Assessment of Accuracy, User Engagement, and Themes of Eating Disorder Content in Social Media Short Videos.

Importance: Social media is simultaneously home to communities of users who promote eating disorders as a lifestyle and users who advocate for recovery. As studies have confirmed an association between exposure to pro-eating disorder content and engaging in disordered eating behaviors, an examination of the accuracy of and interactions with information shared in these complex and contradictory communities can provide insights into content available to users at risk. Objective: To determine the associations among themes, accuracy of information, and user engagement of eating disorder content on a short video-sharing social media platform. Design, Setting, and Participants: This qualitative study included a thematic analysis of a sample of 200 TikTok videos, as well as user engagement metrics and content creator characteristics, between February and June 2022. Data were analyzed from March to June 2022. Main Outcomes and Measures: Content themes, accuracy of information, user engagement, and the associations among these factors were identified in a sample of eating disorder videos on a social media platform. Data were analyzed with Pearson χ2, analysis of variance, linear regression, and random permutation tests. Results: Among the 200 videos assessed, 124 (62.0%) covered prorecovery content, 59 (29.5%) included pro-eating disorder content, and 17 (8.5%) contained anti-eating disorder content. Thematic analysis revealed 4 high-level themes: (1) encouraging the development or sustainment of eating disorders, (2) sharing physical or emotional experiences with eating disorders, (3) sharing narratives of recovery, and (4) social support. While the results of Pearson χ2 test indicated that videos in the prorecovery domain contained more accurate content than videos categorized in the pro-eating disorder and anti-eating disorder domains (χ24 = 157.92; P < .001), the results of analysis of variance demonstrated that there was no significant difference in user engagement between informative and misleading content (likes: F = 0.110; P = .95; comments: F = 2.031; P = .13; views: F = 0.534; P = .59; shares: F = 0.691; P = .50). Results of the 10 000 random permutation tests, in which all P values were between .40 and .60 regardless of the distances, suggested that there was no significant difference in user engagement among the 3 domains. Conclusions and Relevance: This mixed-methods qualitative analysis of misleading eating disorder information on social media found that pro-eating disorder and prorecovery communities were prevalent. However, social media users in the prorecovery community created more informative than misleading content. Furthermore, the study found no significant difference between users' engagement with accurate vs misleading videos, which may suggest that false information alone does not influence the virality of videos.