What does viewing a pro-anorexia website do? An experimental examination of website exposure and moderating effects

Enhancing contact recommendation in social platforms through mental health awareness: Exploring Anorexia Nervosa as a case study

We analyze and propose a solution for the exposure of vulnerable users to harmful content during their interaction with contact recommender systems in social platforms. Our approach is dedicated to maximizing the number of harmless accounts suggested to users at risk. For these users, the over-personalization of recommender systems can result in an exposure to triggering content. We consider anorexia nervosa as a use case. People with anorexia tend to seek accounts of peers that support their unhealthy habits. Contact recommender systems can unintentionally reinforce such behaviors. Our approach modifies the objective function of a content and topology-based recommendation algorithm to maximize the suggestion of harmless accounts for users at risk. This is done with data from Twitter of Spanish speaking users with anorexia. The design and evaluation of the proposal has involved the participation of clinicians and volunteers at the last stages of treatment. Results show that users with anorexia are willing to follow harmless accounts suggested in online platforms. There is a tradeoff in precision (Pr) when comparing our proposal (Pr = 0.41) with a regular recommendation approach (Pr = 0.58). However, results are promising as there is a 55% increase in the percentage of harmless accounts suggested.

Relationship between college lifestyle variables, eating disorder education, and eating disorder risk

Objective: This study examined relationships between eating disorder risk (EDR), lifestyle variables (e.g., exposure to healthy eating media), and differences among male and female college students. Participants: College students (N = 323) completed survey questionnaires (Fall, 2016). Fifty-three participants retook the survey at a later time. Methods: Participants completed a survey measuring EDR using EDI-3 subscales and 10 college lifestyle variables. Female and male EDR and Time 1 and Time 2 EDR were compared. Relationships between EDR and college life-style variables were examined. Results: Exercise, fewer daily meals, less face-to-face interactions, more digital interactions, less exposure to healthy eating media, and having conversations about body image were associated with EDR risk. Male college students showed an increase in EDR over time. Conclusions: Several lifestyle factors predicted EDR in college females and males. These lifestyle factors are modifiable and may be addressed by colleges during orientation and within the campus environment.

Online content on eating disorders: a natural language processing study

BACKGROUND

Online content can inform the personal risk of developing an eating disorder, and it can influence the time and motivation to seek treatment. Patients routinely seek information online, and access to information is crucial for both prevention and treatment. The primary aim of the current study was to quantify the readability scores of online content on eating disorders using natural language processing algorithms, across two languages: English and Italian.

METHODS

Unique terms related to single diagnoses were searched using Google®. The content available on Wikipedia was also assessed. Readability was defined according to the Flesch Readability Ease (FRE) and the Rate Readability Index (RIX). The scientific support of retrieved content and the authoritativeness of sources were measured through standardized variables.

RESULTS

In Italian, online content was more likely published by private psychotherapy institutes or by websites that promote diet-advice or weight-loss. In both languages, the most readable content was on Anorexia Nervosa (RIX 4.18, FRE-en 59.6, FRE-it 41.69), Bulimia Nervosa (RIX 3.99, FRE-en 66.27, FRE-it 39.66) or Binge Eating (RIX 4.01, FRE-en 68.10, FRE-it 38.62). English sources consistently had more references than Italian pages (range 35-182, vs 1-163, respectively). and had a higher percentage of citations available in the target language. The content of these references was mainly reflective of peer-reviewed or clinical manuals.

CONCLUSION

Attention should be given to developing online content for Muscle Dysmorphia and Orthorexia Nervosa, as well as improving the overall readability of online content on eating disorders, especially for languages other than English.

Pro-anorexia coaches prey on individuals with eating disorders

OBJECTIVE

While studies have focused on pro-ana communities and pro-anorexia websites, no research has been conducted on the presence of pro-anorexia coaches within these communities. This study aimed to gain insight into the modus operandi of pro-anorexia coaches.

METHOD

First, three fake profiles were used to attempt interaction with pro-anorexia coaches (n = 31). Second, an online questionnaire on experiences with pro-anorexia coaches was completed by 79 respondents. Third, a follow-up in-depth interview was conducted with 14 of these respondents.

RESULTS

The results show that pro-anorexia coaches' behavior fits a five-staged model which has similarities to stages of online grooming. They focus on (1) building trust and developing a dependency relationship with the aim of (2) obtaining sexually explicit materials. Subsequently, they (3) increase pressure, (4) utilize blackmail methods with acquired content, and (5) groom respondents to meet in person.

DISCUSSION

Pro-anorexia coaches deliberately abuse vulnerable young people who suffer from eating disorders to receive sexually explicit material or to meet face-to-face with a sexual intention. This study shows that the modus operandi of pro-ana coaches is similar to online grooming. Clinical professionals need to be aware of this practice to detect victims and potential victims in order to support and treat them. Prevention is invaluable to further combat pro-anorexia coaches and protect potential victims.

PUBLIC SIGNIFICANCE

Individuals with an eating disorder are avid internet users. A minority frequent pro-anorexia websites and fora seeking help in losing weight. This study showed that pro-anorexia coaches prey on these individuals, often to obtain sexually explicit content. The modus operandi of pro-anorexia coaches shows similarities to online grooming. Awareness of this phenomenon and the way in which pro-anorexia coaches operate is valuable for clinicians, parents, and teachers.

Examining health professional perspectives on social media body image movements: A qualitative exploration

There has been a lack of investigation into the understanding of social media body image movements from the healthcare perspective. Health professionals can have a strong influence on how their patients relate to their own bodies, including experiences of weight-based discrimination. This study examined the perspectives of health professionals on body image social media movements and whether they believed they were relevant to their professional practice. This study recruited 30 medical and allied health professionals to participate in semi-structured interviews. Thematic analysis was used to generate common themes across the data. Overall, participants identified benefits associated with body positivity online content, but expressed concerns for the health status of influencers with larger bodies and that overall, the pro-anorexia movement was harmful. Despite having limited understanding and exposure to the body neutrality movement, participants generally preferred it over body positivity. Finally, participants stated that they believed that these movements were relevant to their practice, yet were rarely discussed in consults. These findings suggest there is a lack of body image-based discussions despite the relevance to patient health across multiple domains. This indicates that health professionals may benefit from social media literacy training to support thorough assessment and treatment of their patients.

Hashtag fitspiration: credibility screening and content analysis of Instagram fitness accounts

BACKGROUND

Fitspiration is a social media phenomenon purported to inspire viewers to lead healthier lifestyles but can result in negative psychological outcomes such as body dissatisfaction. This study aimed to develop a tool to audit Instagram fitspiration accounts and screen for content that could have potentially negative psychological effects.

