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#Orthorexia on Instagram: a descriptive study exploring the online conversation and community using the Netlytic software

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Sara Santarossa at University of Windsor
Sara Santarossa
Jillian Lacasse
Jillian Lacasse
Jillian Lacasse
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Jordan Larocque at Western University
Jordan Larocque
Sarah J Woodruff at University of Windsor
Sarah J Woodruff
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Abstract and Figures

Orthorexia nervosa (ON) is a relatively new phenomenon. The purpose of this study was to investigate (1) the #orthorexia conversation on Instagram (using the Netlytic software), and (2) among a random subsample of images (N = 245), analyse the types of images (N = 145) and author biographies (N = 68). Among the 4,533 downloaded records, there were 48,780 unique words associated with the posts, with the most commonly used being love (n = 535) and #edrecovery (n = 425). Among the images, the majority contained food (68%) and people (13%). Among the unique authors, the majority were female (84%) and mentioned ED (eating disorder) recovery and being food/fitness focused. The ON community on Instagram is relatively small and the positive conversation may suggest a supportive community that focuses on recovery and adopting healthier eating behaviours. Level of evidence Level V, descriptive study.
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Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity (2019) 24:283–290
https://doi.org/10.1007/s40519-018-0594-y
ORIGINAL ARTICLE
#Orthorexia onInstagram: adescriptive study exploring theonline
conversation andcommunity using theNetlytic software
SaraSantarossa1 · JillianLacasse1· JordanLarocque1· SarahJ.Woodru1
Received: 17 April 2018 / Accepted: 4 October 2018 / Published online: 13 October 2018
© Springer Nature Switzerland AG 2018
Abstract
Orthorexia nervosa (ON) is a relatively new phenomenon. The purpose of this study was to investigate (1) the #orthorexia
conversation on Instagram (using the Netlytic software), and (2) among a random subsample of images (N = 245), analyse the
types of images (N = 145) and author biographies (N = 68). Among the 4,533 downloaded records, there were 48,780 unique
words associated with the posts, with the most commonly used being love (n = 535) and #edrecovery (n = 425). Among the
images, the majority contained food (68%) and people (13%). Among the unique authors, the majority were female (84%)
and mentioned ED (eating disorder) recovery and being food/fitness focused. The ON community on Instagram is relatively
small and the positive conversation may suggest a supportive community that focuses on recovery and adopting healthier
eating behaviours.
Level of evidence Level V, descriptive study.
Keywords Orthorexia· Instagram· Online social support· Eating disorders· Netlytic· Hashtag
Introduction
Eating disorders (EDs) such as anorexia nervosa, bulimia
nervosa, and binge-eating disorder have a global presence
[1], and are clinically recognized terms according to the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-5). Although not fully agreed upon, orthorexia ner-
vosa (ON) is defined as the pathological obsession with
consuming only (biologically) pure foods that may lead to
the development of specific ritualistic attitudes towards food
preparation and the restriction of specific food groups that
are perceived as harmful to one’s health [2, 3]. The first
formal proposal for diagnostic criteria appeared in 2015 [4].
ON has been mostly quoted through the internet and social
media, with little data on the prevalence of ON and it has
largely been neglected in the professional and scientific lit-
erature [5]. Nianias [6] suggests that specifically, Instagram
users may use various diets (e.g., paleo, vegan) to cover up
their need for obsessive control over their pure eating habits.
The fixation on food quality is thought to be a desire to max-
imize physical health and well-being, rather than religious
beliefs, sustainable agriculture, environment, and/or animal
welfare [7]. Currently, tools do exist that assess ON such as
the ORTO-15 questionnaire [8] that focuses on the quality
rather than the quantity of food, a key characteristic of ON
[3]. However, this questionnaire does not account for the
obsessive–compulsive behaviour of the individual, and thus
it is often used in conjunction with other assessment tools
(e.g., Maudsley Obsessive Compulsive Inventory (MOCI)
[7]). Moreover, a recent study has suggested that the ORTO-
15 questionnaire may be unable to distinguish pathology
and lacks clinical significance [8]. Albeit, being difficult
to generalize, as sample sizes and populations have varied
across studies, and researchers have deleted items to increase
the scale’s internal consistency (rendering different cut off
points) [8], research regarding the prevalence rates of ON
(using ORTO-15 questionnaire) has been emerging. Studies
have reported results ranging from 27.0% (among 864 young
Polish adults) [9] to 81.9% (among 392 Brazilian dieticians)
[10]. Moreover, a recent US study found a prevalence rate of
71.0% (among 275 college students), however, when further
explored for clinical significance, less than one-half of 1% of
this sample suffered from ON [8]. Such variability could be
This article is part of topical collection on Orthorexia Nervosa.
