Body Image 46 (2023) 230–237

Contents lists available at ScienceDirect

Body Image
journal homepage: www.journals.elsevier.com/body-image

Examining health professional perspectives on social media body image

movements: A qualitative exploration ]]
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⁎
Gemma Sharp a, , Maria Bilal b, Anne Nileshni Fernando a, Kathleen de Boer a
a
Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
b
Royal North Shore Hospital, Sydney, New South Wales, Australia

a r t i cl e i nfo a bstr ac t

Article history: There has been a lack of investigation into the understanding of social media body image movements from
Received 2 March 2023 the healthcare perspective. Health professionals can have a strong influence on how their patients relate to
Received in revised form 6 June 2023 their own bodies, including experiences of weight-based discrimination. This study examined the per­
Accepted 8 June 2023
spectives of health professionals on body image social media movements and whether they believed they
Available online xxxx
were relevant to their professional practice. This study recruited 30 medical and allied health professionals
to participate in semi-structured interviews. Thematic analysis was used to generate common themes
Keywords:
Social media across the data. Overall, participants identified benefits associated with body positivity online content, but
Health professionals expressed concerns for the health status of influencers with larger bodies and that overall, the pro-anorexia
Qualitative movement was harmful. Despite having limited understanding and exposure to the body neutrality
Body positivity movement, participants generally preferred it over body positivity. Finally, participants stated that they
Pro-anorexia believed that these movements were relevant to their practice, yet were rarely discussed in consults. These
Body neutrality findings suggest there is a lack of body image-based discussions despite the relevance to patient health
across multiple domains. This indicates that health professionals may benefit from social media literacy
training to support thorough assessment and treatment of their patients.
© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction physical health as it can deter an individual from engaging with

It is well established that issues relating to body image can have
significant physical and mental health consequences. For instance,
negative body image is related to the development of eating dis­
orders (Mitchison et al., 2017), reduced sexual well-being (Gillen &
Markey, 2019) and negative body image may have implications in
terms of physical development in adolescents (Markey, 2010). Re­
search has found a positive relationship between negative body
image and depression (Begovic-Juhant et al., 2012), social anxiety
(Pawijit et al., 2017), and suicidality (Akram et al., 2022). Further­
more, negative body image may predict later life substance use
(Linardon et al., 2023). It can also have an impact on physical health
in direct and indirect ways. For example, research has found that
negative body image can predict inflammation processes that may
contribute to heart disease and diabetes, independent of body mass
index and waist-to-hip ratio (Černelič-Bizjak & Jenko-Pražnikar,
2014). Perception of body image can have a detrimental impact on
⁎
Correspondence to: Department of Neuroscience, Monash University, 99
Commercial Road, Melbourne, VIC 3004, Australia.
E-mail address: gemma.sharp@monash.edu (G. Sharp).
certain health treatments. For example, body image concerns may
contribute to whether some women with a genetic predisposition
for developing breast cancer choose to undergo potentially life-
saving breast removal surgery (British Psychological Society, 2018).
Some women report being concerned that breast removal will likely
lower their sense of feminity and body image satisfaction (den Heijer
et al., 2012). Body image concerns, particularly genital focused, can
also reduce a woman’s likelihood of engaging with routine cervical
cancer screening (DeMaria et al., 2011).
A particularly concerning body image-related issue in health­
care is weight stigma, defined as the discrimination and deva­
luation of individuals based on their weight, against individuals
who do not conform to social norms and body ideals (Tomiyama
et al., 2018). This stigma may play an especially influential role in
promoting negative body image among the increasingly growing
population of people in larger bodies (Tomiyama et al., 2018). A
number of studies have found positive associations between ex­
periences of weight stigma and negative body image, among
community or non-clinical samples (Annis et al., 2004; Vartanian
& Shaprow, 2008) as well as clinical samples of people experien­
cing obesity (Friedman et al., 2005; Jackson et al., 2000;
Rosenberger et al., 2006), even after controlling for body mass

https://doi.org/10.1016/j.bodyim.2023.06.004
1740-1445/© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
G. Sharp, M. Bilal, A.N. Fernando et al.
index, gender, age, and obesity onset (Friedman et al., 2005; Puhl
& Heuer, 2009; Rosenberger et al., 2007).
