Nutrition is important for improved health and wellbeing and reducing the risk of diet-related health conditions including chronic disease. Members of the public routinely seek health and nutrition-related information from online sources, including social media platforms. A national survey in the US has reported that close to 60% of all adults’ access health information online with over 25% accessing it through social media. Information on diet, nutrition, vitamins and supplements is one of the most common reasons why people use the internet.
The Dangers of Online Nutritional Advice
As broadband and mobile access grows, more people have the ability of sharing their thoughts and beliefs with the wider world. With this, the biggest problem regarding nutritional advice offered online is that anyone can set themselves up and offer advice. In contrary to this, qualified nutritional scientists spend years in education and undertake subsequent training to become evidence-based nutritionists or dieticians. In the UK there is the Association for Nutritionists, which holds the UK Voluntary Register of Nutritionists (UKVRN), a register of competent, qualified nutrition professionals who meet rigorously applied standards for scientifically sound evidence-based nutrition and its use in practice. The UKVRN is the only register of qualified nutritionists recognised by Public Health England, NHS Choices and NHS Careers. As it stands today, allowing anyone to set up and distribute nutrition advice is a potential danger and discredits the voice of qualified nutritional scientists and the evidence-based advice they impart.
Online Nutritional Advice in Australia
In order for public health organisations to address nutrition misinformation, it is essential to grasp the current online nutrition information landscape. A study undertaken in Australia in 2018 identified and examined popular online nutrition content and whether this advice was aligned with the Australian Guideline to Healthy Eating (AGHE). Dietary advice from Facebook pages, websites and blogs was collected and compared with the AGHE across nine categories (vegetables, fruits, legumes, grains, lean meat, dairy/alternative, fat, sugar, salt). As Facebook is the most popular social media platform, this study used Facebook ‘likes’ as an indicator of popularity to identify the most popular diet and nutrition content producers in Australia. Nine Facebook pages met the inclusion criteria, and these nine pages had over 16 million ‘likes’ between them. Of interest, it was noted that the four most-liked pages were hosted by celebrities.
Only three websites were consistent with recommendations in the AGHE, across all food groups, fat, sugar and salt. Of most concern, three websites presented wildly contradicting advice in comparison to the AGHE, with advice including limiting fruit, to going dairy-free, or gluten-free or dropping grains completely. All three promoted consuming full-fat dairy, and saturated fats, including coconut oil. One claimed that fructose elimination was more important than addressing total added sugars.
This study reveals that the most popular nutrition information pages on Facebook are often hosted by celebrities. Promotion of ‘niche’ dietary patterns such as gluten-free and diary-free are concerning as they are promoted to everybody, and should be limited to the special patient groups for whom these diets may be necessary.
There were very few public health organisations promoting AGHE on Facebook and had negligible likes compared with popular pages. This lack of Facebook pages dedicated to the promotion of government dietary guidelines amidst various popular pages was particularly striking. It appears that current online distribution of evidence-based dietary guidelines does not have a large reach in the general population and lacks a strong enough presence on Facebook to counter misinformation circulated by popular pages.
Can Social Media Contribute to Developing Orthorexia Nervosa?
Social media is increasingly popular amongst young adults, now with 90% of UK young adults (aged 16-34 years) accessing social media platforms, and has been shown to have negative effects on body image, depression, social comparison and eating behaviours. Instagram, launched in 2010, is an online social networking service that enables users to post pictures and videos to their profiles. The hashtag #food is one of the top 25 most popular hashtags on Instagram, with healthy food images receiving more ‘likes’ than less healthy images. This indicates a positive attitude towards healthy foods and healthy eating, however, research also suggests that social media is used to inform actual food choices, with 54% of consumers using social media to discover and share food experiences, and 42% using social media to seek advice about food.
Social media has already been associated with mental health problems, where it has been associated with higher levels of depression in young adults, as well as eating disorders and related behaviours. Social media is also playing a role in the ‘healthy eating movement’ in the UK with a powerful presence, reaching and influencing hundreds of thousands of people, despite often having no formal training in health sciences or nutrition. Celebrities have a large following on Instagram, with followers more likely to follow their advice or copy their diets. Often not based on scientific evidence, followers are encouraged to cut out various food groups from their diets, potentially leading to an unbalanced diet, deficiencies and malnutrition. Moreover, this advice may encourage psychological problems around food, and in some cases, lead to eating disorders.
