Pro-Eating Disorder Communities Find New Spaces Online
57:46 Share

From KQED. From KQED in San Francisco, I'm Grace Wan in for Mina Kim. Coming up on Forum, celebrating thinness is nothing new on the internet, but a lack of content moderation on sites like X, formerly known as Twitter, has given rise to a dangerous corner of social media, one where users create communities that encourage eating disorders. We'll talk to experts about what's happening and what can be done about it. That's next after this news.

This is Forum. I'm Grace Wan, in for Mina Kim. On this show, we'll be talking about eating disorders and the impact of social media. If you or someone you know may be struggling with an eating disorder, there are ways to get help. The National Alliance for Eating Disorders has a helpline, and that number is 866-662-1235.

In the corners of the Internet, particularly on the social media site X, formerly known as Twitter, communities that encourage people with disordered eating are flourishing, not to help them stop, but actually to celebrate what people are doing to themselves. Despite societal efforts to celebrate body positivity, content that valorizes both thinness and eating disorders remains a difficult problem for social media.

Here to talk about this issue, we're joined by Caitlin Tiffany, a staff writer covering the internet and technology with The Atlantic. Her recent piece is entitled, The Pro-Eating Disorder Internet is Back. Welcome to Forum, Caitlin. Hi, thanks for having me. Yeah. We're also joined by Christina Lerman, a professor at USC with the Information Sciences Institute. Dr. Lerman has studied the issue of online content that encourages eating disorders. Welcome to Forum, Dr. Lerman.

Thanks for having me here. Yeah. Caitlin, I wanted to start with you. As you note in your article, the glorification of thinness is not a new problem on the internet. But X, formerly known as Twitter, has created a different concern. What is that?

Well, I guess in the story I was kind of trying to, in as little space as possible, illustrate that this has been one of the foundational content moderation problems of social media. It's a very persistent problem. So it's something that people have spent a lot of time thinking about and trying to come up with innovative ways to deal with. And the issue with X was that they

kind of threw all of that out the window. And I used a like baby with the bathwater metaphor in the piece because

Elon Musk's ex has been sort of anti-content moderation in general, as if all of those issues are the same. And I think this has been kind of a demonstration of what that actually means. If you aren't moderating content at all, there are real harms that people have been aware of for a long time that you're going to be disregarding when you get rid of all of these guardrails and when you sort of

to this algorithmic feed that's really popular now on other platforms like TikTok. X's For You feed I talked about in the piece was very simplistic. I searched for eating disorder content one time and was shown eating disorder related stuff in my feed for weeks

afterwards. It was really explicit and like pretty shocking. Well, tell me what kinds of eating disorder content is being shared on X for people who have not experienced this?

Yeah, it's sort of hard to describe. It's not described very explicitly in the story because I think there's kind of a fine line between talking about this problem and like, I don't know, voyeurism or like inadvertently glorifying it in describing it. But a lot of what I saw was people who had usernames that were like,

you know, thinspo and bonespo and like, you know, made references to being like starving and stuff like that. And then a lot of what they're posting is like extreme dieting instructions, you know, what they would consider like helpful tips on how not to eat. And the more, I guess,

The part that seemed like it was kind of a relic from the older forum days was I saw a lot of people posting what they would call mean-spo. So really vicious critiques of other people's bodies. They would post photos and want mean critiques back. Things that were supposed to make them feel so terrible that they would stop eating. Those kinds of things. And then a lot of just like kind of

in-group chatter, I guess is how I would describe it. So people just posting about, I use the example in the story, people posting about quote "wanorexics," so people that they had termed like weren't real anorexics and weren't really part of the community. There was a lot of that, like a lot of posting just to signify like I'm truly part of this.

these such and such people are not truly part of it. That kind of like community building, as it were, that you see in a lot of different internet subcultures. But in this one particular one, it's obviously a little bit or quite a bit more unsettling to see. Well, the headline of your article is the pro-internet, I'm sorry, the pro-eating disorder universe, internet disorder is back. Did it ever go away? No.

No, definitely not. And I did want to just, I don't know, emphasize that I don't think that any social media platform has solved this problem at any point in internet history. And I also don't know that it's a problem that can be completely solved. But I think there have been good faith efforts on a lot of parts and especially online.

you know, motivated by business interests. I think Instagram was in a place of existential crisis where they had to do something about this problem because of the amount of criticism they were getting and the amount of political pushback they were getting about the prevalence of that kind of stuff on their site. So they really had to do something. But when I say that it's back, I guess I mean that like with X, it has, that has become such a

it's become such a hotbed for it that it's developed a reputation on other parts of the internet. So you can go on Reddit or Tumblr or into a Discord server and see people saying, you know,

oh, like if this is what you're looking for, like this is the place to go to to get it because it's not moderated there in any way. And it is, you know, it's hard without access to a lot of data, but it seems anecdotally just based on the growth rates of these communities I was looking at, how quickly they were adding members and based on my own experience of having this content recommended to me in my For You feed that, you know,

