Understanding social, genetic and environmental risk factors across eating disorders

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Social media offers constant opportunities for individuals to compare themselvesto idealised, filtered, and airbrushed versions of people every day. Perhaps it is no surprise then, that use of the socialmedia platform Facebook is associated with both disordered eating1 and with body image concern2, with longitudinalstudies indicating that these effects can last up to 18 months3. Interestingly, one study found that, whilst time spent onFacebook was not associated with concern over body image and disordered eating, engagement with photo-basedactivities on Facebook was4. This finding, coupled with the discovery that pictures are remembered better than words5,means it is vital to explore the effects of the lesser-studied, image-based Instagram on the development of eatingdisorders. Indeed, Instagram is the fasting growing social network in the world6 and is most linked to the 'healthy eatingmovement'7, thus it may have played a key role in the recent rise in eating disorders.To indicate the extent of the food-and-exercise-obsessed nature of Instagram posts, at the time of writing, thereare 62.3 million #fitspo ('fitspiration') posts, 42.4 million #cleaneating posts and 23.9 million #wellness posts. Thepervasive nature of these posts is concerning, given that analyses of photos under the tag #fitspiration revealed anoverwhelming majority contained images of thin, toned women, all in line with current sociocultural trends of beauty8.This limited and narrow-minded view of what 'fit' looks like suggests that being in a larger body is not compatible withbeing fit, and thus undermines #fitspiration's promise to promote health and fitness. Instead, it is not much better than itsmore damaging counterpart #thinspiration; arguably, both serve to promote thinness.The consequences of such posts have been investigated. Social media, unlike mass media, enables viewers toparticipate both actively and passively, and links between both forms of participation and health-related behaviours havebeen identified. A significant relationship was discovered between time spent consuming images on Instagram, i.e.passive participation, and orthorexia nervosa9 (an eating disorder that has symptoms that overlap with anorexia nervosa).In comparison, no association was found with Facebook, Pinterest, and Tumblr, and Twitter actually showed a smallprotective effect. Further, previous research indicates that posting 'fitspiration' images on Instagram, i.e. activeparticipation, is associated with disordered eating behaviours and compulsive exercise.10Overall, I suggest this project takes the opportunity to examine the specific content participants consume onInstagram and its link with eating disorder diagnosis, severity, and trajectory. For example, the number of 'fitspiration','clean eating' and 'wellness' accounts an individual follows could be viewed as both a potential social risk factor and ahealth seeking behaviour. Participants could be asked to report the proportion of accounts they follow that are dedicatedto such domains, and its association with eating disorder severity could be examined. The self-report nature of thisexample and the difficulties associated with its reliability could be addressed through a verification process of a sample ofaccounts. This research is crucial if we are to create methods to mitigate individual risk of eating disorders.