Exploring the role of social media use in eating disorders in adolescents: a scoping review
Intended for healthcare professionals
Evidence and practice    

Exploring the role of social media use in eating disorders in adolescents: a scoping review

David Donovan Eating disorder clinical nurse specialist, child and adolescent mental health service, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, England

Why you should read this article:
  • To enhance your understanding of the relationship between eating disorders and social media use in adolescents

  • To recognise the potential protective and adverse effects of social media in relation to eating disorders

  • To be aware of possible gender differences in social media use and the development of eating disorders

There is a wealth of research on the relationship between young people’s increasing use of social media and the development of mental health issues. In the context of eating disorders, evidence suggests that social media use can have a direct and indirect role in dietary restriction, body dissatisfaction and valuing of thinness in adolescents, which are linked to the development of eating disorders. This article reports on a scoping review that explored the relationship between social media use and eating disorders in adolescents. The findings suggest that social media use is not directly related to the development of eating disorders in adolescents, but rather the potential development of eating disorder cognitions which may increase the risk of eating disorders. The findings also suggest that social media use may have some protective effects, where positive online peer relationships may support adolescents to increase their body appreciation.

Mental Health Practice. doi: 10.7748/mhp.2024.e1690

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence

David.donovan@nottshc.nhs.uk

Conflict of interest

None declared

Donovan D (2024) Exploring the role of social media use in eating disorders in adolescents: a scoping review. Mental Health Practice. doi: 10.7748/mhp.2024.e1690

Published online: 12 March 2024

Background

The relationship between use of social media and increased risk of mental health issues in adolescents has been widely reported in the literature (Primack et al 2017, Kuntz and Halpern 2022, Gega and Thabrew 2023). Furthermore, there has been a rapid increase in social media use among the adolescent age group over the last few years, in part due to the effects of national lockdowns as a response to the coronavirus disease 2019 (COVID-19) pandemic (Schlegl et al 2020, Trafford et al 2023).

In relation to eating disorders, the use of social media has been shown to have both protective effects, for example by providing a space for social support (Kendal et al 2017), and adverse effects, such as increased risk of body dissatisfaction, low self-esteem and psychological distress (Trafford et al 2023). Social media use has also been shown to have direct and indirect effects on eating disorder cognitions (Mohsenpour et al 2023) – that is, where a person’s dysfunctional attitudes about their physical appearance induce eating disorder risk factors, such as dietary restriction, body dissatisfaction and valuing of thinness.

Some social media platforms and content – termed ‘pro-ana’ (pro-anorexia) or ‘pro-mia’ (pro-bulimia) – promote the harmful behaviours and mindsets that form part of some eating disorders (Beat Eating Disorders 2024). Within such platforms, people encourage others to consider eating disorders as a ‘lifestyle choice’ rather than a health condition and encourage them to continue with their disordered eating rather than strive for recovery (Beat Eating Disorders 2024).

This article discusses a scoping review that explored the relationship between social media use and eating disorders in adolescents. The purpose of a scoping review is to give an overview of the research evidence on a topic to inform practice and/or policies and/or to identify areas for future research (Weill Cornell Medicine 2024).

Key points

  • It has been shown that social media use can affect eating disorder cognitions – that is, where a person’s dysfunctional attitudes about their physical appearance induce eating disorder risk factors

  • Protective effects of social media use may include providing a space for social support, whereas adverse effects can include increased risk of body dissatisfaction, low self-esteem and psychological distress

  • Family and peer relationships can support safer social media use for adolescents, for example by reducing the pressures associated with body image or by shifting conversations away from content focused on diet and weight

Aim

To explore the relationship between social media use and eating disorders in adolescents and to make recommendations for practice for mental health teams based on the findings.

Method

The Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate and MEDLINE databases were searched using the search terms listed in Box 1. Boolean operators (AND/OR) were applied to combine search terms. The search was undertaken in March 2023. Inclusion and exclusion criteria are shown in Table 1.

Table 1.

Inclusion and exclusion criteria

Inclusion criteriaExclusion criteria
Participants aged 11-19 yearsParticipants aged under 11 years or over 19 years
Participants in community or inpatient settingsParticipants in inpatient settings only
Full text availableDisordered eating not associated with eating disorder cognitions
Articles published after 2010Articles published before 2010
Articles available in English languageArticles unavailable in English language
Sample size >150 participantsSample size <150 participants
Box 1.