X's negligence actually kind of goes beyond negligence to the point of

you know, promoting these things and maybe getting more vulnerable people to look at them than would seek them out otherwise. I wanted to bring in Christina Lerman here. Christina, you have done some studies on eating disorder content on X. I mean, we all know about these algorithms and these For You pages delivering content to us, as Caitlin described. Is there something about this type of content?

that makes it a little bit more sticky or gets pushed out more? Or is it just the lack of content moderation that's happening on X? Well, there's certainly something about the content. But another point I'd like to add besides algorithms, in addition to algorithms, also there's other types of effects taking place on X. And this is the social dynamics. I call it social dynamics or the formation of echo chambers. People start with X.

you know, who want to glorify, you know, pro-anorexia crowd, they start following each other. There's like the Edie Twitter, so-called Edie Twitter. Edie Twitter is full of community introductions, you know, so new users introduce themselves and then it's like, oh, retweet to create a mutual follower. So they, so-called moots, so they tried following each other and they formed this community, echo chambers that are very sticky

where they trap people inside these echo chambers. Why? Because these communities provide emotional and social support. They provide normalize, they provide validation for people. So that's what makes these types of dynamics very dangerous because once you fall into an echo chamber, pro-anorexia echo chamber, it's very hard to escape because you're isolated from pro-recovery type messaging.

and you just see others who continuously egg each other on to do even more extreme type behaviors. I mean, you labeled these toxic echo chambers because of this behavior. That's correct. They actually can promote unhealthy behaviors. But we have to keep in mind that these online ecosystems, they have dual use. You know, they do allow vulnerable people

struggling with these conditions to find each other, to kind of provide emotional, social support. So they can be helpful in case if it's recovery-minded, you know, can push people towards recovery, but they can also push people towards more unhealthiness, more unhealthy pro-anorexia type behaviors. You know, if you're surrounded by ill people, you'll be pushed towards illness. So that's why moderation is critical. It's crucial to

Kind of get rid of this ill content that's promoting illness. Instead, allow content that promotes recovery. Caitlin, you had mentioned when you were like exploring these communities. I mean, you just mentioned meanspo where somebody posts a picture of themselves and seeks out negative comments in order to, I guess, spur behavior of a certain kind.

Is that old school? You mentioned that this is old school. Was that happening before the lack of content moderation? Is this a way that people have been interacting for a long time around eating disorders? Yeah. I was talking to another researcher, Amanda Green, about this a little bit when I was working on the piece, but just because

because I've been on the internet myself for a long time and also in spaces that are predominantly used by younger women, especially when I myself was a younger woman, a lot of the rhetoric that was being used in the Meanspo posts just kind of

I guess like sort of triggered like distant memories for me of being on like Tumblr or Reddit 10 years ago or so. And when I was talking to Amanda about it, she suggested that perhaps a lot of that story

stuff had actually gone away during this, I don't know, kind of interwar period of stricter content moderation. Maybe people weren't being taking the risks to use such extreme language, which might have been which might have triggered certain filters or, you know, I think I think it would be hard to do that kind of thing on Instagram because they have

put a lot of effort into combating bullying with, you know, with keyword moderation and with which is pretty sophisticated. So I think it is an older style, an older, meaner, cruder style that maybe is being allowed to flourish again in kind of the absence of any supervision whatsoever.

Yeah. Well, we're talking about the rise of unmoderated or lightly moderated eating disorder content on X and other social media sites. We're joined by Caitlin Tiffany, a staff writer at The Atlantic. Her recent article is The Pro-Eating Disorder Internet is Back,

We also have Christina Lerman. She's a senior principal scientist and professor at the Information Sciences Institute at the University of Southern California. And we want to hear from you. Has someone in your life, a child, a friend, or a family member been influenced by online communities promoting eating disorders? You can email your comments and questions to forum at kqed.org. You can find us on Blue Sky, X, Facebook, Instagram, and Threads. We're at KQED Forum. Or give us a call, 1-866-733-6786.

That's 866-733-6786. Support for Forum comes from Broadway SF and Some Like It Hot, a new musical direct from Broadway from Tony Award-winning director Casey Nicholaw.

Set in Chicago during Prohibition, Some Like It Hot tells the story of two musicians forced to flee the Windy City after witnessing a mob hit. Featuring Tony-winning choreography and an electrifying score, Some Like It Hot plays the Orpheum Theatre for three weeks only, January 7th through 26th.

