Kayla Christine Long, 17, did not give particular thought to posting a video to TikTok on New Year's Eve saying that all she had consumed that day was a jug of ice water. She hashtagged it "#whatieatinaday."
It was the kind of video she often saw and interacted with on the platform from young women who wanted to lose weight, something she said she's seen even more of during the coronavirus pandemic. When it started in the U.S. in March, Long said she began to see lots of “thinspo” posts on TikTok — shorthand for "thin inspiration."
“Everyone has so much free time now and wants to get in shape, so creators are promoting very unhealthy habits,” she said.
Long's video amassed 2 million views before she deleted it a week later. The next month, Long was diagnosed with an eating disorder and sent to a treatment center. She said that TikTok, along with other influences on social media like Instagram and Snapchat, had pushed her to restrict her food intake over the past year.
Long is not alone. Seven women in their teens and 20s told NBC News that the content they viewed on TikTok had pushed them to fixate more on their diets and exercise regimens to a dangerous extent. And experts who study eating disorders say the social dynamics on the app mirror the problems found in recent years on other platforms.
“When I initially downloaded TikTok, I saw a lot of really, really negative body image videos,” said Brittani Lancaster, a TikTok body positive activist. “It’s not worth it to keep seeing these posts if it’s worsening your mental health.”
TikTok has emerged in the past year-and-a-half as a destination for young people to express themselves in a wide variety of ways from lip sync videos to dance crazes. The platform's structure and culture encourage users to mimic one another and participate in trends. As of April, the app had been downloaded 2 billion times.
But some users say what they see on the app has led them to develop body issues and eating disorders, a problem that has also been an issue on Instagram and Snapchat. With TikTok's youthful demographic, community-driven platform and powerful recommendation algorithm, experts are worried that the app is particularly dangerous for people who are susceptible to an eating disorder relapse.
TikTok “seems very reminiscent of pro-ana Tumblr circa 2013,” said body positive activist and TikTok user Melody Young, using an abbreviation for pro-anorexia. “‘Fitspo’ images are back, unhealthy eating habits are constantly documented, and it can make it really difficult to avoid relapse when you’re randomly shown content that glorifies eating disorders.”
The problem is magnified by the pandemic, which has pulled people indoors. With students having to entertain themselves outside of school, TikTok’s new possibilities for creative expression are especially attractive.
“Because there’s so much existential anxiety out there with the uncertainty around the pandemic, I think, unfortunately, people are sort of doubling down on whatever path they were on," said Elizabeth Daniels, psychology professor at the University of Colorado, Colorado Springs. "So if they were already restricting their diet a lot I think that’s getting worse.”
At the peak of Long’s eating disorder, she said she liked several posts promoting unhealthy eating habits and disordered behaviors. The app is known to have an algorithm that tracks what users interact with to show them similar content. TikTok also fosters communities with similar interests, which can cultivate a sense of belonging for users but also add the pressure of competition.
Long said that being shown the same content repeatedly was particularly dangerous for people like her, who are prone to relapse.
Marc Faddoul, an associate researcher at the University of California, Berkeley, School of Information, said that “the one thing research scientists are sure about with the TikTok algorithm is that engagement matters.”
TikTok’s community guidelines explicitly ban posting content that supports pro-anexoria or other dangerous behavior to lose weight, a spokesperson for TikTok said.
“Content that supports or encourages eating disorders is strictly against our Community Guidelines and will be removed," the spokesperson said.
Viral posts on TikTok can hit a user unexpectedly with information about diet and exercise or jokes that could prompt thoughts of relapse. For example, posts using #whatIeatinaday, where people list what they eat in one day, have accrued 2.7 billion views.
Claire Mysko, CEO of the National Eating Disorders Association (NEDA), said her organization has heard complaints from several TikTok users that the app is helping to blur the line between fitness and eating disorders.
“The general sentiment is people have been surprised when they have been seeing content promoted that is really actively talking about diet and fitness in a way that’s very linked to weight loss and numbers that’s been harmful for those individuals,” Mysko said.
The comments sections of TikTok videos can also host troubling content, with users disparaging their own bodies. Such comments could be considered “fat talk,” which could lead to negative views about body image, according to a 2017 study by Jacqueline Mills and Matthew Fuller-Tyszkiewicz, researchers at the Deakin University School of Psychology in Victoria, Australia.
Averey Kennedy, an advocate for body positivity and eating disorder recovery, downloaded the app during quarantine. She said that for the first month and a half, she was targeted by videos “joking about how little people ate, how much they hated themselves, and methods they used to starve.”
“Most of these aren’t made with ill intention but can be so triggering,” Kennedy said.
Long deleted her version of #whatIeatinaday when she realized she was influencing other users to think about starving themselves, she said.
Other apps, such as Instagram, have also come under scrutiny by the NEDA for promoting negative body image. Instagram has partnered with the NEDA to raise awareness of perfectionist ideals on social media, according to Carolyn Merrell, head of Instagram’s global policy programs.
“While we do not allow content that promotes or encourages eating disorders, we recognize that people may feel pressure to look a certain way on social media,” Merrell said in an email.
Some activists and researchers recommend getting rid of TikTok altogether and taking a reprieve from the overdose of pro-eating disorder content the algorithm has collected. But the competitive nature of eating disorders often makes it difficult to press the “delete” button.
TikTok includes a feature where the user is able to report a video so the app reviews whether to take it down, but several users said that it is burdensome to report videos while scrolling through their feeds.
Another question for TikTok is whether its moderators should be more involved in user communities, Faddoul, the algorithm expert, said.
“The more difficult question is whether a broader solution calls for having a much more collaborative process. This means engaging the community and being involved to moderate the process,” Faddoul said. “But I don’t think at TikTok that’s really their vision.”
If you are struggling with an eating disorder and are in need of support, please call the National Eating Disorders Association Helpline at 1-800-931-2237. For a 24-hour crisis line, text “NEDA” to 741741.