The rise of new social media platforms often leads to worries that their content might increase the risk of eating disorders. But these concerns predate by far the arrival of TikTok or Instagram. The New York Times ran an article in 1985 entitled “Anorexia: It’s Not a New Disease.” It quoted one scholar who reminded readers that thinness was fashionable in the 19th century, when it was thought that “if you looked too robust, you looked like a working woman.”
To be sure, the vast scope of social media has changed the way young people organize their social life, influencing them in ways unforeseen 50 or 100 years ago. Today adolescents use it for everything from school scheduling to classwork to arranging their social life. They also use it to connect with people like themselves who might be harder to find in the physical world, especially if they are marginalized in other ways. Autistic teens, for example, or those who identify as transgender, especially in places where that identity could carry risk, can find one another in these communities.
Many adolescents view aspects of their social media experiences as positive, but the platforms may pose risks for a vulnerable subset. The advice for mitigating harm related to an issue such as an eating disorder has stayed the same for decades: approach media consumption with a critical eye and a healthy dose of literacy about the content you are interacting with.
The new platforms do undeniably bring novel challenges. Unlike television or print, social media relies on algorithms that “constantly monitor and engage you,” says Komal Bhatia, a global health and nutrition researcher at the Institute for Global Health at University College London (UCL), who co-authored a recent review on public health aspects of disordered eating and social media exposure. She and her UCL colleague Alexandra Dane concluded that social media is a “plausible risk factor” in developing eating disorders, even outside Western cultures, and that its use should be viewed as a global public health issue.
With the power to push out far more images than traditional media, “social media, in that essence, is different” because site runners are “only too happy for us to put our pictures of ourselves out there,” Bhatia says. Users must get into the habit of considering the reality of images purporting to represent a “normal,” “average” or “desirable” body. What many users see on social media represents “a modified reality to some degree,” she says.
Bhatia and Dane examined the influence of social media through the lens of public health, especially global public health. Eating disorders are on the rise: their prevalence in 2013 to 2018, just as some of the most popular platforms were taking off, was twice as high as in 2000 to 2006. Social media reached about half of the global population in 2020, Bhatia and Dane said in their report. They argued that policymakers should add social media use and disordered-eating-related diagnoses to the global public health agenda. In particular, the researchers wrote, a goal should be to encourage young people to be body-positive and use social media “in a progressive way,” and special attention should be paid to identifying at-risk young people and boosting their social media literacy.
With careful use, adolescents can find help and support through these platforms. “It’s important to remember that social media can also provide supportive recovery communities for people with eating disorders,” says Catherine Talbot, a cyberpsychology researcher at Bournemouth University in England. “We now need to focus on building resilience to potentially harmful content online and nudging users towards more supportive spaces in recovery.”
Experiences prior to the rise of social media may help inform our understanding of media impact on the attitudes of young girls. A study conducted in 2002 showed the impact of visual messages conveyed through a new technology on body image and eating practices. The Republic of Fiji had no known cases of bulimia until the 1990s, when televisions there first clicked on. Within just a few years, one in 10 adolescent girls in the country was reporting having engaged in purging. Most of these girls cited exposure to U.S. television series as a motivation. A few more years after TVs were introduced, about half of the girls on the island reported the practice. By 2002 having a TV in the house was associated with tripled odds that a girl would report having disordered eating behaviors.
The Fijian girls in that study viewed thinness not as desirable for beauty but rather for gaining better employment, says Kristen Harrison, a professor at the department of communication and media at the University of Michigan. They felt that becoming more similar to beauty norms on TV programs from the U.S. would yield fiscal rewards for their families. The medium delivered the visuals, but how they were received turned out to be culture-specific.
On online social platforms, cultures evolve within the context of the medium itself. In this way, social media can be wielded for good: marginalized and sometimes overlooked groups can find and support one another in positive ways. Or these platforms can be conduits of harm when online cultures that encourage perpetuation of harmful practices develop.
One example comes from social media and its influence on people with orthorexia nervosa, a harmful obsession with a diet that’s perceived to be healthy. A 2022 study of 185 Instagram users with this condition yielded seemingly incongruous results. Participants felt that their use of the platform might have partly contributed to the development of their condition, yet it also was how they had learned they had it. Eight study respondents interviewed for further information reported using Instagram to “recover, share information and help others” and doing so after being inspired by others they encountered there. They were able to transcend passive consumption by generating a recovery support community built through the platform and fueled by the interactions it facilitated.
Preexisting feelings related to having body dissatisfaction or previously having disordered eating can prime existing body issues, Harrison says. But “if someone in a family with an eating disorder isn’t understood by the family, they may find recognition and validation and acceptance online,” she adds.
Studies in these online communities bear out the benefits and some of the risks. One study looked at the use of a specific hashtag #OrthorexiaRecovery. The researchers found that people in the broader eating disorder community—not only those with orthorexia—were using the hashtag, having turned to social media for support that they could not otherwise find.
