New research from the University of Vermont finds the most viewed content on TikTok relating to food, nutrition and weight perpetuates a toxic diet culture among teens and young adults and that expert voices are largely missing from the conversation.
Published today in PLOS One, the study found weight-normative messaging, the idea that weight is the most important measure of a person’s health, largely predominates on TikTok with the most popular videos glorifying weight loss and positioning food as a means to achieve health and thinness.
“Each day, millions of teens and young adults are being fed content on TikTok that paints a very unrealistic and inaccurate picture of food, nutrition and health,” said senior researcher Lizzy Pope, associate professor and director of the Didactic Program in Dietetics at UVM.
“Getting stuck in weight loss TikTok can be a really tough environment, especially for the main users of the platform, which are young people.”
The study is the first to examine nutrition and body-image related content at scale on TikTok. The findings are based on a comprehensive analysis of the top 100 videos from 10 popular nutrition, food and weight-related hashtags, which were then coded for key themes. Each of the 10 hashtags had over a billion views when the study began in 2020; the selected hashtags have grown significantly as TikTok’s user base has expanded.
“We were continuously surprised by how prevalent the topic of weight was on TikTok. The fact that billions of people were viewing content about weight on the internet says a lot about the role diet culture plays in our society,” said co-author Marisa Minadeo, who conducted the research as part of her undergraduate thesis at UVM.
The approach centers on using non-weight markers of health and well-being to evaluate a person’s health and rejects the idea that there is a “normal” weight that is achievable or realistic for everyone. If society continues to perpetuate weight normativity, says Pope, we’re perpetuating fat bias.
“Just like people are different heights, we all have different weights,” said Pope. “Weight-inclusive nutrition is really the only just way to look at humanity.”
Weight-inclusive nutrition is becoming popular as a more holistic evaluation of a person’s health. As TikTok users, UVM health and society major Minadeo and her advisor Pope were interested in better understanding the role of TikTok as a source for information about nutrition and healthy eating behaviors.
White, female adolescents and young adults accounted for the majority of creators of content analyzed in the study. Very few creators were considered expert voices, defined by the researchers as someone who self-identified with credentials such as a registered dietitian, doctor, or certified trainer.
“We have to help young people develop critical thinking skills and their own body image outside of social media,” said Pope. “But what we really need is a radical rethinking of how we relate to our bodies, to food and to health. This is truly about changing the systems around us so that people can live productive, happy and healthy lives,” said Pope.
Defining Social Media
Adolescent peer groups have been recognized to influence individuals’ health behaviors, including diet . During adolescence, eating behaviors are influenced by peer impacts, such as perceived social norms that can create unique peer pressures [2,3]. Peer-to-peer influence on health behaviors has been documented in face-to-face interactions ; however, few have studied the influence of social media on eating behaviors during adolescence.
Social media has been defined as any social networking site that enables interactive, user-generated content that allows sharing of images, ideas, videos, music, or commentary on internet forums (eg, Facebook), blogs and microblogs (eg, Twitter), and photograph- or video-hosting platforms (eg, Instagram, YouTube, or TikTok) . Individuals or groups of people can communicate, collaborate, and connect in real time via text, video, or phone anywhere that Wi-Fi is available.
Social media channels, such as Facebook or YouTube, were initiated in the early 2000s. However, the first website recognized as being the first social media platform was called Six Degrees—short for Six Degrees of Separation—and it launched in 1997. In 2018, YouTube, Instagram, and Snapchat were identified as the most popular online platforms utilized by teens 13 to 17 years of age . User-generated content on these channels may allow for autonomy, identity, and interpersonal peer relationship development, a hallmark of adolescence .
Social media is an effective channel for engaging adolescents , a target population that has been hard to engage in public health practice. It can be used to influence, inform, and persuade. Social media mobile apps have global reach, use, and engagement . In an earlier global report, approximately 85% of adolescents between the ages of 12 and 17 years across Europe, Latin America, the United States, and South Korea reported using a social media website .
