It was her dentist who first noticed and raised the issue. The issue Ola Fleszar had feared might come up for more than a year. A question which was born from an observation.

“Ola, do you have bulimia?” he asked.

Her closest family and friends hadn’t seen the many other physical telltale signs. Our stomachs contain a concoction of harsh acids – hydrochloric, potassium chloride, sodium chloride – that help break down our foods for digestion. Stomachs are built to hold these volatile gastric juices. Our mouths are not. In our mouths, these chemicals can cause hemorrhaging, swell salivary glands, and burn away the enamel from teeth. So, on a routine checkup, Fleszar’s dentist asked her a question. A common question within a dental office. 

Dentists diagnose 30 percent of bulimia cases.

Fleszar says a large degree of her struggle with anorexia and bulimia was due to social media and the models, actors, and fitness influencers who showcase their bodies to millions of onlookers. Physiques which are gorgeous, enchanting, enviable – and unattainable.

“I used to see women on social media, where every part of their body was perfect. So, I would put on my trainers and my activewear and go on runs for 20km,” Fleszar says.

She’s not alone. A study in the Adolescent Research Review confirmed social media usage is correlated with negative thoughts about our bodies. The images you post online of yourself or what you eat may affect other people. It may affect what they eat or how they think about their bodies. This information is bombarding. Potentially it’s harming. Does this realisation mean that people should be more mindful and perhaps reconsider some of the things they post? Is there a duty of care from the poster to the viewer, given their content could be destructive? Is the quest for a healthy social media feed as unattainable as the bodies it promotes?

Dr Laura Dondzilo is a research associate at the University of Western Australia’s School of Psychological Science. Her work investigates body image disturbances and how food-related content impacts cognitive biases. Dondzilo’s research shows that image comparison is a key driving force behind eating disorders.

“My research has shown that there is a strong link between preferential attention to these idealised body shapes and body dissatisfaction and eating disorders behaviours. It’s directly applicable to social media,” she says.

Constantly scrolling through pictures of perfectly sculpted physiques erodes our relationship with our physical selves. It changes the way we view a fundamental concept of who we are. This, in turn, changes our relationship with food. It makes us question the types of things we put in our mouths, stops us from putting things in our mouths, and sometimes causes us to regurgitate things back up.

Fleszar says: “I used to eat food, then go to the toilet and straight away vomit. All the time. That was every single meal. When I used to go to bed, I would think about the meals for the next day; what I’m going to eat. You’re constantly thinking about food, and you’re basically [always] hungry. You can’t focus on studying. You don’t think about boys. There is nothing else to think about. It’s just food.”

Food content on social media is abundant. Search the word ‘food’ on any platform, and you will find restaurant reviews, ‘what I eat in a day videos, catch-n-cooks, mukbangs, a look inside my fridge, the 24-hour fast challenge, the 10 000-calorie challenge, the 20 000-calorie challenge, 30 000-calorie challenge and more.

Watching people eat is big business. Dondzilo explains food content can also be incredibly harmful when viewed by the wrong eyes. People with eating disorders categorise food differently than people without eating disorders.

“People with anorexia nervosa tend to categorise food in terms of calories, whereas healthy individuals tend to categorise food in terms of tastiness. The more people judge food in terms of calories, the greater their likelihood of developing eating disorder symptoms.” Dondzilo says.

There are eating disorders and then there is disordered eating. Eating disorders make up the more extreme end of the spectrum. They contain binge eating disorde, bulimia, and anorexia. They also contain more niche and less talked about conditions. This includes atypical anorexia nervosa, purging disorder, or night eating syndrome. Around four per cent of Australians live with an eating disorder.  

The less talked about, but more pervasive category, is disordered eating. Disordered eating includes neurotic dieting, meal skipping, obsessive calorie counting, and chronic fasting. According to the National Eating Disorders Collaboration, 30 per cent of Australian adolescents suffer from disordered eating. A figure which has increased sixfold in the past 30 years.

Dr Jeremy Marriot is a clinical psychologist and personal trainer who has watched body image evolve from within the industry over this three-decade period. Marriot believes the biggest impact social media has had on body image has to do with anonymity. Social media has created an environment of strangers. Internet shadows that give nutritional advice then can disappear into the ether. Before the internet, the people who influenced your body image were local. People you could touch, see, smell; build actual relationships with.

“There were always influences in the fitness industry, but those influences were usually local people; people who would be in the gym, win a fitness figure competition, or be local sporting stars. If you had a local person, you would talk to them, get to know them, and get direction in person. There’s no regulation of that online,” Marriot says.

