded theory. The core theme underpinning the grounded theory was balancing aesthetic, health, and functional goals in relation to participants' engagement in muscle-building behaviors. Participants described experiences that encompassed several unique phases of muscle-building engagement, including the initiation phase, beginner phase, preservation phase, and intensification phase. Participants also described unique methods of gathering information on muscle-building behaviors, and their own analysis and decision-making processes driving their behaviors. Findings from this study extend prior theory and research by conceptualizing a novel process theory of engagement in muscle-building behaviors among adolescent and young adults, resulting in important implications for research and practice.

A Normative Framework for Assessing the Information Curation Algorithms of the Internet

It is critical to understand how algorithms structure the information people see and how those algorithms support or undermine society's core values. We offer a normative framework for the assessment of the information curation algorithms that determine much of what people see on the internet. The framework presents two levels of assessment: one for individual-level effects and another for systemic effects. With regard to individual-level effects we discuss whether (a) the information is aligned with the user's interests, (b) the information is accurate, and (c) the information is so appealing that it is difficult for a person's self-regulatory resources to ignore ("agency hacking"). At the systemic level we discuss whether (a) there are adverse civic-level effects on a system-level variable, such as political polarization; (b) there are negative distributional or discriminatory effects; and (c) there are anticompetitive effects, with the information providing an advantage to the platform. The objective of this framework is both to inform the direction of future scholarship as well as to offer tools for intervention for policymakers.

Does medium matter? Investigating the impact of viewing ideal image or short-form video content on young women's body image, mood, and self-objectification

There is a rising prevalence of short-form videos on social media, particularly since the advent of TikTok. Viewing appearance-ideal images has harmful effects on young women's body image. However, the impacts of viewing appearance-ideal short-form videos on body image are largely unknown. This study investigated the impact of viewing appearance-ideal short-form social media video content on young women's (Mage = 19.19, SD = 1.80) state appearance satisfaction, negative mood, self-objectification, and related constructs, compared to viewing appearance-ideal image content and appearance-neutral content. Young women (N = 211) were shown either: (1) appearance-ideal images, (2) appearance-ideal videos, (3) appearance-neutral images, or (4) appearance-neutral videos. Viewing appearance-ideal content regardless of the medium led to decreased appearance satisfaction, and increased negative mood, and self-objectification, and more state internalisation of appearance ideals compared to viewing appearance-neutral content. Further, if women perceived the appearance-ideal content they viewed to be unedited or unenhanced, they reported less appearance satisfaction after viewing video than image content. Thus, the impact of viewing ideal video and image content taken from social media may have similar effects on young women. However, when ideal content is low in perceived enhancement, viewing videos may be more harmful for appearance satisfaction than viewing images.

The body positivity movement is not all that positive on TikTok: A content analysis of body positive TikTok videos

This analysis examined the content of 342 body positive videos on TikTok. Videos were gathered by searching #body positivity and coded for diversity, positive body image messages, negative appearance-focused messages, other relevant themes, and contradictory messaging. Results demonstrate that body positivity videos on TikTok often portrayed young, White women with unrealistic beauty ideals. Approximately 93% of the videos embodied Western culturally based beauty ideals somewhat or to a great extent, while 32% of the videos portrayed larger bodies. Only 32.2% of the videos contained explicit positive body image messaging, and negative appearance-focused themes or objectifying content was rare. Contradictory messaging was not present. Overall, body positive videos on TikTok rarely displayed features aligned with positive body image and promoted unrealistic beauty ideals but also rarely included explicit negative appearance-focused messaging. Future research examining effects of exposure to body positivity messaging on TikTok, in comparison to other social media platforms, is warranted.