Among a sample of 4460 high school students from Turkey in 2019, 88% owned a smartphone and 100% had a social media account . Contagion effect—the rapid communication of an idea that has gone viral among peers on social media platforms—has been recognized as an effective way to promote health behaviors [12-15]. Behavior intent, increased knowledge, and increased awareness are positive attributes of healthful food posts on social media that influence users [16-18].
Extensive social media use, along with other entertainment media use, has been associated with consumption of unhealthy foods, mostly due to snacking behaviors. In particular, Albert found that social media and other entertainment media use among a sample of mostly Latino (68%) middle schoolers was negatively correlated with fruit and vegetable consumption (r=–0.065) and was strongly correlated with fast food and junk food intake (r<0.200) .
In a recent report, Chau et al concluded that social media was a promising channel for obesity prevention in adolescents and young adults . Given that more recent research revealed that 95% of teens 13 to 17 years of age own a smartphone, 51% use Facebook, 69% use Snapchat, 72% use Instagram, and 85% use YouTube , an examination of peer influence, via social media channels, on eating behaviors is warranted. However, no review to date has demonstrated peer influence on eating behaviors via social media networks among adolescents.
Social Media Influence and Eating Behaviors
A social network analysis of adult, in-person peer relationship influences indicated that maladaptive eating behaviors (ie, eating disorders) may be influenced by friendships . Social norms, as well as real and perceived social support, may be underpinning peer influences related to the practice of eating. Peer groups and the type and degree of peer influence may shape one’s relationship with food. Peer influence on eating behaviors may extend from in-person influence to social media influence.
Findings from a US nationally representative sample of young adults, 19 to 32 years of age, revealed an association between a high volume and frequency of social media platform engagement (ie, Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit) and eating concerns . However, some of the most popular social media channels have been noted to influence maladaptive (ie, nonpathological) eating disorders as well as adaptive (ie, pathological) healthy eating.
Social media platforms (ie, Facebook and YouTube) and mobile gaming nutrition-intervention apps (eg, Food Hero) demonstrate utility among young adult populations to raise awareness, increase knowledge, influence intrinsic beliefs, and motivate attitudes . Social media channels, including Facebook, YouTube, and Snapchat, have been recognized by adolescents for providing peer-to-peer support in healthy eating through sharing information and offering social support . This scoping review aimed to elucidate the role of peer influence via social media channels on eating behaviors among adolescents between the ages of 10 and 19 years.
The literature on peer-enhanced social media interventions for eating behaviors is in its nascent stages. This scoping review aims to fill the gap in the literature and to review the evidence on the influence of peer-to-peer enhanced social media environments on eating behaviors among adolescent youth aged 10 to 19 years.
Self-reported, user-generated eating behavior content on social media, supplanted with image recognition, food diaries, nutrient-intake mobile apps, or data synced to wearable devices, such as cameras embedded in eyeglasses, allows for passive data collection with minimal user burden; this data could be integrated into social media in order to build medical evidence to support decision making. Our paper demonstrates that peer social media influence on dietary behaviors warrants a robust amount of additional work to add to the body of scientific medical evidence in the field.
Holmberg and colleagues  reported positive portrayals of healthy eating promoted by adolescents. Fruit and vegetable images that are zoomed-in on and focused on for a picture may place emphasis on the food depicted, due to visual appeal and positive attributes. Poelman et al provide an example of a digital food tracking system that could be embedded into social media apps to understand how food choices are influenced by the real-world food environment .
Another option is the use of digital food record mobile apps, such as FitNinja (Vibrent Health), with image recognition software to collect nutrient content; these have been found to be acceptable tools for digital food records of real-world food intake . Additionally, shared food posts, such as fruits and vegetables marked by peer likes among user networks in social media environments, may represent reinforcement of positive—or any valence—nutrition behaviors as positive, well-liked behaviors .
Commercial advertising on Facebook and Twitter, as described by Thaichon and Quach , may detract from adolescent engagement, as teens may seek to declare their independence outside of the mainstream; in addition, these platforms are targeted to older age groups. Social media platforms may allow teens a digital environment for creative license, personal identity, and autonomy during a time frame when they are transcending into early adulthood and away from parental influence .
