Urgent Responsibility to Reduce Harms Posed by Social Media on risk for Eating Disorders: An Open Letter to Facebook, Instagram, TikTok, and Other Global Social Media Corporations.

Newswise — Reston, VA, November 2, 2021 – We write today to implore you to take swift, decisive, and transparent action to reduce the harms posed by social media on some of your most vulnerable users—those struggling with disordered eating and those who may be at risk. As members of the Academy for Eating Disorders (AED)--an international association committed to eating disorders research, education, treatment, and prevention--we are acutely aware of the complex ways in which social media platforms like Facebook, Instagram, and TikTok can adversely affect users at risk for disordered eating. We acknowledge that social media is a powerful tool with potential to connect its users globally and spread positive, empowering messages for recovery.  However, the preponderance of evidence points to detrimental effects of these platforms on those at risk for or already suffering from negative body image, eating concerns, and/or depressed mood.^1-3 We contend that mere corporate awareness of these harms and covert efforts to “fix the problem” is inadequate and unacceptable. In the case of eating disorders—second only to opioid use disorders in terms of their lethality—we cannot afford complacency or opacity.

Eating disorders affect an estimated 28.8 million individuals in the United States,⁴ with millions more suffering globally.^5,6 Although these disorders affect individuals of all ages, genders, racial and ethnic backgrounds,^7-10 they often begin during adolescence,⁷ thus they affect a key demographic that uses social media platforms frequently. The COVID-19 pandemic has only increased the prevalence and severity of these illnesses,^11,12 causing increased fear and isolation—conditions under which eating disorders thrive, and for which social media may provide a false refuge or sense of connection. Moreover, eating disorders can be characterized by limited insight into the severity of the disorder and its devastating medical effects.^13,14 These factors make individuals with eating disorders particularly susceptible to the pernicious messaging of pro-eating disorder content that pervades social media platforms. Indeed, research evidence concludes that social media usage is associated with increased body image concerns and engagement in disordered eating behaviors, and that these relationships strengthen over time with continued use.^1,2

Social media has devastating effects on users with existing eating disorders who engage with the platforms. Abigail Matthews, PhD, MHA, is the clinical director of the Eating Disorders Program at Cincinnati Children’s Hospital in Cincinnati, Ohio, USA, manages an inpatient eating disorder treatment program for youth and young adults who require hospitalization for medical complications of eating disorders. Speaking from her clinical experience, Dr. Matthews states, “Unfortunately, it's very common for my patients to talk about the negative impact of social media on body image and self-esteem. When on these platforms, they are infiltrated with images of their peers who appear to have it ‘all’—perfect bodies and perfect lives. As most of us know, many images on social media are doctored with filters and editing tools, so the bodies portrayed are unrealistic and unachievable. My patients describe engaging in negative social comparisons with people portrayed on social media, feeling inadequate in comparison to these ‘perfect’ peers, and sometimes end up feeling like a failure.” In turn, this may fuel the eating disorder and push them deeper into the throes of the illness. In light of recent reports that platform algorithms can rapidly and permanently flood users’ accounts with content promoting disordered eating and extreme dieting, we write with an urgent request to corporate leadership at social media platforms like Facebook, Instagram, and TikTok, to take immediate action to modify your platforms to stop these harms.

Regardless of whether these effects are intended, they are real and known. Therefore, we believe you now have a responsibility to minimize  harm, an opportunity to reverse course, and a chance to promote positive and supportive messaging for your most vulnerable users. To this end, we put forth the following requests to improve your platforms and stop the pervasive, deadly effects of eating disorder-promoting content:

1. Increase transparency around the algorithms that guide users toward specific types of content, and more importantly, display community guidelines for appropriate content in plain language in an easily-accessed location within the platform. Public knowledge of how these algorithms can lead to problematic messaging is a good first step toward empowering community members to report disallowed content and reverse its effects.
2. Build easy-access user paths into social media platforms, through which users may report content that is inconsistent with platform guidelines.  Platform designers must be responsible for moderating content according to community guidelines. At the same time, users should also be  empowered to assist with this process if and when desired. Further, they may identify content overlooked by existing algorithms.
3. Direct more resources and funding toward AI-based identification and removal of malicious and eating disorder-promoting accounts and content, as well as those that stigmatize individuals living in larger bodies. Current profit margins should allow for ample room to bolster existing resources and/or build new infrastructure to tackle these problems in a more comprehensive way.
4. Cease the development of an Instagram for users 13-years-old and younger. There is no demonstrated need for a social media platform for this age demographic. Further, given recommendations from authoritative bodies to minimize screen time and limit social media use particularly for younger children and preadolescents,^15,16 the introduction of such a platform would be counterproductive for healthy childhood development.
5. Solicit guidance from expert organizations like the AED to ensure these safeguards are well-suited to tackle the problem in a way that is well-aligned with the needs of the target at risk The goal of the AED is to provide global access to knowledge, research, and best treatment practice for eating disorders. Our worldwide network of experts can contribute unique insight into these challenges.
6. Pre-register future studies on the impacts of social media usage on eating disorders, and disseminate the results to the public in a timely manner. The scientific field increasingly moves toward an open science framework, in which planned study methods are publicly specified in advance, and results are made easily accessible after study completion. To the extent that social media corporations’ user research involves conclusions about the effects of its platforms on user well-being, these results should be shared widely with current and potential users.