When people experience weight stigma, it can understandably
impact their willingness to engage in treatment for health issues.
Previous research has found that individuals with higher weights
were more likely to feel ignored in medical settings and be denied
required medical care where the impacts can be fatal (Carr &
Friedman, 2005). In healthcare, weight stigma may be promoted
through the attitudes of health professionals (Sabin et al., 2012). Our
research indicated that weight stigma is pervasive across a range of
physical and mental healthcare settings and can be perpetuated by
health professionals of all types ranging from general practitioners
to specialist medical professionals including those in weight man­
agement, to mental health professionals like psychologists and
psychiatrists (de Boer et al., 2023). We also found that while all
health professionals in our study understood the concept of weight
stigma, many of them did not understand the negative impacts of
this stigma on their patients’ well-being, including promoting a
negative body image (de Boer et al., 2023). As a result of our findings
and supported by previous research (e.g., Harwood et al., 2022), we
suggested that weight stigma as well as broader body image edu­
cation be included in the standard curriculum of medical and allied
health training programs.
Such educational approaches have been successfully im­
plemented with health professionals, predominantly those working
in the field of eating disorders. For example, Maguire et al. (2019)
studied 480 health professionals (including psychologists, dietitians,
nurses, occupational therapists and general practitioners) who
completed an intensive online eating disorder modular training
course which included body image focused content. The authors
found significant improvements in health professional confidence,
knowledge, skills to treat eating disorders and a reduction in stig­
matised beliefs from pre- to post-training completion. However, as
discussed above, body image concerns are directly and indirectly
related to a range of mental, physical and sexual health issues. Thus,
an understanding of the development of negative body image and its
impacts on health should not be confined to health professionals
working in the field of eating disorders. In addition and as suggested
by Hartman-Munick et al. (2020), “clinicians are advocates both in
their communities and throughout the world” (p. 459), and so
should have an understanding of the broader societal factors that
contribute to negative body image and weight stigma. This includes
the highly accessible, interactive and pervasive influence that is
social media. People are increasingly using social media as a source
of health advice, including for weight and body image focused issues
(e.g., Chen & Wang, 2021; Lupton & Maslen, 2019), and so in order to
provide the best care, health professionals need to have some un­
derstanding of this social media content.
Indeed, there has been a great deal of academic research activity
in the last decade or so investigating the impacts of social media use
and engagement on how people perceive their bodies. Social media
can have a significant influence over body image and contribute to
perpetuating weight bias (Clark et al., 2021). Research has found
engagement with Snapchat and Tumblr was associated with dis­
ordered eating for girls, whilst using all social media accounts (e.g.,
Snapchat, Tumblr, Instagram and Facebook) was associated with
disordered eating for boys (Wilksch et al., 2020). Additionally, a
positive relationship between social media and negative body image
has been found (see Saiphoo & Vahedi, 2019 for a meta-analysis).
Rather than overall time spent on social media platforms, the lit­
erature has shown that it is appearance-based activities which are
most impactful on body image (Faelens et al., 2021; Fardouly &
Vartanian, 2016; Saiphoo & Vahedi, 2019). Specifically, the viewing
of idealised and airbrushed social media images, including selfies,
can negatively impact body image (Cohen et al., 2021; Faelens et al.,
2021; Fardouly & Vartanian, 2016; Saiphoo & Vahedi, 2019).
231
Body Image 46 (2023) 230–237
A particularly extreme version of body image content/imagery on
social media which glorifies the thin ideal comes in the form of pro-
anorexia or “pro-ana”. It includes the sharing of material focused on
how to restrict calories, how to conceal symptoms, as well as sharing
motivational and inspirational content that reinforces cognitions
associated with eating disorders (Harshbarger et al., 2009). The
viewing of such content has been linked to reduced self-esteem, and
negative body image (Bardone-Cone & Cass, 2007). In contrast, var­
ious body image movements have been developed in an attempt to
improve self-worth and combat the negative influence of social
media, such as the body positivity movement. The body positivity
movement aims to promote positive body image through the sharing
of diverse images and bodies that are often counter to social ideals of
thinness and whiteness (Rodgers et al., 2022). Previous research has
indicated a positive relationship between exposure to body positive
content and improved body image (Cohen et al., 2019). However,
despite intentions to share diverse content, some studies on this
movement have found contradictions regarding content shared. In
fact, research has indicated that social media posts claiming to align
with the body positivity movement continue to celebrate thinness
and weight loss (Lazuka et al., 2020). Despite the foundation of body
positivity movements to promote diversity from social ideals, some
researchers argue that the continued focus on body appearance
contributes to perpetuating the idea that physical appearance is a
key driver of self-worth (Lazuka et al., 2020). Additionally, forced
positivity and love towards your body may undermine autonomous
body acceptance and indeed be counterproductive (Legault &
Sago, 2022).