* Sara Santarossa
santaros@uwindsor.ca
1 Department ofKinesiology, University ofWindsor, Windsor,
ON, Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... HVSM is used ubiquitously as a ready and primary source of information on food, exercise, and beauty standards with unprecedented access to advertisements and posts from peers, celebrities, and SM in uencers (14), as well as personalized ad content. The engagement with content either as a producer, consumer, or prosumer (producers and consumers) promotes social comparison, the internalization of thin/muscular ideal, and the aim to adopt an observer's perspective of their bodies and to habitually monitor themselves (15)(16)(17)(18), contributing to the development and maintenance of DE and ED (19,20). Speci cally, the internalization of the thin/muscular idea is in uenced by the use of SM lters. ...
... Filtered photo activity is positively associated with body dissatisfaction, and thin ideal internalization may mediate this relationship (21). HVSM in uences overvaluation of weight and shape, fear of weight gain, and preoccupation with weight and shape, contributing to core ED psychopathology (19,22). ...
Associations between Highly Visual Social Media Use and Eating Disorders and Disordered Eating– A Changing Landscape
Preprint
Full-text available
  • Mar 2023
Background : Although the etiology of eating disorders (ED) and disorder eating (DE) is multifactorial, exposure to highly visual social media (HVSM) may be an important contributor to the onset or worsening of DE and ED symptoms. We aim to understand HVSM use, ED, and DE with a particular focus on gender differences, as well as details of engagement on “selfies” in adolescents and young adults (AYA). Methods: We conducted a literature search in Psycho ED, PubMed, MEDLINE of articles, including participants with DE/ED and users of HVSM, focused on AYA. Studies in which the study population was not well-defined and the methodology to assess ED/HVSM use was not robust were excluded. Results: We found a strong association between HVSM and ED and DE with existing gender differences. The literature also shows specific mechanisms of use of these platforms involving “selfie” preparation and posting. The literature is limited in that the research is mostly cross-sectional with no uniform methodology and not well-defined participant populations. Conclusions: The use of unregulated and profit-driven SM platforms can increase risk for ED. To use these HVSM platforms for positive influence, there is a need to have more transparency, and involvement of clinicians, researchers, and educators. Public Significance : Due to HVSM’s popularity among the adolescent and young adult population, it is important to identify its effects on the prevalence of disordered eating and eating disorders, as well as recognize any gender differences in this relationship. Clinicians, parents and other adults working with youth should be aware of HVSM’s impact of DE/ED, as described by this review.
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... HVSM is used ubiquitously as a ready and primary source of information on food, exercise, and beauty standards with unprecedented access to advertisements and posts from peers, celebrities, and SM influencers [15], as well as personalized ad content. The engagement with content either as a producer, consumer, or prosumer (producer and consumer) promotes social comparison, the internalization of thin/muscular ideal, and the aim to adopt an observer's perspective of their bodies and to habitually monitor themselves [16][17][18][19], contributing to the development and maintenance of DE and ED [20,21]. Specifically, the internalization of the thin/muscular idea is influenced using SM filters. ...
... Filtered photo activity is positively associated with body dissatisfaction, and thin ideal internalization may mediate this relationship [22]. HVSM influences overvaluation of weight and shape, fear of weight gain, and preoccupation with weight and shape, contributing to core ED psychopathology [20,23]. ...
