Eating Disorders and Social Media Prove Difficult to Untangle – The New York Times

A 27-year-old YouTube star, prodded by her millions of followers with concerns about her health. A 19-year-old TikTok creator who features posts about being skinny. Teen communities throughout the internet, cleverly naming and culling their discussions to avoid detection.

They present a nearly intractable problem for social media companies under pressure to do something about material on their services that many people believe is causing harm, particularly to teenagers.

Those concerns came into sharp focus in recent weeks in a pair of Senate subcommittee hearings: the first featuring a Facebook executive defending her company, and the second featuring a former Facebook employee turned whistle-blower who bluntly argued that her former employer’s products drove some young people toward eating disorders.

The hearings were prompted in part by a Wall Street Journal article that detailed how internal Facebook research showed Instagram, which is owned by Facebook, can make body image issues worse for some young people.

On Tuesday, executives from YouTube, TikTok and Snapchat are scheduled to testify before a Senate subcommittee about the effects of their products on children. They are expected to face questions about how they moderate content that might encourage disordered eating, and how their algorithms might promote such content.

“Big Tech’s exploiting these powerful algorithms and design features is reckless and heedless, and needs to change,” Senator Richard Blumenthal, a Democrat of Connecticut and the chair of the subcommittee, said in a statement. “They seize on the insecurities of children, including eating disorders, simply to make more money.”

But what exactly can be done about that content — and why people create it in the first place — may defy easy answers. If creators say they don’t intend to glamorize eating disorders, should their claims be taken at face value? Or should the companies listen to users complaining about them?

“Social media in general does not cause an eating disorder. However, it can contribute to an eating disorder,” said Chelsea Kronengold, a spokeswoman for the National Eating Disorders Association. “There are certain posts and certain content that may trigger one person and not another person. From the social media platform’s perspective, how do you moderate that gray area content?”

The association advises social media companies to remove content that explicitly promotes eating disorders and to offer help to users who seek it out.

But young people have formed online communities where they discuss eating disorders and swap tips for the best ways to lose weight and look skinny. Using creative hashtags and abbreviations to get around filters, they share threads of emaciated models on Twitter as inspiration, create YouTube videos compiling low-calorie diets, and form group chats on Discord and Snapchat to share how much they weigh and encourage others to fast.

Influencers in fashion, beauty and fitness have all been accused of promoting eating disorders. Experts say that fitness influencers in particular can often serve as a funnel to draw young people into extreme online eating disorder communities.

YouTube, Snapchat, TikTok and Twitter have policies prohibiting content that encourages eating disorders. The companies should improve their algorithms that can surface such content, Ms. Kronengold said.

“It becomes an issue, especially when people are coming across this content who can be harmed by it or don’t want to see it,” she said.

Like many other popular YouTube creators, Eugenia Cooney, 27, makes videos that share her favorite fashion and makeup items with her more than two million followers. But for years, her viewers have not focused on the topics of Ms. Cooney’s videos. Instead, they flood her comments with concerns about her health.

Although she spoke in 2019 about her struggles with an eating disorder in interviews with other YouTubers, Ms. Cooney rarely addresses her audience’s concerns. While some viewers flock to her social media profiles on YouTube, Twitter, Instagram and the streaming service Twitch to beg her to seek treatment, others have accused her of using her platform to promote eating disorders to young people.

They say her videos are examples of “body checking,” a habitual behavior of reviewing the appearance of one’s body that is often associated with eating disorders. Over 53,000 people signed a petition in January asking social media companies to remove her content.

“I just kind of feel like everybody has the right to make videos and to post a photo of themselves,” Ms. Cooney said in an August video. “With me, people will always be trying to turn that into such a bad thing.” She did not respond to requests for comment from The New York Times. YouTube said Ms. Cooney’s content did not violate its rules.

“We work hard to strike a balance between removing harmful videos about eating disorders and allowing space for creators and viewers to talk about personal experiences, seek help, and raise awareness,” said Elena Hernandez, a YouTube spokeswoman. “We reduce the spread of borderline content about eating disorders that come close to violating our policies but don’t quite cross the line.”

YouTube does not prevent users from searching for eating disorder content, although it does include an eating disorder help line at the top of its search results for some common terms related to the topic.

