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Predictors of “Liking” Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study

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Background: Adolescence and young adulthood are key periods for developing norms related to health behaviors and body image, and social media can influence these norms. Social media is saturated with content related to dieting, fitness, and health. Health and fitness–related social media content has received significant media attention for often containing objectifying and inaccurate health messages. Limited research has identified problematic features of such content, including stigmatizing language around weight, portraying guilt-related messages regarding food, and praising thinness. However, no research has identified who is “liking” or “following” (ie, consuming) such content. Objective: This exploratory study aimed to identify demographics, mental health, and substance use–related behaviors that predicted consuming 3 types of health and fitness–related social media content—weight loss/fitness motivation pages (ie, “fitspiration”), detox/cleanse pages, and diet/fitness plan pages—among young social media users. Methods: Participants (N=1001; age: median 21.06, IQR 17.64-24.64; female: 723/1001, 72.23%) completed a cross-sectional 112-question online survey aimed at social media users aged between 15-29 years residing in Victoria, Australia. Logistic regression was used to determine which characteristics predicted consuming the 3 types of health and fitness–related social media content. Results: A total of 378 (37.76%) participants reported consuming at least 1 of the 3 types of health and fitness–related social media content: 308 (30.77%) fitspiration pages, 145 (14.49%) detox pages, and 235 (23.48%) diet/fitness plan pages. Of the health and fitness–related social media content consumers, 85.7% (324/378) identified as female and 44.8% (324/723) of all female participants consumed at least 1 type of health and fitness–related social media content. Predictors of consuming at least one type of health and fitness–related social media content in univariable analysis included female gender (OR 3.5, 95% CI 2.5-4.9, P<.001), being aged 15-17 years (OR 3.0, 95% CI 2.2-4.0, P<.001), residing outside a major city (OR 2.0, 95% CI 1.4-2.9, P<.001), having no post–high school education (OR 2.2, 95% CI 1.7-2.9, P<.001), being born in Australia (OR 2.0, 95% CI 1.2-3.2, P=.006), having a self-reported eating disorder (OR 2.4, 95% CI 1.5-3.9, P<.001), being a victim of bullying (OR 1.7, CI 1.3-2.3, P<.001), misusing detox/laxative teas or diet pills (OR 4.6, 95% CI 2.8-7.6, P<.001), never using illegal drugs (OR 1.6, 95% CI 1.2-2.0, P=.001), and not engaging in risky single occasion drinking on a weekly basis (OR 2.0, 95% CI 1.3-3.0, P=.003). Conclusions: Consumers of health and fitness–related social media content were predominantly teenaged girls. There is a need to ensure that this social media content portrays responsible health messages and to research further the role of fitspiration pages, detox pages, and diet/fitness plan pages in influencing body image and health behaviors.
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Original Paper
Predictors of “Liking” Three Types of Health and Fitness-Related
Content on Social Media: A Cross-Sectional Study
Elise R Carrotte1, B Psych (Hons); Alyce M Vella1, BSc (Hons); Megan SC Lim1,2, PhD
1Centre for Population Health, Burnet Institute, Melbourne, Australia
2School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Corresponding Author:
Elise R Carrotte, B Psych (Hons)
Centre for Population Health
Burnet Institute
85 Commercial Road
Melbourne, 3004
Australia
Phone: 61 385062365
Fax: 61 392822100
Email: elise.carrotte@burnet.edu.au
Abstract
Background: Adolescence and young adulthood are key periods for developing norms related to health behaviors and body
image, and social media can influence these norms. Social media is saturated with content related to dieting, fitness, and health.
Health and fitness–related social media content has received significant media attention for often containing objectifying and
inaccurate health messages. Limited research has identified problematic features of such content, including stigmatizing language
around weight, portraying guilt-related messages regarding food, and praising thinness. However, no research has identified who
is “liking” or “following” (ie, consuming) such content.
Objective: This exploratory study aimed to identify demographics, mental health, and substance use–related behaviors that
predicted consuming 3 types of health and fitness–related social media content—weight loss/fitness motivation pages (ie,
“fitspiration”), detox/cleanse pages, and diet/fitness plan pages—among young social media users.
Methods: Participants (N=1001; age: median 21.06, IQR 17.64-24.64; female: 723/1001, 72.23%) completed a cross-sectional
112-question online survey aimed at social media users aged between 15-29 years residing in Victoria, Australia. Logistic
regression was used to determine which characteristics predicted consuming the 3 types of health and fitness–related social media
content.
Results: A total of 378 (37.76%) participants reported consuming at least 1 of the 3 types of health and fitness–related social
media content: 308 (30.77%) fitspiration pages, 145 (14.49%) detox pages, and 235 (23.48%) diet/fitness plan pages. Of the
health and fitness–related social media content consumers, 85.7% (324/378) identified as female and 44.8% (324/723) of all
female participants consumed at least 1 type of health and fitness–related social media content. Predictors of consuming at least
one type of health and fitness–related social media content in univariable analysis included female gender (OR 3.5, 95% CI
2.5-4.9, P<.001), being aged 15-17 years (OR 3.0, 95% CI 2.2-4.0, P<.001), residing outside a major city (OR 2.0, 95% CI
1.4-2.9, P<.001), having no post–high school education (OR 2.2, 95% CI 1.7-2.9, P<.001), being born in Australia (OR 2.0, 95%
CI 1.2-3.2, P=.006), having a self-reported eating disorder (OR 2.4, 95% CI 1.5-3.9, P<.001), being a victim of bullying (OR
1.7, CI 1.3-2.3, P<.001), misusing detox/laxative teas or diet pills (OR 4.6, 95% CI 2.8-7.6, P<.001), never using illegal drugs
(OR 1.6, 95% CI 1.2-2.0, P=.001), and not engaging in risky single occasion drinking on a weekly basis (OR 2.0, 95% CI 1.3-3.0,
P=.003).
Conclusions: Consumers of health and fitness–related social media content were predominantly teenaged girls. There is a need
to ensure that this social media content portrays responsible health messages and to research further the role of fitspiration pages,
detox pages, and diet/fitness plan pages in influencing body image and health behaviors.
(J Med Internet Res 2015;17(8):e205) doi:10.2196/jmir.4803
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KEYWORDS
fitspiration; social media; blogging; adolescent; physical fitness; eating disorders; women’s health
Introduction
Background
Social media is widely used and accepted among young people.
