There is an "urgent need" to exploit the potential of social media to educate and positively influence young people with scientific information on obesity, according to research presented by Antonella Franceschelli, MD, PhD, of UniCamillus International Medical University, Rome, Italy, at the European Congress on Obesity (ECO) 2024 in Venice, Italy.
Her team's analysis revealed that 108 videos posted on TikTok from 2021 to 2024 were watched a total of 4631 times, with an average number of 42,495 views per video. The most watched video, which was about the glucagon-like peptide 1 receptor agonist semaglutide, was watched almost a million times.
"The growing obesity epidemic, particularly among young people, represents a global challenge that requires innovative approaches," Franceschelli said in her presentation. "Over 90% of teens have at least one social media account, and their social media presence continues to grow."
"Food and beverage brands capitalize on this trend by marketing their products on social media to teens," she said. "Depending on the nutritional value of the products marketed, the influence of social media advertisements may contribute to the risk of developing adverse health outcomes such as obesity, hypertension, and type 2 diabetes."
"But there is also huge potential to use social media to disseminate scientific information on obesity and nutrition and support teenagers and young adults in eating healthily," she added.
"TikTok and other social media such as Instagram or Facebook are powerful vehicles for reaching our patients and making them aware of new therapeutic opportunities," she told Medscape Medical News. "Each social platform has its characteristics and opportunities."
Obesity Medication Videos Most Popular
For the TikTok study, researchers analyzed metrics from the Dr Anthos TikTok account, an Italian language account run by Franceschelli that contains short videos about obesity treatment, including information on healthy eating, exercise, and drug treatments, as well as live Q&As with doctors.
The content was categorized by topic, and the number of views for each video were counted. Videos about obesity medication were the most popular, with an average of 135,945 views per video. The audience for these videos was 57% women, and 4% (approximately 38,000) were young people aged 18-24 years.
Videos about combatting the stigma that can be associated with obesity drew 23,587 viewers on average, and those on healthy eating drew an average of 10,262 viewers.
The live Q&As, which offer the opportunity to put questions to an obesity specialist, attracted up to 2000 participants each, with sessions on stigma generating a particularly large amount of discussion between patients and the specialist.
"After one of the last live TikToks, I received 120 appointment requests for obesity treatment in just 1 day," Franceschelli noted. However, "it is necessary to create specific and constantly updated content for social media," she added. It is an "amplifier of our voice, [and] it's up to us to say the right things [on social media] at the right time."
Franceschelli suggested engaging a social media consultant "to know the best way to communicate our professionalism in an ethical, elegant, and effective way." It is up to clinicians to update their content, she said, which also provides "an excellent opportunity to always continue studying."
She acknowledged that social media also takes time. She spends "at least an hour a day" communicating to her patients and colleagues via her social platforms.
Clues to Distorted Body Image
In related work, Franceschelli also presented research at the congress showing that many people living with obesity conceal their body when posting profile pictures on another social media platform: WhatsApp.
Profile pictures of pets, family members, landscapes, flowers, and cartoon characters may indicate an individual has body dysmorphic disorder — a condition in which a person has a distorted image of their body, she said. "They feel dissatisfied with their physical appearance, may experience shame or anxiety about their body, and, in the case of those living with obesity, believe they are heavier than they actually are."
This study involved 59 patients with a mean age of 53 years (49 women; 10 men; mean age, 53 years), each of whom submitted one WhatsApp profile picture. The likelihood of using a profile picture that didn't represent physical reality increased with the degree or severity of obesity.
"This study suggests that something as simple a WhatsApp profile picture could give doctors a valuable insight into whether someone living with obesity has body dysmorphia," Franceschelli said. Identifying body dysmorphia is crucial when treating obesity so that a holistic approach to obesity treatment, including psychological treatments such as cognitive behavioral therapy, alongside medical treatments such as pharmacological therapy and nutritional programs, can be implemented.
'Potential Downsides'
Janet Lydecker, PhD, an assistant professor of psychiatry at Yale and director of Teen POWER, the university's program for teen obesity, weight, and eating research, commented on the study for Medscape Medical News. Teen POWER's Instagram platform features posts about mental health awareness, self-care, and body image/eating disorders. Lydecker has also used TikTok herself to reach out to teens who were bullied because of their weight.
"On the one hand, it is important to meet individuals where they are — and many teens and adults are on various social media platforms," Lydecker said. "It is important that research — on all topics, not limited to obesity — gets disseminated to the public rather than only to academic communities. It's also important to 'interrupt' the feed of nonevidence-based content with evidence-based content."
"While it might be helpful to get evidence-based content to the public through social media, there are also potential downsides," she said. "Social media has a reputation for including misinformation and disinformation alongside evidence-based content, and it is very difficult for viewers to judge whether the content is based on science and/or is an opinion or a form of marketing."
Many fad diets and dieting advice are presented as true on social media but have little or no foundation in research, she noted. "Additionally, we know from psychology research that even when it is obvious whether the source is reliable, people have 'source amnesia,' where they remember the message but not where it came from, which is why it can be easy to disseminate misinformation and disinformation broadly."
Furthermore, she added, "Online, the comments and manipulations of posts can lead to weight bias — for example, someone may comment about people being 'lazy' in a post about metabolic health problems associated with obesity or [express] stigmatizing and nonscientific views."
Once content has been created and posted, she cautioned, "the people creating the content have limited control over how their content might be used."
Franceschelli did not disclose funding for the study. She and Lydecker declared no competing interests.
Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.