Table 1.
Summary of Included Studies
| Author | Location of Research | Sample | Design | Physical Activity and/or Diet Measures | Characteristics of Social Media Intervention and Control Groups | Main Findings |
|---|---|---|---|---|---|---|
| Ashton et al., (2017) [27] | Australia |
N = 50 (100% Male) Mean Age (SD): Intervention Group = 22.4 (2.0), Waitlist Control Group = 21.9 (2.1) Ethnicity = Not reported Target group = Young adult men aged 18–25 years |
RCT | Physical Activity Level (Pedometer), MVPA (Self-reported), Diet Quality & Energy Intake (Australian Eating Survey FFW), Weight, Fat Mass, Skeletal Muscle Mass (Bioelectrical impedance analysis), BMI (stadiometer and weight), Waist Circumference (Tape Measure), systolic and diastolic blood pressure (composite measures), rest heart rate (automatic sphygmomanometer) |
Medium: Facebook Type of Social Media: Information & Interaction - Facebook groups to facilitate social support, notifications for new materials and reminders for sessions. Control Group: continued normal routine and started program after a 3 month delay. Duration: 3 months |
Statistically significant differences for the social media intervention: MVPA (p < 0.05, d = 0.58), daily vegetable servings (p < 0.05, d = 0.62), percentage energy from ED- NP* foods (p < 0.01, d = 0.73), weight loss (p < 0.05, d = 0.63), percentage weight loss (p < 0.05, d = 0.67), waist circumference (p < 0.001, d = 0.89), BMI* (p < 0.01, d = 0.81), body fat mass (p < 0.05, d = 0.67), plasma total cholesterol (p < 0.05, d = 0.60), LDL* cholesterol (p < 0.01, d = 0.83) and ratio of total cholesterol-to-HDL* cholesterol (p < 0.05, d = 0.60) |
| Jane et al. (2017) [28] | Australia |
N = 67 (85% Female; 15% Male) Mean Age (SD): Control Group = 50.2 (2.4); Pamphlet Group = 54.1 (2.3); Facebook Group = 47.0 (2.3) Ethnicity = Not reported Target group = Individuals with a BMI between 25 and 40 kg/m2 (overweight or obese) |
RCT | Weight (digital scales), height (stadiometer), lean mass and fat mass (bioelectrical impedance), waist and hip circumference, blood pressure (sphygmomanometer), fasting blood glucose (glucometer), blood lipids insulin (blood test) all measured at clinical appointments at 6, 12, 18 and 24 weeks. Dietary intake, physical activity and step count (from self-reported three-day food, physical activity and step count records) |
Medium: Facebook Type of Social Media: Information and Interaction - Instructions for specified diet (Total Wellbeing Diet) shared, access to weight management program and interaction with other members via Facebook. Control Group: received standard care Comparison Group: received intervention through pamphlets Duration: 24 weeks |
Intervention group had statistically significant greater weight loss than the control group (group 1) at 6 weeks (− 2.7%, p = 0.01 and − 2.5%, p = 0.02 respectively), 18 weeks (− 4.5%, p = 0.02 and − 4.9%, p = 0.02 respectively), and 24 weeks (− 3.6%, p = 0.05 and − 4.8%, p = 0.01 respectively). Social media intervention had significant reduction in BMI and waist circumference at 18 weeks (− 1.6 kg/m2, p = 0.04 and − 1.5 kg/m2, p = 0.04 respectively) and 24 weeks (− 1.5 kg/m2, p = 0.02). Statistically significant increase in energy expenditure at 6 weeks (+ 588.8 kJ/day, p = 0.03). There was no statistically significant difference between the groups for step count and fat, alcohol or mean energy intake. |
| Pope et al. (2019) [29] | USA |
N = 38 (74% Female; 26% Male) Mean Age (SD): Intervention Group = 21.2 (4.0); Control Group = 21.8 (2.8) Ethnicity: Non-Hispanic White N = 27 Asian N = 11 Target Group = College students aged 18–35 years, BMI > 18.5 kg/m2 |
RCT | Physical Activity (accelerometers for 7 days at baseline, 6 weeks and 12 weeks), Cardiorespiratory fitness (YMCA 3-min step test at baseline and 12 weeks), Height, weight and body composition (stadiometer at baseline and 12 weeks and bioelectrical impedance scale), Dietary behaviours (ASA24 food recall three times at baseline, 6 and 12 weeks). |
Medium: Facebook Type of Social Media: Information - education and health tips were provided twice a week in a Facebook group and participants used a smartwatch to track their physical activity. Control Group: No smartwatch but access to the Facebook Group. Duration:12 weeks |
