Movies, magazines, and television have long glamorized thin bodies — an ideal that researchers acknowledge is a factor that can lead to disordered eating. In recent years, social media has amplified that influence.
With a smartphone in hand, it’s easier than ever to compare your abs or eating habits with someone else’s, though it’s likely the image you’re measuring yourself against has been stretched, filtered, or otherwise altered.
“Social media is so much more ubiquitous than traditional media,” explains Jillian Lampert, PhD, MPH, RD, LD, chief strategy officer for the Emily Program, a national eating-disorder treatment center. “You don’t have to wait for next month’s magazine to arrive. You can just wait two seconds and get a new image in your feed.”
Despite the often edited photos, social media has a misleading veneer of authenticity, says Pamela Ramos, MD, a psychiatrist for Eating Recovery Center in Baltimore.
“You’re not just seeing celebrities,” she explains. “It’s your friend or your neighbor — someone who seems like they could be you — sending you a message or selling you a product. So you tend to question it less.”
Given the rise of social-media influencers — individuals with large online followings — it can be especially challenging to separate fact from fiction. Though most wellness influencers lack the credentials necessary to offer nutrition advice, many do it anyway.
According to one study from the University of Glasgow that examined health bloggers in the United Kingdom, almost 90 percent of them share inaccurate information. And many are also paid to promote particular products on their platforms.
“They’re showing the product or behavior or lifestyle as if they’re an expert,” Ramos says. “But who’s endorsed their expertise? Nobody, and yet some of them are spreading their ideas to millions of followers.”
Plus, influencers may have a vested interest in offering more extreme or outrageous advice, because it attracts more views, likes, and shares. “Citing evidence isn’t nearly as sexy,” explains psychology professor Charlotte Markey, PhD, founding director of the Health Sciences Center at Rutgers University.
Eating disorders are biopsychosocial illnesses, meaning they have no single cause: Multiple complex biological, psychological, and social factors may influence whether a person is at risk.
For many people, media consumption can be one of those factors. And you can be struggling even without a diagnosis.
“A person does not need to be bingeing, purging, or fasting to have disordered eating,” explains Markey. “If thoughts about food start to impinge on other areas of life or take up a lot of mental space, there’s likely a problem.”
Less than 10 percent of Americans have an eating disorder, according to estimates from the National Eating Disorders Association. Yet research suggests that disordered-eating habits are dramatically more prevalent.
A 2013 study on body image among women ages 25 to 45 found that 31 percent of participants had purged in an effort to lose weight, while 74 percent reported that concerns about body shape and weight interfered with their happiness.
Those habits can grow into a disorder if left unchecked. “Like any other illness, it starts with smaller symptoms,” Ramos says. “When you have the flu, first you get congested, then your throat hurts, and then your body aches. The same thing happens with eating disorders: You may start cutting back on a particular food; maybe you stop eating in public. That can quickly snowball into a full-blown illness.”
Although the signs of disordered eating vary, symptoms include frequent dieting, anxiety associated with eating, and feelings of impulsivity or loss of control around food.
A preoccupation with food that affects your social life — avoiding eating in front of others because you fear judgment, for instance, or skipping a party because you’re afraid of what you might eat there — is another warning sign.
“If your perspective toward food starts to impair your ability to live in the ways you want, that’s probably the most significant sign,” Lampert says.
Orthorexia is a condition characterized by an unhealthy obsession with healthy eating. The term was coined in 1997 by Steven Bratman, MD, but awareness of its symptoms has risen in the social-media age.
Research has linked Instagram use to increased orthorexia symptoms. And in a paper published in Medical Humanities in 2019, Cristina Hanganu-Bresch, PhD, calls orthorexia “a contemporary cyberpathy, a digitally transmitted disorder inwardly and narrowly focused on health through the consumption of ‘pure’ foods.”
Orthorexia is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, but its symptoms are very real and can harm your health. It’s similar to anorexia in its restrictive nature, Lampert and Ramos explain, but it can present quite differently.
People tend not to be secretive about an obsession with clean eating — and they may even post evidence of their symptoms as healthy principles on social media.
Influencers with orthorexia may not be aware that their obsession is unhealthy. “They’re sharing their behaviors and often gaining followers by doing so. It’s tied up with both their own pursuit of wellness and bolstering their sense of self,” says Lampert.
The shareability of the disorder may be what differentiates it from anorexia and bulimia, though its effects on mental and physical health can be quite similar.
There’s nothing wrong with wanting to eat mostly whole or minimally processed, organic, and fresh foods — which is typically what influencers mean when they refer to “clean” eating. But when that desire becomes an urgent obsession, or if it leads to social isolation or otherwise strains your mental well-being, that’s when the pursuit of healthy eating can become unhealthy.
An overly rigid, restrictive diet is unsustainable in the long term, Ramos says, “and it comes with a lot of anxiety, at a great personal cost.”
The problem with the idea of clean eating is that it implies that some foods are dirty or bad. What really matters, Lampert explains, is how you feel when you eat, which is why she encourages people to focus on mindful eating.
This can involve taking notice of your body’s cues: Does this meal make you feel nourished and energized, or sluggish and bloated? Do you feel satisfied with this food choice, or guilty and anxious? (For more on how to eat mindfully, see “The Mindful Food Journal”.)
“Mindful eating is about answering the question of how you get to make peace with food for real,” Lampert explains. “It’s important to have a peaceful relationship with food, whatever it is you’re choosing to eat.”