Is it Time to Update Our Prevention Approaches?

by Maddie Mosier

With the relatively recent proliferation of online communication platforms (e.g., Twitter, Instagram, Facebook, YouTube, TikTok, Tumblr), navigating media in the context of eating disorders has become more complex than ever. The interactive nature of these websites allows for frequent and potentially constant social comparison. Indeed, social comparison accounted for a significant negative correlation between Facebook use frequency and self-esteem (Vogel et al., 2014). Other studies suggest that social media use places youth at greater risk for harassment, cyberbullying, and depression (O’Keeffe et al., 2011). These findings are especially alarming given the vast numbers of young people currently active on social media; in 2016, 97.5% of young adults reported engagement with at least one social media platform, while 85% reported regular use of six or more sites (Villanti et al., 2017)—and even more given the public health physical distancing measures necessitated by COVID-19. 

Social media can expose individuals to harmful messages and catalyze unhealthy behaviors that may trigger eating disorder symptoms in those already vulnerable. Often, the nature of engagement, the number of “friends” one has, and the amount of time spent engaging with these sites determines the level of impact social media platforms can have. A heavy dependency on social media sites can lead to low self-esteem, negative body image, and an increased risk for eating disorder symptoms (Santarossa & Woodruff, 2017). The beauty industry plays a role by means of “influencers” who attempt to maximize audience engagement by building friendship and trust with their followers. Some influencers promote an unrealistic and perfectionistic body ideal in an effort to sell products (Pilgrim & Bohnet-Joschko, 2019). As Vogel et al. noted, “people might be comparing their realistic offline selves to the idealized online selves of others, which may be detrimental for well-being and self-evaluations.”

Given these observations, has the time come to revamp our eating disorders prevention programs? In previous research, media literacy prevention programs have reduced eating disorder risk (Watson et al., 2016). Many colleges and schools have made use of programs that largely address engagement with media and advertising, although many of these programs were developed when traditional media (television, radio, print) were dominant and social media was still new. Although these curriculums are publicly available (e.g., Stice & Shaw, 2012; schools can purchase the Media Smart program) the preventions are not widely used, possibly due in part to the vast underestimation of the seriousness of eating disorders (Schaumberg et al., 2017). Despite challenges of having prevention programs reach those who need them, approaches regarding healthy social media use have been shown to work. One pilot intervention resulted in improved body image and fewer eating disorder symptoms in those who participated, underscoring both the way in which a lack of media literacy could be hindering recovery and how important social media literacy may be in protecting against eating disorder symptoms (McLean et al., 2017). Effective programs improve critical thinking and promote skepticism of the Western cultural body ideal of thinness, so information that might negatively affect body image, health, and emotional well-being can be deconstructed and resisted. Our prevention programs cannot be static. It is important that they evolve in parallel with popular culture such that they effectively target the ways in which we communicate and connect with each other.


Santarossa, S., & Woodruff, S. J. (2017). #SocialMedia: Exploring the relationship of social networking sites on body image, self-esteem, and eating disorders. Social Media Society, 3, 205630511770440. doi: 10.1177/2056305117704407

Schaumberg, K., Welch, E., Breithaupt, L., Hübel, C., Baker, J. H., Munn‐Chernoff, M. A., … & Hardaway, A. J. (2017). The science behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders. European Eating Disorders Review, 25, 432-450.

Stice, E., Rohde, P., & Shaw, H. (2012). The body project: A dissonance-based eating disorder prevention intervention. Oxford University Press.

Vogel, E. A., Rose, J. P., Roberts, L. R., & Eckles, K. (2014). Social comparison, social media, and self-esteem. Psychology of Popular Media Culture, 3, 206–222. doi: 10.1037/ppm0000047

Villanti, A. C., Johnson, A. L., Ilakkuvan, V., Jacobs, M. A., Graham, A. L., & Rath, J. M. (2017). Social media use and access to digital technology in US young adults in 2016. Journal of Medical Internet Research, 19. doi: 10.2196/jmir.7303

Watson, H. J., Joyce, T., French, E., Willan, V., Kane, R. T., Tanner‐Smith, E. E., … & Egan, S. J. (2016). Prevention of eating disorders: A systematic review of randomized, controlled trials. International Journal of Eating Disorders, 49, 833-862.

Okeeffe, G. S., & Clarke-Pearson, K. (2011). The impact of social media on children, adolescents, and families. Pediatrics, 127, 800–804. doi: 10.1542/peds.2011-0054

Pilgrim, K., & Bohnet-Joschko, S. (2019). Selling health and happiness how influencers communicate on Instagram about dieting and exercise: mixed methods research. BMC Public Health, 19. doi: 10.1186/s12889-019-7387-8

Mclean, S. A., Wertheim, E. H., Masters, J., & Paxton, S. J. (2017). A pilot evaluation of a social media literacy intervention to reduce risk factors for eating disorders. International Journal of Eating Disorders, 50, 847–851. doi: 10.1002/eat.22708