MVPA from baseline to 6 weeks increased for both intervention (4.2 min) and control (1.6 min) groups (not statistically significant). Decreased daily caloric intake for both groups (intervention = − 41 cal, control = − 143.3 cal) not statistically significant) and decreased vegetable consumption at 6 and 12 weeks for intervention group (− 0.2 cups each time) (not statistically significant). |
| Vogel et al. (2019) [30] | USA |
N = 500 (54.6% Female; 44.8% Male; 0.6% Other) Mean Age (SD) = 20.9 (2.0) Ethnicity: Non-Hispanic Caucasian N = 366 Native American N = 5 African American N = 13 Asian/Pacific Islander N = 6 Hispanic N = 34 Multiple Ethnicities N = 72 Target Group = Young Adults Aged 18–25 years, current smoker and current Facebook user |
RCT | Self-reported questionnaire on diet: (healthy eating, fruit and vegetable consumption) physical activity (regular exercise engagement and MVPA) and latent class analysis on health risk behaviours (high-fat diet, low fruit and vegetable consumption, physical inactivity, poor sleep hygiene, poor stress management, heavy drinking and substance use) |
Medium: Facebook Type of Social Media: Interaction and Information – information about smoking cessation was posted to a private Facebook group once per day and a live counselling session was held once a week on Facebook. Control Group: Referred to smokefree.gov. Duration: 90 days with data collected at baseline, and at 3, 6 and 12 months. |
The Facebook intervention resulted in smoking abstinence. A significant direct effect of 3 month smoking abstinence on lower likelihood of 12 month metabolic risk (P < 0.010). This effect was mediated by readiness to increase fruit and vegetable consumption at 6 months (P < 0.05). A significant and direct effect of 3 month smoking abstinence and readiness to increase fruit and vegetable consumption at 6 months (P = < 0.03). Overall, readiness to increase fruit and vegetable consumption mediated the relationship between abstinence from smoking and decrease metabolic risk behaviours. |
| Chung et al., (2017) [34] | USA |
N = 12 (67% Female; 33% Male) Mean Age: Overweight/Obese Group = 20.3; Healthy weight Group = 19.0 Ethnicity: Caucasian N = 6 African N = 4 Asian American N = 1 American Indian N = 1 Target group = College students (age ≥ 18 years), BMI categorised as overweight/obese (BMI 25–34.9 kg/ m2) or healthy weight (BMI 22.5–24.9 kg/ m2) |
NCBA (Single arm intervention pilot study) | Weight and body fat percentage (Fitbit aria wireless scale), intake of fruit, vegetables and SSB* (self-reported), any lifestyle changes (self-reported) |
Medium: Twitter Type of Social Media: Information, Interaction and Gamification – Private Twitter group and use of a FitBit; tweets between participants and researchers on diet and physical activity, personalised feedback and group challenges with prizes. Intervention Design: Participants were divided into 2 groups: overweight/obese and health weight Duration: 3 months |
Participants had a decline in steps on weekends and during holidays but increased with 1 day challenges and were sedentary for the majority of their day (not statistically significant). An increase in fruit intake was seen for 92% of participants and vegetable intake for 58% (self-reported, not statistically significant). Overweight participants lost 1–5 pounds and healthy weight participants lost 0.2 to 7 pounds (not statistically significant). |
| Williams et al. (2019) [35] | USA |
N = 23 (100% Female) Mean Age = Not reported Ethnicity = Not reported Target Group = Primigravid women, ≥18 years of age, English or Spanish speaking, receiving care at clinic |
NCBA (Feasibility Study Pilot intervention) | Anthropometric measures (height, weight, weight gain during pregnancy, postnatal weight loss, baby length/weight), nutrition and physical activity (pre-post surveys). |
Medium: Facebook Type of Social Media: Interaction and Information – Health messages were shared and interaction was promoted between the participants as well as with the health care worker. Control Group: No control group Duration: 3 years |