In the United States, up to 90% of teenagers and young adults
report using Facebook, whereas more than half use Instagram
and one-third use Twitter [1,2]. Young people are increasingly
turning to social media as a source of health-related information
[3]. A plethora of health and fitness-related social media content
is available to young people and is popular, diverse, and
interactive; when social media users “like” or “follow” health
and fitness-related social media content pages, content appears
in their newsfeeds where the user can view and engage with the
content by commenting on photos or sharing with friends
(through “tagging” or reposting content). One type of health
and fitness-related social media content, “fitspiration,refers
to messages designed to inspire individuals to achieve a health
or fitness goal, usually through exercise and dieting [4].
Common forms of fitspiration include images of toned bodies
overlaid with quotes designed to motivate viewers (Figure 1),
blog entries, and personal stories (eg, “before-and-after” weight
loss pictures), and personal profiles of fitness trainers and fitness
models. Other forms of health and fitness-related social media
content include strict diet/exercise plans and “cleanses” or
“detoxes” that claim to have health and weight loss benefits.
Health and fitness-related social media content is commonly
posted by companies to sell a service or product (eg, personal
trainers, gyms, or brands of juice detoxes). Health and
fitness-related social media content can also be user-generated
and maintained; for example, some social media users
commonly post exercise “selfies” (self-portrait photographs),
statuses about fitness routines, and images of healthy food
desired or prepared by the user [3,5].
Health and fitness-related social media content appears to be a
double-edged sword. Social media can play a role in shaping
body image through social comparison with others and the
maintenance of weight- and appearance-related concerns [6-8].
For example, in an exploratory qualitative study into social
media’s influence on health behaviors [3], young American
adults (mean age 20.4 years) agreed that seeing exercise tips
and instructions, using exercise tracking apps, and viewing
weight loss before-and-after pictures and fitness-related quotes
can be motivational for improving health behaviors. However,
some content, such as friends posting fitness-related selfies with
negative captions about their physical appearance (eg, “[I’m]
still really fat”) can induce negative feelings of body-related
shame in the viewer. Content may be misleading, such as
advertisements or fitness programs/products conveying
unrealistic goals, and users of social media often wish to look
their best for their social network and are selective about the
content they post [3].
Figure 1. Examples of fitspiration-style images. Photo credit: Shutterstock.
Criticisms of Health and Fitness–Related Social Media
Content
Although many social media-based health and fitness initiatives
and interventions are based on scientific research and are run
by qualified teams of health experts [9], some health and
fitness-related social media content has been criticized for
sending inaccurate or irresponsible health messages, a topic of
recent media debate. Common criticisms of fitspiration include
the prominence of fitspiration images that champion pushing
oneself too far during exercise, focus on appearance rather than
fitness, and praise the athletic body type (the “athletic ideal”)
[10] (Figure 1). Internalization of the athletic ideal has been
associated with increased compulsive exercising and negative
mood associated with missing an exercise session [11]. Despite
a general focus on the athletic ideal body, fitspiration aimed at
women often relies on images of slim or thin female bodies to
promote an image of what it means to be healthy, fit, and strong
[12]. As such, fitspiration has been compared to “thinspiration”
and “pro-ana” (pro-anorexia/eating disorder) content, which
idealizes thin bodies (the “thin ideal” [13]) and is designed to
motivate viewers to lose weight. Exposure to these websites
has been associated with adverse effects, such as negative mood
and lowered self-esteem, decreased perceived attractiveness,
and increased dieting in experimental studies [14,15].
Meanwhile, more than one-third of young people with eating
disorders have reported visiting these sites and learning new
weight loss and purging techniques [16].
Forms of health and fitness-related social media content that
focus on diet, health, and well-being have also been criticized.
For example, 2 popular diet programs—the Paleo Diet and the
Sugar Free Diet—have been listed by the British Dietetic
Association as two of the “Worst Celebrity Diets” and criticized
for being unbalanced and unnecessarily restrictive of food
groups [17]. Similarly, liquid-based detox diets that claim to
rid the body of toxins (despite no medical evidence indicating
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this is necessary) have been criticized by the Dietitians
Association of Australia and can result in the loss of healthy
gut bacteria and electrolytes [18]. Despite these concerns, 42%
of American adult social media users have reported that
information found via social media would affect health decisions
related to diet, exercise, or stress management, and nearly 90%
of people aged 18 to 24 years have indicated they would trust
medical information found on social media [19].
Past Research
Two recent analyses have indicated that problematic content is
posted regularly online under the guise of health. In the first
study, which analyzed 21 “healthy living” blogs (which aim to
offer advice and personal experiences regarding health), it was
found that approximately half contained content with negative
or guilt-inducing messages about food and/or content with
stigmatizing language relating to weight [20]. In the second
study, the authors compared 50 websites dedicated to fitspiration
with 50 thinspiration websites. The authors found that although
thinspiration websites were more likely than fitspiration websites
to contain content praising thinness (34% vs 10%) and
championing weight loss (68% vs 42%), both types of websites
were equally as likely to contain objectifying content (32% vs
36%), guilt-inducing messages about weight or the body (both
36%), and stigmatizing messages around fat and weight (both
20%) [4]. The authors suggested that although thinspiration
appears more obviously detrimental to viewers’health and body
image, it is within reason to assume that viewing both types of
websites may negatively impact viewers [4]. Therefore,
fitspiration may also attract people with preexisting eating
disorder symptomology or vulnerability, or influence emerging
psychological concerns such as orthorexia nervosa, an obsession
with healthy eating, food quality, and food “purity” with links
to obsessive-compulsive disorder and anorexia [21].
This Study
Despite significant debate in the media about the potential harms
of health and fitness-related social media content [12,17,18],
little research has examined this content. Previous research has
focused on the content of self-labeled fitspiration rather than
expanding the scope of this field of research to observe other
types of health and fitness-related social media content.
