Six years ago, a popular reality TV show called "The Biggest Loser" suffered a public blow to its credibility. The premise of the show was that overweight and obese contestants would compete to see who could lose the most weight, and by implication, that the show could provide meaningful weight loss inspiration to its viewers. Yet within months of the show ending, virtually all of the contestants were back in the overweight or obese categories. Sometimes the former contestants were even heavier than they had been before.
"Our advice" to people seeking to become healthier "would be to not turn to most TikTok accounts to get ideas on how to improve one's health."
Health experts were not surprised. Despite popular myths, becoming and then staying thin is not solely a matter of will power. Research has shown for decades that long-term weight loss on a large scale is very difficult, and that it is simply untrue that being healthy means you must have a slender body type.
But the same kinds of popular myths that guided "The Biggest Loser" still have a lot of cultural currency, it turns out. A recent study in the medical journal PLOS One found that TikTok — a social media app in which users post short-form videos, and which is so well-trafficked that last year it became more popular than Google — is spreading the same kinds of discredited health premises that the "Biggest Loser" did, to a younger generation.
In the study, researchers from the University of Vermont, Dr. Marisa Minadeo and Dr. Lizzy Pope, analyzed some of TikTok's most popular content. They found 10 popular nutrition, food, and weight-related hashtags that each had over 1 billion views, and then within those groups downloaded one thousand TikTok videos which were analyzed and categorized based on how much they discussed nutrition, food, weight loss and other similar health topics. From there, the most one hundred viewed videos were broken down according to their key themes, which as it turned out included "the glorification of weight loss in many posts, the positioning of food to achieve health and thinness, and the lack of expert voices providing nutrition information."
"The majority of posts presented a weight normative view of health, with less than 3% coded as weight-inclusive," the study reported. "Most posts were created by white, female adolescents and young adults."
The study identifies several key misconceptions among TikTok weight loss proponents. For one thing, they perpetuate the myth of "diet culture," or "a system of beliefs that worships thinness, promotes weight loss as a means of attaining higher status, demonizes certain ways of eating while encouraging others, and oppresses people who do not match up with the prescribed vision of 'health.'" While many diet culture assumptions may seem like conventional wisdom, health research has found that weight management and being thin is not automatically essential to health. Instead, bodies have a wide spectrum of natural shapes and sizes, with research indicating that people of all body sizes can be physically and mentally healthy if they pursue proper nutrition and exercise goals in attainable, stigma-free ways.
"Perhaps portraying weight loss would be less harmful if long-term weight loss was generally achievable," the study's authors write. "However, as Tylka et. al (2014) discussed in their literature review of weight normativity and weight inclusivity, weight loss interventions almost always fail; only about 20% of individuals who participate in weight loss interventions maintain the weight loss after one year, and this percentage decreases by the second year. The collection of videos glorifying weight loss on TikTok represent a moment in time, but do not show the longer-term effects of weight loss interventions, such as weight-cycling, or repeated dieting and weight loss attempts over many years."
Since long-term weight loss is usually not achievable, "moralizing food can cause hyper-awareness about food choices, and foster beliefs that certain foods should be avoided because they will cause weight gain or poor health." Researchers note that such moralizing can lead to the development of eating disorders like orthorexia, or a fixation on eating "correct" foods.
"The majority of posts presented a weight normative view of health, with less than 3% coded as weight-inclusive. Most posts were created by white, female adolescents and young adults."
The authors also noted that, although there were countless videos offering nutrition advice, a scant number came from those with expertise in diet and health.
"Of all the videos, 1.4% were created by registered dietitians, suggesting very little expert nutrition advice on the app," the study points out. "Users without professional knowledge are sharing nutrition tips that can be inaccurate, and often for the purposes of weight loss. These types of videos likely spread and encourage harmful dieting interventions to a vulnerable audience that may not have strong media literacy skills."
Pope, a nutritionist at the University of Vermont and one of the study's co-authors, told Salon by email that people who want to avoid dietary disinformation need "to pay attention to who is providing the information. What are their qualifications? What do they know about your particular situation? It's not necessarily productive for most people to get dietary information from social media, so stepping away from that as a source of nutrition information is probably a good idea." She specifically added that, based on their research, "our advice" to people seeking to become healthier "would be to not turn to most TikTok accounts to get ideas on how to improve one's health."
"More broadly, I'd ask them specifically why they believe their health is tied to their appearance, and whether they could focus on implementing health behaviors regardless of impacts to appearance," Pope added. "I think in general we need to dismantle the system of diet culture that dominates so much of the discourse around food, nutrition, and bodies in this country keeping people focused on the idea that health and appearance are closely linked, we have control over either, and we should quest towards the thin ideal regardless of the harms that may occur."
Salon reached out to several nutrition experts not involved with the study for their views. One of them was Dr. Robert Lustig, a pediatric endocrinologist and professor emeritus at the University of California, San Francisco. As he told Salon by email, he has noticed that all social media (including TikTok) "glorifies thinness."
"It perpetuates the myth that weight is the primary marker of health," Lustig explained. "This is untrue. The issue is that the fat you can see (the subcutaneous fat) is protective for health. It's the fat you can't see (the visceral and the liver fat) that is dangerous. But these depots are not what you measure on the scale."
Dr. Nicole Avena, an assistant professor of neuroscience at Mount Sinai Medical School and a visiting professor of health psychology at Princeton University, wrote the book "Why Diets Fail: Because You're Addicted to Sugar." She observed to Salon by email that "anytime you open TikTok or Instagram, your feed is most likely flooded with viral recipes and food hacks that perpetuate toxic diet culture. From internal showers to eating cloves of garlic as natural antibiotic, most influencers posting about fad diets do not have a background (or degree!) in nutrition or medicine."
Avena added, "This type of 'propaganda' leads the public to think that someone who is genetically thin versus who is genetically not can get results from restriction, crazy trends, and extreme exercise."
But Avena had advice for people who are concerned about eating and exercising in healthy ways. As she advised, "eat whole foods from the earth, reduce your overall added sugar intake, and do something you enjoy as physical activity. This type of lifestyle gives no hard boundaries, no crazy potions, and is research backed." She specifically advocated making sure that at least half of your plate has vegetables, unprocessed whole grains and high-quality protein. In addition, she argued that "physical activity comes with time and discovering what you actually like to do, rather than forcing yourself to do the latest spin trend for example will help you stay consistent." She also urged people to eat sugar in moderation, rather than "restricting so much so that you binge on it later." The key is to "reduce your sugar over time, as opposed to cold-turkey."
For his part, Lustig noted that "the most important measure for health is the waist circumference. If you have a waist smaller than your hips, then you have health. If you have a belly larger than your hips, then you need to do something. The best thing to do is to cut the sugar."
When asked if people focus too much on their weight, Lustig pulled no punches.
"Absolutely," Lustig told Salon. "In most people's minds, people think weight and calories are the same. Focus on the food, not on the weight or the calories."