Tickets on sale now at broadwaysf.com. Support for Forum comes from Earthjustice. As a national legal nonprofit, Earthjustice has more than 200 full-time lawyers who fight for a healthy environment. From wielding the power of the law to protect people's health, preserving magnificent places and wildlife, and advancing clean energy to combat climate change, Earthjustice fights in court because the Earth needs a good lawyer.

Learn more about how you can get involved and become a supporter at earthjustice.org. Welcome back to Forum. I'm Grace Wan in for Mina Kim. On this show, we're talking about eating disorders and the impact of social media. If you or someone you know may be struggling with an eating disorder, there are ways to get help. The National Alliance for Eating Disorders has a helpline, 866-662-1235.

We're joined by Caitlin Tiffany. She's a staff writer at The Atlantic, and her recent article is The Pro-Eating Disorder Internet is Back. We also have Christina Lerman. She's a senior principal scientist and a professor at the Information Sciences Institute at USC. And also joining our conversation is Dr. Jenny Wong-Hall. She's a psychologist who specializes in eating disorders, relational trauma, and anxiety.

We also want to hear from you, our listeners. Has someone in your life, a child, a friend, a family member, been influenced by online communities promoting eating disorders? Or have you or someone you know found a positive online community that has helped combat an eating disorder?

You can give us a call now at 866-733-6786. That's 866-733-6786. Or you can email your comments and questions to forum at kqed.org and find us on Blue Sky X, Facebook, Instagram, and Threads. We're at KQED Forum. Dr. Wong-Hall, thanks for joining this conversation. I wanted to bring you in here to talk about some of the things that we've been discussing previously, and that's seeking community engagement.

Have you noticed in your own practice people that are online and are just looking for community around the idea of an eating disorder?

Absolutely. So thank you so much for having me today. I feel like this is an incredibly important, crucial discussion to be having for folks who have eating disorders. I would say in my practice, the large majority of my clients do seek community, seek a sense of belonging on internet forums, social media pages, in their own accounts.

And it's certainly a really mixed bag. I think a lot of what folks are highlighting today in this conversation is really important. There are aspects of the social media corners of the internet that are very unsafe and can be toxic and damaging. And there are also places where people are really finding safety and even motivation for recovery in these sort of darker corners. So I think it's a conversation that needs a lot of nuance.

Well, Caitlin, Tiffany, you've noted that on other platforms like TikTok and Instagram, there is moderation. When you search for this content, a message will come up. What's the message that you get if you search for under these, with these terms or search for eating disorders? Yeah, I'm not sure what the precise wording is, but I mean, they're pretty much all the same. Just they usually link to a national hotline and other, you know, like magazines.

medical resources regarding eating disorders. And more recently in the last year or so, the last year or so on TikTok, I'm not sure when Instagram added it. But now if you search on those platforms, like the screen pops up and you can't just click through it to the search results, which you can still do on Tumblr. But yeah, on Twitter, there's, or X, there's nothing like that. And I think, you know, there's probably,

a lot of research still to be done about how effective those warnings are. I think there is some research out there looking into that question, but it

It's obviously more effective than having absolutely nothing. Right. A guardrail. I mean, Dr. Lerman, I wanted to ask you, I mean, is that effective if I search for eating disorder on Instagram or TikTok or whatnot and I get this kind of a guardrail message that says, hey, you might need help, which is I did this just to see what it was. Is that an effective way to handle this? Is that an effective form of moderation? Yeah.

Well, I think that's better than nothing. As Caitlin said, we don't have good research on this, but certainly if I'm just, you know, imagine I'm a 12-year-old girl or something that, you know, is concerned about, you know, her weight and, you know, go online to Instagram or TikTok to find content. If there's something pops up prevents me from seeing like really toxic things,

Well, let's go to the phones. We have Alex in Oakland. Alex, welcome to Forum.

Good morning. I am 26 and I've been on Instagram since eighth grade and been on Tumblr and Facebook before that. So just like many of my other peers, especially women my age, I've been very exposed to this type of content. So I've been lucky enough to escape from maybe super explicit skinny inspo on Twitter, now X, but I find that my feed is just constantly...

bombarded with body-related imaging and maybe I'm involuntary clicking on it, whether it's bikini posts or other types of fad diets that I'm seeing. So I'm wondering, is it all kind of negative and does that make it difficult to differentiate and what your recommendations are given the kind of social media culture we live in?

to protect ourselves and to avoid exposure to just like the idea that there's one type of body that's better. Alex, that's such a good question. And Dr. Jenny Wong-Hall, I wanted to bring that to you. I mean, to Alex's point, I mean, how do you differentiate from content that's positive and content that can be undermining?