Intervention was well-received and would be recommended to a friend. Postpartum effects: 70% (5 out of 7) of participants dropped below or within 5 pounds of their pre-pregnancy weight at 5 months postpartum (not statistically significant). Barriers to engaging in physical activity (PA) included no previous PA prior to pregnancy, beliefs or concerns about PA during pregnancy, lower motivation to attend PA class than compared to maternal nutrition/baby information, PA sessions were in a different location, and not all wanted to engage in group walking. |
| Willis et al. (2017) [36] | USA |
N = 70 (84% Female; 16% Male) Mean Age (SD) Intervention Group = 46.8 (13.2) Mean Age (SD) Control Group = 47.6 (11.7) Ethnicity = Not specifically defined; 24% of total sample categorised as “Minorities” Target Group = Adults with obesity |
NCBA (Randomized Feasibility Study) |
Self-monitoring once per week: body weight (self-reported through scales), diet consumed and minutes of PA (using MyFitnessPal app), steps (using Fitbit activity monitor). Outcome Measures were collected in the laboratory by trained staff at baseline and month 6: body weight (digital scales), height (stadiometer) and waist circumference (tape measure). Diet Intake: log all food and beverage in the MyFitnessPal app for 3 consecutive days prior to laboratory visit which was downloaded by research staff. Physical activity: sub-set of participants wore an accelerometer for 7 days. |
Medium: Facebook Type of Social Media: Interaction and Information- Health education lessons and audio recordings were posted and participants commented or posted four times a week (mandatory) on a message board. Control Group: Received same intervention by phone calls rather than through an online social network. Duration: 6 months |
No statistically significant different for intervention and control group for weight change (kg), BMI, waist circumference, weight gain, weight loss, minutes of physical activity or steps. |
| Key et al. (2020) [31] | USA |
N = 56 (66% Female; 35% Male) Mean Age (SD) = 58 (6) Ethnicity: 100% White Target group = Age ≥ 50 years, at risk for CRC*, one or more modifiable CRC risk factors |
Mixed-Methods |
Physical Activity (Fitbit device and self-reported), BMI (collected pre/post intervention), CRC screening status (questionnaire), Dietary Patterns (Vio-FFQ*), Diet Quality (Healthy Eating Index) Inflammatory effect on diet (Dietary Inflammatory Index) |
Medium: Facebook Type of Social Media: Information and Gamification - Daily posts related to nutrition, physical activity and CRC factors and weekly challenges (to increases steps, get most likes) with prizes. Control Group: N/A Duration: 12 Weeks |
The Healthy Eating Index Scores had a significant increase from baseline to post-intervention (p < .001), with the mean score increasing by 9 points (49.9 ± 9.9 to 58.6 ± 12.1). Dietary Inflammatory Index scores had a significant decrease from baseline to post-intervention (p = .002) from 2.8 ± 1.1 to 1.6 ± 1.7 BMI had no significant changes. The steps per day decreased − 33.0 between pre- (2007.1 to 1974,5 and post-intervention (not statistically significant). |
| Pappa et al. (2017) [32] | Not Stated |
N (Total sample) = 107,886 N (Subset of platform users with gender, age, and weight change data available) Female) = 754 (56% Female; 44% Male) Mean Age (SD) = 25 (6) Ethnicity = Not reported Target Group = Users of sub-Reddit community called ‘LoseIt’ |
Mixed-Methods (Randomised Cross-sectional Survey) | Weight, weight check-ins (start, current and goal weight),age gender, height (self-reported) and BMI (calculated) |
Medium: Reddit (Subreddit ‘LoseIt’ community) Type of Social Media: Information and Gamification - User activity on the subreddit group based on content users posted and interactions with other users. Control Group: N/A Duration: 4 years |
3.7% (28/754) of users gained weight (mean 3.88%, SD 4.04), 3.5% (25/754) maintained weight, and 92.9% (701/754) lost weight. 514 of 754 users (68.2%) moved to a healthier weight category (i.e. high obese, moderate obese, low obese, overweight, normal) while part of the LoseIt community (not statistically significant). |
| Torquati et al. (2018) [33] | Australia |
