Video collection

Hashtags are used on social media to collect content related to a specific topic. On TikTok, users can add hashtags to the caption of their post with the hash sign (#) prefacing a word or phrase. When users then click or search certain hashtags or topics, they will be brought to a feed of videos with that hashtag. In this study, initially, a list of thirty body-image and eating-related hashtags was collected by searching TikTok for food, nutrition, weight and body image related content, and noting which hashtags were commonly used by creators and had the most views. The thirty hashtags were generated both by brainstorming a possible list of food, weight, and body image-related words based on professional expertise in the nutrition field, as well as using TikTok for multiple weeks noting what hashtags were commonly used on food, nutrition, and weight-related posts (see Table 1).

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Table 1. Initial list of food/weight/body hashtags.

https://doi.org/10.1371/journal.pone.0267997.t001

All thirty hashtags had at least 9 million views per hashtag, and the most popular had 9.7 billion views. From this list of thirty, we eliminated the “health” and “healthy” hashtags because we felt they were too broad for the specific focus of the study, as they could include content on not smoking, wearing sunscreen, getting sleep, or other health behaviors beyond the focus of this study. The top ten most viewed hashtags from the original list were then included in this study except for choosing #nutrition with 1.1 billion views versus #healthyfood with 1.2 billion views, as it seemed important to analyze the content of videos purporting to be about nutrition which could be weight inclusive or perpetuate diet culture (Table 2). Since the posts were collected in September 2020, #nutrition now has more views that #healthyfood.

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Table 2. Final selected hashtag list.

https://doi.org/10.1371/journal.pone.0267997.t002

Each of the ten hashtags had more than 1.1 billion views per hashtag and we believed were divided between hashtags that were likely to present weight-normative content (#weightloss, #diet, #weightlossjourney, #fatloss, #weightlosscheck) or potentially contain weight-inclusive or weight-neutral content (#whatieatinaday, #plussize, #mealprep, #bodypositvity, #nutrition). Although the original list of thirty hashtags contained several such as #intuitiveeating and #haes that may have been most likely to contain weight-inclusive content, those hashtags had considerably fewer views, 111.2 million and 15.3 million respectively than any of the top 10 hashtags used in this study which each had at least 1 billion views (see Table 1). These more specific weight-inclusive hashtags were then not selected for analysis because they did not represent a large share of the food/weight/body posts viewed on TikTok, and would not give an accurate idea of what the “average” TikTok viewer would find on their for you page, as the for you page is most likely to display videos with many views. The first 100 videos under each of the ten selected hashtags as well as a screenshot of their first frame and caption were downloaded in September 2020, and the files were each labeled with the hashtag and record number. The videos were publicly available and downloadable, so our collection and analysis complied with necessary terms and conditions. TikToks in each hashtag are displayed from the most views to the least views, so downloading the first 100 videos in each hashtag meant that the most viewed videos in each hashtag were collected. Any TikToks that were not downloadable were not included in the study, as a small percentage of users do not allow their videos to be downloaded. Because all videos were publicly available, the study was approved as exempt by the University of Vermont Committee on Human Research in the Behavioral and Social Sciences, STUDY00001190. As all of the TikTok videos analyzed were publicly available, informed consent was waived by the ethics committee.

Codebook development

After preliminary analysis of a subset of 100 TikToks (10 from each hashtag), a list of codes was developed using a template analysis approach that included codes that we expected to find in the data such as posts that were food related, depicted exercise, reflected someone’s body image, represented weight normativity or weight inclusivity, or discussed weight loss, as well as codes reflecting themes that emerged from the subset of TikToks [24]. Demographic codes for age, gender presentation, race/ethnicity, and body size were also included in the codebook, as was a code noting any professional degrees of the user. After codebook creation, two coders watched and coded ten videos from each of the hashtags. Codes from each coder were compared to ensure consistency of code application. Coders then proceeded to code the remainder of the TikTok videos independently. Once all coding was completed individually, cross comparisons were run in Excel between the two coders’ spreadsheets to identify any differences in coding. Videos with discrepancies were viewed again by two coders together and final codes were agreed upon. In total, four coders worked on the project with two coders coding each video. The study authors trained the two additional coders who were nutrition undergraduate students. When coding discrepancies were noted, the two study authors looked at each video and determined final coding. All codes used in the codebook except for demographic codes can be found in the linked supplementary material file.