More recently, there has been a shift to a non-appearance-based
movement called body neutrality. The premise of body neutrality is
to decentre the appearance of bodies, and instead focus on and
prioritise the functionality of bodies (Poirier, 2021). This approach
also emphasises removing judgement towards bodies, highlighting
that it is acceptable to feel neutral towards your body (Poirier, 2021).
This approach, however, is yet to receive as much research attention
as the body positivity and pro-anorexia movements. Recent research
has found that focusing on body functionality, a key component of
body neutrality, may contribute to improved mood and body image
(Mulgrew & Courtney, 2022). However, further research is required
to examine the impacts of body neutrality on body image and
mental health.
Health professionals are not exempt from the influences of social
media and body image movements. As discussed, given their unique
position as perceived authorities in heath, they may play an im­
portant role in contributing to the discussion regarding social media
use, body image, weight stigma and health (Clark et al., 2021). Fur­
thermore, medical and allied health professionals are responsible for
delivering treatment for issues directly related to weight and body
image as well as health conditions impacted by body image and
weight. Clark et al. (2021) recommend that health professionals
should be aware of the relationship between social media, weight
stigma and body image, not only to understand the context in which
an individual might sit, but to also be aware of the potential of social
media to promote health. While body image educational programs
may have upskilled some health professionals in particular clinical
fields like eating disorders (e.g., Maguire et al., 2019), a broader
understanding of the societal factors that contribute to body image
may have been neglected. To our knowledge, no research to date has
examined the understanding and perspective of health profes­
sionals, across a broad range of specialties, regarding social media
body image focused movements, and whether they believe these
play any role in their clinical practice.
Therefore, the aim of this study was to examine the perspec­
tives of health professionals regarding body image movements on
social media, namely: body positivity, pro-anorexia, and body
neutrality. A qualitative approach was used for this study owing to
G. Sharp, M. Bilal, A.N. Fernando et al.
the more exploratory and preliminary nature of the research topic
and to gain a deeper understanding of the perspectives of health
professionals. The study had the following four research ques­
tions:
1. What do health professionals think of the body positivity
movement?
2. What do health professionals think of the pro-anorexia
movement?
3. What do health professionals think of the body neutrality
movement?
4. Are these movements relevant to clinical practice?
2. Material and Methods
2.1. Participants
Participants were initially recruited via the authors’ health pro­
fessional networks, and via snow-ball techniques thereafter. The
recruitment was purposeful and aimed to include both allied and
medical health professionals, practicing clinically across diverse
settings, as previously described (de Boer et al., 2023).
2.2. Procedure
Individuals were invited to participate in a semi-structured
interview, via Zoom. Author KdB conducted the majority of the
interviews; however, where a close relationship was present, in­
terviews were conducted by other team members; GS and MB.
During the online interview, participants were shown social
media-based examples of each body image movement where all
authors agreed that the examples were representative of each
type of movement (see Supplementary Material). Each participant
was shown the same examples, even if stating they were familiar
with the social media movement. If they were unfamiliar with the
movement, a brief verbal description was provided by the inter­
viewer and then the examples shown to ensure understanding
from all participants. Interviews were 24–60 min in duration
(Mean = 45.0; SD = 8.9 min). Participants were reimbursed with an
online voucher worth $30 Australian Dollars equivalent for
their time.
2.3. Qualitative questions
Content relevant for this paper came from a larger qualitative
study, examining weight stigma and social media from the per­
spective of health professionals (de Boer et al., 2023). For the pur­
pose of this study, participants were asked questions regarding their
understanding and impressions of the body positivity, pro-anorexia
and body neutrality movements and their relevance to their clients
and practice.