METHODS

This study developed and implemented an audit tool to (1) identify credible fitspiration accounts (i.e., accounts that do not portray potentially harmful or unhealthy content) and (2) describe the content of identified accounts. The most recent 15 posts of 100 leading Instagram fitspiration accounts were audited. Accounts were deemed non-credible and were excluded if they contained fewer than four fitness-related posts or portrayed nudity or inappropriate clothing, sexualisation or objectification, extreme body types, "thinspiration", or negative messages.

RESULTS

Many accounts contained fewer than four fitness-related posts (n = 41), sexualisation or objectification (n = 26), nudity or inappropriate clothing (n = 22), and/or extreme body types (n = 15). Three accounts failed on all four criteria, while 13, 10 and 33 failed on three, two, or one criterion, respectively. Therefore, only 41% of accounts were considered credible. Inter-rater reliability (percentage agreement and Brennan and Prediger's coefficient κ_q) was high (Stage 1: 92% agreement [95% CI 87, 97], κ_q 0.84 [95% CI 0.73, 0.95]; Stage 2: 93% agreement [95% CI 83, 100], κ_q 0.85 [95% CI 0.67, 1.00]). Account holders of credible fitspiration accounts were predominantly female (59%), aged 25-34 (54%), Caucasian (62%), and from the United States (79%). Half held a qualification related to physical activity or physical health (e.g., personal trainer, physiotherapy; 54%). Most included accounts included an exercise video (93%) and example workout (76%).

CONCLUSION

While many popular Instagram fitspiration accounts offered credible content such as example workouts, many accounts contained sexualisation, objectification or promotion of unhealthy or unrealistic body shapes. The audit tool could be used by Instagram users to ensure the accounts they follow do not portray potentially harmful or unhealthy content. Future research could use the audit tool to identify credible fitspiration accounts and examine whether exposure to these accounts positively influences physical activity.

The Perfect Storm: A Developmental-Sociocultural Framework for the Role of Social Media in Adolescent Girls' Body Image Concerns and Mental Health

In this theoretical review paper, we provide a developmental-sociocultural framework for the role of social media (SM) in adolescent girls' body image concerns, and in turn, depressive symptoms and disordered eating. We propose that the features of SM (e.g., idealized images of peers, quantifiable feedback) intersect with adolescent developmental factors (e.g., salience of peer relationships) and sociocultural gender socialization processes (e.g., societal over-emphasis on girls' and women's physical appearance) to create the "perfect storm" for exacerbating girls' body image concerns. We argue that, ultimately, body image concerns may be a key mechanism underlying associations between adolescent girls' SM use and mental health. In the context of proposing this framework, we provide empirical evidence for how SM may increase adolescent girls' body image concerns through heightening their focus on (1) other people's physical appearance (e.g., through exposure to idealized images of peers, celebrities, and SM influencers; quantifiable indicators of approval); and (2) their own appearance (e.g., through appearance-related SM consciousness; exposure to idealized self-images; encouraging over-valuing of appearance; and peer approval of photos/videos). Our framework highlights new avenues for future research on adolescent girls' SM use and mental health, which recognize the central role of body image.

The link between non-suicidal self-injury (NSSI), body image and activity on social networking sites among female adolescents with an eating disorder

The link between engagement in non-suicidal self-injury (NSSI)-related activities on SNS (e.g. viewing, commenting, sharing and uploading NSSI content) with body image and NSSI behaviour remains under researched in adolescents with EDs. The main aim of the current research was to examine associations between NSSI-related activities on SNS with body image and NSSI behaviour severity among female adolescents diagnosed with an ED. A total of 52 female adolescents (mean age = 15.35 years, SD = 1.49) diagnosed with an ED completed self-report questionnaires related to NSSI behaviour, SNS usage and body image. Participants were divided into two groups: low NSSI behaviour severity (from 0 to 10 NSSI behaviours; n = 28) and high NSSI behaviour severity (more than ten NSSI behaviours; n = 24). Within the high NSSI severity group, individuals that comment and share NSSI online content significantly reported higher negative body image. A hierarchical binary logistic regression showed that the frequency of NSSI online content on SNS emerged as significant predictor of NSSI behaviour severity within last year after controlling for body image and searching for ED content on SNS. Our findings suggest that not only searching for ED content, but also being daily engaged in NSSI online activities may increase the risk of NSSI behaviour severity in female adolescents with EDs.

Adolescent Eating Disorder Risk and the Social Online World: An Update

The role of traditional media (television and magazines) in creating eating disorder risk has long been a topic of discussion and research, but the proliferation of social media and rapid increase in the use of the Internet by adolescents generates new dynamics and new risks for the development and maintenance of eating disorders. Recent research describes the relationship between Internet and social media use and eating disorders risk, with the greatest associations found among youth with high levels of engagement and investment in photo-based activities and platforms. Here, we review different types of online content and how they are relevant to eating disorders and consider the theoretical frameworks predicting relationships between Internet and social media and eating disorders, before examining the empirical evidence for the risks posed by the online content in the development and maintenance of eating disorders. We describe proeating disorder content specifically and examine the research related to it; we then consider the implications of such content, highlight directions for future research, and discuss possible prevention and intervention strategies.

Blurred boundaries between Pro-Anorexia and Fitspiration media? Diverging cognitive and emotional effects

Social media is an emerging source of body-focused messages affecting young women. This research investigated the diverging cognitive and emotional effects of Pro-Anorexia (Pro-Ana) and Fitspiration content using linguistic analysis. Undergraduate college women (N = 129) viewed one of six experimentally-created blogs: text or images of Fitspiration, Pro-Ana, or control (Home Décor) and completed an open-ended prompt with their reaction. Linguistic analysis on post-exposure writing suggested Fitspiration blogs produced positive emotions and social comparison processes; Pro-Ana blogs produced negative and anxious emotions. Participants' history of past disordered eating behavior qualified affective (positive emotion and anxiety), but not cognitive (social comparison) outcomes. Given the cognitive and emotional impact of viewing such media, findings speak to the need for specific content of social media sites to be addressed and discussed in the treatment and prevention of eating disorders.

The "Little Red Riding Hood effect:" Fitspiration is just as bad as thinspiration for women's body satisfaction

Fitspiration is a popular form of social media which outwardly promotes the pursuit of health and strength rather than of thinness. Content analyses, however, suggest that it is thematically similar to thinspiration, which is primarily associated with thinness and presents disordered eating as a lifestyle choice. Exposure to both reduces body satisfaction, but their effect has not been compared. Further, positive body image may act as a protective factor by reducing engagement in appearance comparisons. Female undergraduate students (N = 331) were randomly assigned to view fitspiration, thinspiration, or travel images, followed by measures of state body satisfaction, state appearance comparison, and positive body image. Viewing fitspiration and thinspiration resulted in lower body satisfaction than did viewing travel images. However, whereas women with higher positive body image appeared protected from thinspiration by engaging in lower appearance comparisons than did women with lower positive body image, this same effect was not observed in women who viewed fitspiration. The fact that positive body image is not protective against fitspiration suggests that fitspiration is just as harmful, if not more, than is thinspiration and highlights the need for media literacy programs targeting fitspiration and so-called "healthy living" websites.

