By Ellen Feldman, MD
Altru Health System, Grand Forks, ND
Dr. Feldman reports no financial relationships relevant to this field of study.
• The authors of this exploratory Australian study analyzed data from 534 girls and 462 boys about usage of the social media platforms Facebook, Instagram, Snapchat, and Tumblr and measures of disordered eating (DE).
• A greater number of social media accounts was associated with higher DE scores for all participants. More specifically, girls with Snapchat and Tumblr and boys with Facebook, Snapchat, and Instagram were more likely to have DE behaviors and cognitions. Total daily time spent on Instagram was associated with higher DE scores for girls.
The authors of this exploratory study in 996 young adolescents found an association between time spent on social media, number of social media accounts, and evidence of disordered eating behaviors.
Wilksch SM, O’Shea A, Ho P, et al. The relationship between social media use and disordered eating in young adolescents. Int J Eat Disord 2020;53:96-106.
While the authors of this Australian study looking at disordered eating and social media use among young adolescents predates the COVID-19 pandemic, the implications of the study may be particularly important now, with many teenagers at home and often spending even more time online.
A relationship between eating disordered behaviors, body image, and social media use has been well-studied in teens and young adults, but there is a knowledge gap when looking at younger age groups.1 Social media accounts can be established at age 13, so Wilksch et al believed that investigating such relationships during early adolescence is relevant to building further knowledge in this area and perhaps implementing preventive measures. It is important to note that this is an exploratory study with no evidence or implications regarding causation.
Participants were drawn from five private schools in two Australian states. Ethnicities were not reported; mean socioeconomic status was above average. All data were collected in a classroom setting, with parental consent.
Disordered eating (DE) was evaluated by establishing a combined score incorporating cognitions (attitudes and beliefs) and behaviors associated with eating and body image. The 22-item Eating Disorders Examination Questionnaire (EDE-Q) measured cognitions associated with DE, such as concerns about body shape and weight.2 Respondents also were asked to complete a Project Eating Among Teens (Project EAT) questionnaire, which looks at DE behaviors such as strict exercise, skipping meals, self-inducing vomit, and binge eating.3
Social media use was assessed via yes or no questions regarding type of accounts. A series of subsequent questions allowed participants to document time spent on each account daily, and routine use of pictures and other specified content.
Summary of Results
DE cognitions and behaviors. The authors found that 51.7% of girls and 45% of boys reported at least one DE behavior. In addition, 14% of girls and 5.2% of boys endorsed both a DE behavior and clinically relevant DE cognition (odds ratio [OR], 2.99; 95% confidence interval [CI], 1.86-4.83).
Social media accounts. For the types of social media accounts, more girls reported Instagram and Tumblr accounts and more boys reported Facebook accounts. Overall, 24.7% of girls and 30.2% of boys reported no social media accounts.
Social media accounts and DE. DE cognitions increased with total number social media accounts in both girls and boys. (See Table 1; P < 0.001 for both girls and boys.)
Table 1. Social Media Accounts and Disordered Eating
|
| |
0 Accounts
|
1 Account
|
2 Accounts
|
3-4 Accounts
|
|
Girls mean EDE-Q
|
(n =123)
1.22
|
(n = 99)
1.49
|
(n = 213)
1.65
|
(n = 67)
1.80
|
|
Boys mean EDE-Q
|
(n =129)
0.84
|
(n = 90)
0.93
|
(n = 123)
0.99
|
(n = 87)
1.40
|
|
EDE-Q: Eating Disorders Examination Questionnaire
|
In addition, for girls, Snapchat was associated with specific DE behaviors: limiting intake, meal skipping, and strict meal planning. Tumblr was associated with binge eating for both girls and boys. Girls with Snapchat or Tumblr and boys with Facebook, Instagram, or Snapchat were significantly more likely than peers to endorse DE behavior and cognitions (OR ratio: 0.29-0.48.)
Time on social media and DE. For girls, time spent on Instagram was correlated with higher DE scores (OR, 0.11; 95% CI, 0.01-0.34.) The curve accelerated after about 60 minutes of daily reported time. No such relationship was identified for boys.
Perhaps one of the most striking findings from this exploratory study is that social media use and DE behaviors and cognition are common in young adolescents. It is difficult to understand if the specific social media platform is significant or if the use of such platforms is a reflection of a broader trend. Regardless, Wilksch et al noted that a particular difficulty with conducting research on social media use in adolescents is that these trends seem to shift and change, as evidenced by the finding of relatively low usage of Facebook for girls, for example.
Given that this exploratory study shows correlation without evidence of causation, it is difficult to draw a firm conclusion. Future studies should be prospective and broad-based. However, even with only preliminary and suggestive results, a primary care provider can certainly educate patients regarding implications of these findings. In particular, a wellness plan can remind parents of the need to supervise young adolescents who are on social media and to consider limiting time spent on these platforms. In addition, a frank and open conversation with a young adolescent about social media use can help open the door to further discussion about body image and other related concerns. Primary care providers are well-situated to assist parents in initiating such a conversation.
Although not covered explicitly in this article, it is well worth reminding parents of the importance of role-
modeling. In this case, exhibiting healthy habits around food, body image, and social media use may convey a more powerful message than words alone.
REFERENCES
- Holland G, Tiggemann M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image 2016;17:100-110.
- Luce KH, Crowther JH, Pole M. Eating disorder examination questionnaire (EDE-Q): Norms for undergraduate women. Int J Eat Disord 2008;41:273-276. https://onlinelibrary.wiley.com/doi/pdf/10.1002/eat.20504
- University of Minnesota. School of Public Health. Project EAT. https://www.sph.umn.edu/research/projects/project-eat/