Table 1
Overview of Themes, Sub-Themes and Participant Frequencies Generated from the Data.
Themes
What do health professionals think of the body positivity movement?
What do health professionals think of the pro-anorexia movement?
What do health professionals think of the body neutrality movement?
Are these movements relevant to clinical practice?
Body Image 46 (2023) 230–237
2.4. Ethics approval
The Monash University Human Research Ethics Committee ap­
proved the current study. Written and verbal informed consent was
obtained prior to each interview.
2.5. Data analysis
All interviews were audio-recorded and transcribed verbatim via
Otter (Otter.ai; Corrente & Bourgeault, 2022), a confidential online
subscription transcription service. Interviews were analysed using
thematic analysis, following the six steps outlined by Braun and
Clarke (2021) to identify patterns of meaning in the data. The re­
searchers adopted a broad, critical qualitative approach to analysis.
This was deemed appropriate, given the aim of the analysis was to
examine the perspective of health professionals and the implications
and impacts of such attitudes (Braun & Clarke, 2021). Additionally,
this approach allowed for the use of both inductive and deductive
analysis. The deductive approach allowed the researchers to ex­
amine the data to answer specific research questions, whilst the
inductive approach allowed themes to be generated that were
grounded in the data, rather than be shaped by pre-existing research
agendas. Data analysis was initially deductive, under the following
four domains: body positivity, pro-anorexia and body neutrality, as
well as relevance to clinical practice. Themes under these domains
were then subsequently generated from the data using an inductive
approach. Interviews were analysed by author KdB, via NVivo Plus 12
(QSR International).
To manage bias in analysis, author ANF independently coded 20%
of the interviews. The researchers met to discuss analysis, and re­
solve any differences generated from the data. Complete (100%)
agreement was reached between the two coders (see Supplementary
Material for code list). Themes and sub-themes were presented to
the research team for review and discussion before a consensus was
reached. Although sample size and saturation are debated in the
literature, samples of 15–30 are commonplace in qualitative re­
search (Braun & Clarke, 2013). Positionality statements for all au­
thors are provided in Supplementary Material.
3. Results
The final sample consisted of 22 medical and eight allied health
professionals (16 women, 14 men) working across diverse settings
within Australia. The sample included six general practitioners, four
psychiatrists and three each of bariatric surgeons, endocrinologists
and psychologists, as well as two dietitians. One each of the fol­
lowing were also included in the sample: orthopaedic surgeon, oc­
cupational therapist, exercise physiologist, nurse, obstetrician and
gynaecologist, plastic surgeon, gastroenterologist, general medical
intern and respiratory physician. A total of 25 (83.3%) participants
reported using social media for personal use, and 16 (53.3%) parti­
cipants reported they used social media professionally. Only three
participants reported that they do not engage with social media
Sub-themes Frequencies
n (%)
1. Body positivity is a good and helpful movement. 13 (43.3)
2. Body positivity is good, but there are concerns around health. 11 (36.7)
3. Criticisms of the body positivity movement. 13 (43.3)
1. Pro-anorexia movements are sad and concerning. 23 (76.7)
2. Pro-anorexia movements may create a community but with risks. 8 (26.7)
1. Body neutrality is more realistic and helpful. 21 (70.0)
1. Body image social media movements are relevant to practice and patients. 16 (53.3)
2. Social media movements are not often discussed in consults. 18 (60.0)
232
G. Sharp, M. Bilal, A.N. Fernando et al.
either personally or professionally. The most common platform used
was Facebook (n = 17, 56.7%), followed by Instagram (n = 13, 43.3%)
and Twitter (n = 12, 40.0%). See Table 1 for themes, sub-themes and
accompanying participant frequencies generated from the data.
Please note that participants may have endorsed more than one sub-
theme within a thematic category.
3.1. What do health professionals think of the body positivity
movement?
When asked about their understanding and impression of the
body positivity movement on social media, three themes were
generated from the data: 1. Body positivity is a good and helpful
movement, 2. Body positivity is good, but there are concerns
around health and, 3. Criticisms of the body positivity movement.
Sub-theme 1. Body positivity is a good and helpful movement,
captures responses from just under half of the participants (n = 13,
43.3%) who were encouraging of the movement and, importantly,
did not include caveats regarding concerns around health. For
instance, one participant stated: “I very much…love it and really
kind of cherish that they’re trying to create this new culture for
body image” (Participant 6, Occupational Therapist, Woman).