Psychological Impact of Pro-Anorexia and Pro-Eating Disorder Websites on Adolescent Females: A Systematic Review

(1) Background: Teenagers (in particular, females) suffering from eating disorders report being not satisfied with their physical aspect and they often perceive their body image in a wrong way; they report an excessive use of websites, defined as PRO-ANA and PRO-MIA, that promote an ideal of thinness, providing advice and suggestions about how to obtain super slim bodies. (2) Aim: The aim of this review is to explore the psychological impact of pro-ana and pro-mia websites on female teenagers. (3) Methods: We have carried out a systematic review of the literature on PubMed. The search terms that have been used are: "Pro" AND "Ana" OR "Blogging" AND "Mia". Initially, 161 publications were identified, but in total, in compliance with inclusion and exclusion criteria, 12 studies have been analyzed. (4) Results: The recent scientific literature has identified a growing number of Pro Ana and Pro Mia blogs which play an important role in the etiology of anorexia and bulimia, above all in female teenagers. The feelings of discomfort and dissatisfaction with their physical aspect, therefore, reduce their self-esteem. (5) Conclusion: These websites encourage anorexic and bulimic behaviors, in particular in female teenagers. Attention to healthy eating guidelines and policies during adolescence, focused on correcting eating behavioral aspects, is very important to prevent severe forms of psychopathology with more vulnerability in the perception of body image, social desirability, and negative emotional feedback.

Personality traits and dysfunctional construal of online health promotion messages

PURPOSE

With the Internet becoming increasingly popular as a source of information, blogs offering healthy lifestyle techniques and knowledge have become popular and accessible. Despite their focus on health, these blogs portray content that may be negatively construed by viewers, especially those with or at risk for eating disorders. The present study investigated changes in affect and self-esteem after viewing a prototypic health blog. Personality traits, specifically neuroticism and conscientiousness, were also investigated.

METHODS

A prototypic health blog was constructed after extensive review of existing blogs. A parallel format was then followed to create a home décor website for a control condition. Female undergraduate students were randomly assigned to one of two blog sites, and participants completed an earlier personality assessment and post-viewing study questionnaires.

RESULTS

Contrary to the hypothesis that readers of the health blog will report more negative outcomes, no main effect of blog condition was found. However, individuals high in trait neuroticism experienced greater differences in negative affect, but not self-esteem, when viewing the health blog versus the control blog.

CONCLUSIONS

This study found that viewing health blogs did not have immediate effects on affect and self-esteem, but more neurotic individuals were more inclined to experience negative affect when viewing health promotion messages. Personality traits assessed prior to the experiment were more predictive of negative affect and self-esteem during the experiment than blog viewing conditions. No level of evidence, experimental study.

Social media and children: what is the paediatrician's role?

Social media use has become an integral part of children's and adolescents' lives. It has become a novel way of interaction among people and influences people's social lives and public opinion as well as people's purchasing decisions and businesses. Any website or platform that allows social interaction is considered to be a social media site. Social media use among children in 25 European countries has been reported to be 38% among 9-12 year olds and 77% among those aged 13-16 years. All these children report having their own profile on at least one social network site. While social networking provides children and adolescents with many opportunities and benefits, it also carries many risks. Among the benefits are socialization and communication enhancement, improving learning skills, positive impact on education and getting health information. Potential risks of social media use include falsifying age and identity, cyberbullying, sexting, Facebook depression, gamification, glamourization, cyberostracism and sleep disturbances.Conclusion: Paediatricians play a vital role in promoting the physical, mental and social welfare of all children. There is a critical need for paediatricians to play an active role, guiding children and families appropriately through the impact of social networking, in order to become a real driver of children's development.

Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis

OBJECTIVE

Mental health recovery narratives are often shared in peer support work and antistigma campaigns. Internet technology provides access to an almost unlimited number of narratives, and yet little is known about how they affect recipients. The aim of this study was to develop a conceptual framework characterizing the impact of recovery narratives on recipients.

METHOD

A systematic review of evidence about the impact of mental health recovery narratives was conducted. Searches used electronic databases (n = 9), reference tracking, hand-searching of selected journals (n = 2), grey literature searching, and expert consultation (n = 7). A conceptual framework was generated through a thematic analysis of included articles, augmented by consultation with a Lived Experience Advisory Panel.

RESULTS

In total, 8137 articles were screened. Five articles were included. Forms of impact were connectedness, understanding of recovery, reduction in stigma, validation of personal experience, affective responses, and behavioural responses. Impact was moderated by characteristics of the recipient, context, and narrative. Increases in eating disorder behaviours were identified as a harmful response specific to recipients with eating disorders.

CONCLUSIONS

Mental health recovery narratives can promote recovery. Recovery narratives might be useful for clients with limited access to peers and in online interventions targeted at reducing social isolation in rural or remote locations, but support is needed for the processing of the strong emotions that can arise. Caution is needed for use with specific clinical populations. Protocol registration: Prospero-CRD42018090923.

Cutting Ties With Pro-Ana: A Narrative Inquiry Concerning the Experiences of Pro-Ana Disengagement From Six Former Site Users

Websites advocating the benefits of eating disorders ("Pro-Ana") tend to reinforce and maintain restrictive eating and purging behaviors. Yet remarkably, no study has explored individual accounts of disengagement from these sites and the associated meanings. Using narrative inquiry, this study sought to address this gap. From the interviews of six women, two overarching storylines emerged. The first closely tied disengagement to recovery with varying positions of personal agency claimed: this ranged from enforced and unwelcomed breaks that ignited change, to a personal choice that became viable through the development of alternative social and personal identities. A strong counternarrative to "disengagement as recovery" also emerged. Here, disengagement from Pro-Ana was storied alongside a need to retain an ED lifestyle. With "recovery" being just one reason for withdrawal from Pro-Ana sites, clinicians must remain curious about the meanings individuals ascribe to this act, without assuming it represents a step toward recovery.