Yeah, absolutely. I think this is so important because so much of our current social media world is structured around, you know, body representations or wellness diets or, you know, kind of like food fads and things like that. And I think

what I really encourage my clients to do is ask themselves, how does this make you feel? What kinds of emotions come up for you when you're viewing this content? Because as neutral as the content may in fact be, if it is triggering some sort of body dissatisfaction, some comparison, some internal anxiety, that's time to hit unfollow. That's time to kind of take the steps you need to take to curate your social media feed so you're seeing things that are different. And

As much as we wish that the big tech folks who are making these decisions would be mindful of that, they aren't. So much is dependent on the user to structure their social media engagement in a way that will screen out some of these more toxic influences. Because even things that are really posed as body positivity can in fact be a part of a wellness diet culture trap.

And so it does really fall on the user to curate their feed as much as possible.

Dr. Wong-Hall, I was curious because in the last year, I would say, the conversations that we've been having about thinness have come on the rise because we have these new drugs, these GLP-1s like Ozempic and Monjaro and the like. And that's brought this idea of thinness into the public discourse in a way that we haven't seen in the past because these are drugs that can, in certain instances, combat obesity.

Do you think that these medications are encouraging conversations about thinness, making it more likely that people are having these conversations and valorizing thinness?

I think it really depends on who you're having the conversation with, because I think one of the things that is happening so much in celebrity culture is that, you know, celebrities, actors, musicians are coming out and saying, like, I feel the best I ever have. I've been eating well and working out and kind of behind the scenes. Most folks are thinking like amazing.

Maybe a GLP-1 was at play, but it isn't being explicitly named. And so in that way, I think that some of the glamorization of thinness and what is actually happening to help those people get there is being really invisibilized.

And on the other hand, in my practice, where I see many folks at a wide variety of body sizes, relationships with food, we're having really explicit conversations about the usage of these drugs to pursue thinness. And I think this could also open up a conversation around harm reduction within eating disorders. But what I will say is that having direct conversations about the pursuit of thinness in a paradigm that helps people maintain

as much psychological and physical health as possible is one that we really need to be having in the context of these drugs. It's a level of nuance that you're not going to find in People magazine, I think, right? Caitlin, Tiffany, you've noted that one of the ways in which these communities stay strong is that they evade detection.

And therefore, it makes it more challenging to control this content. I mean, for example, users don't tag this speech as bad speech or hate speech or dangerous, right?

Yeah, I think that's one of the reasons it's a difficult, has always been a difficult content moderation problem is that it's so in the situation of hate speech, a lot of times it's being directed at someone who will report it, obviously, because they don't want to see it. And the same thing with even like misinformation that will be subject to a lot of user reports because it will be seen by a lot of people and a lot of people who see it

we'll see it as content that should be moderated. But with a lot of eating disorder related content, I think just because the communities tend to be pretty insular, the people posting and sharing those things are genuinely communicating with each other. They're not going to report the content. And they're also highly motivated in part because a lot of them are very sick.

to evade detection by content moderation systems that are simplistic. And if you spend a lot of time online in one of these communities, you get savvy, you get familiar with how the systems work, you talk about how the systems work, educate newcomers to the community about how the systems work.

what kind of euphemisms you should use, what kind of like alternate spellings for certain words you should use. So that makes it something that a platform like X, which does

actually have a policy against eating disorder content, it becomes more of a matter of enforcement and the level of resources that you want to put into mitigating these things. Because like we've been saying this entire time, it is extremely complicated. There are downsides to removing a lot of this content all at once as well. If people who are struggling are part of what they feel is a supportive community, it can also be very scary and potentially damaging to have that ripped away from you all overnight.

And like we were also just discussing, like this is such a, it's so tied up in broader cultural issues of glorifying thinness or, you know, masking glorification of thinness with talk about wellness and fitness and et cetera, that it's hard to pull out and separate. One of the reasons that I think it was so important

easy for X to start serving me eating disorder content after I searched for it was just because like, this is a very popular type of content and it's part of a broader, very popular type of content. Um, so there's a lot of it. And, and I think like the, the,

that is part of what makes it challenging and that is that is very that makes it very obvious when a platform has kind of abdicated any responsibility for it because it's just like too complicated of a problem and they don't want to dedicate the time to sorting through all of that. Yeah, really difficult. Let's go back to the phones. Barbara in San Francisco. Welcome to Forum.

Well, thank you, and this triggers a memory of mine. I had a very attractive child, so attractive that when we were looking in the window at Gump's off of Union Square, a talent scout said, call me, we're shooting a movie. She also got active in school in dramatic productions. And I

I remember taking her to a talent scout here in the city, very nicely dressed and looking her best. And we talked for a while, and the talent scout looked at her and said, Honey, you're really cute, but you could lose some weight. Ooh.

Now, that was the point at which I said, no more of this, no way, if that's how the industry treats a child.

