Date: Aug. 7, 2023
America’s teenagers love TikTok, the video-sharing social media app. Nearly 60% of all teens ages 13-17 use it daily, according to the Pew Research Center. And by some estimates, the largest share of TikTok users is between the ages of 10 and 19. That could be a problem, given the findings of a new study that looked at how TikTok users engage with the app’s health content.
The study, in the Journal of Health Communication, analyzed 400 videos tagged with the hashtags #EduTok and #health. Researchers found that the most popular health-oriented videos on the platform tended to focus on three things: diet, exercise, and sexual health. That’s hardly a surprise, given the relative youth of TikTok’s audience. But among those health-oriented videos, the ones with the most engagement featured people offering inspirational appeals and steps for mimicking the creator’s own behavior. In other words, not medical experts. Influencers.
Risky Role Modeling
The study found that videos using this form of motivational behavior, known as role modeling, often provide either misleading information or medical advice provided by a doctor for the influencer’s specific situation, not for the public at large. Much of it also seemed to be things most people couldn’t do.
“Role models on TikTok are rich, beautiful, thin white women. They have the resources to buy expensive vegetables. They can wake up and run on the beach every day,” said Nicole O’Donnell, PhD, the study’s lead author. “It promotes a vision not of health, but of being thin and rich.”
Many of the videos used the word “research” to suggest credibility, but without providing details. They might promise “daily evidence-based health tips” and skip the sources, leaving viewers unable to make sure they’re valid. And many included a sales pitch of some kind, or the suggestion that certain products can help the viewer be like the influencer.
“The problem is that these people are speaking with such authority,” said Katrine Wallace, PhD, an epidemiologist at the University of Illinois who makes TikTok videos to counter the health misinformation she comes across every day. “There are no evidentiary standards for making videos on TikTok. You can say anything you want, with no training, and if you sound like you know what you’re talking about, people will assume you do.”
Terry T., a mom from New Jersey, said her 16-year-old son has fallen prey to these faux-authoritative videos.
“We had a tense moment recently about how much protein teenage boys need,” she explained. “I forced him to look it up on Harvard and the Mayo Clinic, where it’s coming from people who’ve been to medical school, not people trying to sell you a protein supplement.”
Researchers also noted a tendency to take a single point from legitimate scientific research and blow it out of proportion.
“There’s a lot of shock content, like don’t eat out at restaurants, because they’re scraping the pan so much that you’re getting heavy metal poisoning,” O’Donnell said. “The whole purpose of these platforms is to keep people there, keep them viewing content. And if you’re outraged, you’re going to keep watching.”
A Dangerous Trend: Self-Diagnosis
The study found that videos with a message encouraging self-diagnosis also tended to have higher reach and engagement. Ellen R., a mom from San Jose, CA, believes her daughter Bea’s experience resulted from that. By the time Bea deleted TikTok from her phone, she had diagnosed herself with social anxiety, ADHD, anxiety, major depression, borderline personality disorder, and bipolar disorder – and convinced medical professionals she had several of these conditions. At the time, she was 13 years old.
Ellen blamed TikTok, specifically the mental health videos Bea consumed like candy.
“She watched videos with people describing their mental health symptoms and self-harming, and she really latched on to that content,” Ellen said.
The more videos Bea viewed, the more she attributed her ordinary teenage moodiness to mental health crises. And because the videos showed her exactly which symptoms might lead to each diagnosis, she was able to make the case that she had these conditions.
“She had access to all these symptoms and descriptions, so she started identifying with this community of people struggling with mental illness,” her mother said. “She kind of built that up in herself.”
The Role of the Algorithm
One possible reason Bea got so caught up in these videos: TikTok’s algorithm. Among the app’s main features is the FYP, the For You Page. When users open the app, they find a feed of videos not from people they chose to follow, but from people who make content similar to what they’ve already watched. “So if you like cats, you’ll get a lot of videos with cats,” Wallace said. “If you like anti-science misinformation, you’ll get more of that.”
The problem with the FYP is, the algorithm can’t tell why you’re watching a particular video, or why you haven’t just scrolled past something that doesn’t interest you.
“Let’s say the stuff you’re watching is engaging but not a topic you particularly care about, but you sit and watch anyway. The algorithm will show you more of it,” said Allison K. Rodgers, MD, a Chicago fertility doctor and OB/GYN who makes TikTok videos, often with her 16-year-old daughter. Her account has 1.2 million followers. “It just wants to keep you on the app as long as possible.”
For young people, who spend an average of 92 minutes a day on TikTok, that algorithm can take them down some very deep rabbit holes.
The New Peer Pressure
If you were a teenager in the 20th century, you got your information the old-fashioned way: from newspapers, magazines, books, and, mostly, friends. Now, though, teens are as likely to get advice about how to lose weight, work out, or avoid pregnancy from social media. That wider net can have dangerous consequences.
“When people see other people doing something and they’re cool, they want to do it, too,” Rodgers said. She recalled seeing videos urging young women to drink pineapple juice to improve vaginal aroma, and a TikTok challenge that had girls inserting ice cubes into their vaginas.
Ellen blames this new kind of peer pressure for some of her daughter’s self-diagnoses.
“Because of the way the algorithm works, it just gives you more and more and more of that content,” she said. “If all the TikTok videos you see are about depression and cutting and anxiety, you start to think, ‘This is what the world is. This is who I am, too.'” Even viral filters can influence teens’ self-image. When Katie F.’s daughter tried out a filter that supposedly showed her what she’d look like as an old woman, she didn’t like the results. “She found a couple videos of dermatologists, suggesting these apps were really accurate predictors. She also saw some videos of individual people who’d been motivated by this to up their skin care routine,” Katie said. “Eventually she came to me because she was distressed by this. She worried if she didn’t step things up, she’d age prematurely.”
Katie’s daughter was 14 at the time.
How to Navigate TikTok’s Health Content
As any parent knows, you can’t simply cut off your teen from TikTok – they will find a way to get back on it. Instead, there are things you can do help the young people in your life use TikTok safely. Encourage them to:
- Look at credentials. “There are people out there who are anti-medicine, anti-physician, that spread misinformation that has potential to harm,” Rodgers said. Before following any advice, check the content maker’s background, then Google them. “A practicing physician should be found easily.”
- Consider the message. “What are the health messages they’re sharing?” O’Donnell said. “Are they sharing attainable steps or resources? Are they sharing links to WebMD? Or was outrage present? Were they just showing the severity of health concerns?” Dramatic stories about one person’s experience don’t really show anything.
- Understand the importance of data. “An anecdote isn’t the same as a study, and studies aren’t all created equal,” Wallace said. “If something says an ingredient is dangerous, maybe it was based on an animal study where they gave it 30,000 times the human dose.”
- Check for subtle advertising. “People giving medical information probably shouldn’t have a link to buy their supplement, their diet program,” Rodgers said. If the creator pushes specific products, consider it a red flag.
- Watch out for bandwagons. “I saw a video where the creator said…