From the earliest internet forums, to millions of teens’ current TikTok feeds, there has always been an active, influential online culture of “pro” eating disorder “advice” (aka pro-ana or pro-ED content). These online communities are as nuanced as the people who frequent them, full of posts that run the gamut from harmful misinformation to genuine recovery support. Pro-ED content has never been more accessible, even if it doesn’t look as obvious as the rail-thin supermodels on magazine covers of the past. What counts as dangerous, triggering content has never been more ambiguous, and in that sense, it’s never been more insidious.
With eating disorders already on the rise among teens during the pandemic, many experts have found that TikTok exacerbates the risk of falling into eating disordered behaviors. Even though TikTok attempts to censor pro-ana videos, a February 2021 study found that even the “anti-pro-anorexia” videos on TikTok paradoxically lead the users to emulate these “guilty” behaviors. To further understand this phenomenon, and to find out what concerned parents should know about it, I spoke with Dr. Alix Timko, a psychologist in the department of child and adolescent psychiatry at Children’s Hospital of Philadelphia who focuses on eating disorders, as well as Dr. Mesilla Coffin, the senior director of clinical programming at Monte Nido & Affiliates.
An extremely brief overview of pro-ED content
One of the unofficial rules of the internet is that pro-ana communities will always find some sort of home across all social media platforms (with one of the few exceptions being LinkedIn…for now). Therefore, it’s no surprise that in February 2020, Buzzfeed reported on the prevalence of pro-ana content on many TikTok “For You” pages. Like I touched on above, the Buzzfeed investigation references the ways that ED content is not clear-cut, and even works as a dual-edged sword:
Researchers have long known that social media and older online communities can offer support for people with stigmatized conditions like eating disorders. For example, Reddit’s decision to remove the r/proED sub in 2018 was met with outcry from community members who explained that, despite its name, the sub wasn’t actually used as a space to promote eating disorders and functioned more like a support group.
What’s clear is that the danger of modern ED content is that it no longer looks like the in-your-face, easily identifiable “pro-ana” or “thinspo” (thin-inspiration) hashtags of the early internet. Right now, more relevant than the overt “tips and tricks” are the indirect, nuanced, and often coded eating disorder behaviors that proliferate in ostensibly innocuous forms, like the “what I eat in a day” hashtag on TikTok. (I’m not linking to that hashtag, but if you seek it out, you’ll see a disclaimer from TikTok about keeping users safe and redirecting viewers to the National Eating Disorders Association).
What to know about TikTok’s algorithm in particular
More than any other social media platform, TikTok finds a way to show you videos that you’re going to stick around to watch. Dr. Ysabel Gerrard, a researcher and consultant on social media content moderation, writes for WIRED that “the problem TikTok has right now is that its For You page is working exactly as it should when it shows susceptible viewers eating disordered content…The algorithm doesn’t make moral decisions; it learns what you tend to watch and shows you more of it.” Gerrard has previously written about the same problem playing out on Instagram, Pinterest, and Tumblr.
Although well-known pro-anorexia search terms (e.g. #proana or #thinspo) redirect users to a support page, common misspellings of these terms are full of harmful eating disorder videos. (e.g. something like “thyy gapp” over “thigh gap”). (That’s a fake example because I’m not trying to point anyone toward thigh gaps.) Recovery videos in particular are hard to pin down as either helpful or harmful. TikTok’s guidelines allow videos that provide “support, resources or coping mechanisms” for people with eating disorders. “EaTiNg DiSoRdEr ChEcK” and other trends are filled with videos of people showing before and after pictures of their recovery, or documenting their daily life as they get better.
If someone is fascinated by (and susceptible to) pro-ED content, they’ll have no trouble finding an endless supply of it online. Personally, that fact has proven true ever since I first created a Tumblr in 2009. It’s proven true since I downloaded Instagram in 2011. And it’s proven true since I joined TikTok in 2020.
The key thing to know about the TikTok algorithm is that the For You page will show you videos in direct response to your viewing habits (not just from accounts that you intentionally follow, like on Instagram or Tumblr). So try as I might to avoid “what I eat in a day” videos from beauty-standard influencers, TikTok already knows that I tend to stick around and watch them. And so it serves me, and countless others, more of the same ambiguously triggering ED content.