Search terms

  • Eating disorders

  • Anorexia nervosa

  • Bulimia nervosa

  • Disordered eating

  • Social media

  • Social networking sites

  • Facebook

  • TikTok

  • Instagram

  • Snapchat

  • Twitter

  • Teen

  • Adolescent

  • Young adults

The search initially generated 412 articles, of which seven were selected for review following application of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Page et al 2021).

Findings

Table 2 shows a summary of the seven articles included in the scoping review. Analysis of the selected articles, using Arskey and O’Malley’s (2005) framework, generated three main themes – relationships (with subthemes of families and peers), body image, and social media (with subthemes of image-based platforms and social networking sites, blog-based platforms and forums). Although gender was discussed in all seven articles it was not explored as a distinct theme in the scoping review. However, the findings refer to gender within each of the themes.

Table 2.

Summary of articles included in the scoping review

mhp.2024.e1690_0002_tb1.jpg

Relationships

Families

The findings of several studies suggest that risk factors for disordered eating, such as preoccupation with appearance and anxiety related to social comparisons – that is, comparing and contrasting oneself with one’s peers as part of identity formation – are associated with parental pressure to conform to appearance and behaviour ideals (Wilksch et al 2019, Ding and Xu 2021, Zimmer-Gembeck et al 2022).

Lonergan et al (2020) found a positive correlation between time spent online using social media and the risk of eating disorder development when a young person may already be experiencing issues with their mental health. They suggested that parents have an important role in reducing this risk through moderating time spent online on social media platforms. However, evidence also suggests that family and peer relationships can support safer social media use for adolescents, for example by reducing the pressures associated with body image and self-comparisons or by shifting conversations away from content focused on diet and weight (Lonergan et al 2020, Zimmer-Gembeck et al 2022).

Peers

Three studies (Lonergan et al 2020, Ding and Xu 2021, Zimmer-Gembeck et al 2022) demonstrated that sociocultural pressures, social comparisons and peer and family pressures to conform to social ‘norms’ are experienced by adolescents within online spaces and within in-person peer relationships. However, these pressures are often experienced differently based on gender. For example, Lonergan et al (2020) identified that girls avoided posting ‘selfies’ on social media more than boys due to fear of peer judgement and comparison.

Five studies (Kendal et al 2017, Lonergan et al 2020, Ding and Xu 2021, Jankauskiene and Baceviciene 2022, Zimmer-Gembeck et al 2022) showed that online peer comparisons – where individuals compare their bodies with images they see on social media – negatively affected adolescents’ feelings of self-value or self-esteem and increased the risk of disordered eating. Frieiro et al (2021) noted an observable increase in the risk of diet-related behaviours, such as diet restriction or avoidance of particular foods, in adolescents with a higher dependence on social media and more body comparison behaviours than their peers. The study did not clarify whether adolescents who used social media less often were also engaging in body comparison behaviours. However, Frieiro et al (2021) and Kendal et al (2017) also showed that positive relationships with peers in online communities via social media can be supportive, specifically in relation to body appreciation (that is, respecting, accepting and/or holding favourable attitudes towards one’s body).

Body image

Jankauskiene and Baceviciene (2022) and Kendal et al (2017) identified the protective role of body appreciation against being influenced by concepts of thinness ideals. However, in the context of gender, Jankauskiene and Baceviciene (2022) found that higher body appreciation did not appear to protect adolescent boys as much from the risk of developing an eating disorder compared with girls. This may be because these researchers were exploring thinness ideals and boys may more commonly experience a desire for musculature and athleticism rather than thinness (Jankauskiene and Baceviciene 2022). Jankauskiene and Baceviciene (2022) also reported a correlation between avoidance of posting selfies online and increased risk of developing an eating disorder.

Zimmer-Gembeck et al (2022) suggested that social media is an integral part of youth culture and that it is impossible to separate online and offline socialisation. Frieiro et al (2021) found that socialisation via social media can lead to increased risk of developing eating disorder cognitions and body image dissatisfaction linked to low self-esteem. The researchers also emphasised that it is important to be aware of the complex relationship between self-esteem and self-image, online and offline, and discussed how this relationship has a crucial role in both increasing the risk of eating disorders and protecting against their development (Frieiro et al 2021).

Additionally, Ding and Xu (2021) found that increased appearance-based social comparisons via social media positively correlated to body image dissatisfaction and ‘emotional eating’ in adolescents. Higher levels of body appreciation online and offline were found to be associated with lower risk of developing – and lower incidence of – eating disorders (Jankauskiene and Baceviciene 2022).