How does exposure to thinspiration and fitspiration relate to symptom severity among individuals with eating disorders? Evaluation of a proposed model

Thinspiration and fitspiration are classes of social media content characterised by idealised depictions of excessively thin and overtly fit/lean bodies, respectively. It is currently unknown whether and how exposure to thinspiration and fitspiration relates to symptom severity within high-risk clinical populations. Thus, in a clinical sample of individuals with eating disorders, we evaluated a model explaining how exposure to thinspiration and fitspiration relates to eating disorder symptoms. Individuals with self-reported eating disorders (N = 228, 47% with anorexia, 93% female) completed measures of image-centric social media use, thinspiration and fitspiration exposure, physical appearance comparisons, and symptom severity. Results showed that more frequent use of image-centric social media was associated with more frequent exposures to both thinspiration and fitspiration. In turn, these exposures were associated with more frequent physical appearance comparisons, and through these, greater symptom severity. Physical appearance comparisons mediated the relationships of both thinspiration and fitspiration exposure with symptom severity. Exposure to fitspiration was more common than exposure to thinspiration. However, thinspiration exposure evidenced stronger associations with symptom severity than fitspiration exposure. In conclusion, our model provides a useful account of how eating disorder symptoms relate to thinspiration and fitspiration exposure, and to image-centric social media more generally.

"It's the Symptom of the Problem, Not the Problem itself": A Qualitative Exploration of the Role of Pro-anorexia Websites in Users' Disordered Eating

The growing trend in the use of the Internet and social media as a method of self-managing illness presents a critical opportunity to better understand the role of pro-anorexia (pro-ana) websites for eating disorders. Therefore, 155 pro-ana website messages regarding criticism that the site was responsible for developing anorexia were inductively thematically analysed. The analysis revealed five main themes: eating disorders are mental illnesses and websites do not cause mental illness, pro-ana websites and eating disorders are more than wanting to be thin (with sub-theme residents and visitors), eating disorders develop regardless of pro-ana websites, pro-ana sites do not cause eating disorders but they may trigger or encourage them (with sub-theme the problem is the user, not the site) and pro-ana sites provide support. Pro-ana websites and online communities present clinicians with complex treatment challenges. Collaborative, therapeutic consultations about pro-ana website use may help to establish how and when accessing them may hinder the treatment process.

Tweeting weight loss: A comparison of #thinspiration and #fitspiration communities on Twitter

Thinspiration and fitspiration represent contemporary online trends designed to inspire viewers towards the thin ideal or towards health and fitness respectively. The aim of the present study was to compare thinspiration and fitspiration communities on Twitter. A total of 3289 English-language tweets with hashtags related to thinspiration (n = 1181) and fitspiration (n = 2578) were collected over a two-week period. Network analysis showed minimal overlap between the communities on Twitter, with the thinspiration community more closely-connected and having greater information flow than the fitspiration community. Frequency counts and sentiment analysis showed that although the tweets from both types of accounts focused on appearance and weight loss, fitspiration tweets were significantly more positive in sentiment. It was concluded that the thinspiration tweeters, unlike the fitspiration tweeters, represent a genuine on-line community on Twitter. Such a community of support may have negative consequences for collective body image and disordered eating identity.

Implicit attitudes toward eating stimuli differentiate eating disorder and non-eating disorder groups and predict eating disorder behaviors

OBJECTIVE

The current study tested whether people with and without eating disorders (EDs) varied in their implicit attitudes toward ED-relevant stimuli. Additionally, the study tested whether implicit evaluations of ED-relevant stimuli predicted ED symptoms and behaviors over a 4-week interval.

METHOD

Participants were people without EDs (N = 85) and people seeking treatment for EDs (N = 92). All participants completed self-report questionnaires and a version of the affect misattribution procedure (AMP) at baseline. The AMP indexed implicit evaluations of average body stimuli, eating stimuli, and ED-symptom stimuli. Participants with EDs completed weekly follow-up measures of ED symptoms and behaviors for 4 weeks.

RESULTS

Contrary to predictions, the anorexia nervosa (AN) group did not differ from the no ED group on implicit attitudes toward ED-symptom stimuli, and the bulimia nervosa (BN) group had less positive implicit attitudes toward ED-symptom stimuli relative to the no ED group. In line with predictions, people with AN and BN had more negative implicit attitudes toward average body and eating stimuli relative to the no ED group. In addition, among the ED group more negative implicit attitudes toward eating stimuli predicted ED symptoms and behaviors 4 weeks later, over and above baseline ED symptoms and behaviors.

DISCUSSION

Taken together, implicit evaluations of eating stimuli differentiated people with AN and BN from people without EDs and longitudinally predicted ED symptoms and behaviors. Interventions that increase implicit liking of eating-related stimuli may reduce ED behaviors.

A content analysis of an online pro-eating disorder community on Reddit

Pro-eating disorder communities provide a refuge for individuals with eating disorders (EDs) who are ambivalent about seeking treatment. We investigated a pro-ED community on Reddit, an anonymous social networking platform with topical forums, to identify expression of behaviors aligned with ED symptoms and support for these behaviors. A content analysis on four weeks of topic-specific discussion threads (N=125 comments, 115 replies to comments) was conducted to identify behaviors consistent with ED psychopathology and support for these behaviors (informational, tangible assistance, esteem/emotional support). Results indicated that the content aligned with expressions of clinically relevant ED psychopathology, with eating concerns (49/125) and shape concerns (47/125) being most prevalent. The majority (92/115) of replies provided esteem/emotional support to the comment author. Online interventions and/or recovery programs are needed to counteract reinforcing dialogue that occurs on social media sites, like Reddit, and promote ED recovery through supportive messages on these platforms.

A content analysis of thinspiration images and text posts on Tumblr

Thinspiration is content advocating extreme weight loss by means of images and/or text posts. While past content analyses have examined thinspiration content on social media and other websites, no research to date has examined thinspiration content on Tumblr. Over the course of a week, 222 images and text posts were collected after entering the keyword 'thinspiration' into the Tumblr search bar. These images were then rated on a variety of characteristics. The majority of thinspiration images included a thin woman adhering to culturally based beauty, often posing in a manner that accentuated her thinness or sexuality. The most common themes for thinspiration text posts included dieting/restraint, weight loss, food guilt, and body guilt. The thinspiration content on Tumblr appears to be consistent with that on other mediums. Future research should utilize experimental methods to examine the potential effects of consuming thinspiration content on Tumblr.

Inducing Behavioral Change in Seekers of Pro-Anorexia Content Using Internet Advertisements: Randomized Controlled Trial

BACKGROUND

The influence of pro-anorexia (pro-ana) websites is debated, with studies indicating both negative and positive effects, as well as significant variation in the effects of different websites for those suffering from eating disorders (EDs) and the general population. Online advertising, known to induce behavioral change both online and in the physical world, has not been used so far to modify the search behavior of people seeking pro-ana content.

OBJECTIVE

The objective of this randomized controlled trial (RCT) was to examine if online advertisements (ads) can change online search behaviors of users who are looking for online pro-ana content.

METHODS

Using the Bing Ads system, we conducted an RCT to randomly expose the searchers for pro-ana content to 10 different ads referring people to one of the three websites: the National Eating Disorders Association, the National Institutes of Mental Health, and MyProAna. MyProAna is a pro-ana website that was found in a previous study to be associated with less pathological online behaviors than other pro-ana websites. We followed participants exposed and unexposed to the ads to explore their past and future online searches. The ads were shown 25,554 times and clicked on 217 times.

