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A scoping review published in PLOS Global Public Health investigates the association between social media, body image and eating disorders amongst young people.
Dr Agnes Ayton, Chair of the Eating Disorders Faculty at the Royal College of Psychiatrists, said:
“This report highlights the potentially harmful relationship between online content and young people’s mental health. We are seeing record referrals for children and young people with eating disorders and I often hear the pernicious effect social media has had on those in crisis.
“However, we still have a limited understanding of how social media impacts our children. To truly know the relationship between the online world, eating disorders and mental health more generally we need social media companies to share data with independent researchers.
“The government needs to ensure that the Online Safety Bill will allow for the development of a data sharing framework with user consent, so that the likes of Twitter, Facebook, and TikTok are compelled to share their vital information.”
Dr Dawn Branley-Bell, Chair of the BPS Cyberpsychology Section and chartered psychologist, said:
How is ‘social media use’ described? Does this say any social media use of associated with body image concerns, eating disorders and poor mental health or specific content or behaviours online?
“Social media use is a very difficult concept to accurately measure. Time using social media is not sufficient, usage is much more nuanced than that – are users actively engaging, or passively lurking? What type of activities are they doing during their period of usage, and what type of content are they viewing, sharing and/or engaging with – and for what reasons? We must be very careful not to try to over simplify social media use just to enable ‘measurement’ but to ensure we take into account how nuanced and complex usage is.
“These are not the only factors influencing accurate/appropriate measurement of social media use, other factors include: Self-report bias (people may not accurately report their social media use, either intentionally or unintentionally, leading to inaccurate data); Lack of standardisation (as there is no standard way of measuring social media use, this makes it difficult to compare studies); and Platform-specific differences (Unique features and usage patterns make it challenging to compare data across platforms).
“To address these challenges, researchers often use a combination of self-reported data, behavioural data (such as website tracking), and qualitative methods (such as interviews and surveys) to gain a more comprehensive understanding of social media use. However, as mentioned there is currently no standard, universally adopted measurement of social media use.
How does this work fit with the existing evidence?
“Some colleagues and I recently published a very thorough meta-analysis on screen media – including social media – and mental health (Ferguson et al., 2022). We concluded that there is little evidence to suggest that social media contributes mental health concerns. The findings from this article by Dane & Bhatia also does not indicate a causal relationship.
Are the studies included able to ascribe a causal mechanism leading from social media use and poorer outcomes?
“We must not assume causal mechanisms when discussing possible relationships between social media use and poor health outcomes. There can be many different reasons why we may find a relationship between social media ‘use’ (however that is measured – which is a complex problem in itself!) and issues linked to body image, body dissatisfaction and/or eating disorders. There are numerous potential factors which can influence the impact of social media use and/or content for users (e.g. age, gender, type of use, personality traits, motivations for use, content accessed).
Social media use can have both positive, neutral and/or negative impacts on body image, self-esteem and eating disorder symptoms or recovery – but these cannot be explained by one over-simplified explanation. This paper highlights many of the factors that can play a role in positive or negative outcomes linked to social media use, and the authors do specify that this is not suggestive of a causal relationship. It is important that the nuance of social media usage, and the presence of both positive and negative outcomes is not misconstrued.
What are the implications in the real world? Is there any over speculation?
“It is important that this article is not mistakenly interpreted as evidence of a causal link between social media use and body image concerns or mental health issues. The data may indicate potential risk factors which
influence whether individuals are more vulnerable to negative impacts of social media use; However, there are also many positive aspects of social media use (e.g. social support, eating disorder recovery information). The authors of this paper do acknowledge that they are not implying a causal link. It is vital that we resist oversimplification of a very complex and nuanced research area, and that we do not over speculate.”
Dr Paul Jenkins, Associate Professor of Clinical Psychology, University of Reading, said:
“The article by Dane and Bhatia rightly highlights the seriousness, impact, and prevalence of eating problems and its findings reflect what many clinicians might suspect – that social media use can have negative effects on those at risk of developing eating problems. It is also easy to see how exposure to ‘photoshopped’ images and the unregulated use of algorithms can affect self-esteem, particularly in the most vulnerable.
“The study reaches similar findings to a 2019 review (https://doi.org/10.5817/CP2021-3-6). The conclusion that social media use is more nuanced than just the time spent on apps is in line with research on video gaming, for instance, which suggests that the time itself has little impact on well-being, and rather has more to do with the individual’s motivations (https://doi.org/10.1098/rsos.220411).
“The study is a ‘scoping review’, which aims to offer a preliminary assessment of available research literature, identifying the nature and extent of research evidence and thus providing an overview of the evidence. As such, a limitation is that the conclusions drawn from studies it reviews can be quite broad. For instance, whilst social media might have an effect on disordered eating, it isn’t clear how strong this effect is. (A technique called meta-analysis could derive something called an ‘effect size’ from existing studies, which could inform this.)
“Similarly, the authors conclude that social media use is a “plausible risk factor for the development of… eating disorders across a range of country income groupings”. However, as noted by the authors, 90% of studies were conducted in High-Income countries (and none in LICs) and it doesn’t (or, perhaps more accurately given the design, can’t) speculate on whether this variable affected outcomes (e.g., whether participants in ‘more affluent’ countries are impacted differently). It also isn’t clear whether studies looked at the development of eating disorders, rather than associations with some behaviours of concern.
“The authors are clear regarding several key limitations, particularly that the majority of studies included in this review used ‘cross-sectional’ designs, with measurements taken at one point; this means that it is not possible to draw causal links between social media use and eating problems (i.e., it’s possible that the reverse relationship – greater eating problems leading to more social media use – is true). Only two of 45 studies included in this review used a longitudinal observational design, for instance. However, a recent study collecting data across several time points seems to confirm the idea that social media use is associated with later eating disorder symptoms (https://doi.org/10.1080/08870446.2022.2141239).”
Dr Amy Orben, Programme Leader Track Scientist, MRC Cognition and Brain Sciences Unit, University of Cambridge, said:
“This review examined 50 studies (45 quantitative and 5 qualitative). The majority of studies were cross-sectional and “moderate” in quality, therefore no conclusions can be drawn about the causal link between social media use and any of the outcomes of interest. Further the measurements in many studies were low in quality, and some of the experiments lacked a convincing control condition. The authors’ proposed cycle of risk assumes causal pathways that cannot be supported by the reviewed work.”
‘The social media diet: A scoping review to investigate the association between social media, body image and eating disorders amongst young people’ by name of first author et al. was published in PLOS Global Public Health at 18:00 UK time on Wednesday 22 March, which is also when the embargo will lift
DOI: 10.1371/journal.pgph.0001091
Declared interests
Dr Dawn Branley-Bell was a co-author on this recent meta-analysis around the screen media and mental health:
Ferguson, C. J., Kaye, L. K., Branley-Bell, D., Markey, P., Ivory, J. D., Klisanin, D., Elson,
M., Smyth, M., Hogg, J. L., McDonnell, D., Nichols, D., Siddiqui, S., Gregerson, M., &
Wilson, J. (2022). Like this meta-analysis: Screen media and mental health. Professional
Psychology: Research and Practice, 53(2), 205–214. https://doi.org/10.1037/pro0000426
Dr Amy Orben: “I have no COI to declare.”
For all other experts, no reply to our request for DOIs was received.