A scoping literature review of the associations between highly visual social media use and eating disorders and disordered eating: a changing landscape
Article
Full-text available
  • Sep 2023
Background Although the etiology of eating disorders (ED) and disorder eating (DE) is multifactorial, exposure to highly visual social media (HVSM) may be an important contributor to the onset or worsening of DE and ED symptoms. We aim to understand HVSM use, ED, and DE with a particular focus on gender differences, as well as details of engagement on “selfies” in adolescents and young adults (AYA) through a scoping review of the literature. Methods We conducted a literature search in Psycho ED, PubMed, MEDLINE of articles, including participants with DE/ED and users of HVSM, focused on AYA. Studies in which the study population did not include AYA, the SM platforms used did not include HVSM platforms, and the methodology to assess ED/HVSM use was not robust were excluded. Results We found a strong relationship between HVSM and ED and DE with existing gender differences related to the nature of engagement and preference of content. The literature also shows effects of the specific mechanisms of use of these platforms involving “selfie” preparation and posting. Existing research is limited and consists of mostly cross-sectional studies with no uniform methodology and with participant populations that are not well-defined. Conclusions The use of unregulated and profit-driven SM platforms can increase risk for ED. To use these HVSM platforms for positive influence, there is a need to have more transparency, and involvement of clinicians, researchers, and educators. Public significance Due to HVSM’s popularity among the AYA population, it is important to identify its effects on the development of DE and ED, as well as recognize any gender differences. Clinicians, parents, and other adults working with youth should be aware of HVSM’s impact on DE/ED, as described in this review.
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... To cover central keywords used in EDR communities, the following four hashtags, including different areas of the eating disorder spectrum, were scraped using a self-written Python crawler: #recovery, #edrecovery, #anarecovery, #miarecovery. All hashtags were identified based on groundwork and previous research in the community (Santarossa et al., 2019). The web-layout of Instagram represents the nine most popular posts of each day, enriched with all new posts below. ...
#recovery – creating common ground through visual and textual information shared in the eating disorder recovery community on Instagram
Article
Full-text available
  • Jan 2025
  • INFORM RES
Introduction. This exploratory study contributes to information practice research, aiming at increasing the understanding of the perspective of individuals in the social setting of a health community by focusing on the common ground created through shared information. The investigation concentrates on individuals sharing health information in an eating disorder recovery community on Instagram. Method. This study analyses representations of eating disorder recovery on Instagram, focusing on visual and textual shared information. The Instagram posts (pictures and texts) were collected structurally with a crawler based on four selected hashtags. Analysis. The analysis was data-driven, using qualitative and quantified content analysis. The centre of analysis was on image types, and structure, tone and content of the captions. Results. Four types of posts emerged that represent the common ground of affected individuals on Instagram: the Eating Disorder Recovery diary, the proof of eating, the personal transformation, and affirmations. Reflections on community participation and the information practice of sharing were identified. Conclusion. This study provides a deeper understanding of the eating disorder recovery community on Instagram, offering insights into the individuals' personal experiences and thoughts on eating disorder recovery, as well as topics essential for individuals going through recovery. Further, first insights on the health information sharing practices of individuals in eating disorder recovery were gained.
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... netlytic was used for social media analysis and cloud storage. Some studies have used netlytic to analyze social media for various issues, such as health (Santarossa et al., 2018), politics (Gruzd et al., 2016), and psychology (Santarossa et al., 2017). netlytic provided the ethical decision-Making and internet Research Recommendations by the association of internet Researchers and declared their support for using social media data ethically to carry out public interest research. ...
A social media analysis of students’ perspective toward online learning during the COVID-19 pandemic
Article
Full-text available
  • Jul 2024
During the spread of coronavirus disease 2019 (COVID-19) worldwide, many countries have instructed the shutdown of all educational facilities to break the chain of virus transmission. Since March 2020, approximately 45 million students in Indonesia have adapted to online learning due to the COVID-19 pandemic. This study aimed to analyze Indonesian students’ perceptions of online schools using social media data, specifically Twitter. Based on the search query, there were 12,243 tweets collected from the Netlytic software from March 1st to 31st, 2021. From this social media platform, we found that students did not experience good things in an online school. Some of them might enjoy online school, but most of the students felt that it had a negative impact on them. In the word-level sentiment analysis, 1,649 words (81.59%) were considered negative words; for example, students frequently complained about how they felt ‘lazy’, ‘tired’, and ‘bored’. Meanwhile, the remaining 372 words (18.41%) were considered positive words as the students expressed their feelings with words like ‘comfortable’, ‘thanked God’, and ‘good’. Based on this finding, we suggest that educational facilitators prepare to adjust course materials and delivery to improve students’ online learning experiences.