Specifically, it is unclear who is liking and following
(“consuming”) health and fitness-related social media content
via social media. The overarching aim of this exploratory study
was to identify the characteristics of young people who consume
3 types of health and fitness-related social media content:
fitspiration pages, detox pages, and diet/fitness plan pages. The
secondary aims of this study were to determine (1) which
demographics predict consuming health and fitness-related
social media content, (2) whether young people who consume
health and fitness-related social media content have poorer
self-rated mental health than those who do not consume this
content, and (3) whether young people who consume health and
fitness-related social media content use various legal and illegal
substances at different rates compared to those who do not
consume this content. It was hypothesized that health and
fitness-related social media content would be more commonly
consumed by young women versus young men and that
self-reported mental health problems and misuse of detox
teas/laxatives and diet pills would be associated with consuming
health and fitness-related social media content.
Methods
Data
Participants were recruited via the 2015 Sex, Drugs and
Rock’n’Roll study, developed by Burnet Institute: a
cross-sectional convenience sample of people aged 15 to 29
years living in Victoria, Australia. The study consisted of a
112-question online survey, which covered demographics, social
media use, and general mental and sexual health. The survey
was available on Burnet Institute’s website for 6 weeks between
February and March 2015. Participants were recruited via social
media, advertisements on Facebook targeted to young people,
and word of mouth. Only complete responses were analyzed.
Participants had the opportunity to win a gift voucher for
participating. Informed consent was obtained from each
participant. Approval for this study was granted by the Alfred
Hospital Human Research Ethics Committee, Melbourne,
Victoria. No specific funding was received for this study.
Measures
Demographics
Demographic details included gender (male, female, transgender,
or other with option to specify) and age, which was calculated
from month and year of birth. A binary variable was created for
gender (male/female; due to sample size, only participants
identifying as male and female were included in gender-related
data analyses) and age was recoded into 3 categories (15-17,
18-19, and 20-29 years). Country of birth was dichotomized as
Australian-born or born outside Australia. Participants specified
their highest level of completed education, which informed a
binary variable which distinguished between participants who
were currently completing or had completed any post–high
school education and those with high school education or lower
(including those still at high school). Participants indicated their
sexual identity; a binary variable distinguished between
participants identifying as heterosexual and participants
identifying as gay, homosexual, lesbian, bisexual, queer,
questioning, or other (GLBQQ+). Recreational spending was
analyzed to assess socioeconomic status and dichotomized as
less than AUD $120 to spend on oneself per week or AUD $120
or more. Participants’ postcodes informed a binary variable to
indicate their area of residence, which was major city or
nonmajor city.
Health and Fitness–Related Social Media Content
Participants were asked, “Do you like/follow any of the
following types of pages on Facebook, Instagram, or Twitter?”
with the option to choose all that applied. Four of the options
were as follows, based on researcher observations of 3 common
types of health and fitness–related social media content and a
fourth option that was used for the purpose of comparison:
1. Weight loss/fitness motivation profiles (eg, personal
trainers, athletes, fitness models)
2. Cleanses or detoxes (eg, , juice detox)
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3. Diet plans or weight loss/fitness challenges (eg, I Quit
Sugar, Michelle Bridges 12WBT, Kayla Itsines Bikini Body
Challenge)
4. Other health-related pages (eg, Cancer Council)
Binary variables were created to identify whether participants
liked or followed (ie, consumed) the 3 types of health and
fitness–related social media content of interest (hereafter referred
to as fitspiration pages, detox pages, and diet/fitness plan pages)
and other health pages, respectively (see Multimedia Appendices
1-3for screenshot examples). A binary yes/no variable was
created to identify whether participants consumed at least 1 of
the 3 types of health and fitness–related social media content
of interest.
Mental Health
Participants were asked, “In the last 6 months have you had any
mental health problems? This includes any issues that you
haven’t spoken to a health professional about.Options were
“yes,” “no,or “I don’t wish to say.If participants answered
“yes” to having mental health problems in the last 6 months,
they were asked, “Could you please specify what this mental
health problem/s was?” with an option to choose all that applied.
Options were anxiety disorder (eg, generalized anxiety disorder,
obsessive-compulsive disorder), mood disorder (eg, depression,
bipolar disorder), eating disorder (eg, anorexia nervosa, bulimia),
“I don’t wish to say,” and “other” with the option to specify.
Binary yes/no variables were created to identify participants
experiencing anxiety disorders, mood disorders, and/or eating
disorders. Participants were asked if they had been the victim
of bullying in the last 6 months, which informed a binary yes/no
variable.
Substance Use
Participants were asked to report illegal drug use both in their
lifetime and in the last month, if they currently smoked
cigarettes, and how often they consumed alcohol. Binary yes/no
variables were created for these behaviors; weekly “risky single
occasion drinking” was defined as consuming 6 or more standard
drinks on a weekly basis based on the Alcohol Use Disorders
Identification Test [22]. Participants were also asked, “‘In the
last 12 months, have you used any of the following
drugs/substances illicitly, not as directed or prescribed to
someone else? (Tick all that apply)” with options including diet
pills and detox/laxative teas. A binary yes/no variable was
created to identify participants who had ever misused either diet
pills or detox/laxative teas.
Analysis
All statistical analyses were performed using Stata version 13
(StataCorp LP, College Station, TX, USA). Cross-tabulations
and univariable logistic regression were used to compare
differences in demographics, mental health, and substance use
between those who consumed health and fitness–related social
media content (“consumers”) and those who did not.
Multivariable logistic regression was performed using variables
significant at P<.05 at the univariable level to identify
independent predictors of consuming health and fitness–related
social media content. In the multivariable model, variables
significant with the Bonferroni-adjusted Pvalue of .0125 (.05/4
tests) were deemed to be significant independent predictors of
consuming health and fitness–related social media content.
Results
The survey was completed by 1001 participants.The mean age
was 21.40 years (SD 4.12) and the median age was 21.06 years
(IQR 17.64-24.74); 269 (26.87%) identified as male, 723
(72.23%) identified as female, 4 (0.40%) identified as
transgender, 3 (0.20%) reported their gender as “other,” and 2
(0.20%) did not specify their gender. A total of 308 participants
(30.77%) consumed fitspiration pages, 145 (14.49%) consumed
detox pages, and 235 (23.48%) consumed diet/fitness plan pages.
In all, 378 (37.76%) participants consumed at least 1 of the 3
types of health and fitness–related social media content, 212
(21.17%) consumed at least 2 types, and 96 (9.59%) participants
consumed all 3 types. Of the health and fitness–related social
media content consumers, 85.7% (324/378) identified as female
and 44.8% (324/723) of all female participants consumed at
least one type of health and fitness–related social media content.