RESULTS

Exposure to the ads was associated with a decrease in searches for pro-ana and self-harm content. Reductions were greatest among those referred to MyProAna (reduction of 34.0% [73/215] and 37.2% [80/215] for pro-ana and self-harm, respectively) compared with users who were referred elsewhere (reduction of 15.47% [410/2650] and 3.21% [85/2650], respectively), and with users who were not shown the ads, who increased their behaviors (increase of 57.12% [6462/11,314] and 4.07% [461/11,314], respectively). In addition, those referred to MyProAna increased their search for treatment, as did control users, who did so to a lesser extent. However, users referred elsewhere decreased their searches for this content.

CONCLUSIONS

We found that referring users interested in ED-related content to specific pro-ana communities might lessen their maladaptive online search behavior. This suggests that those who are preoccupied with EDs can be redirected to less pathological online searches through appropriate pathways.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03439553; https://clinicaltrials.gov/show/NCT03439553 (Archived by WebCite at http://www.webcitation.org/6xNYnxYlw).

Extreme body messages: themes from Facebook posts in extreme fitness and nutrition online support groups

BACKGROUND

Extreme fitness and nutrition programs, that are said to "jump start" a healthy lifestyle, are becoming more pervasive. While some research has explored the harmful impact of fitspiration, thinspiration, and pro-anorexia/bulimia websites, no studies have examined the content associated with these extreme programs that advertised as promoting a healthy lifestyle. The objective of this study was to analyze posts found on extreme fitness and nutrition program support pages on Facebook. As these programs have become more popular, along with Facebook platforms for their participants, examining online user-generated posts related to these programs can provide information about the types of messages being promoted, and whether these can contribute to disordered eating and other harmful health behaviors.

METHODS

User data were selected from one month from public posts on two popular Facebook fitness groups. Both groups were short-term programs that set extreme guidelines for fitness and nutrition. Researchers examined the data for harmful health messages using an individual coding strategy with inter-rater reliability (Kappa =0.92).

RESULTS

Majority (88.6%) of messages analyzed promoted harmful health messages. Common categories of messages included losing weight/fat, promoting dieting/restraint, and harmful body messages, which promoted unsafe ways to attain certain body types.

CONCLUSIONS

The data analyzed in this study represent overwhelmingly negative commentary relating to harmful health and body messages. Messages in this study normalized dysfunctional behaviors and promoted fixating on certain body parts and objectifying bodies. These Facebook groups, though intended to be a sort of online support forum, provide an open space for body negativity and promotion of extreme behaviors for the sake of thinness. Most concerning, participants of these programs, which are advertised as promoting health, are expressing unhealthy thoughts and behaviors surrounding food, exercise, and body image. Given the ease of accessibility to this content using online platforms, these harmful messages can reach large groups of people and continue adding to a culture that values physical appearance to the detriment of health.

Validity and Reliability of the Brazilian Version of the Weight Control Behaviors Scale

OBJECTIVE

To develop and validate the weight-control behaviors (WCBs) scale and to evaluate its psychometric properties.

STUDY DESIGN

We made use of data from a cluster-randomized trial assessing the effectiveness of the Brazilian New Moves Program. The Brazilian New Moves Program was a multicomponent intervention aimed at preventing weight-related problems among adolescent girls in public schools in São Paulo, Brazil.

RESULTS

Healthy and unhealthy WCBs were strongly associated. A 2-factor solution was the best model to explain the correlation across items, including following constructs: (1) healthy WCB: exercising, eating more fruits and vegetables, drinking less regular soda or sweetened drinks, eating fewer sweets, and paying attention to portion sizes; and (2) unhealthy WCB: skipping meals and the presence of any other, combined unhealthy weight-control behaviors, including fasting, eating little, going on a diet, vomiting, taking diet pills, using diuretics (water pills), using laxatives, using food substitutes (powder/special drinks), and smoking more cigarettes. The WCB scale was determined to be reliable (internally consistent) and valid, with high scores positively associated with body dissatisfaction and high body mass index values. Individual reliability values were high for factors representing healthy and unhealthy WCBs.

CONCLUSIONS

Our findings support the use of the WCB scale as a screening tool for overall weight control behaviors among female adolescents. This assessment tool should be considered in future observational and experimental prospective studies.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials: RBR-6ddpb3.

[Influence of the internet on eating disorders in teenagers]

Thanks to new technologies, young people can keep themselves informed, communicate, socialise and perform a host of other activities more easily, online. Adolescence is also a period of vulnerability for the development of eating disorders. This expansion of digital media in the daily lives of adolescents raises questions regarding the long-term implications and the possible impacts of the internet on the evolution and treatment of people with eating disorders.

Beauty in the eye of the beholder: Using facial electromyography to examine the association between eating disorder symptoms and perceptions of emaciation among undergraduate women

Thin-ideal internalization, drive for thinness, and over-evaluation of the importance of thinness are associated with eating disorders (EDs). However, little research has examined to what extent perceptions of emaciation are also associated with ED symptoms. In the present study, 80 undergraduate women self-reported on ED symptomatology and perceptions of emaciated, thin, and overweight female bodies. While participants viewed images of these different body types, facial electromyography was used to measure activation of facial muscles associated with disgust reactions. Emaciated and overweight bodies were rated negatively and elicited facial responses consistent with disgust. Further, ED symptomatology was associated with pronounced aversion to overweight bodies (assessed via self-report pleasantness ratings), and attenuated negative affect to emaciated bodies (assessed via facial electromyography). The latter association was significant even when controlling for self-reported perceptions of emaciation, suggesting that psychophysiological methods in ED research may provide valuable information unavailable via self-report.

A thematic content analysis of #cheatmeal images on social media: Characterizing an emerging dietary trend

Despite the pervasive social endorsement of "cheat meals" within pro-muscularity online communities, there is an absence of empirical work examining this dietary phenomenon. The present study aimed to characterize cheat meals, and explore the meaning ascribed to engagement in this practice. Thematic content analysis was employed to code the photographic and textual elements of a sample (n = 600) that was extracted from over 1.6 million images marked with the #cheatmeal tag on the social networking site, Instagram. Analysis of the volume and type of food revealed the presence of very large quantities (54.5%) of calorie-dense foods (71.3%) that was rated to qualify as an objective binge episode. Photographic content of people commonly portrayed highly-muscular bodies (60.7%) in the act of intentional body exposure (40.0%). Meanwhile, textual content exemplified the idealization of overconsumption, a strict commitment to fitness, and a reward-based framework around diet and fitness. Collectively, these findings position cheat meals as goal-oriented dietary practices in the pursuit of physique-ideals, thus underscoring the potential clinical repercussions of this socially-endorsed dietary phenomenon.