Some participants even explicitly acknowledged that they did not
believe that the body positivity movement “encourages obesity”.
For example, one medical doctor said: “I don’t personally think
that the body positivity movement, its main goal is to encourage
obesity. It’s about acceptance in my mind” (Participant 30,
Medical Intern, Woman).
In contrast, slightly over a third of participants (n = 11, 36.7%)
endorsed the body positivity movement, yet also expressed parti­
cular concerns around the health of those with larger bodies. These
concerns did not appear to be related to the gender or the specialty
of the participant. Furthermore, some participants believed body
positivity was good for non-weight related issues, which were still
related to appearance, such as skin pigmentation or amputees and
was good to help build confidence in people with larger bodies, on
the condition they were still able to maintain good health. For in­
stance, one participant stated: “I just want to make sure that they
don’t have any physical health conditions that they’re ignoring, just
to feel better about their body” (Participant 23, Endocrinologist,
Man). Another participant stated: “having a happy mindset, con­
fidence is good. But you also need a healthy physical body while
you’re alive, so I am concerned that this is not presenting a rea­
sonably holistic view of how…someone should live their life”
(Participant 28, Gastroenterologist, Man).
The third sub-theme generated was regarding criticisms of the
body positivity movement. When discussing the body positivity
movement, for as many participants who supported the movement
without any caveats, there were participants who raised concerns in
terms of the content shared (n = 13, 43.3%); for example, promoting
individuals who fit into the social norms and ideals. For instance:
“my concern is that I’ve already seen the body positive movement
co-opted by conventionally attractive, skinny white women”
(Participant 2, Psychiatrist, Woman). Another key concern identified
by participants was that being positive about your body may be out
of reach for many people. For instance, one participant said: “in an
ideal world, we’d all be hugely positive about our body and our­
selves. But I think perhaps that’s unrealistic to expect” (Participant 1,
Dietitian, Woman). This sentiment was echoed by others, with some
highlighting cultural conflicts within the body positivity movement.
For instance: “I think what comes with that, sometimes deliberately
or otherwise, is pressure on people to celebrate their bodies in ways
that they’re not ready for yet, or that may not fit with them cultu­
rally” (Participant 21, Bariatric Surgeon, Man).
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Body Image 46 (2023) 230–237
3.2. What do health professionals think of the “pro-anorexia”
movement?
Participants appeared to have less familiarity with the pro-an­
orexia movement, and when asked about their impression of it (after
receiving verbal and visual depictions), two sub-themes were gen­
erated within the data: 1. Pro-anorexia movements are sad and
concerning and 2. Pro-anorexia movements may create a community
but with risks. The prevailing sense from the vast majority of par­
ticipants (n = 23, 76.7%) was that the pro-anorexia movement was
unhelpful and harmful; participants used words such as “dis­
turbing”, “horrifying” and “deeply concerning” to describe the
movement. For instance: “[I] find it quite concerning, really, it’s so
easy to sort of get into that…[becoming] quite obsessed with trying
to achieve it [extreme weight loss] because someone somewhere has
showed that it’s possible” (Participant 5, Psychologist, Woman).
Another participant shared: “that creates such harm…and to have a
group of people pushing them along down that road…that’s just
absolute negligence and irresponsibility” (Participant 27, Plastic
Surgeon, Man).
Despite the consensus that the pro-anorexia movement is
harmful and problematic, a minority of participants (n = 8, 26.7%)
identified that social media platforms and pro-anorexia may provide
a sense of community for individuals with an isolating illness. For
instance, one participant stated: “the only way I could see that sort
of thing has been helpful is that to give…someone living with an
isolating illness, some degree of a community” (Participant 16,
General Practitioner, Man).
3.3. What do health professionals think of the body neutrality
movement?