Further, 57.1% (184/322) of teenaged girls consumed at least
one type of health and fitness-related social media content;
48.7% (184/378) of all consumers were teenaged girls.
Univariable logistic regression compared health and
fitness–related social media content consumers (378/1001,
37.76%) and consumers of other health pages (358/1001,
35.76%). Consuming other health pages predicted consuming
health and fitness–related social media content (OR 2.6, 95%
CI 2.0-3.4, P<.001). Other health pages were significantly more
likely to be consumed by female participants than male
participants (OR 1.6, 95% CI 1.2-2.1, P=.003) and GLBQQ+
participants than heterosexual participants (OR 1.6, 95% CI
1.2-2.1, P=.003). No significant results were observed for other
demographics regarding other health pages.
Logistic regression was used to examine correlates of consuming
at least 1 of the 3 types of health and fitness–related social media
content (Table 1). In univariable analysis, significant differences
(P<.05) were found; consumers of any health and fitness–related
social media content were more likely to report female gender,
younger age, location in a nonmajor city, no post–high school
education, being born in Australia, experiencing eating
disorders, being a victim of bullying, misusing detox/laxative
teas or diet pills, never using illegal drugs, and not engaging in
weekly risky single occasion drinking compared to those who
did not consume any health and fitness–related social media
content. In multivariable analysis (pseudo R2=.11), significant
independent predictors of consuming any health and
fitness–related social media content at Bonferroni-adjusted
P<.0125 were female gender (OR 2.6, 95% CI 1.8-3.7, P<.001),
being aged 15-17 years (OR 2.5, 95% CI 1.4-4.4, P=.002), and
misusing diet pills or detox teas (OR 3.5, 95% CI 2.0-5.9,
P<.001).
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Table 1. Descriptive statistics and univariable logistic regression comparing consumers of at least one type of health and fitness–related social media
content (consumers) and participants who did not consume any health and fitness–related social media content (nonconsumers).
POR (95% CI)Nonconsumers, n (%)
n=623
Consumers, n (%)
n=378
Total, n (%)
N=1001
Variable
Gender
1.0218 (81.0)51 (19.0)269 (26.87)Male
<.0013.5 (2.5-4.9)399 (55.2)324 (44.8)723 (72.23)Female
Age (years)
<.0013.0 (2.2-4.0)125 (44.8)154 (55.2)279 (27.87)15-17
.021.6 (1.1-2.4)77 (60.2)51 (39.8)128 (12.79)18-19
1.0421 (70.9)173 (29.1)594 (59.34)20-29
Place of residence
<.0012.0 (1.4-2.9)65 (47.5)72 (52.6)137 (13.69)Nonmajor city
1.0246 (64.5)300 (35.6)846 (84.52)Major city
Education
<.0012.2 (1.7-2.9)167 (49.7)169 (50.3)336 (33.57)No post–high school
1.0456 (68.7)208 (31.3)664 (66.33)Post–high school
Country of birth
.0062.0 (1.2-3.2)543 (60.8)350 (39.2)893 (89.21)Australia
1.073 (75.3)24 (24.7)97 (9.69)Outside Australia
Sexual identity
.101.3 (1.0-1.8)467 (60.8)301 (39.2)768 (76.72)Heterosexual
1.0153 (66.8)76 (33.2)229 (22.88)GLBQQ+a
Recreational spending per week (AUD $)
.201.2 (0.9-1.7)471 (61.2)299 (38.8)770 (76.92)<$120
1.0149 (65.9)77 (34.1)226 (22.58)$120
Anxiety b
.6401.1 (0.8-1.4)248 (61.4)156 (38.6)404 (40.36)Yes
1.0375 (62.8)222 (37.2)597 (59.64)No
Eating disorder b
<.0012.4 (1.5-3.9)32 (42.1)44 (57.9)76 (7.59)Yes
1.0591 (63.9)334 (36.1)925 (92.41)No
Mood disorder b
.081.3 (1.0-1.7)214 (58.6)151 (41.4)365 (36.46)Yes
1.0709 (64.3)227 (35.7)636 (63.54)No
Bullied (last 6 months)
<.0011.7 (1.3-2.3)139 (52.5)126 (47.6)265 (26.47)Yes
1.0484 (65.8)252 (34.2)736 (73.53)No
Misused detox/laxative teas or diet pills (last 12 months)
<.0014.6 (2.8-7.6)24 (28.9)59 (71.1)83 (8.29)Yes
1.0599 (65.3)319 (34.8)918 (91.71)No
Ever used illegal drugs
1.0365 (67.0)180 (33.0)545 (54.45)Yes
.0011.6 (1.2-2.0)257 (56.3)195 (43.7)446 (44.56)No
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POR (95% CI)Nonconsumers, n (%)
n=623
Consumers, n (%)
n=378
Total, n (%)
N=1001
Variable
Last month illegal drug use if ever used drugs
.711.1 (0.7-1.5)219 (66.4)111 (33.6)330 (33.00)Yes
1.0146 (67.9)69 (32.1)215 (21.48)No
Risky single occasion drinking weekly or more often
1.092 (75.4)30 (24.6)122 (12.19)Yes
.0032.0 (1.3-3.0)61.1 (463)295 (38.9)758 (75.72)No
Current smoker
1.0135 (65.6)71 (34.6)206 (20.68)Yes
.2901.2 (0.9-1.6)486 (61.5)304 (38.5)790 (79.32)No
aGay, lesbian, bisexual, queer, or questioning.
bBased on self-reported diagnosed and undiagnosed conditions in the last 6 months.
