Social media forms one of the cornerstones of modern society. It is extremely influential in our daily lives, and can be pivotal in disseminating news, public health advice and unfortunately, clownery. We’re going to break down why fReEdOm oF sPeEcH in the nutrition sphere is particularly harmful.

From WebMD to Instagram RD: Why We Seek Out Nutrition Advice Online

Much like any article in any major scientific journal, we cannot mention anything about diet without throwing in the statement that non-communicable diseases (e.g. obesity, CVD) are leading causes of death globally ^[1]. One of the biggest influences on these diseases is poor diet ^[2]. The health of our population is influenced by our long-term dietary patterns. The role of nutrition in health cannot be understated, and most of us appreciate this on some level.

It makes sense then, that we would seek out nutrition advice for optimising health. Social media is an ideal platform for communicating nutrition advice to broad audiences. It’s accessible, low cost and direct. Roughly 92% of the Irish population had access to the internet at home in 2021 ^[3]. Online health/nutrition-information seeking is a common phenomenon. Indeed, up to 75% of us look for health information online ^[4], and 25% of us use social media for health information ^[5]. This makes social media a pivotal influence on behaviour change.

No Evidence, No Problem: The Lack of Accountability in the Twitterverse

Most of us are seeking out nutrition advice online that will improve our health ^[6]. However, anyone can disseminate information on the internet, regardless of educational background or expertise. This is particularly problematic in the nutrition-sphere. Nutritionist isn’t a protected title, and consequently, anyone can ascribe this title to themselves. As a result, social media has allowed misinformation to fester. We are exposed to a variety of advice and recommendations that aren’t always evidence-based.

The phrase “evidence-based” itself has lost all meaning as a consequence of social media. There is no benchmark for “evidence” in social media. For some, it’s clinical trials and meta-analyses, and for others it’s just a matter of putting “evidence-based” in your Instagram bio. This lack of accountability and regulation has contributed to the rise of “bodily capital”, where nutritional knowledge and expertise can be equated to an individual’s body fat percentage and follower count ^[7].

As Sabbagh et al. discuss in their 2020 paper, influencers connect with their followers. This creates a sense of trust and esteem between us and the influencer ^[8]. Of course, that’s not necessarily a bad thing. Building meaningful social connections on the internet is one of the positives of social media. However, when it comes to nutritional information, this where the waters tend to be muddied. Many individuals will dispense advice and guidance that is grounded in their own anecdotal evidence and not necessarily “science”.

I have to believe that most influencers think they are helping individuals by engaging in this behaviour, but a sinister undercurrent emerges when it comes to sponsored posts and products. Many products and nutritional strategies that are not backed by research are platformed by influencers. Fat burners, detox teas and exposing your genitals to direct sunlight for a few hours a day (don’t ask, and certainly don’t Google it) are just some of the things we are exposed to. At best, these products are a waste of money and at most they are dangerous.

The Quality of Nutrition Advice Online

Doctor Google

We don’t always get correct nutrition advice from medical professionals such as doctors, potentially due to a lack of training ^[9]. Some doctors do not feel comfortable providing this information directly to patients, but also fail to regularly refer patients to the appropriate specialists ^[10]. This has potentially contributed to patients seeking nutritional advice from the internet.

It has also given rise to predatory individuals (Dr. Tim Hoax, Dr. Never-Touched-A-Hyman) who prey on the vulnerabilities of the general public to sell their products and diet plans. These individuals use their status to act outside their scope of practice and convince unsuspecting members of the public that the Way of the Almighty Nutrition King [WANK] is the only way, and will solve all of their problems. Now, that’s an issue for a different time, but for now it’s just something to keep in mind – not everyone has the best interest of the general public at heart.

Won’t Someone Please Think of the Guidelines

Any study that analyses the accuracy of nutrition information provided online by qualified and unqualified professionals is equal parts hilarious and horrifying. In general, most advice, be it from those clad in PhD titles or high-waisted leggings encourages individuals to limit processed foods and eat more “unprocessed” foods ^[6]. As a general concept, this is not bad advice. However, when we go beyond the broad, it becomes a hellscape of confusion and misinformation.

It is of course not practical to expect anyone distributing general nutrition advice to have read every randomised control trial (RCT) and meta-analysis out there. However, it is completely unacceptable for individuals to be unable to provide information concurrent with the basics that are widely-distributed and well-established. I’m talking following basic public health nutrition/health guidelines set out by government bodies.

And on social media, individuals have developed a sort of “selective blindness” when it comes to this. Sabbagh et al. (2020) demonstrated that the majority of influencers do not reference or cite guidelines when distributing advice. Very few were actually qualified to give weight-management advice, but never let the truth get in the way of a good Instagram ^[8]. Now, this was a small sample (n=9) of influencers, but other studies demonstrated similar findings. In a study of popular nutrition blogs from celebrities, dietitians and weight-loss companies, contradictory information is rife.

Many give non-evidence based advice that overstates the health benefits or harm of categories of food that differs from government guidelines, such as limiting fruit, eating saturated fat or dropping entire food groups ^[6]. Chan et al. (2020) compared nutrition advice from registered dietitian (RD) bloggers and non-RD bloggers, and again we see this conflicting information. Non-RD bloggers promoted “moderation”, but also encouraged individuals to avoid a list of foods. Non-RDs were more likely to cite themselves as “experts” despite having no qualifications or published research, challenge conventional medical practice (YIKES) and assert credibility by referring to what the “studies show” and citing no studies. This study is hilarious in generating almost a Charlatan Playbook, which is perhaps another article for another day^[4].

The All-Knowing Fitspo

In a depressing but unsurprising turn of events, 36% of nutrition influencers were deemed to have low credibility. To further twist the knife, popular influencers with low credibility had the highest reach ^[11] (note: this is a summit abstract, not a full paper – so we need to be careful when extrapolating these findings to the wider fitspo population, #notallfitspos).