Well, that sounds like some good parenting, Barbara. You understand that we didn't touch that industry after that at all. Yeah. And I wanted to bring that to you, Dr. Wong-Hall. I mean, as a parent who is, you know, you're trying to make sure that your kids get positive messages and have the ability to filter out the negative ones. What do you think about Barbara's decision? And what's your advice to parents whose children get comments like that?

Barbara, I think absolutely it was the right decision to completely remove your child from an environment that was clearly going to be harmful. I think that what we're really living in and is so challenging for parents today is that there is all this conversation around body positivity and let's make every child, let's make every person feel beautiful. Every body is a good

body, all of these kinds of messages. And unfortunately, what that really creates is a pretty stark contrast for children and young adults who are seeing all these conversations and yet feeling so inadequate, experiencing for a variety of reasons their own insecurities. And what I would say for parents is that really the conversation that we need to be moving towards is one of body neutrality.

And this is something that the eating disorder field is having a lot of conversations around. How do we help children, young adults, even older adults come to a place where they have respect for their body, they can experience esteem and dignity in their body, but

without having there be a fixation on their appearance or the size and shape of their body because they already get enough of that messaging. And to then swing to body positivity is likely an unrealistic expectation. So, so much of the conversation I have with parents now is around working towards that body neutrality piece.

Christina Lerman, I want to ask you this. I mean, there's been this movement to take phones out of schools and to limit the amount of time or access that younger people have to social media. Do you think that that effort is going to help combat issues like these very pernicious and sticky communities that you've called these toxic echo chambers?

Absolutely. I do. You know, there's a lot of debate and controversy right now in the research community about the exact role of social media and its impact on adolescents and children. But I have no doubt that, you know, the John Haidt movement, you know, the John Haidt who is the scientist at NYU, New York University, taking phones out of schools, I'm sure his side will be vindicated in the future because he

You know, we've never lived in a time in history where when kids grew up

Being able to see what everybody else was doing all over the world, you know, within their peer groups, outside of their peers' groups. I can't imagine that this is healthy. So, yes, taking phones out of kids, you know, limiting access to social media content for young preteens and, you know, all the way through, like, 16 to 18-year-olds, you know, it will have beneficial effects, I'm confident. Yeah, I'm...

curious, I mean, Caitlin, you kind of mentioned this about the body positivity movement. I mean, especially in how you're saying, you know, the pro-eating disorder internet is back. What's happened to the body positivity movement? It was supposed to eradicate or at least address this issue online, and it seems to not have had much of an impact. Yeah, I guess, you know, I

I do understand what you're saying. I think I did a story of several years ago about the rebranding of Lean Cuisine and that was trying to get into this sort of like duplicity of saying that, as we've been saying, that all bodies are beautiful when in fact that doesn't seem to be the way that society actually feels about them. But I do

I do think it has had an impact. I would say one of the reasons I'm kind of ambivalent about the push to take teens off of social media or heavily moderate their use of social media is that I do see a lot of different types of people on my Instagram reels with different bodies who aren't

you know, drawing attention to their bodies all the time. I mean, there's a lot of comedy TikToks or, you know,

crafting, art, dancing, cooking. I think it is good to be exposed to a lot of different images of people doing things that they find interesting or that make them happy. It's just kind of a matter, I guess this is what we've been saying the whole time, it's just kind of a matter of where do you draw the line? Where does it start to slip into

You know, I'm just seeing image after image of someone who's like lifestyle and appearance I envy. And that's making me feel worse about my life. Right. Which social media can do. I mean, we're talking about the rise of unmoderated or lightly moderated eating disorder content on X and other social medias.

platforms. We're joined by Dr. Jenny Wong-Hall, a psychologist who specializes in eating disorders, Christina Lerman, a senior principal scientist and professor at the Information Sciences Institute at USC, and Caitlin Tiffany, a staff writer at The Atlantic, whose recent article is, The Pro-Eating Disorder Internet is Back.

We want to hear from you. Has someone in your life, a child or a friend, been influenced by online communities promoting eating disorders? Give us a call at 866-733-6786 or send us an email, forum at kqed.org. I'm Grace Wan, in for Mina Kim. More Forum after this break. Support for Forum comes from Broadway SF and Some Like It Hot, a new musical direct from Broadway from Tony Award-winning director Casey Nicholaw.

Set in Chicago during Prohibition, Some Like It Hot tells the story of two musicians forced to flee the Windy City after witnessing a mob hit. Featuring Tony-winning choreography and an electrifying score, Some Like It Hot plays the Orpheum Theater for three weeks only, January 7th through 26th.

Tickets on sale now at broadwaysf.com. Support for Forum comes from Earthjustice. As a national legal nonprofit, Earthjustice has more than 200 full-time lawyers who fight for a healthy environment.