The third movement that was explored with the participants was
the body neutrality movement. The participants had very little fa­
miliarity with the body neutrality movement; in fact, a large portion
of the participants (n = 22, 73.3%) had never heard of it and so a
verbal description was provided by the interviewer before showing
examples. One sub-theme was generated from the data: 1. Body
neutrality is more realistic and helpful. Often, participants compared
body neutrality with body positivity, and believed the unrealistic
attitude of loving your body perpetuated by body positivity, might
not be realistic for some individuals. Indeed, the vast majority of
participants (n = 21, 70.0%) thought adopting a neutral stance was
more achievable and helpful for their clients. For instance:
“I think that it’s unrealistic [body positivity], because sure there
are going to be some days when we are really happy with our
body, there’s also going to be days where we’re not. And that’s
normal for anyone. And I think that neutrality kind of idea…it’s…
a lot more of a realistic goal” (Participant 5, Psychologist,
Woman).
This adoption of a neutral stance was often in the context of
recognising the difficulty of some people moving from hating their
body, or wanting to change their body, to loving their body all the
time, and this may be too big of a shift for them. One participant
stated: “that idea [body neutrality]…is a little bit more realistic for
people as well to not have to go all the way to kind of loving their
body always” (Participant 6, Occupational Therapist, Woman).
3.4. Are these movements relevant to clinical practice?
When discussing body image movements, participants were also
queried whether they believed this social media content was re­
levant to their clinical practice. Overall, two sub-themes were gen­
erated from the data: 1. Body image social media movements are
G. Sharp, M. Bilal, A.N. Fernando et al.
relevant to practice and patients, yet 2. Social media movements are
not often discussed in consults. Overall, across all social media
movements, the majority of participants (n = 16, 53.3%) believed that
these were relevant to their patients and practice, and this was true
across various specialties. For instance, one doctor stated: “it is de­
finitely relevant in terms of knowing what my patients might be
thinking” (Participant 23, Gastroenterologist, Man). This sentiment
was reinforced by a dietitian: “it’s definitely relevant. Because this is
something that people are exposed to” (Participant 9, Dietitian,
Woman). Furthermore, one participant emphasised how having an
understanding of various social media movements contributed to
their practice. They stated:
“I think understanding more about patient perspective is really
important. And I think that’s something social media has defi­
nitely helped me as a doctor…just more understanding of how
significant the negative experiences people have has really
helped me and…it’s shaped how I approach talking to people.”
(Participant 20, Endocrinologist, Woman).
The second sub-theme identified captures content relating to
whether social media movements were discussed in interactions
with their clients. There was less consistency across the specialties
with this theme, with 60.0% (n = 18) of participants reporting that
the topic did not often arise or arise at all in discussions with pa­
tients. For instance, one participant stated: “I don’t think that they’ve
actually had anyone mention it specifically” (Participant 24, Nurse,
Woman). One General Practitioner even acknowledged that the fact
it might not arise could be contributed to by their lack of under­
standing on the topic, for example: “it hasn’t come up. But I think
maybe it’s my lack of understanding of the topic” (Participant 17,
General Practitioner, Man).
However, discussion around social media being raised in clinical
practice appeared more relevant for those who had specific experi­
ence working with eating disorders. For example: “that has come
up…like how some of the young people we’re seeing on the wards
are accessing things like TikTok and social media…people who are
portraying eating disorders” (Participant 15, Psychiatrist, Man). This
was shared by a psychologist who stated: “definitely…body positive
kind of stuff…I do hear a fair bit about that, from my client per­
spective” (Participant 5, Psychologist, Woman). A dietitian with ex­
perience working with eating disorders stated they frequently
discuss social media with patients, and actively encourage disen­
gagement from platforms promoting unhelpful content. They
shared:
“we often work on with our clients is a weeding of social media
and removal of anything that does exacerbate any sort of feelings
and behaviours [related to disordered eating]…individuals need
support and guidance to curate their world and…almost recalibrate
how they receive information and respond to information”
(Participant 1, Dietitian, Woman).
4. Discussion
The aim of this study was to examine the perspectives of health
professionals regarding body image movements on social media,
namely, body positivity, pro-anorexia, and body neutrality, and
whether health professionals believe these movements are relevant
to their practice. The findings from this study are novel. To our
knowledge, there has been no previous investigation of the per­
spective of health professionals focused on body image social media
movements. The findings suggest that some health practitioners see
benefits in the body positivity movement yet some expressed con­
cerns regarding the health status of some influencers, especially
those with larger bodies. The vast majority perceived the pro-anor­
exia movement as harmful, with a minority identifying that social
media may provide a platform for connection for those with eating
234
Body Image 46 (2023) 230–237
disorders. Finally, participants were less familiar with body neu­
trality and, when comparing it to body positivity, this was the pre­
ferred movement. Furthermore, the study found that, although
health professionals mostly believed that these movements were
relevant to their patients and clinical practice, most participants
rarely had discussions about body image movements in their prac­
tice. Overall, it appeared that health professionals may have under­
estimated their power for advocacy in the body image space and the
promotion of good mental and physical health.