In addition, Instagram and Snapchat, which were launched in 2010 and 2011, respectively, are messaging apps whose early adopters are nearly a generation younger than Facebook users. Facebook may not be as relatable, given its inception with a college cohort in 2004, a generation currently approaching middle age.
Peer influence via social media could be an effective channel to engage this typically hard-to-reach population on health topics, including health behaviors. Social media networks were a consistent setting for engaging adolescents with healthy eating messages . Visual appeal was a strong engagement characteristic that influenced users both positively and negatively. Unfortunately, fast food advertising is also pervasive and influential on social media channels targeting adolescents, which could have negative consequences on weight status and other chronic disease risks .
Facebook was the most common social media network reported, despite the rising popularity of Instagram and Snapchat over Facebook among adolescents . Only one Swedish study  analyzed adolescents’ perception of food on Instagram. This may be due to the time lag in research. One advantage to this could be that as adolescents move away from Facebook, they may be less exposed to the commercial fast food marketing commonly reported on that social media channel.
Healthy eating posts may reflect an aspirational lifestyle change among people in the contemplation phase toward healthy eating. Kinard  and Holmberg et al  found that obese and overweight adolescents and adults were more likely to engage with healthy food posts than with unhealthy junk food posts on Instagram and Facebook . Similarly, Holmberg et al  commented that fruits and vegetables were portrayed in a favorable way that connoted palatability. Health promotion marketing of healthy foods may aid to inspire healthful behavior change as users are drawn to the visual appeal.
As social norms are modified in a digital milieu, cautionary monitoring of peer pressures may be needed. Social media peer pressures may affect body image ideals  that could lead to maladaptive eating behaviors and poor well-being.
Healthful Social Media Interventions for Adolescent Eating Behaviors
Multipronged interventions with in-person and social media components have reported successful weight loss among participants  and an increase in feelings of social support in adolescent populations . Kulik and colleagues  reported that social networking builds peer social support for weight loss in conjunction with an in-person intervention. Peer support may offer teens safe space to share emotional vulnerability, where they can relate to and confide in peers, while also serving as a source of accountability for healthful dietary goals.
Similarly, significant weight loss was found as a result of a weight loss intervention that used Facebook private messaging and text messaging among a diverse group of college students . Additionally, Barragan et al found that social media platforms (ie, Facebook, Twitter, and YouTube) increased knowledge on excess calorie intake from sugar-sweetened beverages and increased self-reported intention to reduce sugar-sweetened beverage consumption . Additionally, online discussion forums served as a source of mental health support for eating disorder recovery and relapse prevention .
Nutrition information may raise awareness and promote nutrition literacy when content is verified. Mixed messages in the media on the healthfulness of certain foods may be misleading to the public . Additionally, dietary information shared on social media is oftentimes misaligned with national dietary guidelines and evidence-based dietary recommendations.
Nutrition content on social media needs to be both accurate and engaging to avoid increasing consumer confusion and skepticism of dietary advice altogether . Public health practitioners, nutrition educators, and researchers need to partner with food industry advertisers, social media influencers, and social marketing leaders to ensure that consumers are accurately informed, particularly for vulnerable populations such as adolescents.
Negative Effects of Social Media on Adolescent Eating Behaviors
Social media may influence poor eating habits and maladaptive eating behaviors. Thaichon and Quach  reported an association between overweight and obese Australian adolescents and behavior intent toward eating fast food due to advertisements viewed on Facebook.
Incentive advertising combined with fast food and soda endorsed by their peers may reinforce the promotion of unhealthy food choices. Additionally, two European studies [29,31] engaged adolescents around maladaptive eating behaviors related to eating disorders. Users provided each other with tips and strategies for bulimic or anorexic eating behaviors, promulgating harmful eating behaviors and extreme diets.
Limitations of the Current Literature
Unfortunately, these studies do not help in understanding the role of social media influence or impact in real-world dietary behavior change in adolescent peer groups. Measurements of actual behavior change need to be studied in conjunction with social media marketing campaigns (eg, purchasing behavior and food intake).