Instagram use is linked to increased symptoms of orthorexia nervosa

PURPOSE

Social media use is ever increasing amongst young adults and has previously been shown to have negative effects on body image, depression, social comparison, and disordered eating. One eating disorder of interest in this context is orthorexia nervosa, an obsession with eating healthily. High orthorexia nervosa prevalence has been found in populations who take an active interest in their health and body and is frequently comorbid with anorexia nervosa. Here, we investigate links between social media use, in particularly Instagram and orthorexia nervosa symptoms.

METHODS

We conducted an online survey of social media users (N = 680) following health food accounts. We assessed their social media use, eating behaviours, and orthorexia nervosa symptoms using the ORTO-15 inventory.

RESULTS

Higher Instagram use was associated with a greater tendency towards orthorexia nervosa, with no other social media channel having this effect. In exploratory analyses Twitter showed a small positive association with orthorexia symptoms. BMI and age had no association with orthorexia nervosa. The prevalence of orthorexia nervosa among the study population was 49%, which is significantly higher than the general population (<1%).

CONCLUSIONS

Our results suggest that the healthy eating community on Instagram has a high prevalence of orthorexia symptoms, with higher Instagram use being linked to increased symptoms. These findings highlight the implications social media can have on psychological wellbeing, and the influence social media 'celebrities' may have over hundreds of thousands of individuals. These results may also have clinical implications for eating disorder development and recovery.

Skinny Is Not Enough: A Content Analysis of Fitspiration on Pinterest

Fitspiration is a relatively new social media trend nominally intended to promote health and fitness. Fitspiration messages are presented as encouraging; however, they might also engender body dissatisfaction and compulsive exercise. This study analyzed fitspiration content (n = 1050) on the image-based social media platform Pinterest. Independent raters coded the images and text present in the posts. Messages were categorized as appearance- or health-related, and coded for Social Cognitive Theory constructs: standards, behaviors, and outcome expectancies. Messages encouraged appearance-related body image standards and weight management behaviors more frequently than health-related standards and behaviors, and emphasized attractiveness as motivation to partake in such behaviors. Results also indicated that fitspiration messages include a comparable amount of fit praise (i.e., emphasis on toned/defined muscles) and thin praise (i.e., emphasis on slenderness), suggesting that women are not only supposed to be thin but also fit. Considering the negative outcomes associated with both exposure to idealized body images and exercising for appearance reasons, findings suggest that fitspiration messages are problematic, especially for viewers with high risk of eating disorders and related issues.

Proeating disorder websites and subjective well-being: A four-country study on young people

OBJECTIVE

Proeating disorder (pro-ED) communities online encourage harmful weight-loss and weight-control practices. This study examined the association between exposure to pro-ED content online and subjective well-being (SWB) among adolescents and young adults in four countries.

METHOD

Cross-national data were collected in the US, Germany, the UK and Finland from Internet users aged 15-30 years (N = 3,557; 50.15% male). The questionnaire assessed SWB, exposure to harm-advocating websites, online activity, prior victimization, and social belonging. Ordinary least squares (OLS) regression models assessed the relationship between SWB and pro-ED exposure and adjusted for a number of confounding factors.

RESULTS

Of the participants, 17% had been exposed to pro-ED content (US 20%, Germany 7%, UK 21%, Finland 22%). Exposure to pro-ED content online was negatively associated with SWB in the US, Germany, and Finland, also after adjusting for the confounding factors. Offline social belonging moderated the association between pro-ED and SWB.

DISCUSSION

Participants who visited pro-ED websites reported lower SWB than others did. The potentially harmful impact of visiting these sites was buffered by the strong offline social belonging. Given the observed similarities across the countries, it is important for families, health professionals, and educators to stay abreast of online communities that have possible contra recovery influences and to be able to discuss such Internet contents in a way that increases treatment motivation. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017; 50:50-57).

Experiences of using pro-eating disorder websites: a qualitative study with service users in NHS eating disorder services

PURPOSE

Previous research into the impact of pro-eating disorder (pro-ED) websites has predominantly been undertaken using experimental and survey designs. Studies have used both clinical and non-clinical (college student) samples. The present study aimed to explore the underlying functions and processes related to the access and continued use of pro-ED websites within a clinical eating disorder population using a qualitative research design.

METHODS

Participants were recruited through NHS community mental health teams and specialist eating disorder services within South Wales, UK. Face-to-face semi-structured interviews were conducted with seven adult women in treatment for an eating disorder who had disclosed current or historic use of pro-ED websites. Interviewees ranged in age from 20 to 40 years (M = 31.2; SD = 7.8). Constructivist Grounded Theory was used to analyse interview transcripts.

RESULTS

Five key themes were identified within the data, namely fear; ambivalence; social comparisons; shame; and pro-ED websites maintaining eating disordered behaviour. The pro-ED websites appeared to offer a sense of support, validation and reassurance to those in the midst of an eating disorder, whilst simultaneously reinforcing and maintaining eating disordered behaviour.

CONCLUSION

Themes are discussed in relation to implications and recommendations for clinical practice. Limitations of the present study and suggestions for future research are also outlined.

Facebook usage among those who have received treatment for an eating disorder in a group setting

OBJECTIVE

This study explored Facebook use among individuals with a history of receiving treatment for an eating disorder (ED) in a group setting (e.g., inpatient, residential, outpatient group), focusing primarily on comparisons individuals make about their bodies, eating, or exercise to those of their peers from treatment on Facebook and the relation between these comparisons and ED pathology.

METHOD

Individuals (N = 415; mean age 28.15 years ± 8.41; 98.1% female) who self-reported receipt of ED treatment in a group setting were recruited via e-mail and social media to complete an online survey.

RESULTS

Participants reported having an average of 10-19 Facebook friends from treatment and spending up to 30 min per day interacting on Facebook with individuals from treatment or ED-related organizations. More comparison to treatment peers on Facebook was associated with greater ED psychopathology and ED-related impairment. Conversely, positive interaction with treatment peers on Facebook was associated with lower ED psychopathology and ED-related impairment. Individuals who had been in treatment longer, more times, and more recently had more Facebook friends from treatment and ED-related organizations as well as spent more time in ED groups' pages on Facebook. Few participants (19.5%) reported that a therapist asked about the impact of Facebook on pathology.

DISCUSSION

Interactions on Facebook could affect patients' recovery and potential for relapse. It may be helpful for treatment providers to discuss Facebook use and its potential benefits and drawbacks with patients preparing for discharge from group treatment. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:764-777).

Differences in physical status, mental state and online behavior of people in pro-anorexia web communities

BACKGROUND

There is a debate about the effects of pro-anorexia (colloquially referred to as pro-ana) websites. Research suggests that the effect of these websites is not straightforward. Indeed, the actual function of these sites is disputed, with studies indicating both negative and positive effects.