"Follow to *actually* heal binge eating": A mixed methods textual content analysis of #BEDrecovery on TikTok

Binge eating disorder (BED) has been relatively overlooked in research on eating disorders and social media. Existing literature suggests that time spent on social media may be associated with increased binge eating. However, more granular details of social media experiences such as the consumption of pro-recovery content have not received sufficient scholarly attention. The present study begins to address this gap through analysis of 1074 captions from public posts on TikTok, a video-based social media platform, tagged with #BEDrecovery between July 2021-2022. We generated six themes by examining word frequencies in the data and engaging in reflexive categorization of commonly used words within the context of different posts. These themes were: (1) diets and eating approaches, (2) help and support, (3) mental health, (4) diet culture critique, (5) body monitoring, and (6) fitness. To understand which videos in the BED recovery community had the broadest reach, we also examined how themes were associated with user engagement - concretely, the number plays (times the post was watched) and shares (times users shared a link to the post with other TikTok users). Notably, we found that the number of shares was significantly lower in posts that included diet culture critique than in those that did not. By contrast plays and shares were higher in posts with body monitoring than in those without. Our findings suggest that highly engaged with #BEDrecovery TikTok content may include the promotion of diet culture and potentially create an unproductive environment for individuals seeking BED recovery support.

Visions of recovery: a cross-diagnostic examination of eating disorder pro-recovery communities on TikTok

Individuals seeking support or inspiration for eating disorder recovery may turn to pro-recovery content on social media sites such as TikTok. While research has thus far treated pro-recovery social media as a fairly homogeneous space, many pro-recovery hashtags single out particular eating disorder diagnoses. This exploratory study used codebook thematic analysis of 241 popular pro-recovery videos on TikTok to compare the presentation of eating disorders and eating disorder recovery across five different diagnosis-specific hashtags: #anarecovery, #arfidrecovery, #bedrecovery, #miarecovery, and #orthorexiarecovery. These hashtags refer to the following eating disorder diagnoses respectively: anorexia nervosa, avoidant restrictive food intake disorder, binge eating disorder, bulimia nervosa, and orthorexia nervosa. Our analysis generated the following qualitative themes across the entire dataset: (1) centrality of food to eating disorders and recovery, (2) what eating disorders look and feel like, (3) recovery as a process, (4) getting and giving help, and (5) negotiating diet culture in recovery. To supplement our qualitative findings and facilitate cross-diagnostic comparisons, we also conducted one-way ANOVAs and chi-square tests to probe for statistically significant differences in audience engagement and code prevalence across the different hashtags. Our results indicate that there are clear differences in how recovery is envisioned on TikTok based on which diagnostic hashtags are employed. Such variations in how different eating disorders are imagined on popular social media demand further investigation and clinical consideration.

Socio-cultural power of social media on orthorexia nervosa: An empirical investigation on the mediating role of thin-ideal and muscular internalization, appearance comparison, and body dissatisfaction

As social media continues to penetrate users' daily lives, concerns about its negative impact on body image issues and eating disorders are becoming focuses of research. It remains unclear whether social media should be held responsible for promoting orthorexia nervosa-a problematic and extreme fixation on healthy eating. The present study draws on socio-cultural theory and tests a social media-based model in the context of orthorexia nervosa to enhance knowledge of social media's influence on body image issues and orthorectic eating tendencies. The socio-cultural model was tested using structural equation modeling based on responses from a German-speaking sample (n = 647). The results indicate that social media users' involvement with health and fitness accounts is associated with higher orthorectic eating tendencies. Thin-ideal and muscular internalizations mediated this relationship. Interestingly, body dissatisfaction and appearance comparison were not mediators, which can be attributed to the characteristics of orthorexia nervosa. Higher involvement with health and fitness accounts on social media was also related to higher appearance comparisons. The results highlight the powerful influence of social media on orthorexia nervosa and the relevance of socio-cultural models in investigating the mechanisms underlying this influence.