Hawkins et al  reported that perceived norms and preferences around eating among a sample of English university students (mean age 22 years) on Facebook were predictive of users’ actual food consumption . Facebook users’ perceived social norms were predictive of users’ actual fruit and vegetable intake, and perceived social norms were predictive of participants’ actual snack and sugar-sweetened beverage consumption. Also, MySpace and Reddit were not included as social media platforms in the search terms list. Omission of MySpace may account for reduced representation by Black and other racial and ethnic minority groups.
Future research should emphasize methodological rigor to elucidate peer influence on dietary behavior change. An extensive amount of research is needed in the field, including objective measures of actual dietary intake with social media interventions and social network analysis of peer influence change agents on food behavior outcomes.
In a pilot study that examined whether promoting red peppers via a social media influencer on Instagram would increase actual vegetable intake among adolescents in the Netherlands, no effect was found on users’ actual dietary intake . Additional work is needed to understand the influence of peer-to-peer behavior transmission and adoption in social media environments.
The lack of appropriate medical evidence to support decision making might be resolved with more research studies utilizing social media channels alongside objective eating behavior measures. Social media geographic location check-in tools could build off of this approach.
Additionally, fact checking of user-generated content and use of credible dietary sources on social media may be questionable. Content verification of nutrition information  may also be affected by perception of friendship ties . Perceived degrees of connection and measurement, or lack thereof, of health outcomes are also limitations when understanding the utility of social media use for adolescent health behaviors .
Future research may also include Snapchat and other novel platforms that are now pervasively used by youth . TikTok is also a popular social media platform that was released in 2016 by ByteDance.com that is gaining popularity, particularly during the COVID-19 global pandemic. This video sharing social networking service started in China and gained traction in the United States in 2018 after merging with musical.ly. The social media channel allows users to create short lip sync, dance, and comedic videos .
Racial and ethnic youth of color are underrepresented in studies of this kind. Only Kulik et al, who conducted a study in the United States, included minority youth; in their study of Facebook as a complement to an in-person weight loss intervention, 20% of the sample was African American and 21% were participants from other groups of color . Since non-Hispanic Black (22%) and Hispanic (26%) youth experience obesity rates consistently higher than their White counterparts (14%) , more research is needed to understand the impact of social media influence on eating behaviors in adolescents of color.
Racial and ethnic health disparities experienced by people of color give rise to a heightened need for targeted healthful marketing via social media channels to engage youth. Racial and ethnic minority youth are heavily targeted for fast food marketing [49,50], and communities of color tend to be inundated by food swamps (ie, an abundance of fast food restaurants concentrated in a ZIP Code).
Therefore, in order to act against these high-calorie, nutrient-poor advertising messages , culturally tailored approaches are needed to promote healthful eating behaviors among this population . In addition, health literacy has been identified as a key social determinant of health among adolescents . Accurate nutrition-related health literacy conveyed through photos, video imagery, and text is critical to addressing diet-related comorbidities among adolescent youths of color.
Future research should evaluate the role of social media engagement with peer influencer change agents in dietary behavior change interventions. The pervasiveness of social media usage among adolescents calls attention to a communication channel that cannot be ignored. Moreover, the cell phone technology that allows touchscreen access to social media may enhance the capacity of peer influencer change agents that could be more powerful than prior print or television media.
In the social media realm, evidence from social network analysis indicates that peer influencers are effective health behavior change agents based on leadership styles by peers, social network connectedness, and communication patterns between the peer influencer change agent and end recipient .
Even prior to the global popularity of social media, peer influencers were highly regarded change agents. Peer educator change agents were the most commonly used HIV prevention framework, as peer change agents were more likely to be recognized for their leadership qualities .
Gender differences may also be explored in future research about adolescent influence on eating behaviors in social media environments. Constant cell phone engagement offers a technology medium that could not only engage adolescents about eating behaviors but could also support adoption of targeted change behaviors.
reference link :https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212626/
Original Research: Open access.
“Weight-normative messaging predominates on TikTok—A qualitative content analysis” by Marisa Minadeo et al. PLOS ONE