Gender and Sexual Orientation Differences in the Relationship Between Social Media Use and Disordered Eating: Results...

The COVID-19 pandemic associated with a sustained increase in youth online activity and a sharp increase in eating disorder-related hospitalizations. Social media use and its portrayal of unrealistic body types have been previously linked to poor body image and disordered eating (DE), particularly affecting girls, transgender and gender-expansive (TGE) individuals, and sexual minorities (SM). We aimed to assess the effects of time on social media on DE among youth in British Columbia (BC), Canada, across intersecting identities of gender and sexual orientation.

Our serial cross-sectional study used 2022-2024 data from the Youth Development Instrument, a population-level youth well-being survey conducted annually in British Columbia schools, primarily among Grade 11 students. Our exposure was self-reported time spent on social media, and our outcome was DE. We fitted linear and logistic regression models across strata of gender and sexual orientation. The adjustment set included age, number of adverse childhood experiences (ACEs) and protective childhood experiences (PCEs), and affluence. We also estimated the effect of abstaining from social media on DE scores.

Among 35,067 youths, 8,256 (23.5%) experienced DE. This proportion was higher among transgender and gender-expansive participants (40.9%) and SM girls (43.3%) compared to cis-hetero girls (32.2%), SM boys (16.5%), and cis-hetero boys (9.2%). We found a dose-response relationship for all groups. Social media abstention reduced the counterfactual outcome score by 16.0% for cis-hetero girls, 16.3% for SM girls, 13.9% for SM boys, 11.6% for transgender and gender-expansive youth, and 7.5% for cis-hetero boys.

Longer time spent on social media is significantly associated with increased odds of DE in youth, with the odds increasing progressively with higher levels of social media use, independent of income, age, adverse childhood experiences , and protective childhood experiences. Abstaining from social media may be protective against DE for all groups, but girls may benefit substantially more.