Univariable analyses were repeated for each type of health and
fitness–related social media content separately (Tables 2-4). In
multivariable regression (pseudo R2=.09), significant
independent predictors of consuming fitspiration pages at
Bonferroni-adjusted P<.0125 were female gender (OR 2.0, 95%
CI 1.4-2.8, P<.001), being aged 15-17 years (OR 2.7, 95% CI
1.5-4.9, P=.002), identifying as heterosexual (OR 1.6, 95% CI
1.1-2.4, P=.009), and misusing diet pills or detox teas (OR 2.1,
95% CI 1.3-3.5, P=.004). Significant independent predictors of
consuming detox pages at Bonferroni-adjusted P=.01 in
multivariable regression (pseudo R2=.24) were female gender
(OR 52.1, 95% CI 7.2-377.6, P<.001), being aged 15-17 years
(OR 3.4, 95% CI 1.5-7.7, P=.003), misusing diet pills or detox
teas (OR 4.7, 95% CI 2.7-8.0, P<.001) and using illegal drugs
in the last month (OR 2.5, 95% CI 1.3-4.9, P=.008). Significant
independent predictors of consuming diet/fitness plan pages at
Bonferroni-adjusted P<.0125 in multivariable regression (pseudo
R2=.17) were female gender (OR 9.8, 95% CI 4.9-19.6, P<.001)
and misusing diet pills or detox teas (OR 3.6, 95% CI 2.2-6.0,
P<.001).
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Table 2. Descriptive statistics and univariable logistic comparing consumers of fitspiration pages and nonconsumers.
POR (95% CI)Nonconsumers, n (%)
n=693
Consumers, n (%)
n=308
Total, n (%)
N=1001
Variable
Gender
1.0221 (82.2)48 (17.8)269 (26.87)Male
<.0012.6 (1.8-3.6)464 (64.2)259 (35.8)723 (72.23)Female
Age (years)
<.0012.8 (2.1-3.8)151 (54.1)128 (45.9)279 (27.87)15-17
.011.7 (1.1-2.6)85 (66.4)43 (33.6)128 (12.79)18-19
1.0457 (76.9)137 (23.1)594 (59.34)20-29
Location
<.0011.9 (1.3-2.8)77 (65.2)60 (43.8)137 (13.69)Nonmajor city
1.0603 (71.3)243 (28.7)846 (84.52)Major city
Education
<.0012.0 (1.5-2.7)198 (58.9)138 (41.1)336 (33.57)No post–high school
1.0495 (74.6)169 (25.5)664 (66.33)Post–high-school
Country of birth
.021.8 (1.1-3.0)607 (68.0)286 (32.0)893 (89.21)Australia
1.077 (79.4)20 (20.6)97 (9.69)Outside Australia
Sexual identity
.021.5 (1.1-2.1)517 (67.3)251 (32.7)768 (76.72)Heterosexual
1.0173 (75.6)56 (24.5)229 (22.88)GLBQQ+a
Recreational spending per week (AUD $)
1.3 (1.0-1.9)522 (67.8)248 (32.3)770 (76.92)<$120
.081.0167 (73.9)59 (26.1)226 (22.58)$120
Anxiety b
.921.0 (0.8-1.3)279 (69.1)125 (30.9)404 (40.36)Yes
1.0414 (69.3)183 (30.7)597 (59.64)No
Eating disorder b
<.0012.4 (1.5-3.9)38 (50.0)38 (50.0)76 (7.59)Yes
1.0655 (70.8)270 (29.2)925 (92.41)No
Mood disorder b
.101.3 (1.0-1.7)241 (66.0)124 (34.0)365 (36.46)Yes
1.0452 (71.1)184 (28.9)636 (63.54)No
Bullied (last 6 months)
.0041.5 (1.1-2.1)165 (62.3)100 (37.7)265 (26.47)Yes
1.0528 (71.7)208 (28.3)736 (73.53)No
Misused detox/laxative teas or diet pills (last 12 months)
<.0012.8 (1.8-4.4)39 (47.0)44 (53.0)83 (8.29)Yes
1.0654 (71.2)264 (28.8)918 (91.71)No
Ever used illegal drugs
1.0405 (74.3)140 (25.7)545 (54.45)Yes
<.0011.7 (1.3-2.3)280 (62.8)166 (37.2)446 (44.56)No
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POR (95% CI)Nonconsumers, n (%)
n=693
Consumers, n (%)
n=308
Total, n (%)
N=1001
Variable
Last month illegal drug use if ever used drugs
.880.9 (0.7-1.4)246 (74.6)84 (25.5)330 (33.00)Yes
1.0159 (74.0)56 (26.0)215 (21.48)No
Risky single occasion drinking weekly or more often
1.0518 (68.3)240 (31.7)122 (12.19)Yes
.0012.2 (1.4-3.7)191 (82.8)21 (17.2)758 (75.72)No
Current smoker
1.0148 (71.8)58 (28.1)206 (20.68)Yes
.391.2 (0.8-1.6)543 (68.7)247 (31.3)790 (79.32)No
aGay, lesbian, bisexual, queer, or questioning.
bBased on self-reported diagnosed and undiagnosed conditions in the last 6 months.
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Table 3. Descriptive statistics and univariable logistic comparing consumers of detox pages and nonconsumers.