The company surfaces one of Ms. Cooney’s fashion videos among its top search results for “thinspo,” a common phrase that refers to “thin inspiration,” along with compilations of videos that originally appeared on TikTok.

YouTube allows Ms. Cooney to make money from her videos. Ads from health food companies like Sweetgreen, Imperfect Foods and HelloFresh often appear on her content, even though Ms. Cooney mainly discusses makeup and fashion rather than diet or food.

Mishel Levina, a 19-year-old college student in Israel with 21,000 followers on TikTok, encourages her viewers to “block if you’re sensitive.” Her videos show off her waist and stomach, feature song snippets about being skinny, and include text about losing weight.

Ms. Levina acknowledged that some of her behavior was unhealthy, but said she was just sharing her life and was not urging other people to starve themselves.

“I’m being called out for promoting bad eating habits — I’m not promoting them,” she said in an interview. “I’m just making a joke out of them — it’s all a joke. It’s social media. I’m not pushing this on you. I’m sharing information. It’s your decision to take it and use it or to leave it aside and just skip it.”

Last year, TikTok began cracking down on content that explicitly encourages eating disorders and blocking some hashtags that promote disordered eating. But it has allowed creators to continue to share videos that discuss recovery or crack subtle jokes about eating disorders.

Despite efforts to hide harmful content, some content that promotes eating disorders is still available. Some hashtags related to the topic have over 70 million views. But searching for phrases like “anorexia” prompts the app to offer a phone number for the National Eating Disorders Association instead of any videos.

TikTok said that it, too, tried to differentiate videos of people sharing their personal experiences from more harmful content that promoted unhealthy behavior.

“We aim to foster a supportive environment for people who share their recovery journey on TikTok while also safeguarding our community by removing content that normalizes or glorifies eating disorders,” Tara Wadhwa, TikTok’s director of U.S. policy, said in a statement.

But many popular TikTok trends that do not explicitly promote eating disorders still highlight thin bodies, implicitly advocating thinness as the ideal.

“My first trend, ironically, is something that makes me feel awful,” said McKenzie Ellis, 26, whose music was featured in a recent “hip walking” trend where creators filmed close-ups of their waist while walking.

On Twitter, creators routinely share advice for crash diets and encourage disordered eating, and some amass tens of thousands of followers in the process. Twitter’s algorithms automatically suggest related accounts and topics for users to follow, based on the accounts they view. When a Twitter user views accounts that promote eating disorders, Twitter recommends topics like “fashion models,” “fitness apps & trackers,” “mindful eating” and “workout videos.”

Twitter said that its policies prohibit content that promotes eating disorders or provides instructions or strategies for maintaining them, and that the company primarily relies on users to report violative content. A spokeswoman for the company said that its topic recommendations differed by account.

“While we remove content that violates our policies on suicide and self harm, we also allow people to share their struggles or seek help,” the spokeswoman said.

On Snapchat, users often form group chats dedicated to privately encouraging one another to pursue eating disorders. Some of the chats are focused on providing negative feedback, essentially bullying the participants about not fulfilling their diet goals. Others provide positive feedback.

After an inquiry from The New York Times, Snapchat said it would ban terms related to the group chats from being used in users’ display names, group chat names and search. The company previously blocked a number of common terms associated with eating disorders and provides suggestions for resources, a spokeswoman said.

Ms. Levina, the TikTok creator, said she did not think she needed to moderate her content to avoid influencing young people to start unhealthy behaviors. Instead, Ms. Levina suggested, teenagers were old enough “to understand the information given and decide what to do.”

But Dr. Khadijah Booth Watkins, the associate director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital, said that young people are especially impressionable, so content creators should consider that they could be swaying teenagers into making dangerous health choices.

“Having the awareness that you are being followed and that people are listening to you and seeking your guidance bears with it a certain level of responsibility,” Dr. Booth Watkins said. “Reliable and valid information about weight loss, particularly on social media, should only be done by qualified, licensed nutritionists.”

If you or a loved one is struggling with an eating disorder, contact the National Eating Disorders Association help line for support, resources, and treatment options at (800) 931-2237. You can find additional resources at NationalEatingDisorders.org.

Sheera Frenkel contributed reporting.