Social media and adolescent body image: What to know

Girl looking at cell phoneThe two strongest influencers on children’s attitudes toward their body image are their family unit and media. As clinicians, we must be attuned to our patients’ family dynamics and their online activities — and understand how these environmental factors influence their psychological and physical health. 

Adolescents and the social media landscape

As clinicians, we must be attuned to our patients’ family dynamics and their online activities – and understand how these environmental factors influence their psychological and physical health.Tweens and teens average six and nine hours, respectively, using media each day. Social media are particularly attractive to the developing teen brain as youth seek autonomy distinct from their parents, often by forming close peer relationships. Social media facilitate formation of these connections beyond traditional school and extracurricular activities, giving them 24/7 access to a space in which they can share their thoughts, feelings and mutual interests.

As they do “in real life,” teens use social media platforms for validation; they seek to fit in with desired peer groups, especially when it comes to how they look.

Social media, like television and magazines, are commercially-supported advertising venues. They use time-honored techniques of making people feel inadequate in order to fill the created void with the latest “self-improvement” products and procedures. On social media, this marketing occurs on a personal, as well as corporate level, as individuals promote themselves — posting messages and images that portray themselves in the best possible light (often filtered, cropped and airbrushed) .

teen boy looking at cell phoneLike the media they consume, the messages teens share with each other are frequently self-promoting; “Look how thin I am!” “Look how cool I am!” “Look how much fun I am!” Ever since the Duchess of Windsor asserted, “You can never be too rich or too thin,” thin has been equated with attractiveness, happiness and success.

Advertising can (intentionally) motivate young people to strive for an impossible ideal. Social media posts can intimidate others and spur competition to be thinner, happier and sexier in order to garner more “likes” and positive comments — the currency by which teens measure their social capital and the degree to which they fit in. Social-media-potentiated peer pressure can lead teens to believe that their looks are inadequate, warping their body image, and in some cases, leading to an eating disorder, such as anorexia nervosa and bulimia.

Social media, body image and disordered eating

Eating disorders are among the most complex, confusing and life-threatening psychiatric conditions pediatricians will face in their practices. They typically present during the teen and young adult years. However, disordered eating behaviors can emerge as early as age 5. While eating disorders are highly individualized, with a number of contributing factors but no single cause, they often stem from an individual’s dissatisfaction with her or his own body. And in extreme cases, eating disorders can become more problematic through social media.

Some users promote anorexia nervosa and bulimia nervosa as a lifestyle choice, instead of a serious illness through pro-ana and pro-mia websites. These “thinspirational” websites encourage teens to embrace their distorted body image, offering suggestions and support for disordered eating behaviors, and advice on how to hide these behaviors from parents, teachers and clinicians who are trying to help them.

It is crucial for 21st Century pediatricians to understand how our patients’ social-media use affects how they see and understand their bodies. I ask all my patients from 5 to 25 years old how they feel about their bodies and what kinds of media they use and what they see:

Questions to ask your patients

  • What types of food do you eat? How often do you eat?
  • Are you on any kind of diet?
  • What kinds of media do you like?
  • What social media do you use? Facebook, Instagram, Snapchat?
  • What kinds of things do you share on social media?
  • What kinds of things do you see there?
  • What posts do your friends share?
  • How do such posts make you feel about how you look?
  • Are you happy with how you look?
  • Do you have any questions about your body?

The answers your patients provide, coupled with their physical exam, psychological status, and any observed family dynamic, will give you a more complete picture of how they view their bodies and whether any intervention is needed. Part of our job is to help our patients think critically about what they consume, not just by mouth but through media, and to help them understand that they are changed by what they consume.

Guide your patients into examining what it is that makes them truly happy (not just what they think should make them happy based on what they see online). Encourage them toward healthy behaviors, understanding that the “thin ideal” is unattainable, unhealthy and unfulfilling.

Addressing body image: Resources for you and your patients


Michael Rich headshotAbout the author: Michael Rich, MD, MPH, FAAP, FSAHM, is the founder and director of the Center on Media and Child Health at Boston Children’s Hospital and associate professor at Harvard Medical School and Harvard School of Public Health. He is the recipient of the AAP’s Holroyd-Sherry Award and the SAHM New Investigator Award, has developed media-based research methodologies and authored numerous papers and AAP policy statements, testified to the United States Congress and makes regular national press appearances.