Orthorexia nervosa is a relatively new eating disorder defined as an unhealthy obsession with eating healthily. It has been discovered that an increased incidence of orthorexia nervosa is found in populations who take an active interest in their health and body. Orthorexia nervosa often co-occurs with anorexia nervosa. Orthorexia symptoms are associated with healthy lifestyle choices such as eating more fruit and vegetables, eating less white cereals, shopping in health food stores, exercise and reduced alcohol consumption. But orthorexia is also associated with significant dietary restrictions, malnutrition and social isolation.
A study in the UK has recently investigated whether there are links between social media use and orthorexia symptoms. 680 social media users who followed health food accounts were investigated regarding their social media use, and their eating behaviours, and orthorexia symptoms using the ORTO-15 inventory were assessed. The study showed that a higher Instagram use was associated with a greater tendency towards orthorexia nervosa, with no other social media channel having this effect. Further analyses showed that Twitter use had a small positive association with orthorexia symptoms. The prevalence of orthorexia nervosa among the study population was 49%, which is significantly higher than the general population (<1%).
The relationship between Instagram use and orthorexia symptoms has potential clinical implications, as orthorexia nervosa has been found to occur alongside both anorexia nervosa and bulimia nervosa. In fact, orthorexia symptoms have been found to worsen following treatment for other eating disorders, suggesting that orthorexia nervosa may be a compromise by which patients continue to exercise control over food and their body.
Moving Forward
Social media has the ability to facilitate healthy food choices, however the content and accuracy of nutrition-related posts needs to be closely monitored. Members of the public seeking nutritional health information have, at their fingertips, an array of online dietary information and lifestyle advice. Much contradicting advice is found within these pages and few public health goals are promoted. As such, members of the public seeking advice are often left confused and unsure what advice is true.
The findings from the orthorexia nervosa study highlight the implications social media can have on psychological wellbeing, and the influence celebrities may have over hundreds of thousands of followers. Overall, these findings provide an initial indication of the role that modern social media may play in the onset and progression of eating disorders and may also have clinical implications for eating disorder development and recovery.
It is imperative that public health organisations become more engaged on popular internet platforms such as Facebook, Instagram and Twitter. There is a clear opportunity for public health organisations and health communicators to utilise the power of social media to promote healthy eating guidelines. The content of such pages should be tailored in light of popular online nutrition themes. In addition, websites set up by lay members of the public offering nutritional advice need to be regulated. Ways need to be sought where popular sites are produced by qualified nutritional scientists that are engaging to the public and share accurate nutrition content. Partnership with celebrities also needs to be explored as may be a method to improve reach and impact of evidence-based diet recommendations online more effectively in the future. Celebrity-power allows for a vast following and social media influence, and positive influences from celebrities on public health has been highlighted before such as ‘Jamie Oliver’s School Dinners’ campaign.
Organisations like the Association for Nutritionists should be championed for improving the quality and consistency of nutrition messaging. By setting up such an organisation they are protecting and benefiting the public by only allowing qualified evidence-based nutritionists entry onto the UKVRN, which is an assurance that they meet rigorous standards of competence and professionalism. Furthermore, recognising high quality, relevant nutrition training is imperative in highlighting sound nutritional advice. As such, the public need to be made aware of the Association for Nutritionists, and their profile should be raised in order to protect the public in the rising demand for online nutritional information. Only websites endorsed by Registered Nutritionists and Dietitians should be recognised as the go to places for nutritional advice online.
References
Ramachandran D et al. (2018) Food Trends and Popular Nutrition Advice Online – Implications for Public Health. Online J Public Health Inform. Sep 21;10(2):e213.
Turner PG et al. (2017) Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord. Jun;22(2):277-284.
Sidani JE et al. (2016) Association between social media use and depression among US young adults. Depress Anxiety. 33(4):323–331.
Fox S (2011) The Social Life of Health Information. Pew Research Center: Internet, Science & Tech. Available from: http://www.pewinternet.org/2011/05/12/the-social-life-of-health-information-2011/.
The Association for Nutrition. http://www.associationfornutrition.org/
