Could WhatsApp profile pictures help obesity doctors spot patients with body dysmorphia?

New research being presented at the European Congress on Obesity (ECO) in Venice, Italy (12-15 May) has found that many people who are living with obesity conceal their body in their WhatsApp profile pictures. 

Profile pictures of pets, family members, landscapes, flowers and cartoon characters may indicate the individual has body dysmorphic disorder, says lead Dr Antonella Franceschelli, of Unicamillus International Medical University, Rome, Italy.

Body dysmorphic disorder is a condition in which a person has a distorted image of their body. They feel dissatisfied with their physical appearance, may experience shame or anxiety about their body and, in the case of those living with obesity, believe they are heavier than they actually are.

This excessive concern about physical appearance can be exacerbated by social media, where unrealistic standards of beauty and physical shape are often shared.¹

“People with body dysmorphic disorder can be particularly sensitive to these influences, constantly comparing themselves to idealised images and feeling inadequate in comparison,” says Dr Franceschelli.

To explore the association between obesity and body dysmorphia, Dr Franceschelli and colleagues conducted a qualitative study of WhatsApp profile images of individuals living with obesity.

The study involved 59 patients (49 females, 10 males, mean age 53 years, mean BMI 32 kg/m²), each of whom submitted one WhatsApp profile picture.

The content of the pictures was then examined for the presence of body dysmorphic behaviour, for example, choosing to show their face but not their body or choosing an image of something else entirely.

The analysis provided clear evidence of body dysmorphia, with 90% of the men and 86% of the women using profile pictures that didn’t represent their physical reality.

Some individuals used images of pets, family members, landscapes, cartoon characters or objects such as flowers.  Others used headshots in which their face was almost covered and their body couldn’t be seen, old photos or pictures that had been edited to make them look thinner.

Dr Franceschelli says: “They may have chosen such pictures to have some control over the image they present to others and to avoid exposing themselves to criticism about their body.

“The pictures may also represent a desire to be seen and accepted for who they are, rather than how they look, as well as provide a source of comfort during social media use.”

The likelihood of using a profile picture that didn’t represent physical reality increased with the degree or severity of obesity.

The study didn’t include a control group and so the researchers weren’t able to look at how the images compared to those used by individuals of normal weight, for example.  However, the finding that those with a higher degree of obesity were likely to use pictures that didn’t represent their physical reality strongly suggests obesity was affecting choice of profile picture, say the researchers. 

As it was a qualitative study, there isn’t any data on the strength of the associations.

Dr Franceschelli says: “This study suggests that something as simple a WhatsApp profile picture could give doctors a valuable insight into whether someone living with obesity has body dysmorphia.

“It is crucial that body dysmorphia is identified when treating obesity.  Once identified, patients can be given psychological treatments, such as cognitive behavioural therapy, alongside medical treatments such as pharmacological therapy and nutritional programmes.

“This sort of holistic approach to obesity treatment increases the chance of weight loss and enhances the overall wellbeing of patients.”