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... The gender imbalance may limit the generalizability of this research study, though it is well known that females are more likely to contribute to research in this field [77]. This study was entirely advertised and conducted online, predominately through social media accounts, most of whom likely have followers who are more 'health conscious' and thus may not truly be representative of the general population [56,78]. ...
Assessing the presence and motivations of orthorexia nervosa among athletes and adults with eating disorders: a cross-sectional study
Article
Full-text available
  • Dec 2023
  • EAT WEIGHT DISORD-ST
Purpose Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects. Methods Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET). Results ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) ( F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity ( r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity ( r = 0.23, 95% CI [− 2.24, − 0.34], p = 0.008; r = 0.26, 95% CI [− 2.11, − 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001). Conclusion Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior. Level of evidence III: Evidence obtained from cohort studies.
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TikTok, a now iconoclastic social media platform, hosts millions of videos on health, wellness and physical fitness, including content on postpartum wellness and ‘bouncing back’. At present, few studies analyse the content of postpartum videos urging viewers to bounce-back or the potential influence of these videos. Given the acknowledged relationship between social media use and adverse mental health outcomes (eg, lowered self-esteem, increased stress, disordered eating risk), an investigation of bounce-back-related postpartum content on TikTok explores important intersections between wellness and fitness cultures and the embodied experience of postpartum recovery. Using a qualitative thematic analysis of bounce-back videos (n=175), we explore three themes: (1) Smoothies: eat, but don’t be fat; (2) Bone broth: bounce-back with today’s wellness trends; (3) Fitspo: moving your body matters. Importantly, videos recycle historically constructed thinking about what makes a ‘good’ or ‘bad’ body, invoke vintage diet-culture tropes (ie, drinking water to fill up before eating), and maintain potentially dangerous expectations for caregivers rooted in historical gender, race and class constructs. This results in a postfeminist mishmash of modern maternity practices and traditional hierarchies. Unpacking the historicity of TikTok content assists health practitioners, scholars and users in understanding the potential impacts of video content on new parents, as well as how to flag and contextualise potentially harmful content. Future studies should examine other TikTok subcultures, including teen mothers and trans parents, and explore the messaging directed at and the impact on those communities.
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A influência das mídias sociais sobre a obsessão por uma alimentação saudável em adolescentes
Article
Full-text available
  • Apr 2024
Introdução: O termo Ortorexia Nervosa é definido como a obsessão e fixação em comer alimentos saudáveis, a ponto de se tornar patológico. O perfil dos indivíduos vulneráveis inclui pessoas meticulosas, organizadas e com exacerbada necessidade de autocuidado ou proteção. Esse grupo pode incluir mulheres, adolescentes, pessoas adeptas de modismos alimentares e atletas. Destaca-se a preocupação com os adolescentes, visto que nessa fase há intensas alterações no organismo e na vida e questões relacionadas à alimentação merecem atenção. Objetivo: Identificar fatores relacionados à Ortorexia em adolescentes. Métodos: Foi realizada uma revisão narrativa de literatura entre agosto e outubro do ano de 2023 com busca por artigos nas bases de dados: Scientific Eletronic Library Online (SciELO), Google Acadêmico, US National Library of Medicine (MEDLINE/PubMed), Biblioteca Virtual de Saúde (BVS) e ScienceDirect. Como critérios de inclusão foram selecionados artigos originais e que referiam à temática, disponíveis gratuitamente na íntegra, nos idiomas inglês, espanhol e português. Discussão: Nos estudos foram identificados alguns grupos vulneráveis, dentre eles destacam-se os adolescentes. Além disso, foi apontado que as mídias sociais têm grande impacto na percepção que os adolescentes têm sobre seus próprios corpos, sucedendo a uma excessiva alimentação saudável desencadeando sintomas de ON. Conclusão: As mídias sociais podem intensificar os sintomas depressivos e de transtornos, especialmente na adolescência. A dificuldade associada à Ortorexia é diferenciar o indíviduo que prioriza hábitos alimentares saudáveis daquele que apresenta comportamento obsessivo. Os estudos ainda são escassos sobre Ortorexia Nervosa e por isso, há necessidade de mais pesquisas sobre o tema.
