Q&A: Frequent social media use linked to eating disorders among adolescents

Recent media reports have highlighted the health risks associated with social media use among adolescents.

According to reporting by the Wall Street Journal, Facebook failed to address flaws within the platform after research conducted by its subsidiary Instagram showed that frequent use was linked to increased levels of anxiety, depression, body dysmorphia, eating disorders and suicidal thoughts among adolescent girls.

The discovery that social media use is linked to body dysmorphia and eating disorders is not novel, according to Pamela Keel, PhD, a distinguished research professor of psychology at Florida State University. In 2014, Keel and colleagues published an empirical article in the International Journal of Eating Disorders that showed more frequent Facebook use led to greater disordered eating, weight and shape concerns and anxiety. Yet, the recent news surrounding Facebook’s lack of transparency has caused a resurgence in attention paid to the health consequences of social media.

Healio Primary Care spoke with Keel to learn more about the association and what primary care physicians can do to mitigate the harm of social media use with regard to eating disorders.

Healio Primary Care: What impact can social media use have on eating disorders and body dysmorphia, specifically?

Keel: We have found that time spent on Facebook reinforced weight and shape concerns and caused increases in anxiety. We also found that posting photos of the self on Instagram caused increased weight and shape concerns, and that posting edited photos caused the greatest increases in these concerns. Weight and shape concerns are a robust risk factor for developing eating disorders, and this may explain the association between increased use of social media and eating pathology observed in college students.

Healio Primary Care: What populations are particularly vulnerable to these effects?

Keel: Research from other groups has indicated that those who are more likely to compare their own appearance to who they see on social media are more vulnerable. Although we found that women were more likely than men to use social media in problematic ways, the association between posting edited photos on Instagram and eating pathology did not differ between women and men. This suggests that how people use social media places them at risk for negative consequences.

Healio Primary Care: What should PCPs be doing to monitor social media’s influence over their patients?

Keel: PCPs can make a major difference in the health of their patients by screening for eating disorders in their patients. Most individuals with eating disorders never seek treatment for their problems, and waiting for a parent or a child to identify that there is a problem means waiting until the problem has become severe and more likely to become entrenched.

Healio Primary Care: For young children and teenagers, what do you recommend in terms of social media use? Would pulling them off social media completely be detrimental to their mental health as well?

Keel: There are a few things to consider. First is the amount of time spent on social media compared to other activities that help kids connect with one another. Second is how they are spending their time on social media. Photo-based activities, particularly things like comparing one’s body or weight to photos of others, editing and posting photos of oneself, are riskier behaviors. Third is the child’s age. There’s content on social media that’s not appropriate for young children.

Healio Primary Care: What are the dangers of developing an eating disorder or body dysmorphia so young? How can this impact someone’s health in the long term?

Keel: Eating disorders are dangerous at any age, and they become especially dangerous when there are delays in getting help. Medical consequences are linked to starvation (including loss of muscle, bone and brain mass) and purging (including dehydration, electrolyte imbalances and problems with kidney and heart function). Individuals with eating disorders should be seen by a physician to address potential medical complications.

References:

Facebook knows Instagram is toxic for teen girls, company documents show. https://www.wsj.com/articles/facebook-knows-instagram-is-toxic-for-teen-girls-company-documents-show-11631620739. Published Sept. 14, 2021. Accessed Oct. 20, 2021.

Mabe AG, et al. Int J Eat Disord. 2014;doi:10.1002/eat.22254.