Social media

Image-based platforms

Examples of image-based platforms include Instagram and Snapchat. Wilksch et al (2019) found that image-based social media platforms are predominantly used by girls and that these platforms therefore pose a greater risk to girls than boys in relation to possible eating disorder cognitions and development. Lonergan et al (2020) suggested that image-based social media and image-sharing behaviours may be related to increased eating disorder risk. However, these researchers also found that people tended to make body comparisons with images posted by others, rather than posting selfies.

The idea that distress from looking at and comparing oneself to images increases the risk of developing an eating disorder is supported by Jankauskiene and Baceviciene (2022), who considered the effects of media pressure on adolescents and how observing others’ body ideals can negatively affect adolescents’ self-esteem and self-worth, which may increase the risk of developing eating disorders.

Social networking sites, blog-based platforms and forums

Examples of blog-based platforms and forums include Facebook and Tumblr. Zimmer-Gembeck et al (2022) found that appearance-related conversations online were a notable risk factor in eating disorder development. Wilksch et al (2019) reported that adolescent boys were more likely to use Facebook than adolescent girls, their online profiles were more likely to be publicly viewable and they did not generally have their parents or carers as ‘followers’. This may mean that they lack the potential mitigation of parental social media moderation, which could increase their risk of developing eating disorder cognitions or behaviours (Ding and Xu 2021).

Only Kendal et al (2017) explored the risks and benefits to adolescents of using moderated forum-based social media. The researchers found that such forums were generally beneficial for adolescents who were recovering from an eating disorder and that supportive and anonymous peer relationships appeared to assist their recovery in a way that in-person relationships did not (Kendal et al 2017). However, Kendal et al (2017) also noted that some posts on these forums appeared to be made by individuals who still displayed symptoms of disordered eating.

Discussion

The findings of this scoping review suggest that social media use is not directly related to the development of eating disorders, but rather the potential development of eating disorder cognitions which may increase the risk of eating disorders. McCrory et al (2022) highlighted a significant link between image-based social media and risk to young people’s mental health, specifically in relation to body image. While this does not relate directly to the risk of eating disorders, Zimmer-Gembeck et al (2022) and Jankauskiene and Baceviciene (2022) discussed the relationship between the adverse effects of negative body image and the development of eating disorder cognitions and behaviours. Engaging in self-comparison and body image avoidance behaviours – where the person avoids observing their body, whether in person or by refraining from sharing images on social media – may be more prevalent on social media platforms than ‘offline’ (Jankauskiene and Baceviciene 2022, Zimmer-Gembeck et al 2022). As the use of social media among adolescents increases, it could be argued that the risk of eating disorder cognitions, and therefore the risk of eating disorder development, is also likely to increase.

Mohsenpour et al (2023) identified that excessive social media use can be directly and indirectly associated with disordered eating behaviours, with the use of more social media platforms and spending more time on these platforms increasing the risk of deteriorating body image and body appreciation. de Valle and Wade (2022) also found that use of image-based social media platforms was linked with negative body image and low self-appreciation.

In contrast, social media use has been found to have some protective effects, where positive online peer relationships may support adolescents to develop or rebuild their body appreciation. For example, Kendal et al (2017) and Frieiro et al (2021) discussed the positive effects of online socialisation and the supportive role peers may have in body appreciation. Kendal et al (2017) considered the potential benefits of posting on forums. While many eating disorder treatment models suggest the need for parental support (Le Grange 2005), Kendal et al (2017) suggested that positive online communication with peers offered adolescents with eating disorders support by enabling them to feel less controlled or judged by adults, providing them with a sense of greater autonomy in terms of their recovery. However, social media platforms may also enable bullying or teasing behaviours.

While Kendal et al (2017) identified benefits of using online forums for adolescents, Goh et al (2022) found that posts on such forums often reveal signs of ongoing eating disorder behaviours and cognitions, with limited seeking of professional help.

Gender

While gender was not explored in this review as a distinct theme, it was discussed in the studies reviewed. Most of the studies considered gender in a binary male or female form; only Lonergan et al (2020) referred to data from participants who described their gender as ‘other’, which these researchers removed from their findings.

While the risks associated with developing eating disorder cognitions in the context of social media use are similar in boys and girls, the way in which they use social media differs (Lonergan et al 2020, Jankauskiene and Baceviciene 2022). Therefore, the author recommends that future research should explore this difference in further detail. This might enable the development of gender-oriented interventions that could be used by healthcare professionals and parents to promote positive use of social media, reduce the risk of eating disorder cognitions and eating disorders and support recovery.