POR (95% CI)Nonconsumers, n (%)
n=856
Consumers, n (%)
n=145
Total, n (%)
N=1001
Variable
Gender
1.0268 (99.6)1 (0.4)269 (26.87)Male
<.00165.5 (9.1-470.7)581 (80.4)142 (19.6)723 (72.23)Female
Age (years)
<.0015.2 (3.5-7.9)198 (71.0)81 (29.0)279 (27.87)15-17
.0012.5 (1.4-4.4)107 (83.6)21 (16.4)128 (12.79)18-19
1.0551 (92.8)43 (7.2)594 (59.34)20-29
Location
<.0012.4 (1.6-3.7)101 (73.7)36 (26.3)137 (13.69)Nonmajor city
1.0738 (87.2)108 (12.8)846 (84.52)Major city
Education
<.0013.9 (2.7-5.6)247 (73.5)89 (26.5)336 (33.57)No post–high school
1.0608 (91.6)56 (8.4)664 (66.33)Post–high school
Country of birth
.072.0 (0.9-4.2)757 (84.8)136 (15.2)893 (89.21)Australia
1.089 (91.8)8 (8.3)97 (9.69)Outside Australia
Sexual identity
.131.4 (0.9-2.2)650 (84.6)118 (15.4)768 (76.72)Heterosexual
1.0203 (88.7)26 (11.4)229 (22.88)GLBQQ+a
Recreational spending per week (AUD $)
.021.7 (1.1-2.8)648 (84.2)122 (15.8)770 (76.92)<$120
1.0204 (90.3)22 (9.7)226 (22.58)$120
Anxiety b
.121.3 (0.9-1.9)337 (83.4)67 (16.6)404 (40.36)Yes
1.0519 (86.9)78 (13.1)597 (59.64)No
Eating disorder b
<.0013.3 (2.0-5.5)51 (67.1)25 (32.9)76 (7.59)Yes
1.0805 (87.0)120 (13.0)925 (92.41)No
Mood disorder b
.061.4 (1.0-2.0)302 (82.7)63 (17.3)365 (36.46)Yes
1.0553 (87.1)82 (12.9)636 (63.54)No
Bullied (last 6 months)
.011.6 (1.1-2.4)214 (80.8)51 (19.3)265 (26.47)Yes
1.0642 (87.2)94 (12.8)736 (73.53)No
Misused detox/laxative teas or diet pills (last 12 months)
<.0017.2 (4.5-11.6)43 (51.8)40 (48.2)83 (8.29)Yes
1.0813 (88.6)105 (11.4)918 (91.71)No
Ever used illegal drugs
1.0473 (86.8)72 (13.2)545 (54.45)Yes
.191.3 (0.9-1.8)374 (83.9)72 (16.1)446 (44.56)No
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POR (95% CI)Nonconsumers, n (%)
n=856
Consumers, n (%)
n=145
Total, n (%)
N=1001
Variable
Last month illegal drug use if ever used drugs
.0012.8 (1.5-5.1)273 (82.7)57 (17.3)330 (33.00)Yes
1.0200 (93.0)15 (7.0)215 (21.48)No
Risky single occasion drinking weekly or more often
1.0110 (90.2)12 (9.8)122 (12.19)Yes
.151.6 (0.9-3.0)646 (85.2)112 (14.8)758 (75.72)No
Current smoker
.101.4 (0.9-2.1)169 (82.0)37 (18.0)206 (20.68)Yes
1.0684 (86.6)106 (13.4)790 (79.32)No
aGay, lesbian, bisexual, queer, or questioning.
bBased on self-reported diagnosed and undiagnosed conditions in the last 6 months.
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Table 4. Descriptive statistics and univariable logistic comparing consumers of diet/fitness plan pages and nonconsumers.
POR (95% CI)Nonconsumers, n (%)
n=766
Consumers, n (%)
n=235
Total, n (%)
N=1001
Variable
Gender
1.0260 (96.7)9 (3.4)269 (26.87)Male
<.00113.0 (6.6-25.8)498 (68.9)225 (31.1)723 (72.23)Female
Age (years)
<.0013.2 (2.3-4.4)173 (62.0)106 (38.0)279 (27.87)15-17
.011.8 (1.1-2.8)95 (74.2)33 (25.8)128 (12.79)18-19
1.0498 (83.8)96 (16.2)594 (59.34)20-29
Location
.091.4 (0.9-2.1)97 (70.8)40 (29.2)137 (13.69)Nonmajor city
1.0655 (77.4)191 (22.6)846 (84.52)Major city
Education
<.0012.5 (1.9-3.4)218 (64.9)118 (35.1)336 (33.57)No post–high school
1.0547 (82.4)117 (17.6)664 (66.33)Post–high school
Country of birth
.0082.3 (1.2-4.3)672 (75.3)221 (24.8)893 (89.21)Australia
1.085 (87.6)12 (12.4)97 (9.69)Outside Australia
Sexual identity
.121.3 (0.9-1.9)579 (75.4)189 (24.6)768 (76.72)Heterosexual
1.0184 (80.4)45 (19.7)229 (22.88)GLBQQ+a
Recreational spending per week (AUD $)
.081.4 (1.0-2.0)580 (75.3)190 (24.7)770 (76.92)<$120
1.0183 (81.0)43 (19.0)226 (22.58)$120
Anxiety b
.071.3 (1.0-1.8)297 (73.5)107 (26.5)404 (40.36)Yes
1.0469 (78.6)128 (21.4)597 (59.64)No
Eating disorder b
<.0013.1 (1.9-5.0)41 (54.0)35 (46.0)76 (7.59)Yes
1.0725 (78.4)200 (31.6)925 (92.41)No
Mood disorder b
.021.4 (1.1-1.9)264 (72.3)101 (27.7)365 (36.46)Yes
1.0502 (78.9)134 (21.1)636 (63.54)No
Bullied (last 6 months)
<.0012.2 (1.6-2.9)174 (65.7)91 (34.3)265 (26.47)Yes
1.0592 (80.4)144 (19.6)736 (73.53)No
Misused detox/laxative teas or diet pills (last 12 months)
<.0015.3 (3.4-8.5)35 (42.2)48 (57.8)83 (8.29)Yes
1.0731 (79.6)187 (20.4)918 (91.71)No
Ever used illegal drugs
1.0438 (80.4)107 (19.6)545 (54.45)Yes
.0021.6 (1.2-2.2)320 (71.8)126 (28.3)446 (44.56)No
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POR (95% CI)Nonconsumers, n (%)
n=766
Consumers, n (%)
n=235
Total, n (%)
N=1001
Variable
Last month illegal drug use if ever used drugs
.111.4 (0.9-2.2)258 (78.2)72 (21.8)330 (33.00)Yes
1.0180 (83.7)35 (16.3)215 (21.48)No
Risky single occasion drinking weekly or more often
1.0101 (82.8)21 (17.2)122 (12.19)Yes
.121.5 (0.9-2.4)579 (76.4)179 (23.6)758 (75.72)No
Current smoker
.831.0 (0.7-1.5)159 (77.2)47 (22.8)206 (20.68)Yes
1.0604 (46.5)186 (23.5)790 (79.32)No
aGay, lesbian, bisexual, queer, or questioning.
bBased on self-reported diagnosed and undiagnosed conditions in the last 6 months.
Discussion
Our study, to the best of our knowledge, was the first to explore
characteristics of the consumers of health and fitness-related
social media content. Our results indicate that consuming health
and fitness-related social media content is common; 378 of 1001
(37.76%) participants reported liking or following at least one
of the included health and fitness-related social media content
types on Facebook, Instagram, or Twitter, most commonly
fitspiration pages (308/1001, 30.8%), followed by diet/fitness
plan pages (235/1001, 23.5%), and detox pages (145/14.49,
14.5%). The majority of health and fitness-related social media
content consumers identified as female, supporting our
hypothesis. This result was unsurprising; health and
fitness-related social media content is largely aimed at women
and often driven by female celebrities and fitness models.