One of the main issues with these fitness influencers is the lack of accountability. Other professions, such as doctors, nurses, radiographers or allied-healthcare professionals are governed by a scope of practice and code of ethics that prevents them acting like snake-oil salesmen. Accredited nutritionists and dietitians are rigorously trained. Fitspos can order an AliExpress PT certificate and claim they are a ”nutritional therapist”. There is no recompense for influencers who adopt dangerous stances to health and nutrition, be it by demonising food groups, offering to “hack” your hormones or even promoting anti-vax sentiments. No, the only person that is affected is the poor unsuspecting individual who stumbles upon their content and can never unhear such clownery. My brain chemistry has been forever altered by some of the tripe individuals can spout without any redress.

It constantly bewilders me that I can get my radiographic registration revoked for behaving inappropriately and endangering patients. I can simultaneously go home, and tell the internet that gluten causes autism, and the only thing that will happen to me is I get offered a supplement sponsorship. How do we rationalise that?

The Need for Regulation

So, why the hell is it important to regulate social media information? Clark et al. (2022) perhaps put it best when they said:

“Misinformation can undermine the scientific work done by healthcare professionals, and threaten the health/lives of individuals by creating barriers for accessing, understanding and utilizing informed-guidance in making health decisions” ^[12].

If we are truly serious about improving public health and nutrition, we need to implement some form of control over misinformation. Given up to 20% of us report social media posts have a high influence on our food choice and 32% of us say influencers inspire us to make better food choices ^[13], it is no longer good enough for us to put our head in the sand or roll our eyes at individuals spouting harmful bullshit on the internet.

Government-owned public health organisation social media pages are few, and typically report poor engagement ^[6]. Micheál Martin in a Gymshark cut-off doing a few bicep curls whilst regaling the benefits of eating fruit and vegetables will not report the same engagement as your favourite neighbourhood influencer.

And all joking aside, Koball et al. best illustrate exactly why it’s important we have evidence-based information out there. In their study of bariatric surgery support groups, they found individuals were mostly looking for help in meeting nutrition guidelines, what amounts of foods to eat, whether certain foods were “okay” to eat and looking for psychological support regarding their eating patterns ^[14]. Unfortunately, over half of the responses were inaccurate, with individuals giving advice based on what they had “heard”, not evidence. This is a big old yikes. This is an already vulnerable population, many of whom have gone through major weight-loss surgery or are preparing for same. Giving your opinion on medical nutritional management of post-surgical patients is a big no. Your n=1 experience is not helpful here, no matter how well-intentioned.

That’s just one example of how important it is we have some form of regulation of nutrition information on the internet. We saw how pivotal this was in the regulation of misinformation from the tinfoil hat anti-vaxxers, and maybe now it’s time we nipped the biohackers in the bud, before they cause any more harm.

Nutrition is a contentious issue, and this lack of accountability across the board means we have created an ideal environment for charlatans. In my opinion, if we are to actually act in the best interest of the general public, de-platforming these cretins is the best way to start. Namaste.

References

1. McNamara K, Alzubaidi H, Jackson JK (2019) Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? Integr Pharm Res Pract 8, pp. 1-11.

2. Loef M, Walach H (2012) The combined effects of healthy lifestyle behaviors on all cause mortality: A systematic review and meta-analysis. Prev Med 55(3), pp. 163-170.

3. Central Statistics Office (2021) Statistical Yearbook of Ireland 2021: Part I People & Society. Available at: https://www.cso.ie/en/releasesandpublications/ep/p-syi/statisticalyearbookofireland2021part1/soc/internetusagebyhouseholds/.

4. Chan T, Drake T, Vollmer R (2020) A qualitative research study comparing nutrition advice communicated by registered Dietitian and non-Registered Dietitian bloggers. J Comm Health 13(1), pp. 55-63.

5. Fox S (2011) The Social Life of Health Information. Pew Research Center. Available at: http://www.pewinternet.org/2011/05/12/the-social-life-of-health-information-2011.

6. Ramachandran D, Kite J, Vassallo AJ (2018) Food Trends and Popular Nutrition Advice Online – Implications for Public Health. J Pub Health Inf 10(2), pp. 1-15.

7. Hutson DJ (2013) “Your body is your business card”: Bodily capital and health authority in the fitness industry. Soc Sci Med 90, pp. 63-71.

8. Sabbagh C, Boyland E, Hankey C et al. (2020) Analysing Credibility of UK Social Media Influencers’ Weight-Management Blogs: A Pilot Study. Int J Env Res Pub Health 17(23), p. 9022.

9. Crowley J, Ball L, Jiddink GJ (2019) Nutrition in medical education: a systematic review. Lancet Planet Health 3(9), pp. 379-389.

10. Adamski M, Gibson S, Leech M et al. (2018) Are doctors nutritionists? What is the role of doctors in providing nutrition advice? Nutr Bull 43(2), pp. 147-152.

11. Fernandez MA, Caretero A, Jacob E et al. (2022) Credibility and reach of nutrition influencers on social media. BMJ Nutr Prev Health 5.

12. Clark L, Lopez ED, Barroso CS et al. (2022) Nutrition-related information shared by Latine influencers: A YouTube content analysis. Health Prom Pract 1.

13. Byrne E, Kearney J, MacEvilly C (2017) The role of influencer marketing and social influencers in oublic health. Proceed Nutr Soc 76(3).

14. Koball AM, Jester DJ, Pruitt MA et al. (2018) Content and accuracy of nutrition-related posts in bariatric surgery Facebook support groups. Surg Obes Rel Dis 14(12), pp. 1897-1902.