If you’re a parent or are otherwise concerned about someone’s susceptibility to this sort of inevitable, relentless pro-ED content, you might feel helpless against the all-powerful stranglehold that social media has. Luckily, eating disorder experts have some advice for how you can help keep the young person in your life safe from harmful content online.
Be mindful and make social media work for you
Kids aren’t oblivious. Timko stresses the fact that many young users are knowledgeable about how social media impacts their body image, and that they can’t trust everything they see online as “real life.” At the same time, by virtue of their age, many teens and tweens still lack self-awareness about how all the images they’re exposed to will impact them on a deeper level. Through her client work and research, Timko finds that a lot of kids “objectively know that filters are not reality, and [kids] think that means they personally know how to appropriately interpret what they see online. However, that objective knowledge can go out the window” and get replaced by more emotional reactions.
Put more simply, kids know that other people use filters and lie online. But that knowledge doesn’t always protect them from feeling insecure anyway. Timko encourages parents to talk to their kids about body image and healthy habits, rather than letting social media control the narrative.
Likewise, Coffin says that many of her clients found themselves in rabbit holes following any number of influencers’ food and body behaviors. What she says is most helpful to her young clients is having them ask themselves, “What am I getting when I check social media? Is there another way to meet that need?” Encourage your kid to become in tune with their emotional reactions to all the images they’re seeing, no matter what their rational brain is telling them. If they’re seeking a feeling of connection, encourage them to reach out to real people they know rather than identifying with (and comparing themselves to) influencers online. If they’re feeling sucked into the swirls of insecurity, it might be time to simply hit “unfollow” on accounts making them feel that way.
One idea is to create accounts that follow all the same accounts that your kid does, so that you can suss out the content and step in if necessary. For parents, Coffin encourages you to “get curious” and try to change the algorithm to match your values around body positivity and affirmation.
Have family dinners, literally or metaphorically
Timko speaks to the importance of family dinners as not simply mealtimes, but dedicated time to have a safe space for frank conversation. Even if you don’t physically sit around the table to eat together, try to have a “designated time where you check in on what’s really going on in your children’s lives.”
Have direct conversations about social media
When you’re having that designated family time, open the gates to direct, honest conversations about social media. When it comes to how much digital privacy you should give your kids, remember that while young kids are not entitled to absolute privacy on their devices, there’s no way for you to monitor everything. Therefore, it’s always going to be more important to keep open lines of communication.
This is extra important given the ways the social media landscape is constantly changing, Coffin says: “Your kid is going to evolve both as they grow up and as tech grows up with them,” so the social media conversation is never going to be one-and-done.
For additional help, Timko recommends that parents look into whether their local school districts have information sessions for parents to gain resources and learn about media literacy. Both Timko and Coffin point out that kids are inevitably going to outsmart older generations in terms of finding work-arounds to however their social media is monitored, so the most important thing to do is create those ongoing, honest talks at home.
We’ve written a good bit about how to navigate your child’s social media usage. Read up on our past coverage about how to introduce your kid to social media, how to dial back your kid’s screen time, and what we actually know about how social media affects teens’ mental health.
Identifying ED warning signs
Many warning signs of eating disorders and any number of disordered behaviors can look healthy and positive on the surface. Timko says to look out for any drastic changes in their eating habits, such as cutting out food groups or moralizing what they eat. Try to model a non-judgmental approach to food, so that you don’t set up your kid to view “junk food” as a moral failure, or “clean eating” as a moral achievement.
Similarly, keep an eye out for drastic changes in exercise intensity, frequency, and emotions around it, e.g. checking whether your kid gets distressed when exercise is prevented or changed for any reason. For a full list of eating disorder warning signs and symptoms, check out the National Eating Disorder Association’s resources.
Social media is sticking around. Rather than trying to block and ban an endless flow of triggering content, focus on making the algorithm appeal to content you approve of. “You can make social media whatever you want to make it,” Coffin says. If you seek out triggering content, you’ll find it. But if you look for body positivity and healthy behaviors, you can find that, too.
As with any concerns over your kids’ wellbeing, one of the most important things you can do is make them feel safe and heard through open lines of communication.