Considering the number of objectifying messages previously
observed in fitspiration [4], and the potential internalization of
messages such as these by girls and women in Western society
[23], it is potentially concerning that nearly half of female
participants reported consuming this content. Even so, some
health and fitness-related social media content is aimed at men
(ie, bodybuilding pages featuring endorsement from male
athletes) and there is potential for this content to negatively
affect the body image of young men, such as increasing a drive
for muscularity [24].
Other demographic differences were noted fairly consistently
in the data. Key characteristics of health and fitness-related
social media content consumers were being younger and less
educated; more than half of participants aged between 15 and
17 years and more than half of participants with no post-high
school education (which included those still in high school)
reported consuming at least one of the health and fitness-related
social media content types, although this latter variable was not
significant in adjusted analyses. In all, nearly half of all
consumers (48.7%, 184/378) were teenaged girls. These findings
are of concern because adolescence is a particularly challenging
time in terms of body image [25] and more educated people are
generally more likely to engage in healthy behaviors, such as
engaging in physical activity and not smoking [26], and have
higher health literacy [27].
Some differences were observed regarding mental health and
substance use, partially supporting our hypothesis. Participants
with eating disorders were 2 to 3 times more likely to consume
health and fitness-related social media content than participants
without eating disorders. It is likely that this relationship is
bidirectional; this content may attract people with eating
disorders or body image concerns, but the content may
exacerbate or validate symptomology and behaviors [8]. Further,
a significant difference emerged with regards to mood disorders:
participants with mood disorders were more likely than those
without mood disorders to consume diet/fitness plan pages,
although this was not significant in adjusted analyses. This
finding is interesting in the context of thinspiration research,
which has found more negative affect after viewing thinspiration
websites [14]. It is unclear why this relationship emerged for
the diet/fitness plan pages, but not the other types of health and
fitness-related social media content.
Approximately 70% of participants who reported misusing
detox/laxative teas or diet pills in the last 6 months consumed
any health and fitness-related social media content, supporting
our hypothesis. These weight loss materials have been shown
to have detrimental health effects and use actually predicts
weight gain over time in adolescents [28,29]. Consumers of any
health and fitness-related social media content were significantly
less likely than nonconsumers to report ever using illegal drugs
or to report weekly risky single occasion drinking. This was an
interesting finding; it is possible that consumers of health and
fitness-related social media content are concerned about the
effect of substance use on their health, thereby avoiding
consumption. However, several of these results were not
significant in adjusted analyses and it is possible that these
findings were related to the age of participants because younger
participants were more likely to consume health and
fitness-related social media content. In adjusted analyses,
consumers of detox pages were more likely to have used illegal
drugs recently than nonconsumers. This association may be
related to use of illegal drugs for weight loss or maintenance,
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such as psychostimulants [30]. These relationships should be
explored in future research.
It is possible that for the majority of consumers, health and
fitness-related social media content is beneficial and provides
motivation for healthy behaviors. Yet the key characteristics of
consumers of health and fitness-related social media content
appear to be female gender and a younger age, with at-risk
groups including those with eating disorder symptomology,
being a victim of bullying, and misusing detox/laxative teas and
diet pills. Health and fitness-related social media content
potentially has the power to impact on these individuals,
including influencing the formation of young people’s norms
regarding ideal body shape and what it means to be healthy;
emerging research indicates that adolescent girls are increasingly
turning to fitness models as role models [31]. It can be difficult
to distinguish between health and fitness-related social media
content that is helpful or motivational and content that is
harmful, and to whom messages championed by this content
are negatively affecting; however, it appears that some
vulnerable individuals are consuming health and fitness-related
social media content.
Nearly 90% of American young adults have reported they would
trust medical information found on social media [19]. Therefore,
there is a need to ensure that health and fitness-related social
media content portrays adequate, responsible health messages
championing accurate information about health and fitness,
motivating individuals to exercise without shaming those who
do not or cannot, having realistic health and fitness goals, and
encouraging a healthy lifestyle without objectifying messages.
Health promotion initiatives should target consumers of health
and fitness-related social media content in terms of health
literacy and body positivity, teaching at-risk individuals to be
critical of media messages in relation to what it means to be fit
and healthy. Some recent campaigns have attempted this, such
as the UK campaign “This Girl Can,” which aims to celebrate
women’s participation in sport regardless of physical appearance
[32].
Another possible option for dealing with potential harms of
health and fitness-related social media content is regulating
social media content, although this can be challenging.
Thinspiration is recognized as harmful by most social media
sites and is shut down or censored with varying degrees of
success [33]; for example, Facebook community standards state
“We prohibit content that promotes or encourages...eating
disorders” [34] and if users search for thinspiration and related
terms, Instagram and Tumblr provide warnings for graphic
content and referrals to eating disorder information and recovery
resources. However, due to varying rates of effective moderation
and social media sites not wishing to censor users’ recovery
journeys, it is still easy to find thinspiration content across nearly
every social media platform [35]. No specific guidelines exist
for health and fitness-related social media content. Current
advertising guidelines on Facebook indicate that images that
“emphasize an ‘ideal’ body or body parts, or images showing
unexpected or unlikely results, such as ‘before and after
images’” are not allowed, and that “ads that promote acceptable
dietary and herbal supplements may only target users who are
at least 18 years of age” [35], but such guidelines do not appear
to exist for page or user-generated content, even when the page
is advertising a product. Considering problematic health and
fitness-related social media content messages may be subtle or
labeled as “healthy,” these guidelines may not adequately
identify harmful content.
Two additional barriers to regulating health and fitness-related
social media content on social media have been raised. Firstly,
social media is saturated with health and fitness-related social
media content: this content has huge followings (eg, more than
23 million posts on Instagram have been tagged with “#fitspo”
at the time of writing) and the nature of social media means that
health and fitness-related social media content is often viewed
by social media users even if they do not necessarily wish to
view it (ie, if one user “likes” an image, this image will then
appear in the newsfeeds of many of their friends). The nature
of targeted advertisements means that merely mentioning food
or exercise on social media can result in users being presented
with advertisements related to health and fitness-related social
media content [5]. Secondly, health and fitness-related social
media content is largely celebrated, user-generated, and talked
about in a positive manner, reinforcing content and behaviors
to peers on social media [3]. An argument for clinically
distinguishing orthorexia from anorexia and
obsessive-compulsive disorder is that people with orthorexia
are likely to flaunt their health behaviors, such as via social
media [21], because these behaviors are largely socially
desirable and celebrated, making it difficult to determine where
health behaviors are obsessive and/or no longer healthy. The
saturation and popularity of health and fitness-related social
media content means that its messages are unavoidable for many
users of social media and easily normalized regardless of actual
health benefits. This reinforces the importance of media literacy
and education programs around health and fitness for young
people.
