Self-presentation in digital media among adolescent patients with obesity: Striving for integrity, risk-reduction, and social recognition

Abstract

BackgroundEmerging research suggests that social media has the potential in clinical settings to enhance interaction with and between pediatric patients with various conditions. However, appearance norms and weight stigmatization can make adolescents with obesity uncomfortable about using these visual-based media. It is therefore important to explore these adolescents’ perspectives to identify the implications and concerns regarding the use of social media in clinical settings.ObjectiveTo explore the experiences of adolescents in treatment for obesity in terms of how they present themselves on social media, their rationale behind their presentations, and their feelings related to self-presentation.MethodsInterviews were conducted with 20 adolescents enrolled in a pediatric outpatient obesity clinic, then transcribed and categorized using qualitative content analysis and Goffman’s dramaturgical model. Participants used a screen-recorded laptop to demonstrate their online self-presentation practices.Findings: Adolescent girls and boys undergoing treatment for obesity used visual-based social media, but girls in particular experienced weight stigma online and undertook self-presentation strategies to conceal weight-related content such as avoiding showing close-up photos of their bodies and not posting images of unhealthy “fattening” foods. Participants perceived the potential use of social media in clinical settings as being too risky and private.ConclusionsGiven the complexity of general visual-based social media use by adolescents, and not wanting their patient status to be visible to peers, healthcare should primarily focus on working with more restricted instant messaging when engaging with adolescents with obesity.

Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review

“…A total of six studies met the full inclusion criteria and were included in the final sample (Figure 1). Table 1 shows the details of these six studies [26][27][28][29][30][31].…”

“…Both positive and negative influences were found in eating behavior content among adolescents. Holmberg et al [26,27] were the only researchers to leverage a contemporary social media platform (ie, Instagram) and identify positive eating behaviors promoted among adolescents. Their study setting across Sweden, Norway, and Denmark is a leading example of the utility of social media to influence eating behaviors in a positive way.…”

“…Engagement: semistructured interviews that described adolescent social media engagement with food Themes: Sweden 13-16 Holmberg et al [27] 1. Protecting self-esteem by not disclosing body weight, body images, or unhealthy foods, to minimize the risk of receiving hurtful comments 2.…”

“…Food brands with positive associations among peers that signified social status and generated likes and positive comments were viewed as favorable among teens in Sweden. In a qualitative study with Swedish teens, one 14-year-old participant described her reasoning for sharing a Starbucks image as follows: "Even if one has never had a Starbucks beverage or visited the place, one still loves it, because one knows that everyone else loves it" [27].…”

#Online harms or benefits? An ethnographic analysis of the positives and negatives of peer‐support around self‐harm on social media

“…There is emerging evidence that social technologies may detrimentally impact young people’s mental health (Kelly et al, 2019; RSPH, 2019; Shakya & Christakis, 2017). Cyberbullying has been linked to depression, anxiety, self‐harm and suicide (Field, 2018; John et al, 2018), and correlations have been drawn between social media use and depression (Primack et al 2017), impaired sleep (Woods & Scott, 2016) and poor body image (Burnette, Kwitowski, & Mazzeo, 2017; Holmberg, Berg, Hillman, Lissner, & Chaplin, 2018). These findings have recently been accompanied by cross‐sectoral concern regarding online self‐harm content.…”