AIM

This is the first study which systematically examined the differences between pro-anorexia web communities in four main aspects: web language used (posts); web interests/search behaviors (queries); users' self-reported weight status and weight goals; and associated self-reported mood/pathology.

METHODS

We collected three primary sources of data, including messages posed on three pro-ana websites, a survey completed by over 1000 participants of a pro-ana website, and the searches made on the Bing search engine of pro-anorexia users. These data were analyzed for content, reported demographics and pathology, and behavior over time.

RESULTS

Although members of the main pro-ana website investigated appear to be depressed, with high rates of self-harm and suicide attempts, users are significantly more interested in treatment, have wishes of procreation and reported the highest goal weights among the investigated sites. In contrast, users of other pro-ana websites investigated, are more interested in morbid themes including depression, self-harm and suicide. The percentage of severely malnourished website users, in general, appears to be small (20%).

CONCLUSIONS

Our results indicate that a new strategy is required to facilitate the communication between mental health specialists and pro-ana web users, recognizing the differences in harm associated with different websites.

#Proana: Pro-Eating Disorder Socialization on Twitter

PURPOSE

Pro-eating disorder (ED) online movements support engagement with ED lifestyles and are associated with negative health consequences for adolescents with EDs. Twitter is a popular social media site among adolescents that provides a unique setting for Pro-ED content to be publicly exchanged. The purpose of this study was to investigate Pro-ED Twitter profiles' references to EDs and how their social connections (followers) reference EDs.

METHODS

A purposeful sample of 45 Pro-ED profiles was selected from Twitter. Profile information, all tweets, and a random sample of 100 of their followers' profile information were collected for content analysis using the Twitter Application Programming Interface. A codebook based on ED screening guidelines was applied to evaluate ED references. For each Pro-ED profile, proportion of tweets with ED references and proportion of followers with ED references in their own profile were evaluated.

RESULTS

In total, our 45 Pro-ED profiles generated 4,245 tweets for analysis. A median of 36.4% of profiles' tweets contained ED references. Pro-ED profiles had a median of 173 followers, and a median of 44.5% of followers had ED references. Pro-ED profiles with more tweets with ED references also tended to have more followers with ED references (β = .37, p < .01).

CONCLUSIONS

Findings suggest that profiles which self-identify as Pro-ED express disordered eating patterns through tweets and have an audience of followers, many of whom also reference ED in their own profiles. ED socialization on Twitter might provide social support, but in the Pro-ED context this activity might also reinforce an ED identity.

Strong is the new skinny: A content analysis of fitspiration websites

"Fitspiration" websites are media that aim to inspire people to live healthy and fit lifestyles through motivating images and text related to exercise and diet. Given the link between similar Internet content (i.e., healthy living blogs) and problematic messages, we hypothesized that content on these sites would over-emphasize appearance and promote problematic messages regarding exercise and diet. Keywords "fitspo" and "fitspiration" were entered into search engines. The first 10 images and text from 51 individual websites were rated on a variety of characteristics. Results indicated that a majority of messages found on fitspiration websites focused on appearance. Other common themes included content promoting exercise for appearance-motivated reasons and content promoting dietary restraint. "Fitspiration" websites are a source of messages that reinforce over-valuation of physical appearance, eating concerns, and excessive exercise. Further research is needed to examine the impact viewing such content has on participants' psychological health.

'Strong is the new skinny': A content analysis of #fitspiration images on Instagram

'Fitspiration' is an online trend designed to inspire viewers towards a healthier lifestyle by promoting exercise and healthy food. This study provides a content analysis of fitspiration imagery on the social networking site Instagram. A set of 600 images were coded for body type, activity, objectification and textual elements. Results showed that the majority of images of women contained only one body type: thin and toned. In addition, most images contained objectifying elements. Accordingly, while fitspiration images may be inspirational for viewers, they also contain a number of elements likely to have negative effects on the viewer's body image.

Go big or go home: A thematic content analysis of pro-muscularity websites

Existing content analyses of pro-eating disorder web content have focused on thinness-oriented eating disorder pathology. With the increasing prevalence of muscularity-oriented body image concerns, we conducted a systematic content analysis of 421 active pro-muscularity websites including static content websites, blogs, and online forums. Emergent coding methods were utilized (Cohen's kappa range=.78-.88), and eight distinct thematic categories were identified: rigid dietary practices (26.2%), rigid exercise rules (18.4%), the broader benefits of muscularity (16.1%), the encouragement of the drive for size (15.9%), the labeling of non-ideal body (11.4%), marginalizing other areas of life (6.1%), muscle enhancing substances (3.3%), and minimizing medical risk (2.6%). Pro-muscularity websites provide explicit material surrounding potentially non-healthful muscularity-oriented eating and exercise practices. Clinician awareness of the potentially non-healthful behaviors involved in the pursuit of muscularity may enhance the detection and treatment of male eating disorders, in particular.

Internet and smartphone application usage in eating disorders: A descriptive study in Singapore

Eating disorders are associated with significant morbidity and mortality. The Internet is a popular medium for individuals with eating disorders to discuss and reinforce their affliction. However, the available literature on Internet usage and eating disorders is scarce, especially in the area of social media and smartphone application ("app") usage. This study looked at the Internet and smartphone app usage patterns of participants who presented with an eating disorder in Singapore, and whether it corresponded to severity of illness. Individuals who presented to the Eating Disorders clinic at the Singapore General Hospital completed a self-reported questionnaire on Internet and app usage. They also completed the EDE-Q, EAT-26 and CIA 3.0. 55 participants completed the study. 41.8% had anorexia nervosa, 34.5% had bulimia nervosa, and 9.1% were ED-NOS. 41.8% felt that apps helped to perpetuate their illness while 32.7% felt that the apps were helpful for recovery. Overall, any smartphone application usage was associated with younger age and greater eating disorder psychopathology and psychosocial impairment. While 30.9% had encountered eating disorder-related content on Facebook, only 12.7% visited Facebook groups related to eating disorders. For YouTube, "Cooking and Food" and "Beauty and Fashion" videos were among the top 3 types of videos that participants watched. In conclusion, Internet and smartphone app usage is significant, and they are associated with greater severity of illness. It is necessary to include interventions in this aspect as part of treatment of eating disorders.

A content analytic comparison of fitspiration and thinspiration websites

OBJECTIVE

"Pro-ana" or Thinspiration websites are internet sites that support weight loss and eating disorders. Fitspiration websites are a newer type of site that supposedly advocates a fit and healthy lifestyle.

METHOD

The first 10 images from a sample of 50 Fitspiration and 50 Thinspiration websites, chosen using a standard internet search protocol, were rated on a variety of weight, eating, and appearance characteristics. χ(2) analyses were conducted to compare website content.