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Ortorektik Eğilimlerin Sosyal Medya Bağımlılığı, Yeme Tutumu ve Beden Algısı İle İlişkisiAssociation of Orthorexic Tendencies with Social Media Addiction, Eating Attitudes and Body Perception
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“Follow to *actually* heal binge eating”: A mixed methods textual content analysis of #BEDrecovery on TikTok
Article
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Binge eating disorder (BED) has been relatively overlooked in research on eating disorders and social media. Existing literature suggests that time spent on social media may be associated with increased binge eating. However, more granular details of social media experiences such as the consumption of pro-recovery content have not received sufficient scholarly attention. The present study begins to address this gap through analysis of 1074 captions from public posts on TikTok, a video-based social media platform, tagged with #BEDrecovery between July 2021-2022. We generated six themes by examining word frequencies in the data and engaging in reflexive categorization of commonly used words within the context of different posts. These themes were: (1) diets and eating approaches, (2) help and support, (3) mental health, (4) diet culture critique, (5) body monitoring, and (6) fitness. To understand which videos in the BED recovery community had the broadest reach, we also examined how themes were associated with user engagement - concretely, the number plays (times the post was watched) and shares (times users shared a link to the post with other TikTok users). Notably, we found that the number of shares was significantly lower in posts that included diet culture critique than in those that did not. By contrast plays and shares were higher in posts with body monitoring than in those without. Our findings suggest that highly engaged with #BEDrecovery TikTok content may include the promotion of diet culture and potentially create an unproductive environment for individuals seeking BED recovery support.
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Orthorexia nervosa - a separate clinical entity, a part of eating disorder spectrum or another manifestation of obsessive-compulsive disorder?
Article
Full-text available
  • Apr 2018
Objectives: The aim of the study was to determine the prevalence of orthorexia nervosa in the population of adolescents and young adults, as well as to determine whether orthorexia is a separate clinical entity, a part of eating disorder or another manifestation of obsessivecompulsive disorder. Methods: The study group consisted of 864 subjects (599 females and 265 males). The mean age of female participants was 20.21±3.27 years, and of male participants 18.93±3.67 years. As a part of the study, we used a proprietary questionnaire to collect patient data, as well as following diagnostic questionnaires: ORTO-15 by Donini et al. (Polish version validated by Janas-Kozik et al.), EAT-26 by Garner and Garfinkel, and MOCI (Maudsley Obsessive Compulsive Inventory) by Hodgson and Rachman. The results were analysed statistically. Results: 27% of subjects were found to be at risk of orthorexia nervosa (score of 35 was considered a cut-off point). These subjects achieved significantly higher scores in the EAT-26. There were no statistically significant differences in the MOCI scores. The highest risk of orthorexia was observed in subjects aged 13-16 years old (junior secondary school) and the lowest in 16-19-year-olds (senior secondary school). Individuals with suspected orthorexia tended to have significantly higher BMI. Specific analysis of environmental features will be exposed in the next issue. Conclusions: Orthorexia nervosa is not a separate clinical entity. It does not belong to the OCD spectrum, but meets the criteria of eating disorder spectrum.
