COMMENTARY

TikTok Time Bomb: Perpetuating Weight Loss and Diets

Caroline Apovian, MD

Disclosures

November 16, 2022

A recent study analyzing the content of TikTok videos from popular nutrition, food, and weight-related hashtags, each with 1 billion views, revealed glorification of weight loss as well as a lack of experts providing nutrition information.

Caroline Apovian, MD

Most of the content creators were revealed to be female adolescents and young adults in high school and college who lacked credentials, such as registered dietitian, doctor, or certified trainer. The distinct themes of the videos promoted the idea that intense weight loss programs are achievable and that being unable to lose weight is attributable to lack of willpower and motivation.

Having graduated from college 30 years ago, there's a lot that's new here, including the internet and TikTok and the rapid transfer of information, both inaccurate and accurate.

However, there's a lot that is disappointingly not new. We have not moved on from the idea that weight loss will provide us the self-worth and happiness that we need and crave.

Many years ago, I struggled with an eating disorder, which did one thing: It diverted my attention away from the joy of learning new things and fed my lack of self-worth until I was able to conquer it on my own. It allowed me to waste quite a bit of time focusing on the size of my thighs instead of using my mind to learn science, art, music, and languages and making strong friendships. Underlying eating disorders is certainly a battle with depression and anxiety that comes from a culture that rewards an ideal view of beauty and thinness, although this is slowly starting to change.

The fact that most of the young adults creating content about weight loss on TikTok are female continues to identify women as falling prey to ideals regarding beauty and size. The feminist movement has a long way to go.

On Repeat: Thin Is In

What will change this recurring theme of the ideal body image being thin like Twiggy, the lean supermodel from the 1960s? We may have morphed Twiggy into a similar silhouette, only more muscular — but equally unattainable.

How can we help young people develop critical thinking skills and their own personal body image ideals that reflect health at their genetic size? Here are some thoughts:

  • Infuse TikTok with credentialed expertise — we need dietitians and exercise specialists who can teach in a style that captures the TikTok audience while promoting evidence-based nutrition and physical activity advice.

  • Continue to advance the message that obesity is a disease and that environmental changes are also responsible for obesity until it becomes public knowledge. The inability to lose weight in this environment and keep it off is not a moral or motivational failing. The difference between weight loss to improve health and weight loss to achieve thinness must be distinguished here.

  • Develop a better marker of excess body fat than the body mass index or weight. A marker of poor health due to excess body fat could be a blood marker or fat biopsy showing inflammation, for example. Once this is established in the medical world, weight related comorbidities can be separated from cosmetic weight concerns. A separate distinction can then be made regarding medical weight loss for health reasons and cosmetic weight loss. Health at any size is a good start, but without a clear distinction between medically unhealthy and healthy weights, the field cannot move forward a clear message to the public.

The big difference between today and 30 years ago is the higher prevalence of obesity affecting our children and adolescents as well as young and older adults. The clear message from the research world is that the environment is quickly changing to promote this higher prevalence, as our genes haven't changed in this short amount of time.

Studies intimate that when faced with highly processed foods, we eat more calories than when presented with unprocessed foods. The obvious antidote to this is to adopt healthy eating patterns that avoid highly processed foods. However, a new eating disorder has emerged called orthorexia nervosa, which can be defined as a fixation on attaining optimum health by only eating unprocessed foods at all costs. Playing with your body's need to maintain a certain body weight can wreak havoc with appetite and satiety and promote overeating and shame.

Orthorexia nervosa is the modern-day (2020s) version of an eating disorder that is also affecting males in addition to females. At its worst, it can affect relationships and also lead to malnutrition, much like anorexia nervosa and bulimia nervosa. Orthorexia nervosa can be considered to be an epigenetic phenomenon because of the modern-day attention to highly processed foods and focus on healthy unprocessed foods. This has affected those with a genetic predisposition to obsessive-compulsive disorders and other depressive disorders. It affects men in greater numbers than its associated disorders anorexia nervosa and bulimia nervosa because the focus is not on food quantity, but on food quality. The focus is less on weight "perfection" and more on food "perfection."

How else can we help young adults navigate this maze of nutritional adversity? The key to food and nutrition and healthy relationships with food and health may be more focus on psychology. Depression and anxiety can lead to many dysfunctional relationships to food, exercise, drugs and alcohol. From an obesity medicine and nutrition specialist point of view, there aren't enough psychologists, psychiatrists, and social workers in the medical field who specialize in eating disorders and weight-related illnesses.

I found my own way out of an eating disorder via athletics. I grew up prior to Title IX but developed a sense of empowerment and strength via running, swimming, and biking. It also helped me burn all those calories I ate out of desperation from depression.

The science of exercise physiology is expanding because of new research exploring the cross-talk between muscles and white and brown adipose tissue. Perhaps the way out of unhealthy eating behaviors and ultraprocessed foods is additional education regarding the body weight set point along with how muscle talks to fat and vice versa. The body weight set point is determined by the brain after receiving signals from fat adipose tissue, muscle, and other organs. Understanding this will give more credence to food as medicine and exercise as medicine. It may be that we need to point the finger at highly processed foods as detrimental to our body weight set points. With highly processed foods eliminated, there will be less highly palatable foods that are nutrient poor and calorie dense to offset our natural healthy body weight set points.

Imagine there are no highly processed foods? I wonder if we can. Maybe I'm a dreamer, but there is a healthier world out there now, with so much less tobacco smoking than there was in the 1960s and before.

The cardiovascular and lung damage caused by tobacco smoking was revealed to the public via educational messaging and elimination of advertisements to smoke, especially to young people.

TikTok can promote messaging from credentialed experts educating our young people regarding healthy eating and exercise based on evidence from the literature. The processed food study referenced above showed that eating a highly processed food diet naturally caused people to eat 500 kcal more per day before experiencing fullness than an unprocessed diet did. Let's promote this information on TikTok — as long as it doesn't start a rash of orthorexia. That old adage about moderation comes to mind.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....