RESULTS

Thinspiration sites featured more content related to losing weight or fat, praising thinness, showng a thin pose, and providing food guilt messages than Fitspiration sites. However, sites did not differ on guilt-inducing messages regarding weight or the body, fat/weight stigmatization, the presence of objectifying phrases, and dieting/restraint messages. Overall, 88% of Thinspiration sites and 80% of Fitspiration sites contained one or more of the coded variables.

DISCUSSION

Prior research has examined Thinspiration websites and noted the potentially hazardous messages contained on these sites. This content analysis indicates that sites supposedly devoted to healthy pursuits (fitness) may also contain thematically similar content.

The limits to pride: A test of the pro-anorexia hypothesis

Many social psychological models propose that positive self-conceptions promote self-esteem. An extreme version of this hypothesis is advanced in "pro-anorexia" communities: identifying with anorexia, in conjunction with disordered eating, can lead to higher self-esteem. The current study empirically tested this hypothesis. Results challenge the pro-anorexia hypothesis. Although those with higher levels of pro-anorexia identification trended towards higher self-esteem with increased disordered eating, this did not overcome the strong negative main effect of pro-anorexia identification. These data suggest a more effective strategy for promoting self-esteem is to encourage rejection of disordered eating and an anorexic identity.

What's eating the internet? Content and perceived harm of pro-eating disorder websites

The internet is a popular tool for information dissemination and community building, serving many purposes from social networking to support seeking. However, there may be a downside to using some online support communities. For individuals with eating disorders (EDs), it is possible that certain online communities may reinforce the negative social aspects that encourage these disorders, rather than positive aspects that would facilitate treatment and recovery. Previous research identified several linguistic themes present on pro-eating disorder websites in an attempt to better understand the web-based conversation in the pro-eating disorder movement. We hypothesized that differences in theme presentation may predict changes in perceived harm. The present study sought to understand the perceived harm, and presentation patterns of pro-eating disorder (Pro-ED) website content. We replicated and extended previous research by having laypersons code these websites' content using previously identified linguistic themes and rate perceived harm. Our data replicate and extend the previous research by finding the same associations between co-occurring themes, and investigating associated perceived harm. We found that themes of Sacrifice, Control, Deceit, and Solidarity were associated with the highest perceived harm scores. In addition, we suggest an initial conceptualization of the "Eating Disorder Lifestyle", and its associations with the themes of Isolation, Success, and Solidarity. This research may provide clinicians with information to better understand the potential influence these sites have on eating disorders.

"Exercise to be fit, not skinny": The effect of fitspiration imagery on women's body image

Fitspiration is an online trend designed to inspire viewers towards a healthier lifestyle by promoting exercise and healthy food. The present study aimed to experimentally investigate the impact of fitspiration images on women's body image. Participants were 130 female undergraduate students who were randomly assigned to view either a set of Instagram fitspiration images or a control set of travel images presented on an iPad. Results showed that acute exposure to fitspiration images led to increased negative mood and body dissatisfaction and decreased state appearance self-esteem relative to travel images. Importantly, regression analyses showed that the effects of image type were mediated by state appearance comparison. Thus it was concluded that fitspiration can have negative unintended consequences for body image. The results offer support to general sociocultural models of media effects on body image, and extend these to "new" media.

A Meta-Analysis Examining the Influence of Pro-Eating Disorder Websites on Body Image and Eating Pathology

Previous research has indicated that exposure to pro-eating disorder websites might increase eating pathology; however, the magnitude of this effect is unknown. This study aimed to conduct a systematic review and meta-analysis to examine the effect of exposure to pro-eating disorder websites on body image and eating pathology. Studies examining the relationship between exposure to pro-eating disorder websites and eating pathology-related outcomes were included. The systematic review identified nine studies. Findings revealed significant effect sizes of exposure to pro-eating disorder websites on body image dissatisfaction (five studies), d = .41, p = .003; dieting (six studies), d = .68, p < .001, and negative affect (three studies), d = 1.00, p < .001. No effect emerged for bulimic symptoms (four studies), d = .22, p = .73. Findings confirmed the effect of pro-eating disorder websites on body image and eating pathology, highlighting the need for enforceable regulation of these websites.

The urgent matter of online pro-eating disorder content and children: clinical practice

During the last decade, much concern has been expressed about online pro-eating disorder communities (e.g., pro-anorexia websites and blogs) which encourage their users to engage in disordered eating behavior. The aim of the current paper is to reemphasize the importance of pro-eating disorder communities in light of the recent changes in the media landscape. With the increase of social networking sites, pro-anorexia messages have transplanted to more volatile and constantly changing media, such as Snapchat, Twitter, Facebook, Instagram, Pinterest, and many others. Most parents, educators, and health professionals are unaware of the sheer scope and nature of such pro-anorexia messages in these new contexts. The current paper will provide a review of pro-eating disorder websites, overview the effects of such websites on young people's health, examine the emergence of these messages on social media platforms, and highlight a number of guidelines for clinicians and parents.

CONCLUSION

The dissemination of online pro-eating disorder content to different types of social networking sites is becoming an urgent issue.

WHAT IS KNOWN

• Existing research on pro-eating disorder websites examines the prevalence and the content of these websites, and the effects of pro-eating disorder content on both clinical (eating disordered individuals) and non-clinical samples (non-eating disordered individuals). • The scope and nature of such anorexia messages is unknown to most adults, and many people (including parents and medical professionals) are insufficiently aware of the ease with which young people access, navigate, and use a wide range of online platforms.

WHAT IS NEW

• Pro-anorexia messages are no longer limited to websites that can be easily monitored, but instead have been transplanted to more volatile and constantly changing media such as Snapchat, Twitter, Facebook, Pinterest, and Tumblr which makes pro-eating disorder content much more easily accessible. • This paper wants to emphasize the implications of the presence of pro-eating disorder content on websites and social media. A number of guidelines for parents and clinicians are provided.

"I am a waste of breath, of space, of time": metaphors of self in a pro-anorexia group

According to recent research on eating disorders, heavy users of pro-anorexia (pro-ana) sites show higher levels of disordered eating and more severe impairment of quality of life than non-heavy users. A better understanding of how pro-ana members self-present in the virtual world could shed some light on these offline behaviors. Through discourse analysis, I examined the metaphors the members of a pro-ana group invoked in their personal profiles on a popular social networking site, to talk about the self. I applied the Metaphor Identification Procedure to 757 text profiles. I identified four key metaphorical constructions in pro-ana members' self-descriptions: self as space, self as weight, perfecting the self, and the social self. These four main metaphors represented discourse strategies, both to create a collective pro-ana identity and to enact an individual identity as pro-ana. In this article, I discuss the implications of these findings for the treatment of eating disorders.