Why eating disorder content continues to spread

In late January, a volunteer at the National Alliance for Eating Disorders helpline received a call from someone who had seen an alarming trend on TikTok. The hashtag #legginglegs started to trend as users posted about the slim bodies seemingly deemed most desirable for leggings.

The organization, which works directly with social media companies such as TikTok, Meta and Pinterest, quickly identified the trend towards TikTok. Less than a day later, the platform banned the hashtag and began directing users who searched for it to the organization's hotline and other resources.

Trends like 'legging legs' are part of a long history of harmful body image content that has spread online since the early days of the internet. “As soon as they ban one hashtag, another one pops up,” says Amanda Raffoul, an instructor at Harvard Medical School and Boston Children's Hospital who researches eating disorders. But she and other eating disorder experts said the evolution of social media platforms has presented an even trickier problem: how to approach algorithms that build on a user's interests to curate a feed that can quickly become dangerous. for people who are particularly vulnerable.

For example, if a teen is looking for healthy snack ideas or has interacted with certain cooking posts, a platform can offer videos about low-calorie foods. That could indicate an interest in weight loss — and soon that teen might be getting advice on limiting snacks or tips for crash dieting. A user's feed can then be filled with posts that support unhealthy behavior, or glorify one body type over another.

“I don't think we're in a space where we can ignore the harm that the algorithm can cause,” said Johanna Kandel, CEO of the National Alliance for Eating Disorders. “The fact is that individuals can start a journey of health and wellness and within minutes be fed content that is extremely unhealthy for them.”

For the companies charged with overseeing these posts, experts say, this poses challenges beyond free speech concerns. There is no clear distinction between sharing a story about eating disorder recovery and posting content that could lead to eating disorders, or between posting healthy recipes and encouraging eating behaviors that could be harmful to some adolescents or to others who may already be struggling with eating disorders. body image or eating disorders.

TikTok did not respond to a request for comment. Ms Kandel, who works with social media companies including TikTok to tackle harmful content, said she cannot remember a potentially harmful trend being identified and removed as quickly as TikTok removed the hashtag legging legs.

For years, public health experts have worried about the role social media can play in the development of eating disorders and other mental health problems. More than 29 million Americans will have a clinically significant eating disorder during their lifetime, and people of any age, race, gender or body type can develop eating disorders, according to the National Alliance on Eating Disorders.

But with algorithms controlling more of your social media feeds than ever before, it's become even more challenging to build a healthy relationship with what you see on social media, says Jillian Lampert, Chief Strategy Officer of the Emily Program, which treats eating disorders. While people can choose who they follow, their past actions can determine what appears in other places, such as “for you” or “discover” pages.

Dr. Lampert said that as a teenager in the 1980s, she came across messages about the “ideal body” or extreme diets in magazines, movies and television shows. But, she said, it wasn't nearly as inescapable as it is for young people today.

Dr. Lampert said understanding how clients use social media — and what they see online — was an important part of the work at the Emily Program, which operates in-person treatment centers in four states and sees patients virtually. Because social media algorithms depend in part on who you follow and what content you interact with, providers are asking customers which accounts they might need to unfollow for their own well-being.

“We are rebuilding a different relationship with social media,” said Dr. Lampert.

The algorithms that can subtly serve up harmful content can also be a powerful weapon in combating it. When Emily Pearl, a social media consultant, saw “#legginglegs” on TikTok, her own outraged response against the story found a huge audience.

“Social can be so toxic that it really blows my mind,” Ms. Pearl said in an interview video which has now been viewed more than 11 million times. Ms. Pearl, 26, said on the phone that while she knew how to identify problematic content and take care of her feeding to some extent, she worried about her nieces and nephews and other young people who might not be aware how harmful the videos were. they might be watching.

“There has to be a safer way,” she said.