Being overlooked by clinicians or unable to afford their services also drives such community-building. A small study of Instagram users from the eating-disorder-recovery population found that they turned to social media in part “as an alternative to professional treatment.” They sought it out because their symptoms didn’t meet diagnostic thresholds or for financial reasons. As one respondent in the study put it, “I tried to get help … from my therapist, but unfortunately, because of my body type, I was not taken seriously.” The authors concluded that social media could offer benefits through social support and validation but that there were risks related to poor moderation or exposure to harmful content. The study respondents seemed to have been aware of some of these pitfalls, commenting, “There’s a thin line that distinguishes useful contents from toxic contents” and “You have to be careful who to follow.”
Even before social media existed, print media was exposing people to a barrage of images communicating a socially constructed desirability of thinness. How relentless the messaging is matters. In his book Thinking, Fast and Slow, Daniel Kahneman wrote that “a reliable way to make people believe in falsehoods is frequent repetition, because familiarity is not easily distinguished from truth.” For decades, visual media have delivered the falsehood that thinness meant glamour, success, beauty, and more. And this falsehood came to seem true, in part because the constant exposure made these images take on the contours of “normal.”
“I tell students, ‘Your eye will get used to what you keep showing it, and that will seem normal,’” Harrison says. If young people consuming media, social or otherwise, see only extremely thin bodies all the time, then “you look at your not-quite-extremely-thin body in the mirror, and it genuinely looks fat to you because what you’ve been looking at has changed your standard.” To avoid warping reality in this way, Harrison says, consumers must engage with people who are like them “so that you don’t look ‘wrong’ when you look in the mirror.”
Studies dating back decades have shown that viewers of such images understand the influence they exert on their psyche. One study as far back as 1990 noted that women looked at media as the primary source of pressures about thinness. Research clearly linked these exposures to risk for eating disorder symptoms, and researchers also understood that they could be countered: exposure to models with generous contours was associated with less body image disturbance. Furthermore, well before the advent of today’s social media, studies from the late 1990s and early 2000s showed that women who had “pre-existing dissatisfaction” with how they looked were the “most sensitive to the adverse effects of media exposure.”
In 1997 Harrison and her colleagues published a study showing that magazine reading, even more than television viewing, predicted “endorsement [among women] of personal thinness and dieting and select attitudes in favor of thinness and dieting for women.” Also, exposure to thinness-promoting media was associated with increased symptoms of eating disorders.
In the pre-social media era and today, one solution has been to encourage media literacy in young people, especially in at-risk groups. In 2001 researchers test-drove three interventions to help women feel less body image disturbance from seeing ubiquitous advertisements and other media promoting the “ideal thin standard of feminine beauty.”
One of them encourages people to preemptively be critical consumers. Those who absorb political news should be mindful of sifting for truth from spin or disinformation, and the same applies for consuming images and other messages about wellness, “thinspiration” and that “ideal thin standard of feminine beauty.” In a 2006 perspective and review, researchers wrote that although media literacy won’t completely protect “girls and women from the harmful influence of idealized images, it can foster vital critical thinking skills.”
In a 2022 study, when consumers were encouraged before exposure to visuals to be critical of media imagery, they were less likely to report body image disturbances after viewing. In that study, the authors’ critique of the media was that fashion models tend not to be an appropriate “norm” for social comparison because they are distinct in appearance from most people. Setting the stage for this criticism ahead of time meant study participants had less inclination to engage in negative comparisons about themselves.
As part of social media literacy, Harrison says, “young people need to pre-engineer their own media diet, pun intended, to deliver to them what they know makes them feel seen and validated and understood and also, if it matters to them, attractive or at least normal.”
From a public health perspective, Bhatia says, it’s important to address risks of social media, especially in the most vulnerable populations, who need support without being stigmatized. “If we view this as a public health problem,” she says, “we want to do it in a way that is sensitive, without further entrenching vulnerability and risks that people come to it with.” For adolescents, it’s adults who have a “duty of care” when it comes to access, Bhatia adds.
Harrison describes education to develop a critical eye toward social media consumption as an ongoing back-and-forth between young people and adults. “A sort of equal partnership discussion is necessary where you can talk to kids and say, ‘How do you feel after you watch this?’” she says. “A lot of times, kids will come and tell you, ‘I don’t think I should be using TikTok anymore. I keep seeing videos of all of these people wanting to be as thin as possible,’” Harrison notes. Young people need to understand that “TikTok is all about the algorithm. It will keep giving you more of what you click on, so seek out what is better for you and see how the algorithm changes.”
Guiding young people to develop critical skills makes it possible for them to be proactive and is preferable to just telling them they can’t use these platforms, Harrison says. A draconian approach does little to equip them with the skills they need, and they can still get the negative messages some other way. But if they look for content that “makes them feel good and connects them with actual community for people who are like-minded and want to find a better way of being in the world,” she says, “they can take measures to coax that content into their algorithm.”
If you or someone you know is struggling with an eating disorder, you can contact the National Eating Disorders Association’s Helpline by calling 1-800-931-2237 or clicking here to chat. For crisis situations, you can text “NEDA” to 741741 to connect to a trained volunteer at the Crisis Text Line.