The authors recognize the limitations of this study. The sample
was an online convenience sample and may not be generalizable
to all social media users. The questions asked were broad and
lacked specificity; we did not enquire after the number of health
and fitness-related social media content pages liked or followed,
the degree of interaction with the content, or break down the
pages any further (eg, by examining participants who
specifically followed self-labeled fitspiration pages on social
media). Data were self-reported and, therefore, vulnerable to
recall bias; social media users often follow a large number of
pages [36] and are unlikely to remember all of them. Those who
consumed fitspiration pages, detox pages, and diet/fitness plan
pages were more likely to follow other health pages too, possibly
reflecting an interest in health in general rather than just the 3
types of health and fitness-related social media content we
studied. We only focused on Facebook, Instagram, or Twitter,
potentially excluding participants who follow health and
fitness-related social media content on Tumblr or Pinterest (used
by 23% and 33% of teenage girls, respectively, more than 3
times the rate of use by teenaged boys [2]) or engage with other
user-generated forums and groups such as those on Reddit. We
only asked about participants misusing diet pills and
detox/laxative teas; it would have been worth exploring any use
of diet/weight loss materials. Our cross-sectional design and
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analysis strategy was unable to determine direction of
relationships or causality. Due to the length of the larger survey,
we did not examine body image or use validated measures of
mental health, although single-item self-report measures of
psychosocial variables can be as valid as multiple-item scales
[37]. Further, due to the exploratory nature of the study, we
included a large number of statistical tests; we applied the
conservative Bonferroni correction, which thereby increases
the risk of type II error.
Observed gender differences are likely related to the types of
health and fitness–related social media content we chose to
examine. The diet plans and challenges included as examples
were heavily female-led (eg, branded with female celebrities)
and focused (eg, bikini body challenges), potentially biasing
recall. Gender differences may have also been related to women
consuming more health-related pages on social media than men
in general. We did not specifically examine, or include as
examples, health and fitness–related social media content aimed
at men, such as bodybuilding or other muscularity-based
initiatives. Such health and fitness–related social media content
is worth exploring in the future.
This is the first study to characterize consumers of 3 types of
health and fitness-related social media content: fitspiration
pages, detox pages, and diet/fitness plan pages. Overall, the
results of this exploratory study indicate that the consumers of
health and fitness-related social media content are largely
teenaged girls and that individuals reporting eating disorders
and detox or laxative misuse are more likely to consume health
and fitness-related social media content. The results emphasize
the need to perform further research into this area and consider
the role of health and fitness-related social media content in the
formation of body image, health ideals and behaviors, and
emerging mental health issues such as orthorexia within the
complex context of normative processes and development,
particularly among at-risk individuals [8]. Future experimental
or longitudinal research should determine whether health and
fitness-related social media content actually impacts the
consumer’s body image and health behaviors and, if so, how it
can be addressed. There is also a need to perform a content
analysis on health and fitness-related social media content to
determine to what degree these pages are championing accurate
versus unhealthy or unscientific health messages and determine
which social media platforms are best to target for future
interventions.
Acknowledgments
The authors gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program
received by Burnet Institute. MSCL is supported by an Australian Government Department of Health Preventive Research
Fellowship.
Conflicts of Interest
None declared.
Multimedia Appendix 1
Example of fitspiration page: ‘Fitspore’profile on Instagram.
[PNG File, 1MB - jmir_v17i8e205_app1.png ]
Multimedia Appendix 2
Example of detox page: ‘SkinnyMe Tea’ on Facebook.
[PNG File, 529KB - jmir_v17i8e205_app2.png ]
Multimedia Appendix 3
Example of diet/fitness plan page: ‘Ashy Bines Bikini Body Challenge’ on Facebook.
[PNG File, 969KB - jmir_v17i8e205_app3.png ]
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Abbreviations
GLBQQ+: gay, lesbian, bisexual, queer, or questioning
Edited by G Eysenbach; submitted 05.06.15; peer-reviewed by D Crane, E Lyons, I Prichard; comments to author 09.07.15; revised
version received 21.07.15; accepted 05.08.15; published 21.08.15
Please cite as:
Carrotte ER, Vella AM, Lim MSC
Predictors of “Liking” Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study
J Med Internet Res 2015;17(8):e205
URL: http://www.jmir.org/2015/8/e205/
doi:10.2196/jmir.4803
PMID:
©Elise R Carrotte, Alyce M Vella, Megan SC Lim. Originally published in the Journal of Medical Internet Research
(http://www.jmir.org), 21.08.2015. This is an open-access article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete
bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information
must be included.
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... Shame and comparison on social media reinforce the body as a key site of "identity, empowerment and control" (Beattie et al., 2019:18) with self-surveillance continually being reinforced, along with increases in appearance concerns (Spettigue & Henderson, 2004;Wick & Keel, 2020). There are eating disorders sites with stories about purging and BMIs and advice on how to lose weight (Brotsky & Giles, 2007:106) and posts that can induce feelings of bodyrelated shame (Carrotte et al., 2015). Tiggemann and Anderberg (2019) asked participants to view different images on Instagram and self-report their responses using various scales to assess body dissatisfaction. ...
... Some social networking sites revolve around images including "physical appearance and self-representation" (Mingola et al., 2017: 2) where people upload their own images. Content on social media ranges from "perfect bodies" (Tiggemann & Anderberg, 2019:3) to food, lifestyle, health and fitness posts (Carrotte et al., 2015). Many additional studies have explored the relationship between social media, body image and eating disorders (Basterfield et al., 2018;Karsay et al., 2021;McClean et al., 2015;Saffran et al., 2016;Tiggemann & Anderberg, 2019;Williams & Ricciardelli, 2014) although few studies also included religiosity/spirituality alongside. ...
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