Nutrition, diet, and fitness are among the most sought-after health topics by internet users. However, this pursuit can sometimes lead to negative outcomes, such as unhealthy weight control behaviors.
Understanding Health-Related Internet Users
Health-related internet users are diverse in their motivations and individual characteristics. Studies on internet usage regarding diet, weight loss, and fitness have found that a significant percentage of users are female. Consequently, it is common to see individuals with disordered eating symptomatology joining online communities to get tips and tricks for weight loss, as well as social support.
Internalization plays a crucial role. Media often promotes an ideal of beauty that people internalize, making them more prone to inappropriately change their nutrition or physical activity habits, such as engaging in strenuous exercise to achieve the "ideal body." Rather than a one-way effect of media use on attitudes and behaviors, there is a mutual reinforcement. For instance, a recent study exploring the characteristics of women who post travel images and women who post "fitspiration" images (i.e., promoting a healthy lifestyle through fitness) found higher levels of compulsive exercise and disordered eating in the fitspiration group.
Large studies suggest that internet usage for health information is highly motivated by the opportunity to get advice from others. A study of an online community of individuals with high levels of disordered eating found that the main motive to join the group was to get support and advice regarding weight loss. Similarly, some people turn to the internet to supplement professional medical advice, particularly when they are looking for advice on specific health issues or conditions.
The Study: Methods and Participants
A study was conducted to assess the links between various factors related to health behaviors and internet use. The Research Ethics Committee of Masaryk University approved the study, and data were collected through an open Web survey between May and October 2016. A total of 307 different online platforms were asked to publish the invitation to the survey.
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All participants were informed about the purpose of the research, the estimated time needed to fill out the questionnaire, and their right to withdraw from the questionnaire at any time. They were provided a link to further information about the project and were asked to provide informed consent by clicking on the link to the questionnaire. Participants were motivated by the chance to win one of five vouchers for an e-shop, each worth 40 Euros.
Participants who indicated that they visited sites about nutrition or sports not for themselves but mainly to help with the nutrition or sport of another person were excluded. Respondents with occasional missing values were also excluded. The final sample comprised 623 respondents aged 13 to 39 years, with a mean age of 24.11 years. The sample was predominantly female (83.6%) and Czech (91.7%).
Measures Used in the Study
Several tools were used to gather data:
- Excessive Exercise: Five items from the excessive exercise subscale from the Eating Pathology Symptoms Inventory Scales were used, answered on a 5-point scale.
- Risk of Eating Disorders: The SCOFF screening tool, consisting of 5 items with Yes/No response options, was used.
- BMI: Respondents reported their current height and weight, which were used to calculate their BMI. Weight status data were then obtained using international cut-off points for adults and adolescents.
- Media Influence: Respondents were asked to what extent certain statements applied to them regarding these sites, with 3 items adapted from the Multidimensional Media Influence Scale: "I am comparing my appearance with people on these sites," "I am trying to look like the people on these sites," and "The content on these sites inspires me in how to look attractive." The items were answered on a 4-point scale.
- Social Support: Respondents were asked to what extent certain statements applied to them with regard to these sites, with 3 items adapted from the Online Social Support for Smokers Scale: "I get advice and support here that I would not get elsewhere," "It is encouraging to know that there are other people making similar efforts (with regard to nutrition or sport)," and "I feel that other visitors (or authors) of sites are giving me support." The items were answered on a 4-point scale.
Findings and Implications
To assess the links between the studied factors, a base linear regression model with observed variables was tested, predicting all 3 outcomes. The final model had an acceptable fit. These results can contribute to future initiatives for the prevention of eating and weight-related problems through the internet.
There is a global trend among some young women to pursue a healthier lifestyle by improving their diet, nutrition, and fitness. Dietary information on the internet, such as on blogs and social media, is found to be very useful for internet users, given that they can find recipe ideas for cooking and social support to have a healthier diet and/or to pursue a healthier lifestyle. However, health communication among online users may be contaminated by inaccurate health information and/or by health beliefs originating from the misinterpretation of the information that they find on the internet.
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Weight loss concerns are widespread among young women and particularly among those with higher levels of internalization, those who are overweight, and those with disordered eating behavior. Excessive exercise is frequently used for weight control purposes and is a common compensatory behavior among people with eating disorder symptomatology. For overweight individuals, the internet is an easy-to-access source to find quick-fix weight loss solutions. Women who obtain weight loss information from the internet are more likely to exhibit unhealthy weight control behaviors.
Internet users with certain characteristics, such as body or weight concerns, eating disorder symptomatology, and excessive exercise, are more likely to upload inspirational content (i.e., to promote weight loss) as well as fitspirational content. Viewers of this content may feel inspired to pursue the "thin ideal body" and to adopt unhealthy weight control behaviors through psychological mechanisms, such as observational learning. Media literacy interventions aimed at promoting a critical examination of media messages regarding weight loss may serve as a useful public health initiative to ameliorate the potential harmful effects of these kinds of messages. In this sense, the role of internalization should be further explored.
Previous studies on internet use regarding diet, weight, and physical activity have found secular trends by gender, suggesting changes over time regarding gender differences in internet use. Moreover, there are seasonal and geographical variations regarding physical activity and dieting, as well as in the frequency of internet searches for fitness and weight loss information. Future research should further investigate this dynamic aspect of health-related internet use and the sociodemographic characteristics associated with it.
Excessive exercise is not a unique characteristic of individuals with eating disorders or those practicing sports. Indeed, fitness activities that are apparently healthy may become problematic when they lead to excessive exercise patterns due to individual factors such as personality traits (e.g., perfectionism). A recent meta-analytic review found a strong relationship between internalization and the use of appearance-related features in social networking sites. Similarly, internalization is associated with higher levels of compulsive exercise.
Privacy attitudes are important in online health communication, particularly regarding the self-disclosure of body weight and weight loss concerns. Anonymity is easier online compared with offline peer-to-peer communication, and studies have found that this anonymity in the online context provides an opportunity for shared self-disclosure of eating and weight loss concerns among members of online communities and blog users.
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Limitations and Strengths
The study has some limitations. The data are self-reported, which needs to be considered regarding the actual frequency of visits (as compared with the recalled and reported one) as well as with eating disorder symptomatology, body weight, and height. The sample is also limited in terms of generalizability, considering that women were overrepresented and underweight individuals were underrepresented. However, the study also has strengths. It was a population-based survey that included diverse participants of both genders rather than a specific sample such as female college students.
Conclusion
The results of this study have important implications, particularly for the prevention of eating and weight-related problems such as eating disorders and obesity. Public health policies can be implemented to help with the personalization of Web content targeting individuals with a higher risk of developing eating and weight-related problems.