From wielding the power of the law to protect people's health, preserving magnificent places and wildlife, and advancing clean energy to combat climate change, Earthjustice fights in court because the Earth needs a good lawyer. Learn more about how you can get involved and become a supporter at earthjustice.org.

Welcome back to Forum. I'm Grace Wan in for Mina Kim. We're talking about communities on the internet that valorize and celebrate eating disorders and what we can do about that. We're joined by Dr. Christina Lerman, a senior principal scientist and professor at the Information Sciences Institute at USC, Dr. Jenny Wong-Hall, a psychologist who specializes in eating disorders, and Caitlin Tiffany, a staff writer at The Atlantic, who's recently written an article called The Pro-Eating Disorder Internet is Back.

We're taking your calls and questions. Has somebody you know, a child, a friend or family member, been influenced by online communities promoting eating disorders? Or has someone you know found a positive online community that's helped combat an eating disorder?

You can give us a call at 866-733-6786. That's 866-733-6786. You can email your comments and questions to forum at kqed.org or find us on Blue Sky X, Facebook, Instagram, and Threads. We're at KQED Forum.

I wanted to take this comment from Janet, who writes,

The drugs may not be addictive in the conventional sense, but the entire weight loss experience may spiral into the addiction of anorexia. Please ask if these GLP-1 drugs are found in online groups and also how parents and others can be emotionally affected by seeing their child come close to a death they cannot prevent.

Well, Dr. Wong-Hall, I mean, I don't know if you can speak to the whether Ozempic is addictive, but this cycle of wanting to be thin, and we spoke a little bit about GLP-1 drugs and what kind of conversation they're creating. I mean, what do you see with how this intersects in your own practice? Yeah.

Yeah, so I will say the majority of folks that I do see have come to me already with an eating disorder and then have chosen to use the GLP-1 after the fact. So I do have sort of that kind of sample set. However, I will say that what I see more broadly happening in the mental health community is exactly what this commenter is speaking to, which is that

Individuals will go on these medications wanting to lose X number of pounds. And then what happens with the medication is what I would call kind of a reliance because what we know with the medication, at least the research has indicated so far and I'm seeing anecdotally and clinically, is that once somebody goes off the medication, if the food and behavior and fitness, you know, kind of choices have not shifted, then

people inevitably are going to gain that weight back. That causes a great deal of distress and then can absolutely lead to that spiral where individuals are saying, okay, I don't have this medication on my side anymore. Now I need to engage in X, Y, and Z kind of restrictive behavior or other eating disorder behaviors and absolutely can be a huge trigger for the onset of an eating disorder. So I think this commenter's certification

surviving, you know, family member from the eating disorder is absolutely spot on. And those of us treating eating disorders are highly concerned about this. Let's go to Katie and Marin. Katie, welcome to Forum. Hi, thank you. Tell us your story. My story is one that's really complex. But I am one of three sisters with a mother who's 80 now. And I just wanted to mention that

I'm 50 and my sisters are close in age. And I think that this affects so much more. It's a generational issue. And it is so sneaky and so pervasive and can look...

like so many different things. But I just want to say, like, I think that older women struggle with this and that mothers can struggle with this and impart some of those issues on their children. And just even with social media and the impacts and the complex

to be in today's world, like cleanses and detoxes and healthy living and healthy eating and only eating vegetables or only eating just the pressures that we feel to like, you know, be on our health, et cetera, I think can also translate into these kind of other worlds of eating disorders that are less obvious. And, um,

Um, it's concerning to me and it's confusing to me as a woman, um, because, you know, I'm trying to eat a non, an anti-inflammatory diet. Um, but what it feels like when I'm trying to eat an anti-inflammatory diet is like an eating disorder. You know, I shouldn't be eating breads. I shouldn't be eating high sugar content. I shouldn't be eating. And so managing through that has been really tricky for me, but I just want to say, um,

You know, I have a queen daughter and I don't really allow her to spend much time with her grandmother just because of the focus on outside beauty and what that looks like. And yeah, I just yeah, I just want to address kind of the generational issue of this with social media and all of the health issues.

Yeah. Yeah.

Yes, that's absolutely correct. Eating disorders, particularly anorexia, are experienced by many as a chronic illness.

individuals may feel that at points in time they go into remission and at other points they are in a flare, they're in a relapse. And so, yes, I see this impacting women and people of all genders throughout the course of their lives. I think speaking to that intergenerational transmission of eating disorders piece is extremely important and something that I do frequently in my practice. Yeah, I mean, and this idea that we

We want to, you know, Katie is trying to keep her tween daughter away from her mother just because she doesn't want those messages. I mean, and that's what we're trying to do on social media, Dr. Lerman. Isn't that right? We're trying to make sure that the younger people around us aren't being influenced by not just our parents and relatives, but just the worldwide Internet.

