The study population consisted of 146 girls and 163 boys with an average age of 16.0 years, recruited from two randomly selected high schools in Istanbul. The researchers calculated their minimum sample size using G*Power software, adopting a small-to-medium effect size consistent with Cohen’s criteria for the social and behavioral sciences, and determined that at least 285 students would be needed to detect significant relationships in correlation and regression analyses. Participants were physically and mentally healthy volunteers drawn from a total school population of 1,457 students. Height and body weight were measured directly, and body mass index-for-age percentiles were calculated according to standard pediatric classifications, with 78.3 percent of participants falling within the healthy weight range.

The methodological design relied on three validated psychometric instruments administered face-to-face. The social media use scale, developed by Deniz and Tutgun-Ünal, contains eight items divided into two subscales: continuity of social media use and social media use competence. The continuity subscale captures not merely the duration of daily use but the habitual, psychologically embedded nature of access, reflected in items such as checking accounts immediately before sleeping and right after waking. The social appearance anxiety scale, developed by Hart and colleagues and adapted into Turkish by Doğan, comprises 16 items assessing the anxiety and stress experienced when one’s physical appearance is evaluated by others. The Eating Disorder Examination Questionnaire-Short Form, or EDE-Q-13, evaluates eating behaviors over the preceding 28 days across five subdimensions: eating restraint, shape and weight over-evaluation, body dissatisfaction, binging, and purging. Internal consistency coefficients for the three scales were 0.824, 0.930, and 0.890 respectively, indicating strong reliability.

The descriptive findings reveal the sheer ubiquity of social media in adolescent life. WhatsApp was the most widely used application at 83.2 percent, followed closely by Instagram at 81.2 percent. A substantial majority of participants, 73.8 percent, reported engaging with social media for one to five hours daily, a pattern consistent with previously reported global trends and reinforcing the view that digital platforms have become a primary environment for adolescent socialization. Gender differences emerged in platform preferences and behaviors: girls were significantly more likely to use Snapchat, to apply social media effects to their photos, and to care about friends’ opinions regarding shared photos. While 72.6 percent of adolescent girls indicated that peer feedback on their visual content mattered to them, only 38.0 percent of boys said the same.

The central statistical finding concerns social appearance anxiety, defined as the anxiety and stress experienced during the evaluation of one’s appearance by others. The mean social appearance anxiety score for girls was 38.1, significantly higher than the boys’ mean of 30.8. In the multiple linear regression model examining predictors of social appearance anxiety, the model was statistically significant and accounted for 26.4 percent of the variance. Three independent variables emerged as significant: being male was associated with lower anxiety, increasing age was associated with decreasing anxiety, and continuity of social media use was associated with increasing anxiety, with a coefficient of 0.963 and a 95 percent confidence interval of 0.520 to 1.406. This finding suggests that the habitual, always-on nature of social media access, rather than mere technical proficiency with digital devices, is what drives the psychological burden.

Correlation analysis further illuminated the web of relationships among the study variables. Social appearance anxiety was positively correlated with social media use continuity, eating restraint, shape and weight over-evaluation, body dissatisfaction, binging, purging, and overall eating disorder risk. The strongest correlations were with shape and weight over-evaluation and body dissatisfaction, both exceeding 0.43. Social media continuity itself was positively correlated with shape and weight over-evaluation, body dissatisfaction, and eating disorder risk. These bivariate associations paint a coherent picture: adolescents who remain continuously connected to social media report greater dissatisfaction with their bodies and more disordered eating attitudes.

However, the multivariate regression analysis for eating disorder risk revealed a more nuanced mechanism. The model accounted for 29.6 percent of the variance in eating disorder risk, but the direct effect of social media continuity dropped below statistical significance once social appearance anxiety was included. Instead, two independent variables remained significant: social appearance anxiety, with a coefficient of 0.068 and a 95 percent confidence interval of 0.053 to 0.083, and body mass index-for-age percentile, with a coefficient of 0.019. This pattern suggests that the observed risk is primarily driven by underlying psychological constructs rather than by social media use itself. The researchers interpret this as evidence that social appearance anxiety functions as the proximal psychological pathway through which continuous digital exposure translates into disordered eating attitudes.

The theoretical framework underlying these findings draws on body image theories, which hold that the media transmits social appearance ideals through which pressures regarding appearance are placed on individuals and comparisons are made. Social media users compare their own appearance with that of others and may edit their photos, generating negative thoughts about body image and body dissatisfaction. Body dissatisfaction, in turn, forms a basis for the development of eating disorders. The relationship may also be bidirectional: adolescents heavily exposed to idealized visual content may develop body image anxiety, while those with high body image anxiety may use social media as a tool to seek approval and attention regarding their appearance. The cross-sectional design prevents the establishment of causality, but the findings suggest that continuity of social media use and concerns about social appearance are mutually reinforcing factors that may trigger eating disorder risk through this process.

The broader epidemiological context amplifies the urgency of these results. Eating disorders are chronic and treatment-resistant physical and mental illnesses with high mortality rates, affecting all age groups, ethnicities, body sizes, socioeconomic statuses, and religions regardless of sex. Between 1999 and 2022, 22.36 percent of children and adolescents were reported to have disordered eating, and the incidence of eating disorders has increased over the last 40 years in parallel with the rise of social media use among adolescents. The present study also found that increasing body mass index-for-age percentile was associated with increased eating disorder risk, consistent with previous research by Flament and colleagues linking weight status to eating disorder diagnoses in community adolescents.

The authors acknowledge several limitations that temper generalization. The study was conducted in only one city and two high schools, potential confounding factors such as depression, anxiety disorders, self-esteem, and socioeconomic status were not examined, and the explanatory power of the regression models remained relatively limited. Pubertal development stages were not objectively determined, and body dissatisfaction was not directly assessed. Nevertheless, the conclusions carry practical weight. The researchers recommend designing social media literacy education programs for adolescents, organizing school activities to raise awareness, creating environments for face-to-face communication, and developing national policies aimed at conscious social media use. Educating adolescents about social media use and monitoring their usage, they argue, may be associated with a potential reduction in eating disorder risk and related health problems in the long term.

Subject of Research: Health

Article Title: Association between social media use, social appearance anxiety, and eating disorder risk in adolescents

Article References: Özkan, G. Ö., Yüce, M. N., & Karagöl, B. (2026). Association between social media use, social appearance anxiety, and eating disorder risk in adolescents. Frontiers in Nutrition, 13, Article 1812469. https://doi.org/10.3389/fnut.2026.1812469

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.1812469

Keywords: adolescents, eating disorders, social media, social appearance anxiety, body image, mental health, nutrition, Association, between, social, media, appearance