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Instagram use is linked to increased symptoms of orthorexia nervosa
Article
Full-text available
  • Jun 2017
  • EAT WEIGHT DISORD-ST
Purpose: Social media use is ever increasing amongst young adults and has previously been shown to have negative effects on body image, depression, social comparison, and disordered eating. One eating disorder of interest in this context is orthorexia nervosa, an obsession with eating healthily. High orthorexia nervosa prevalence has been found in populations who take an active interest in their health and body and is frequently comorbid with anorexia nervosa. Here, we investigate links between social media use, in particularly Instagram and orthorexia nervosa symptoms. Methods: We conducted an online survey of social media users (N = 680) following health food accounts. We assessed their social media use, eating behaviours, and orthorexia nervosa symptoms using the ORTO-15 inventory. Results: Higher Instagram use was associated with a greater tendency towards orthorexia nervosa, with no other social media channel having this effect. In exploratory analyses Twitter showed a small positive association with orthorexia symptoms. BMI and age had no association with orthorexia nervosa. The prevalence of orthorexia nervosa among the study population was 49%, which is significantly higher than the general population (<1%). Conclusions: Our results suggest that the healthy eating community on Instagram has a high prevalence of orthorexia symptoms, with higher Instagram use being linked to increased symptoms. These findings highlight the implications social media can have on psychological wellbeing, and the influence social media 'celebrities' may have over hundreds of thousands of individuals. These results may also have clinical implications for eating disorder development and recovery.
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When Image Isn't Everything: The Effects of Instagram Frames on Social Comparison
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Full-text available
  • Jan 2016
In recent years visual social media have become increasingly popular mechanisms for communication. Past research suggests links between using social media, upward social comparison, and negative affect. The present online experiment of U.S. women (N = 58) takes a media psychology approach to understanding how text frames on image-based social media contribute to social comparison and perceptions of the self. Findings suggest that individuals who were in a body-positive experimental condition reported higher levels of self-esteem than did the women in a body-negative experimental condition. Those in the negative conditions ranked significantly higher on state social comparison with the images than those in the posi-Jennifer Lewallen, PhD, is a post doctoral fellow in the Department of Communication and the Reynolds Journalism Institute at the University of Missouri. Correspondence can be directed to jenniferlewallen@mizzou.edu.
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Engaging Moms on Teen Indoor Tanning Through Social Media: Protocol of a Randomized Controlled Trial
Article
Full-text available
  • Nov 2016
Background Indoor tanning elevates the risk for melanoma, which is now the most common cancer in US women aged 25-29. Public policies restricting access to indoor tanning by minors to reduce melanoma morbidity and mortality in teens are emerging. In the United States, the most common policy restricting indoor tanning in minors involves parents providing either written or in person consent for the minor to purchase a tanning visit. The effectiveness of this policy relies on parents being properly educated about the harms of indoor tanning to their children. Objective This randomized controlled trial will test the efficacy of a Facebook-delivered health communication intervention targeting mothers of teenage girls. The intervention will use health communication and behavioral modification strategies to reduce mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning relative to an attention-control condition with the ultimate goal of reducing indoor tanning in both daughters and mothers. Methods The study is a 12-month randomized controlled trial comparing 2 conditions: an attention control Facebook private group where content will be relevant to teen health with 25% focused on prescription drug abuse, a topic unrelated to tanning; and the intervention condition will enter participants into a Facebook private group where 25% of the teen health content will be focused on indoor tanning. A cohort of 2000 mother-teen daughter dyads will be recruited to participate in this study. Only mothers will participate in the Facebook groups. Both mothers and daughters will complete measures at baseline, end of intervention (1-year) and 6 months post-intervention. Primary outcomes include mothers’ permissiveness regarding their teenage daughters’ use of indoor tanning, teenage daughters’ perception of their mothers’ permissiveness, and indoor tanning by both mothers and daughters. Results The first dyad was enrolled on March 31, 2016, and we anticipate completing this study by October 2019. Conclusions This trial will deliver social media content grounded in theory and will test it in a randomized design with state-of-the-art measures. This will contribute much needed insights on how to employ social media for health behavior change and disease prevention both for indoor tanning and other health risk behaviors and inform future social media efforts by public health and health care organizations. ClinicalTrial Clinicaltrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807 (Archived by WebCite at http://www.webcitation.org/6mDMICcCE).