Exactly, because people actually, you know, like older adults, your family members, your peers, they teach you how to think. So if people don't teach specific, you know, normalize and teach people have to have these bad thoughts or like unhealthy thoughts.

ideas and cognitions about their body, then it also creates, kind of stops the problem in its tracks or at least prevents it from spreading further. And I mean, Caitlin, I wanted to ask you about Katie's other point, which was that

This idea that sometimes disordered eating is sort of, quote unquote, hidden as healthy eating or an anti-inflammatory diet. I mean, those are the reasons why these communities are so hard to address, right? Because on the one hand, you don't want to take away some healthy tips and content, but that healthy eating can, you know, tip over into something very scary a little bit more easily than we might think.

Yeah, I think that's totally true. And then when I was working on the story too, I was reading some papers about pro-recovery communities on TikTok in particular, which have some benefits like very clearly. But I think that kind of also becomes a little bit of a complicated situation because

when people are trying to come out of an eating disorder or talk to someone else that wants to come out of an eating disorder, they are still doing the sort of the same thing of giving each other tips on how to eat and how to feel okay about what they're eating. But oftentimes they're not really ready to be giving that advice. And the advice that they're giving is still very, you know, destructive and harmful and coming from this place of having, you know,

having liberalized their idea very slightly of what's an acceptable type of body to look at, but not fully. And they're still not getting the type of nutrition they need or still not thinking about the way that they're eating in a healthy way. So I think that that sort of vagueness of the spectrum of dieting advice and cooking advice and stuff on social media is part of what's so hard, especially in this era

of internet life where short form video content is kind of the dominant form of internet content. You're hearing people talk, you know,

you know, the front facing camera and they're speaking very relatably and they may even like put, you know, use language that sounds actually very encouraging and, you know, body positive and like they might even give disclaimers saying that they are not encouraging people to starve themselves, even as they're like making these recommendations for, you know,

eating less than a thousand calories a day or whatever, you know, avoiding all kinds of foods that are bad foods and things like that. So I think it is really, really complicated and hard for people to, for especially young people to know what they're actually supposed to be doing. Well, Noel on Discord writes, what is the line between orthorexia, which I understand is obsessive healthy eating, and a full-on eating disorder? Dr. Wong-Hall?

I think that's a great question, which the eating disorder field and the psychological, you know, kind of mental health field in general is really grappling with. There has been a lot of discourse as to whether or not orthorexia should be added as its own diagnostic code. What I'll say is that orthorexia in itself tends to have a specific set of fixations around this healthy eating, clean eating. There's a lot of kind of puritanical things

energy around orthorexia, whereas anorexia oftentimes has more kind of complex emotional layers underneath just those direct behavioral rigidities. There is such enormous overlap that I think it's really difficult to pull the two apart. And oftentimes, orthorexia is really a gateway into what we would more broadly describe as anorexia. So that orthorexic piece rarely stands alone for very long. Mm-hmm.

I mean, I wanted to ask you, I mean, back to this idea of what's hard to distinguish as good on the Internet and not so good on the Internet. Dr. Wong-Hall, have you found positive communities that help support people struggling with an eating disorder? So I think this is great.

I'm going to give kind of a disclaimer, which is that the conversation we're having is, of course, around the harms and the toxicity of some of these pro-Anna, pro-mia, pro-eating disorder spaces.

What I want to really highlight from having worked with folks for a decade plus who are in these communities is that, in fact, some of the conversations that occur in these darker corners of social media actually can be very helpful in keeping people alive. And so it feels like maybe a little bit twisted, but what I want to articulate here is that in some of those pro-eating disorder corners, one of the things that happens is that people will say,

you're engaging in this behavior, this behavior, and this behavior. Here's how to avoid an esophageal tear. Here's how to avoid sussing out. Make sure you get this nutrient at this time. And that is really a harm reduction lens that we're finding increasingly important in the eating disorder field. It's happening on the ground in these secret corners. Is it happening in the way that I most would want it to and would recommend when practicing harm reduction in my practice? Of

Of course not. However, I will say that some of those practices are happening there. And the other component in these circles is that this means though that we're kind of talking about, oftentimes what we see with people with eating disorders is they don't feel sick enough.

They don't feel like they belong in that community. So they're asking for all this critique, all of this negative feedback to validate, you know, whether or not they are sick enough. And oftentimes people actually do respond to those mean spoke kind of posts saying like,

this is enough, you aren't looking good, which how you look really has very little bearing on the severity of your eating disorder. But sometimes in those conversations, there actually can be the, you are sick enough, which then might empower somebody to go get help. So even in these darkest corners, I think we are seeing things that are helpful that professionals may not be able to provide. Well, you're listening to Forum. I'm Grace Wan in for Mina Kim.