TikTok, TikTok, the time is now: Future directions in social media and body image

This article synthesizes practical strategies and future directions proposed by contributors to the special issue in Body Image on social media and body image. It also moves beyond the contributions of the special issue in an effort to provide additional guidance to researchers, clinicians, educators, and policymakers. First, we recommend that research on social media and body image extend beyond convenience sampling of young, White women and include children and older adults, boys and men, and underrepresented groups. Second, we urge researchers to move away from simplistic measures of social media and to utilize mixed-methods approaches. Third, we advocate for the development of new theories that can be tested longitudinally and that capture the unique influences of social media, rather than relying solely on existing models that were developed for traditional media. Fourth, we provide recommendations regarding practical strategies, such as the inclusion of media literacy campaigns, increased research on the role of reality check disclaimers, and further examination regarding the role of body positivity in prevention and intervention efforts. Finally, we end with recommendations regarding advocacy, such as using social media to harness positive efforts and partnering with social media companies regarding their use of algorithms.

Screen time, social media use, and weight-change behaviors: Results from an international sample of adolescents

This study aimed to investigate whether screen time and social media use are associated with weight-change behaviors among an international sample of adolescents. Cross-sectional data from the 2020 International Food Policy Study Youth Survey (ages 10-17; Australia, Canada, Chile, Mexico, United Kingdom, United States; N = 12,031) were analyzed. Self-reported hours of use of five forms of screen time (e.g., social media use), and total screen time per weekday were assessed. Use of six contemporary social media platforms (e.g., Facebook, Instagram) were also assessed. Weight-change behaviors included current attempts to gain weight, lose weight, stay the same weight, and not do anything to change weight, as well as dieting to lose weight in the past 12 months. Greater total screen time per weekday was associated with attempts to gain weight and lose weight, and dieting to lose weight. Specific social media platform use was associated with weight-change behaviors. For example, use of Twitter was most strongly associated with attempts to gain weight, lose weight, and dieting to lose weight. Findings underscore the international pervasiveness of screen time and social media use correlating with weight-change behaviors among adolescents. Global efforts are needed to ensure the appropriate use of screens and social media among adolescents.

Integrating social media variables as predictors, mediators, and moderators within body image frameworks: Potential mechanisms of action to consider in future research

In this article, we consider how social media variables may be integrated as predictors, mediators, and moderators within dominant theoretical frameworks of body image in order to identify potential mechanisms of action that can be empirically examined in future research and used to direct prevention and intervention efforts. To achieve this goal, we first articulate social media variables that have been investigated as predictors, mediators, and moderators in body image research. Next, we present the following critical and sociocultural theoretical frameworks: social comparison theory, tripartite influence model, objectification theory, developmental theory of embodiment, acceptance model of intuitive eating, cultivation theory, and uses and gratifications theory. Additionally, we present the theory of development of critical body awareness, a newly developed model that may provide further insight regarding the relationships between social media and body image-related outcomes. For each model, we articulate extant research that has explored social media variables within its context and explicate how social media variables could potentially be studied as predictors, mediators, and moderators within its structure. To conclude, we address pertinent limitations and gaps within this research space that could direct future research across the theoretical frameworks.

Contemporary screen use and symptoms of muscle dysmorphia among a national sample of Canadian adolescents and young adults

PURPOSE

Screen time has been previously linked to body dissatisfaction and eating disorder behaviors. However, less is known about whether use of common forms of screen technology is associated with symptoms of muscle dysmorphia (MD), which was the aim of this study.

METHODS

Data from the Canadian Study of Adolescent Health Behaviors (N = 2538) were analyzed. Associations between hours of use of six contemporary forms of recreational screen time, as well as total screen time, and symptoms of MD were determined using multiple linear regression models, stratified by gender, and adjusting for potential confounders.

RESULTS

Among both men and women, greater total screen time and texting were associated with greater symptoms of MD; however, differences emerged across the screen time modalities by gender. Among women, video chatting was most strongly associated with symptoms of MD, while social media use was most strongly associated with symptoms of MD among men.

CONCLUSION

Findings add to the growing literature documenting the potentially harmful correlates of screen time by including MD symptomatology. Findings have important implications for health care, public health, and policymaking professionals.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.