Data analysis

Demographics were coded for videos in which the creator was visible in the video. Following the methods used by Lucibello et al., demographic codes were determined based on the perceived age (teenager, young adult, millennial, middle aged adult or elderly person), gender presentation (male, female, trans male, trans female, non-binary) and race/ethnicity (white presenting or non-white presenting) of the person in the video [4]. The body size of the user (average/medium frame, thinner than average frame, and larger than average frame) was also coded for, in line with methods from previous research [4,6]. Users with health professional degrees were coded if they explicitly stated their profession in the video or the comments.

TikTok content was analyzed using thematic analysis with quantification, which allowed us to identify, analyze, and report key themes from the qualitative TikTok data [25]. Code frequencies were tabulated using SPSS Software (IBM Corp., Chicago). The frequency data helped identify how often various codes and resulting themes appeared in each hashtag. The research group reviewed and refined key themes together, and identified TikToks that were emblematic of each key theme. The analytic plan was pre-specified, and the hypotheses were determined before data was collected.

Young female creators predominate on TikTok

Our results indicate that the majority of TikTok content analyzed was created by young users of high school (11.1% of posts) and college ages (42.4% of posts) versus millennials (28.2%) and those in middle age (3.3%). Age could not be determined in 15.2% of posts. When considering previous literature on the negative influence of social media on young people’s body image and eating behaviors, there is reason to be wary of the impact of the app on its young adult users [26–28]. Most videos (64.6%) were created by female presenting users, as opposed to male presenting users (30.6%). Young females who create and engage with weight or food-related content on TikTok are at risk of having internalized body image and disordered eating behaviors from other aspects of their lives [29] making exposure to weight, food, or body-related content particularly troublesome. When observing race and ethnicity, white presenting individuals were most represented (56.1%) followed by non-white presenting individuals (32.6%). Thirty-four percent of TikToks were created by users coded to be of an average/medium frame, versus only 16.6% of posts showing someone with a larger than average frame. Therefore, the most common creators engaging with the nutrition-related hashtags, even those explicitly related to weight loss were actually those who most conformed to the thin ideal. These results are similar to explorations of the fitspiration, cheatmeal, and weightloss hashtags on Instagram where researchers also found a lack of body diversity, with mostly thin, muscular individuals depicted [3,6,7].

The glorification of weight loss and frequency of a weight-normative perspective

When looking at the data, a striking theme was the prevalence of weight-related content across all ten hashtags. Nearly 44% of all the videos coded in this study had content about weight loss, and 20.4% of all videos explicitly showed a person’s weight transformation in the video. Many of these videos followed the same format and included similar hashtags, filters, and sounds, speaking to the nature of TikTok and the ability for trends to become popular. Even, the whatieatinaday hashtag and mealprep hashtags that we believed at the beginning of the study may be weight-neutral and portray a variety of eating styles and meal preparations were quite weight normative with users showing how they meal prepped for a certain diet, or what they ate in a day to lose weight. In fact, the whatieatinaday hashtag has become so weight normative and triggering that videos using it now carry a trigger warning for eating disorders including a link to the National Eating Disorder Association’s help line because so many people were using the hashtag to show how little they ate in a day [21].

The glorification of weight loss across many videos, and reoccurring suggestion that if you just try hard enough you can lose weight too, undoubtedly elevate the key principles of weight normativity, and may reinforce to viewers the belief that weight is an important indicator of health status and overall self-worth [9,30]. This danger is increased by the substantial number of views that these hashtags are receiving. The weight loss hashtag alone had almost 10 billion views at the time the videos were collected, showing that billions of people are interested enough in losing weight to engage with the hashtag. The number of views the weight-loss focused hashtags received vastly outnumbered the number of views more explicitly weight-inclusive hashtags received (see Table 1). In our study, less than 3% of all videos were coded for weight inclusive messaging or content, suggesting that weight-inclusive messaging is not prevalent across some of the most viewed nutrition, food, and body-related hashtags on TikTok.

Among the videos that depicted weight loss transformation, common themes included exercise routines and diet plans, often with images of routine weigh-ins and clothing “down-sizes.” Twenty-two percent of videos depicted physical activity. Many of the videos depicting physical activity were also coded for weight loss, indicating that physical activity was being portrayed not for its inherent benefits to physical and mental health [31], but as a means to achieve weight loss. In multiple cases, the creator mentioned finally becoming “happy” after losing the weight, and how their journey to “better themselves” was not done yet, exemplifying diet culture’s message that a person’s body size is indicative of their health and moral status.