Our findings potentially suggest that although health profes­
sionals recognise the relevance of these movements for their pa­
tients, explicit conversations were generally confined to eating
disorder treatment settings. This is an important gap, as research has
demonstrated the role of social media in perpetuating weight bias
and both the physical and psychological impacts weight bias may
have (Lee et al., 2021; Tomiyama et al., 2018) and such health out­
comes are relevant across health specialties. The findings suggest
that health professionals may be sitting at the periphery of the
conversation regarding body image and weight-related issues. Fur­
ther, given the prevalence of social media use, patients may be using
this content as a source of evidence and health advice, yet health
professionals seemingly appear not to explicitly acknowledge this
influence within their practice.
Overall, the findings from health professionals correspond with
previous research from social media users’ perspectives. Generally,
the benefits associated with the body positivity movement noted by
the participants are reflective of those benefits reported in previous
research (e.g., Cohen et al., 2019; Stevens & Griffiths, 2020). A size­
able percentage of participants shared criticisms of the body posi­
tivity movement, such as continuing to promote thin white bodies
and pressuring people to love themselves, which have been reported
in previous studies (e.g., Lazuka et al., 2020). Similarly, the sample
overwhelmingly acknowledged the potential harm associated with
pro-anorexia movements, which is reflective of the current state of
the literature, and suggests exposure to such movements may ne­
gatively impact mental and physical health (e.g., Dignard & Jarry,
2021; Prichard et al., 2020).
When viewing body positive content, participants also expressed
concerns regarding the health status of individuals depicted in the
imagery, particularly those in larger bodies. This may suggest a level
of internalised weight stigma, and such attitudes may translate into
their in-person consultations (de Boer et al., 2023). Moreover, the
conflicting attitude between some health professionals who did not
express concerns around weight and health, and those who did, may
potentially prompt confusion for patients receiving care from multi-
disciplinary health teams (Halmi, 2009). For instance, a psychologist
may recommend a patient engage with body positive social media
content, yet an endocrinologist may not be so embracing of this
messaging citing a pro-weight loss perspective, and ultimately po­
tentially leaving a patient confused about how to improve their
health.
The findings from this research significantly contribute to the
literature regarding body neutrality. The results suggest health
professionals were quite unfamiliar with this movement. Yet, de­
spite their limited understanding, the overall preference from
participants for body neutrality due to perceived benefits, such as
being more realistically achievable for patients, is reflective of
previous research (e.g., Mulgrew & Courtney, 2022). Mulgrew and
Courtney (2022) found that viewing content related to body func­
tionality contributed to increased body appearance satisfaction.
Future research regarding the body neutrality movement is war­
ranted to examine whether it provides messaging that aligns across
health specialties, ensuring more consistent messaging to patients.
Additionally, research could examine whether health professionals
may be able to leverage social media in health interventions around
body image and weight.
G. Sharp, M. Bilal, A.N. Fernando et al.
There are several important strengths associated with this study.
The sample was comprised of diverse participants, not only in terms
of their profession, but as well as their engagement with social
media. The sample also included a fairly equal representation of men
and women health professionals, although the perspective of gender
diverse professionals should be included in future research. The use
of qualitative methods allowed the in-depth exploration of the
perspectives of the participants. The use of qualitative research is
especially relevant when examining topics that have not received
much research attention. This study examines the experience of a
key population that consumes social media and may have biases
when viewing body image social media content. Such biases, for
instance internalised weight stigma, may impact weight-based pa­
tient discussions.
There are some key limitations associated with this study. While
we collected details of the participant’s professional practice and
social media use, we did not collect demographic information be­
sides gender (e.g., age, ethnicity). Furthermore, health system
structures can vary considerably throughout the world so the per­
ceptions of our purely Australian based sample may not necessarily
generalise to health professionals in other geographic regions.
