Social media use associated with orthorexia symptoms, review finds

A systematic review and meta-analysis found a small positive association between social media use and orthorexic tendencies among adolescents and adults. Across 33 included studies, 22 contributed data to the pooled analysis, which produced a correlation of r = 0.20 with a 95% confidence interval of 0.15 to 0.25. The authors rated the certainty of the evidence as very low, meaning the results do not establish causation or directionality.

The review examined original studies assessing the relationship between social media use and orthorexia nervosa, including symptoms and diagnostic measures. The search covered PubMed, Web of Science, Embase, Scopus and PsycINFO through January 2026. The researchers pooled zero-order correlations using Fisher’s z transformation and a random-effects model estimated with restricted maximum likelihood.

Statistical heterogeneity was high, with I² = 84.3% in the main correlation analysis. The authors also conducted subgroup and meta-regression analyses, sensitivity tests, leave-one-out analyses and assessments of publication bias. Estimates remained within a narrow range of r = 0.18 to r = 0.20 across the leave-one-out, subgroup and sensitivity analyses, while a bias-adjusted estimate was r = 0.17.

The narrative synthesis suggested that the type of content consumed was more consistently associated with orthorexic tendencies than the platform used or the duration of social media use alone. The supplied findings do not identify particular content categories, platforms or mechanisms, however, so they cannot show that a specific type of social media content causes orthorexic symptoms. Reported prevalence varied sharply with the diagnostic threshold used.

The pooled prevalence was 39.9% when studies applied an ORTO-15 cutoff below 35 and 65.5% with a cutoff below 40. Heterogeneity exceeded 90% in these prevalence comparisons, showing that estimates differed substantially across studies and making the pooled percentages difficult to interpret as a single uniform prevalence. A secondary analysis of two studies with reconstructable 2 × 2 data suggested greater odds of orthorexia among heavier social media users.

The estimated odds ratio was 1.57, with a 95% confidence interval of 1.25 to 1.97. This finding rests on only two studies and therefore offers narrower support than the broader meta-analysis of correlations. All of the included studies used cross-sectional designs.

These studies measure social media use and orthorexic symptoms at the same point in time, so they cannot determine which came first. Reverse causality remains plausible: social media use may be associated with orthorexic tendencies, but people with those tendencies may also engage differently with social media. The evidence therefore supports a cautious conclusion of association rather than a causal effect.

The authors said longitudinal and experimental research is needed to clarify the direction of the relationship.

Subject of Research: Association between social media use and orthorexic symptoms in adolescents and adults

Article Title: The association between orthorexia nervosa and social media use: A systematic review and meta-analysis

Article References: Nakhl, A.-M., Barakat, M. A., Kotaich, J., Elleik, E., Afyouni, A., & Abou Abbas, L. (2026). The association between orthorexia nervosa and social media use: A systematic review and meta-analysis. PLOS Mental Health, 3(10), e0000758. https://doi.org/10.1371/journal.pmen.0000758

Image Credits: AI Generated

DOI: 10.1371/journal.pmen.0000758

Keywords: orthorexia nervosa, social media, systematic review, meta-analysis, orthorexic symptoms, adolescents, adults, cross-sectional studies, evidence certainty, eating disorders, association, between