Abstract

BackgroundThere is increasing concern around communities that promote eating disorders (Pro-ED) on social media sites through messages and images that encourage dangerous weight control behaviors. These communities share group identity formed through interactions between members and can involve the exchange of “tips,” restrictive dieting plans, extreme exercise plans, and motivating imagery of thin bodies. Unlike Instagram, Facebook, or Tumblr, the absence of adequate policy to moderate Pro-ED content on Twitter presents a unique space for the Pro-ED community to freely communicate. While recent research has identified terms, themes, and common lexicon used within the Pro-ED online community, very few have been longitudinal. It is important to focus upon the engagement of Pro-ED online communities over time to further understand how members interact and stay connected, which is currently lacking.ObjectiveThe purpose of this study was to explore beyond the common messages of Pro-ED on Twitter to understand how Pro-ED communities get traction over time by using the hashtag considered to symbolize the Pro-ED movement, #proana. Our focus was to collect longitudinal data to gain a further understanding of the engagement of Pro-ED communities on Twitter.MethodsDescriptive statistics were used to identify the preferred tweeting style of Twitter users (either as mentioning another user in a tweet or without) as well as their most frequently used hashtag, in addition to #proana. A series of Mann Whitney U tests were then conducted to compare preferred posting style across number of followed, followers, tweets, and favorites. This was followed by linear models using a forward step-wise approach that were applied for Pro-ED Twitter users to examine the factors associated with their number of followers.ResultsThis study reviewed 11,620 Pro-ED Twitter accounts that posted using the hashtag #proana between September 2015 and July 2018. These profiles then underwent a 2-step screening of inclusion and exclusion criteria to reach the final sample of 967 profiles. Over 90% (10,484/11,620) of the profiles were found to have less than 6 tweets within the 34-month period. Most of the users were identified as preferring a mentioning style of tweeting (718/967, 74.3%) over not mentioning (248/967, 25.7%). Further, #proana and #thinspo were used interchangeably to propagate shared themes, and there was a reciprocal effect between followers and the followed.ConclusionsOur analysis showed that the number of accounts followed and number of Pro-ED tweets posted were significant predictors for the number of followers a user has, compared to likes. Our results could potentially be useful to social media platforms to understand which features could help or otherwise curtail the spread of ED messages and activity. Our findings also show that Pro-ED communities are transient in nature, engaging in superficial discussion threads but resilient, emulating cybersectarian behavior.

Highlights

  • The prevalence of eating disorders (EDs) has been on the rise ever since the condition was listed in the Global Burden of Disease Study [1]

  • Our analysis showed that the number of accounts followed and number of promote eating disorders (Pro-ED) tweets posted were significant predictors for the number of followers a user has, compared to likes

  • Our results could potentially be useful to social media platforms to understand which features could help or otherwise curtail the spread of ED messages and activity

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Summary

Introduction

The prevalence of eating disorders (EDs) has been on the rise ever since the condition was listed in the Global Burden of Disease Study [1]. The use of the internet to communicate using common online platforms has become more popular due to the increasing focus on usability, the decreasing cost in access, and the ability of communications to cross large geographical distances [9] This transition has seen the emergence of social and interpersonal support networks for users and in particular, the emergence of pro-eating disorder (Pro-ED) communities online [10,11,12]. There is increasing concern around communities that promote eating disorders (Pro-ED) on social media sites through messages and images that encourage dangerous weight control behaviors These communities share group identity formed through interactions between members and can involve the exchange of “tips,” restrictive dieting plans, extreme exercise plans, and motivating imagery of thin bodies. It is important to focus upon the engagement of Pro-ED online communities over time to further understand how members interact and stay connected, which is currently lacking

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