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Orthorexia Nervosa: A Review of the Literature
Article
  • Dec 2017
Background: The phenomenon of orthorexia nervosa (ON) has been noted by clinicians since 1996 and described in the scientific literature, and yet there is no formal recognition of ON as a psychiatric diagnosis. Objective: Review the latest available literature regarding diagnoses similarities, presentation uniqueness, assessment/assessment tools, and suggested treatments of ON. Method/design: A literature search of four databases focusing on articles published between 2000 and 2016 was conducted to evaluate the status of the literature on Orthorexia. Results: Among the 15 articles selected for this review, similarities with other psychiatric disorders emerged, confusion about use of assessment tools existed, and the lack of evidence based treatments for ON was pronounced. Conclusion: More research is needed to determine the prevalence of pathologically unhealthy, obsessive, "self-defined healthy," eating behaviors, and to determine if ON is a unique eating disorder or just a subset of another disorder.
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Fat is Fashionable and Fit: A Comparative Content Analysis of Fatspiration and Health at Every Size® Instagram Images
Article
  • May 2017
In step with the proliferation of Thinspiration and Fitspiration content disseminated in popular web-based media, the fat acceptance movement has garnered heightened visibility within mainstream culture via the burgeoning Fatosphere weblog community. The present study extended previous Fatosphere research by comparing the shared and distinct strategies used to represent and motivate a fat-accepting lifestyle among 400 images sourced from Fatspiration- and Health at Every Size®-themed hashtags on Instagram. Images were systematically analyzed for the socio-demographic and body size attributes of the individuals portrayed alongside content reflecting dimensions of general fat acceptance, physical appearance pride, physical activity and health, fat shaming, and eating and weight loss-related themes. #fatspiration/#fatspo-tagged images more frequently promoted fat acceptance through fashion and beauty-related activism; #healthateverysize/#haes posts more often featured physically-active portrayals, holistic well-being, and weight stigma. Findings provide insight into the common and unique motivational factors and contradictory messages encountered in these fat-accepting social media communities.
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Attitudes toward orthorexia nervosa relative to DSM-5 eating disorders
Article
  • Mar 2017
  • INT J EAT DISORDER
Objective: A pattern of disordered eating involving a pathological fixation with healthy food consumption, labeled orthorexia nervosa (ON), has recently generated attention; however, research has not yet investigated perceptions of ON-related behaviors. This study examined potential stigmatization of ON, compared with DSM-5 ED diagnoses. Method: Participants (N?=?505) were randomly assigned to read a vignette depicting a woman with anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), or ON. They then answered questions about the individual depicted in the vignette. A series of MANOVAs investigated whether opinions and beliefs about the person depicted varied as a function of the disorder described in the vignette. Results: Individuals with ON were perceived as less likely to "improve with treatment" than individuals with BN, and less likely to "pull themselves together," than individuals with BED. Individuals with ON and AN were viewed as "hard[er] to talk to" and more of a "danger to others" compared with individuals with BED. ON was viewed as less distressing, less likely to evoke sympathy, and more acceptable than the other disorders. Finally, "poor living choices" were perceived as contributing more substantially to ON. Participants' attributions of various personality characteristics did not differ based on ED diagnosis. Discussion: Results suggest that ON is viewed as less severe, more desirable, and more often the result of personal life choices. However, findings also imply that ON is associated with stigma, similar to DSM-5 EDs. These negative attitudes might reinforce ON behaviors, and limit awareness of their potential complications.
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Face-to-Face and Online Networks: College Students' Experiences in a Weight-Loss Trial
Article
This study aimed to understand how college students participating in a 2-year randomized controlled trial (Project SMART: Social and Mobile Approach to Reduce Weight; N = 404) engaged their social networks and used social and mobile technologies to try and lose weight. Participants in the present study (n = 20 treatment, n = 18 control) were approached after a measurement visit and administered semi-structured interviews. Interviews were analyzed using principles from grounded theory. Treatment group participants appreciated the timely support provided by the study and the integration of content across multiple technologies. Participants in both groups reported using non-study-designed apps to help them lose weight, and many participants knew one another outside of the study. Individuals talked about weight-loss goals with their friends face to face and felt accountable to follow through with their intentions. Although seeing others' success online motivated many, there was a range of perceived acceptability in talking about personal health-related information on social media. The findings from this qualitative study can inform intervention trials using social and mobile technologies to promote weight loss. For example, weight-loss trials should measure participants' use of direct-to-consumer technologies and interconnectivity so that treatment effects can be isolated and cross-contamination accounted for.
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