Recommendations for practice

The findings of this scoping review suggest that using social media can negatively and positively influence adolescents’ perceptions of body image and body appreciation. Parents have an important role in moderating social media use, for example by limiting time spent on social media platforms and promoting positive body appreciation to reduce the risk of eating disorder cognitions, and mental health professionals may support parents to understand and do this. Mental health professionals may also educate parents about the potential protective effects of social media use for adolescents through positive online socialisation and interactions.

Mental health professionals, as well as other professionals such as school nurses, could explore safe and positive use of social media with young people, for example by discussing engagement in positive online peer relationships, body image avoidance behaviours and body appreciation (Lonergan et al 2020, Jankauskiene and Baceviciene 2022). School nurses are well placed to offer early intervention and support to young people in relation to the prevention of eating disorders (Hopkinson and Petty 2022). Mental health teams and school nurses could also work with adolescents to foster their self-esteem, self-worth and emotional resilience (O’Reilly et al 2018) in the context of online peer relationships and influences, which might contribute to eating disorder risk reduction and support earlier intervention (Knightsmith et al 2013). However, to do this effectively, mental health and school nurse services may require additional funding to enable expansion of their roles and service provision (McKenna et al 2017).

Kendal et al (2017) and Lonergan et al (2020) suggested that healthcare professionals could be involved in moderating posts on social media platforms such as forums to identify whether users may be showing signs of an eating disorder. While this suggestion may not be practical, mental health and other professionals could instead risk-assess the social media behaviours of adolescents who are seen in eating disorder services. This could also support adolescents in their recovery from an eating disorder.

Limitations

This scoping review was limited by the focus on the adolescent age group, which could mean studies that may have contributed to the discussion were excluded. Articles published before 2010 were excluded; however, some social media platforms existed before this date, such as Twitter (now known as X) and Facebook, so some relevant literature may have been missed. Finally, there was a lack of consistent language with regard to descriptions of social media in the studies reviewed, which makes it challenging to compare platforms and associated behaviours. Future research could focus on specific social media platforms.

Conclusion

The relationship between social media use and increased risk of mental health issues in adolescents has been widely reported. In addition, there has been a rapid increase in social media use among this group, partly due to the effects of COVID-19 lockdowns. Social media use in this age group has been shown to have both protective and adverse effects, with direct and indirect influences on eating disorder cognitions and the development of eating disorders. Parents have an important role in moderating adolescents’ use of social media and in encouraging positive body appreciation. Healthcare professionals can support young people to engage in positive online relationships and to foster positive body appreciation, self-esteem and resilience and educate parents about the effects of social media use on eating disorder cognitions. Further research is required to explore how gender may influence social media use and the development of eating disorders.