As discussed earlier, TikTok is unique in that users can choose from a variety of sounds to add to their videos. Several sounds were found to occur frequently as part of the weight loss trends and included language that poses weight loss as paramount. Dialogue, sounding like a pep talk from a coach or a trainer, containing phrases such as “no excuses,” “get up” and “if you want it bad enough, you’ll do it,” implies that deciding not to pursue weight loss or being unable to lose weight is a personal motivation failure. These videos may give viewers the idea that intense weight loss transformations are both attainable and something to strive for–not only for appearance purposes but also for physical and mental well-being as previous research has illustrated the strong influence that media reinforcing the thin ideal has on people’s self image [32,33]. Although some may argue that viewing weight transformation videos is motivating, Jebeile et. al found that adolescents in larger bodies reported that viewing successful weight loss videos felt unmotivating and discouraging when weight loss was portrayed as very easy, as it often is on social media [3].

Perhaps portraying weight loss would be less harmful if long-term weight loss was generally achievable. However, as Tylka et. al (2014) discussed in their literature review of weight normativity and weight inclusivity, weight loss interventions almost always fail; only about 20% of individuals who participate in weight loss interventions maintain the weight loss after one year, and this percentage decreases by the second year [9]. The collection of videos glorifying weight loss on TikTok represent a moment in time, but do not show the longer-term effects of weight loss interventions, such as weight-cycling, or repeated dieting and weight loss attempts over many years [34]. All these outcomes can result in negative impacts to both mental and physical health [35–37]. Furthermore, each time someone questing to lose weight is unable to keep the weight off, the perception that they must then be lazy or lacking in willpower is reinforced [38,39].

A large percentage (21%) of total users did portray a positive body image, however very few posted videos lacking weight-normative undertones. Often creators were positive about their body image because they had lost weight, and rarely were depicting body positivity for a body that would not be deemed “acceptable” by diet culture. Similarly, while there were videos that mentioned or showed a person’s weight gain, these videos were the minority of weight-related content and reinforced diet culture beliefs. Weight-gain content tended to be masked with body positive hashtags and mentions of “self-love,” but still suggested that weight gain is inherently negative. Voice-overs and comments in these videos excused their weight gain or reassured themselves that it was okay to have gained weight. For example, a common caption would be something like, “I gained 20 pounds, but I still love myself.” Having to state that you still love yourself when your weight increases suggests exposure to weight bias and fat phobia [40]. Such weight-related stigmas lead to social issues such as devaluation, discrimination and rejection of individuals who are in fat bodies [40].

Strengths and limitations

This study is the first to our knowledge to examine nutrition and body-image related content on TikTok. TikTok’s popularity especially among young people makes it an important driver of cultural trends, and therefore it is imperative to understand the content present on the app. The study also included a large sample of highly viewed videos, indicating that the themes identified are representative of the content millions of users are engaging with. Additionally, the study deliberately coded for weight inclusive content in an effort to better understand if weight inclusivity is widely represented on a social media site. Previous work on social media has not specifically examined the presence or absence of weight inclusivity.

It is important to note that all videos were coded based on subjective observations by the four female coders. This means that gathering results such as user demographics (age, race, gender, body size) was not meant to be definitive, but rather to gather a general understanding of the people who are creating this type of content based on the available information that could be observed from the video. While differences in coder opinions were accounted for by having each video coded by two different coders, and then running cross comparisons, there is no way of knowing the exact demographics of each user beyond merely our observations. Additionally, not all TikTok videos were downloadable. A small percentage were skipped over when collecting the 100 videos from each hashtag because of this, and were not included in the study. Some of the videos appeared in more than just one of the selected hashtags, so the total 1000 videos that were coded included several duplicates, possibly reducing variety in the data. However, since the first 100 downloadable videos of each hashtag were chosen, duplicates in this study exist because they were popular enough to appear in the top viewed videos of more than one of hashtags, and so their inclusion in the study still provides valuable insights. The videos also only capture one point in time, and trends across TikTok change frequently. Therefore, it is possible that although the hashtags analyzed remain quite popular on the app, specific trends depicted in the video may have changed over time. Finally, as the study only examined one social media platform, the results cannot be generalized across various other social media outlets.