Furthermore, although a wide range of health specialties were re­
presented in this study, cardiology was a notable absence. In addi­
tion, despite giving the same definitions/examples of social media
movements, it cannot be guaranteed that all participants shared the
same understanding of each movement throughout the interview.
The interviews were vulnerable to self-presentation and social-de­
sirability bias. Although some participants expressed concerns re­
garding the weight of some individuals within the body positivity
space, they may have tempered their responses regarding their
impression of these movements. Furthermore, this study did not
explore the fitspiration movement, which is distinct from pro-an­
orexia content. Fitspiration content includes images and videos that
represent a “fit ideal” and is becoming increasingly popular on social
media (Deighton-Smith & Bell, 2018). Research has found that there
are thematic similarities across both movements, including themes
of thinness, eating guilt and restriction (Boepple & Thompson, 2016).
Further research could examine if health professionals may perceive
fitspiration content to be acceptable compared to pro-anorexia,
particularly if research indicates it may continue to perpetuate
harmful messaging (Pryde & Prichard, 2022).
4.1. Implications
This study highlights several key implications. The findings po­
tentially suggest that health practitioners are not having conversa­
tions with their patients about body image, outside of the context of
eating disorders, despite the pervasive health implications negative
body image and weight stigma may have. Health professionals are
now practicing in a new era of health messaging, where information
about optimal health is presented outside of consultation rooms and
in a way that does not sound like traditional medical advice. Health
professional involvement on social media may dismantle traditional
silos of information and may contribute to disseminating evidence-
based medical information in an accessible way to the wider po­
pulation. This suggests that health professionals may potentially
benefit from social media literacy interventions, in addition to
general body image education (Aniulis et al., 2021), not only to en­
hance critical engagement with the media but harness the potential
to use social media in health interventions, as suggested by Clark
et al. (2021).
Multiple systematic reviews have found that media literacy in­
terventions are effective at enhancing body image (Kurz et al., 2022;
McLean et al., 2016) and may improve body dissatisfaction in women
at high risk for eating disorders (Coughlin & Kalodner, 2006). Such
interventions may have flow-on health impacts and may be relevant
235
Body Image 46 (2023) 230–237
for addressing weight stigma in health professionals as well. More
specifically in terms of the pro-anorexia movement, health practi­
tioners may benefit from including exploration of social media use
and engagement with pro-anorexia content when assessing clients.
Harshbarger et al. (2009) suggest that clinicians who are aware of
“tips and tricks” shared on such platforms regarding anorexia may
be better placed to identify eating disorder symptoms in their pa­
tients.
4.2. Conclusions
To our knowledge, this is the first study to examine the per­
spective of health professionals on body positivity, pro-anorexia, and
body neutrality movements, and whether practitioners believed
them to be relevant to clinical practice. Overall, the findings suggest
that health professionals found benefits associated with the body
positivity movement yet had prevailing health concerns. Ultimately,
health professionals appeared to endorse body neutrality without
reservations, despite their limited exposure to the concept. This re­
search found that most health professionals recognised that these
movements were relevant to their clinical practice, despite few
identifying occasions on which social media movements were dis­
cussed. This may imply that health practitioners may benefit from
education regarding the relationship between weight, health and
social media as well as social media literacy training. In this way,
health professionals can better serve as advocates in the protection
of body image satisfaction, and, in turn, broader good health.
Funding
This work was supported by the General Sir John Monash
Foundation Collaborative Grant scheme.
CRediT authorship contribution statement
Gemma Sharp: Conceptualization, Funding acquisition,
Methodology, Investigation, Writing – original draft, Writing – re­
view & editing, Supervision, Project administration. Maria Bilal:
Conceptualization, Funding acquisition, Methodology, Investigation,
Writing – original draft, Writing – review & editing. Anne Nileshni
Fernando: Formal analysis, Writing – review & editing. Kathleen de
Boer: Investigation, Data curation, Formal analysis, Writing – ori­
ginal draft.
Data Availability
The data that has been used is confidential.
Declaration of Competing Interest
None.
Acknowledgments
The authors would like to thank all the health professionals for
their time in participating in this research project.
Appendix A. Supporting information
Supplementary data associated with this article can be found in
the online version at doi:10.1016/j.bodyim.2023.06.004.
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