References

  1. American Psychiatric Association (2013) The Diagnostic and Statistical Manual of Mental Disorders. 5, Text Revision. APA, Washington DC.
  2. Arskey H, O’Malley L (2005) Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 8, 1, 19-32. doi: 10.1080/1364557032000119616
  3. Beat Eating Disorders (2024) The Dangers of Pro-Ana and Pro-Mia. http://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/dangers-of-pro-ana-and-pro-mia (Last accessed: 15 January 2024.)
  4. de Valle MK, Wade TD (2022) Targeting the link between social media and eating disorder risk: a randomized controlled pilot study. International Journal of Eating Disorders. 55, 8, 1066-1078. doi: 10.1002/eat.23756
  5. Ding N, Xu Z (2021) China adolescents comparisons on social media and emotional eating: a moderated analysis. Child and Adolescent Social Work Journal. 40, 107-117. doi: 10.1007/s10560-021-00750-3
  6. Frieiro P, González-Rodríguez R, Domínguez-Alonso J (2021) Self-esteem and socialisation in social networks as determinants in adolescents’ eating disorders. Health and Social Care in the Community. 30, 6, e4416-e4424. doi: 10.1111/hsc.13843
  7. Gega L, Thabrew H (2023) ACAMH Podcasts. Technology and Mental Health for Children and Adolescents: Pros and Cons. http://www.acamh.org/podcasts/camh-special-issue-technology-and-mental-health (Last accessed: 16 January 2024.)
  8. Goh AQ, Lo NY, Davis C et al (2022) #EatingDisorderRecovery: a qualitative content analysis of eating disorder recovery-related posts on Instagram. Eating and Weight Disorders. 27, 4, 1535-1545. doi: 10.1007/s40519-021-01279-1
  9. Hopkinson E, Petty J (2022) Why eating disorders in children and young people are increasing: implications for practice. Nursing Children and Young People. doi: 10.7748/ncyp.2022.e1445
  10. Jankauskiene R, Baceviciene M (2022) Media pressures, internalization of appearance ideals and disordered eating among adolescent girls and boys: testing the moderating role of body appreciation. Nutrients. 14, 11, 2227. doi: 10.3390/nu14112227
  11. Kendal S, Kirk S, Elvey R et al (2017) How a moderated online discussion forum facilitates support for young people with eating disorders. Health Expectations. 20, 1, 98-111. doi: 10.1111/hex.12439
  12. Knightsmith P, Treasure J, Schmidt U (2013) Spotting and supporting eating disorders in school: recommendations from school staff. Health Education Research. 28, 6, 1004-1013. doi: 10.1093/her/cyt080
  13. Kuntz L, Halpern J (2022) Concerning Content: TikTok’s Effect on Child and Adolescent Mental Health. http://www.psychiatrictimes.com/view/concerning-content-tiktoks-effect-on-child-and-adolescent-mental-health (Last accessed: 16 January 2024.)
  14. Le Grange D (2005) The Maudsley family-based treatment for adolescent anorexia nervosa. World Psychiatry. 4, 3, 142-146.
  15. Lonergan AR, Bussey K, Fardouly J et al (2020) Protect me from my selfie: examining the association between photo-based social media behaviors and self-reported eating disorders in adolescence. International Journal of Eating Disorders. 53, 5, 485-496. doi: 10.1002/eat.23256
  16. McCrory A, Best P, Maddock A (2022) The relationship between highly visual social media and young people’s mental health: a scoping review. Children and Youth Services Review. 115, 105053. doi: 10.1016/j.childyouth.2020.105053
  17. McKenna H, Dunn P, Northern E et al (2017) How Health Care Is Funded. http://www.kingsfund.org.uk/publications/how-health-care-is-funded (Last accessed: 16 January 2024.)
  18. Mohsenpour MA, Karamizadeh M, Barati-Boldaji R et al (2023) Structural equation modeling of direct and indirect associations of social media addiction with eating behavior in adolescents and young adults. Scientific Reports. 13, 1, 3044. doi: 10.1038/s41598-023-29961-7
  19. O’Reilly M, Adams S, Whiteman N (2018) Whose responsibility is adolescent’s mental health in the UK? Perspectives of key stakeholders. School Mental Health. 10, 4, 450-461. doi: 10.1007/s12310-018-9263-6
  20. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 372, n71. doi: 10.1136/bmj.n71
  21. Primack BA, Shensa A, Sidani JE et al (2017) Social media use and perceived social isolation among young adults in the US. American Journal of Preventive Medicine. 53, 1, 1-8. doi: 10.1016/j.amepre.2017.01.010
  22. Schlegl S, Maier J, Meule A (2020) Eating disorders in times of the COVID-19 pandemic – results from an online survey of patients with anorexia nervosa. International Journal of Eating Disorders. 53, 11, 1791-1800. doi: 10.1002/eat.23374
  23. Trafford AM, Carr MJ, Ashcroft DM et al (2023) Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study. The Lancet Child and Adolescent Health. 7, 8, 544-554. doi: 10.1016/s2352-4642(23)00126-8
  24. Weill Cornell Medicine (2024) Systematic Reviews: Scoping Reviews. http://med.cornell.libguides.com/systematicreviews/scopingreviews (Last accessed: 16 January 2024.)
  25. Wilksch SM, O’Shea A, Ho P et al (2019) The relationship between social media use and disordered eating in young adolescents. International Journal of Eating Disorders. 53, 1, 96-106. doi: 10.1002/eat.23198
  26. Zimmer-Gembeck MJ, Hawes T, Scott RA et al (2022) Adolescents’ online appearance preoccupation: a 5-year longitudinal study of the influence of peers, parents, beliefs, and disordered eating. Computers in Human Behaviour. 140, 107569. doi: 10.1016/j.chb.2022.107569

Share this page

Related articles

Giving staff confidence to discuss sexual concerns with patients
This article describes a countywide event to raise awareness...

Saudi Arabian women’s experiences of breast cancer treatment
Aim The aim of this study was to explore the cultural...

How play specialists can reduce use of anaesthesia during radiotherapy
Radiotherapy practice is complex and daunting for children....

Adherence to oral chemotherapy: a review of the evidence
Oncology is rapidly changing. Over the past few years there...

The experience of care for people affected by mesothelioma
This article reports on an analysis of patient and carer...