I wanted to read this comment from a listener. "As a man in a larger body with an eating disorder, I recently entered and fairly quickly was discharged from an eating disorder treatment program. It was clear that the programs weren't for me despite my burning desire to heal. I appreciate your note at the start of the program about getting help and it would be irresponsible to not provide resources, but I wanted to be clear that in addition to the issues you're highlighting today, the world of eating disorder treatment is a complete private equity dumpster fire.

I mean, from that comment, I want to take that, you know, finding the resources to get better are, of course, difficult in our fractured health care climate. But also going back to you, Dr. Wong-Hall, this isn't just an issue that affects women and girls. This is an issue that affects men and boys as well.

It absolutely is. It is an issue that affects people of all genders. In fact, what we're seeing now is that in the research we're seeing essentially people with a variety of marginalized identities are far more at risk for eating disorders and are receiving either no care or poor care. But speaking to the issue of individuals who are being marginalized,

you know, subjected to eating disorder treatment in a larger body, oftentimes what happens because they are, you know, these private equity run kind of corporations, essentially, they are really legislated by insurance and insurance is going to either decide to cover treatment or not cover treatment, usually based on metrics related to weight.

And so if somebody is entering into treatment in a larger body, the metrics by which the treatment center and the insurance are assessing basically their progress are very murky. And oftentimes what happens is people are receiving really poor and invalidating care that actually can lead to what we call treatment trauma.

And so to this individual who experienced this treatment, I am so sorry that you went through this and the eating disorder treatment field is simply not built for everyone. And that is an area that the field just has leaps and bounds of growth to do.

Dr. Lerman, in the minutes that we have left, I wanted to kind of address this idea of is there a technological solution to moderating these groups? I mean, as Dr. Wong-Hall said, there's some positivity to be found in it. But what is your suggestion on how they can be moderated, if at all?

That's an excellent, excellent question. So my answer will be twofold. So going back to tools that exist right now, as actually Dr. Van Gogh was recommending to original listener, take curation of your feet into your own hands. You can block, you can unfollow, you can do these things.

But going forward, actually, this is what the topic of my research currently, you know, can we actually use AI technology, use the tools that are coming online right now to get a better understanding of human beings? So to understand all the nuances that we've been talking about with eating disorders and create tools that can automatically recognize harmful, unhealthy, unsafe content, right?

And I do think in the future we'll be able to do this. And my research lab is actually right now trying to develop AI tools to understand all these nuances. Well, I certainly hope that that is going to work out. I want to leave us with this last listener comment.

I'm a 58-year-old woman who grew up without the internet. Even back in the mid-80s, we had all kinds of negative information about our bodies telling us how thin we should be. Didn't come from the internet, but rather some of the fashion magazines at the time, TV shows, and of course, our friends and schoolmates.

The peer pressure was great. And I understand the social media influence can make it so much worse, but there's also a very positive influence on the Internet telling girls and women that not everybody needs to be a size two. In the 80s, we had none of that.

Well, we've been talking about the impact of social media on eating disorders, and we've been joined by Caitlin Tiffany, a staff writer covering internet and culture at The Atlantic. Thanks for joining us, Caitlin. Yeah, thanks for having me. And Christina Lerman, she's a senior principal scientist and professor at the Information Sciences Institute at USC. Thanks so much for joining us, Professor Lerman.

Thank you very much. It was fun. And we had Dr. Jenny Wong-Hall. She's a psychologist who specializes in eating disorders and relational trauma and anxiety. Thanks so much for joining us, Dr. Wong-Hall.

Thank you for having me. Thanks to all our listeners for their calls and comments. And please remember, if you or someone you know may be struggling with an eating disorder, there are ways to get help. The National Alliance for Eating Disorders has a helpline at 866-662-1235. I'm Grace Wan, in for Mina Kim, and you've been listening to Forum.

Funds for the production of Forum are provided by the John S. and James L. Knight Foundation, the Generosity Foundation, and the Corporation for Public Broadcasting. Support for Forum comes from Broadway SF and Some Like It Hot, a new musical direct from Broadway from Tony Award-winning director Casey Nicholaw. Set in Chicago during Prohibition, Some Like It Hot tells the story of two musicians forced to flee the Windy City after witnessing a mob hit.

Featuring Tony-winning choreography and an electrifying score, Some Like It Hot plays the Orpheum Theatre for three weeks only, January 7th through 26th. Tickets on sale now at broadwaysf.com. Support for Forum comes from Earthjustice. As a national legal nonprofit, Earthjustice has more than 200 full-time lawyers who fight for a healthy environment.

From wielding the power of the law to protect people's health, preserving magnificent places and wildlife, and advancing clean energy to combat climate change, Earthjustice fights in court because the Earth needs a good lawyer. Learn more about how you can get involved and become a supporter at earthjustice.org.