The lack of relationships on social media breeds a more dangerous situation; unregulated and unqualified advice delivered over the internet. Marriot says this can be incredibly harmful.

“Fitness professionals like me know we are never to give nutritional advice, and we are told very clearly to refer them [to the correct people]. With social media, a lot is happening in that space, and it’s unregulated.”

Regulation and censorship of social media content is a divisive topic. The argument is just as tense within nutrition and body image content. April Ooi is a food influencer and food reviewer for The West Australian and has a TikTok channel with more than 20 000 followers. She does not believe social media platforms should regulate the type of content food-based influencers make.

“That [regulation] would be too onerous on content creators,” Ooi says.

However, social media companies are adjusting and beginning to self-regulate based on harmful content popping up on their platforms. Even TikTok, Ooi’s platform of choice, has taken major steps in this direction. What has been labeled ‘pro-ana’ (short for pro-anorexia) content became so prevalent that the platform had to ban it early in 2022.

Dondzilo believes self-imposed regulation is an imperfect practice. Producers of pro-eating disorder content are finding new ways to sneak past regulation. New hashtags can be created, and videos can be labeled with deceptive titles. Algorithms evolve to fight trickery, but the tricksters likewise evolve in turn.

Instead, Dondzilo favors methods that remove all gamesmanship from the contest between content producers and social media employees. Power must be given to the viewer. People need greater social media literacy, education, and body-positive content. It’s common practice to compliment a friend on their appearance when they post things online. As Dondzilo explains, these comments are well-intentioned, but those pixels which make up their lettering form a poisoned chalice. Contrary to popular belief, positive appearance comments on social media are harmful because they reinforce the focus on body image.

Dr Dondzilo says TikTok it as an especially damaging platform in this regard.  

“A TikTok trend that particularly promotes a dangerous relationship with food is the ‘what I eat in a day’ trend. They often focus on restricting caloric intake and eating as little as possible. These trends can be very triggering for people recovering from an eating disorder or at risk of developing one.”  

As a large TikTok influencer, Ooi holds a contrasting opinion.

“I think social media does a good job [with nutrition]. My TikTok for you page is all ‘what I eat in a day,’ and in those videos, there’s always so much food, there’s no longer this idea that people are eating nothing,” she says.

For Ooi, social media has removed a veil. A veil that healthy people eat nothing. In her feeds healthy people gorge. They eat the foods they want. They seek the foods they crave, and they are better for it. It’s a healthier mindset. It’s intuitive.

She says the bigger issue lies with body image content. Fads like the ‘collarbone challenge.’ A challenge where people see how many coins they can fit in the nape of their collarbone. These are the things that are damaging. The seemingly irreverent craze or the absurd trend that tells people beauty can only be achieved by one measure: thinness.

Dondzilo is pressed to find food and body image content that isn’t inherently harmful. A way to showcase what we eat without hurting others. A way to put our bodies online without causing damage. A way to exist in the online world without causing people to have eating disorders.

In the vacuum left by pro-ana content, anti-pro-ana content emerged aimed at helping people recover from eating disorders. While this content is often heralded as beneficial for eating disorders, a 2021 study in the Journal of Environmental Research and Public Health found anti-pro-ana content had the opposite effect than what it is congratulated for; helping people recover. Rather watching pro-ana-content emulated the effects of ana-content for viewers.

For Fleszar, help didn’t come from positive content. Her remedy was to purge all social media from her life. Simply unfollowing those that made her feel bad about herself was enough to spark a positive change.

“I had to cure myself, and what I started with was unfollowing people,” she says. “Like actresses, models even friends. Friends that I’m still close with just because of the things that they posted. It made me feel worse.”

What Fleszar wants to see on social media and what she thinks will make the biggest change in the space is body diversity. Dondzilo agrees and says research has shown body diverse content is correlated with positive ideas on body image.

Body diversity is a burgeoning movement within the body image space. It aims to showcase figures of different sizes, shapes, compositions, ethnicities, and ages. By exhibiting bodies of numerous forms, body diversity seeks to redefine social media’s beauty standards to be more holistic.

Two old idioms stand hand in hand. You are what you eat, and you believe what you see. But are they true? As Dondzilo explains, what is shown on social media speaks to notions of our ideals of beauty. But our screens form a façade. They create something that does not exist beyond the formless pixelated confines of smartphones and computers. Body diversity seeks to achieve ‘realness’ and honesty. Things that exist in the real world are sometimes less harmful than those we imagine.