Social media is part of a ‘self-perpetuating cycle of risk’ for eating disorders and negative body image, per study

Social media use is linked with body image concerns and eating disorders among young people, according to a new review of the scientific literature. But rather than social media being a direct cause of these issues, a “self-perpetuating cycle of risk” could be to blame, with more vulnerable teens and young adults succumbing to online pressures, the authors say.

Women, people with higher body weights, and those with preexisting body image concerns were more at risk for the potential harms of social media use, according to the review. But social media literacy and strong body appreciation were found to be “moderators” that may protect users against ill effects.

The review, published Wednesday in PLOS Global Public Health, builds on previous reviews and meta-analyses that found an association between social media use and body image or eating disorders. The authors, Komal Bhatia and Alexandra Dane of the Institute for Global Health at University College London, analyzed 50 studies on social media, body image, and eating disorders, from 17 mostly high-income countries.

“It is extending the findings of previous work in a way that I think is useful,” said Rachel Rodgers, an associate professor in the Department of Applied Psychology at Northeastern University’s Bouvé College of Health Sciences.

Across the studies, specific online experiences — certain social media trends, pro-eating disorder content, and a focus on appearance and photo platforms — had a stronger relationship to negative outcomes. And having preexisting body image concerns could put users at higher risk of disordered eating and worsened self-image. The cycle of risk the authors describe is “a very good model” that should be tested, said Nick Allen, director of the Center for Digital Mental Health at the University of Oregon, who was not involved in the review.

Bhatia and Dane included in their review 45 quantitative and five group discussion or interview-based studies published between January 2016 and July 2021. Most of the papers were from Australia or the United States, but others came from nations not usually included in such reviews, including low- and middle-income Asian countries. Participants were typically 10 to 24 years old, and most studies included males and females (one study included transgender participants).

While the review’s inclusion of more recent papers from other countries was good, experts told STAT, there were other pitfalls. Only papers in English were included. And the review used mostly data of “moderate quality” — less rigorous than is ideal. That made it impossible to draw firm conclusions.

A majority of research on this topic is based on participants’ self-reporting, an often untrustworthy source, Allen said. And much of it only captures people’s experiences at one point in time. Such research wouldn’t explain, for example, a participant’s mental or emotional state when they accessed a social media platform, or how exactly they used the app, or what they felt while on it, he said.

A person’s use of social media is likely to evolve over time, said Rodgers. Someone with body image concerns might start using social media in a way that increases their focus on appearances. Then the algorithms take over, spoon-feeding such content to the user. Or, perhaps, someone notices their social media use is harming their mental health, so they start to steer clear of that material.

People’s relationship to these platforms can be too fluid to measure, especially since technology advances faster than researchers can keep up. There still isn’t much research on the effects of TikTok, which has a predominantly young and female audience.

“And so the real challenge for us as researchers is to develop better quality studies so that we can actually come to a consensus and then give clear advice,” said Allen, who is collaborating with Google on a study of how smartphones affect people’s well-being.

In a growing youth mental health crisis, adults have pinned some of the blame on the internet and social media. School districts are suing big tech companies; last year Meta admitted that Instagram, which it owns, can be harmful for teen girls. Some experts, like Amanda Raffoul, a researcher focused on eating disorders and an instructor of pediatrics at Harvard Medical School, say there needs to be more transparency regarding those secretive algorithm-driven processes that can take a young user from “healthy snacking” to “take this diet pill.”

For now, investigators researching links between social media and eating disorders say there isn’t enough evidence to know whether social media is causing disordered eating and negative body image. Eating disorders are complex in nature, and are thought to be the result of risk factors that include genetics, social environments, personality traits, and more.

As indicated in Bhatia and Dane’s review, children and young adults who are more concerned with appearance might be liable to seek out social media pages and influencers who reflect that interest. While it’s not possible to know if eating disorders and body image concerns are more common now, what’s clear is “the social focus on physical appearance as a strong element of social capital has increased, and that the desirable appearance has become less attainable,” said Rodgers, who directs Northeastern’s Applied Psychology Program for Eating and Appearance Research (APPEAR).

There are some objectively negative forces, like the pro-eating disorder groups that have formed online in recent years, despite regulatory efforts to shut them down. But it’s understood that, in general, “The things that make kids vulnerable to bad outcomes offline are similar to the ones that make them vulnerable to bad outcomes online,” Allen said.

Still, experts are struggling to bring public attention to the prevalence of these dangerous disorders. Both inpatient and outpatient clinics saw significant increases in the number of people seeking care for eating disorders — which can be deadly — during the pandemic. Despite this, experts say eating disorder research is underfunded, and the conditions have continued to be excluded from nationally representative surveys like the Center for Disease Control and Prevention’s Youth Risk Behavior Surveillance System, leaving a major data gap.

Some believe there’s enough evidence to demand more protections for young people online.

“I’m hopeful that reviews like this that synthesize evidence can highlight the severity of the issue and the magnitude of this association,” Raffoul said. Noting that large cultural forces make it especially hard for people to personally overcome stigma and accept their bodies, she believes more regulation of these companies is needed. Current measures like age verification for social media and attempts to remove obviously harmful content and hashtags “are like putting a Band-Aid on a gaping wound,” she said.

Having high social media literacy was one of the strategies that emerged in the review as a shield from bad effects. Researchers are still figuring out the best way to measure social media literacy, in part because online platforms change so frequently that it can be challenging to assess people’s proficiency, said Rodgers. (She developed a 2015 framework for studying social media impacts, body image, and eating disorders that was used in the review.)

Research has suggested younger children may be affected more strongly by social media than older children and young adults. They also have more trouble identifying an advertisement on social media than they would on television or on a billboard, studies suggest. In such a landscape, education is key, experts told STAT.

For parents, both Allen and Rodgers recommended having regular conversations with children about their social media use and how online experiences make them feel. While it’s important for children to feel a sense of independence, parents can create age-appropriate structures so children can trust and rely on adults for guidance. This might include using parental content controls, establishing screen time limits, or setting ground rules for what kind of social media use is allowed. And all users could benefit from exploring the emotional context behind their online habits, Rodgers said.

When it comes to body appreciation — another protective force the review authors found in the research — that can be increased, too. “Unconditional body acceptance of others, either directly stated or modeled,” Rodgers said, has been shown in empirical studies to boost a person’s body appreciation. Negative and positive comments about someone’s body aren’t as helpful as comments that embrace another’s physical form no matter what. The goal is to appreciate and care for the body for all it is able to do, not just for its physical attributes.

Something like, “‘It doesn’t matter to me what size your body is, I just love the way it hugs me,’” fits the bill, Rodgers said.

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.