Social media is an integral thread in the fabric of our global community. It will likely continue to evolve and transform our world. When designed and deployed with thought and care, it can be used as a tool to promote health, well-being, and justice for all. By taking the above actions, we firmly believe that your platforms can move in that direction, becoming part of a solution and not contributing to the problem. We welcome an ongoing dialogue to work toward this goal.

AED MEMBER CONTRIBUTORS:

Hallie Espel-Huynh, PhD
[email protected]
The Miriam Hospital/Alpert Medical School of Brown University

Abigail Matthews, PhD, MHA
[email protected]
Cincinnati Children’s Hospital Medical Center

Jenny Loudon, MPA
[email protected]
Alaska Eating Disorders Alliance

Helena Lewis-Smith, PhD 
[email protected] 
University of the West of England, Bristol

Millie Plotkin, MLS
[email protected]
Academy for Eating Disorders (Director for Online & Social Media)

Gry Kjærsdam Telléus, PhD
[email protected]
Aalborg University Hospital/Aalborg University

References

1. Zhang J, Wang Y, Li Q, Wu C. The relationship between SNS usage and disordered eating behaviors: A meta-analysis. Frontiers in Psychology 2021; 12: 641919-.
2. Fardouly J, Vartanian LR. Social media and body image concerns: Current research and future directions. Current opinion in psychology 2016; 9: 1-5.
3. Frison E, Eggermont S. Browsing, posting, and liking on Instagram: The reciprocal relationships between different types of Instagram use and adolescents' depressed mood. Cyberpsychology, Behavior, and Social Networking 2017; 20(10): 603-9.
4. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders., 2020.
5. Hoek HW. Review of the worldwide epidemiology of eating disorders. Current Opinion in Psychiatry 2016; 29(6): 336-9.
6. Thomas JJ, Sing L, Becker AE. Updates in the epidemiology of eating disorders in Asia and the Pacific. Current Opinion in Psychiatry 2016; 29(6): 354-62.
7. Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry 2007; 61(3): 348-58.
8. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry 2011; 68(7): 714-23.
9. Rodgers RF, Berry R, Franko DL. Eating disorders in ethnic minorities: An update. Current Psychiatry Reports 2018; 20(10): 90.
10. Udo T, Grilo CM. Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of U.S. adults. Biological Psychiatry 2018; 84(5): 345-54.
11. Termorshuizen JD, Watson HJ, Thornton LM, et al. Early impact of COVID-19 on individuals with self-reported eating disorders: A survey of ~1,000 individuals in the United States and the Netherlands. International Journal of Eating Disorders 2020; 53(11): 1780-90.
12. Phillipou A, Meyer D, Neill E, et al. Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. International Journal of Eating Disorders 2020; 53(7): 1158-65.
13. Vitousek K, Watson S, Wilson GT. Enhancing motivation for change in treatment-resistant eating disorders. Clinical Psychology Review 1998; 18(4): 391-420.
14. Treasure J, Schmidt U. Ready, willing and able to change: Motivational aspects of the assessment and treatment of eating disorders. European Eating Disorders Review 2001; 9(1): 4-18.
15. Council on Communications and Media. Media and young minds. Pediatrics 2016; 138(5): e20162591.
16. Keeffe GS, Clarke-Pearson K, Council on C, Media. The impact of social media on children, adolescents, and families. Pediatrics 2011; 127(4): 800.

ABOUT

The Academy for Eating Disorders (AED) is an international professional association committed to leadership in eating disorders research, education, treatment, and prevention. The goal of the AED is to provide global access to knowledge, research, and best treatment practice for eating disorders. For additional information, please contact Jennifer Lundgren, PhD ([email protected]) and visit the AED website at www.aedweb.org.

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