Interplay of Support, Comparison, and Surveillance in Social Media Weight Management Interventions: Qualitative Study (Preprint)

Abstract

BACKGROUND The trend of using social media as a platform to deliver weight management interventions is substantial. This illustrates a need to develop a holistic understanding of doctor-patient communication and patient-patient communication in social media and the impacts on overweight and obese adults’ weight management. Studies like this will shed light on how social media can be more effectively integrated into weight management programs to enhance individuals’ short-term and long-term weight management behaviors and to improve the end result of preferred weight outcomes. OBJECTIVE This qualitative study explored the interplay of three social influence factors: social support, social comparison, and surveillance derived from two sources: doctor-patient communication and peer interactions in a social media-based weight management program. The study aimed to address how social media support, comparison, and surveillance affect overweight and obese adults’ self-regulation of weight management. The program, designed and implemented by the research team based in a tertiary referral hospital in a southeastern province in China, included both diet and physical activity components. METHODS We conducted in-depth interviews with 32 program participants with variations in age (M = 35.59, SD = 7.67), gender, duration of program membership (M = 1.4 years), and weight loss outcomes (-9.4% to 54.2% weight loss). All interview data were audio-recorded, transcribed, and translated using the translation-back-translation technique. Nvivo software was used to facilitate the coding process. RESULTS Results of thematic analysis indicated the distinct functions of professionally-led support and peer support. Professional support was presented in the form of capacity building. Peer support fostered empathy and sense of belonging and had a mutually constitutive relationship with peer comparison and peer-based surveillance. Peer comparison enhanced motivation and positive competition. However, it could also reinforce negative group norms and resulted in downturns in reference standards. Social media surveillance prompted participants’ reactions to the gaze from medical professionals and peers that could be cooperative or resisting. Findings from this study illustrated the interrelated and fluctuant influences of support, comparison, and surveillance. CONCLUSIONS This study revealed that the interactive characteristics of social media eased the practices of social support and social comparison and created new forms of surveillance related to weight management. The theoretical contribution of the study was an in-depth understanding of social media influences on individuals’ weight management behaviors. Practical implications of the study concerned improved strategies for maintaining the positive dynamics of social media interactions and preventing negative resistance to surveillance technology. CLINICALTRIAL Clinical Trials ChiCTR1900025861.