N = 47 (87% Females; 13% Male) Mean Age (SD) = 41.4 (12.1) Ethnicity = Not reported Target Group = Registered Nurses aged > 18 |
Mixed-Method (Pilot Intervention) | Changes to physical activity behaviour including MVPA, light activity, sedentary and steps per day (accelerometers), diet behaviour and dietary patterns (FFQ* Australian Eating Survey; Australian Recommended Food Score), chronic disease risk markers (weight, BMI, waist circumference and blood pressure), health, diet and physical activity self-efficacy (self-reported) |
Medium: Facebook Type of Social Media: Information and Interaction – information and education content was shared through posts. Control Group: N/A Duration: 12 weeks |
MVPA and daily steps decreased at 3 months (P = .01 and .04, respectively) and MVPA further decreased at 6 months. A significant time × interaction effect for MVPA and average daily steps (P = .01 and .05, respectively). Intake of fruit and vegetables improved significantly at 3 months and decreased slightly at 6 months (P = 0.04) |
| Wang et al. (2021) [39] | China |
N = 110 (59% Female; 41% Male) Median Age (SD) = 18(1.0) (Intervention Group), 18(1.0) (Control Group) Ethnicity: Not reported Target Population: College Students |
CBA (Non-randomized Control Intervention) | Diet (dietary intake estimates at baseline, logging meals and sharing food pictures), food intake (Self-reported), physical activity (physical activity at baseline, recommended to exercise 150 min/week and share this on the WeChat community), completion of daily tasks (self-check questionnaire), physical fitness (i.e. push-ups, squares, planks), body composition, waist, resting metabolic rate (completed at baseline and 21 days after) |
Medium: WeChat and Zhishi mini-program Type of Social Media: Information, Interaction and Gamification– (i) daily health-related information shared, (ii) discussions initiated on health education content, sharing food pictures and physical activity performance in the WeChat group, (iii) mini exercise challenges were assigned. Control Group: Same as intervention but did not receive health-related information Duration: 21 days |
Daily food intake for the intervention group significantly improved after 21 days in comparison to baseline (P < 0.05) for vegetable, fruit, milk and dairy products. Frequency intake of soybean (and related soybean products) significantly increased in the intervention group (P = 0.030). A significant enhancement of physical activity was shown for the intervention group, with 48 having low physical activity at baseline and 26 having a higher level at the end of the intervention (P = 0.004). Better changes in physical fitness were shown for the intervention group, with the length of squat time (P = 0.005) and plank time (P = 0.008) of the intervention group better than the control group. No food intake changes were shown for the control group between baseline and 21 days (P > 0.005) |
| Krishnamohan et al. (2017) [41] | India |
N = 45 (47% Female; 53% Male) Age Ranges: Control Group 18–23); Intervention Group 18–23 N (Ethnicity) = Not reported Target group = First or Second Year Clinical University Students with a BMI ≥23 kg/m2 |
CBA | Changes in physical activity and diet patterns such as intake of fruits, vegetables and junk food (WHO STEPS questionnaire), BMI (scales and stadiometer), changes in weight (measurement not reported). |
Medium: Facebook Type of Social Media: Information - Posting health education messages and content to participants three times a week. Control Group: 2nd year students with no access to social media Duration: 6 weeks |
Statistically significant decrease in mean number of days per week of junk food intake reduced for both control (2.91 to 2.65 days) and intervention (3.27 days to 2 days) (P < 0.01). Significant decrease in BMI for those in the control group (25.57 to 25.15) (P < 0.05). BMI increased for those in the intervention group (26.66 to 26.74) (not statistically significant). Increase in mean minutes per week of moderate physical activity (9.32 min to 12.27 min) and for physical activity during travel (298.18 min to 496.36 min) for intervention group (not statistically significant). Increase in mean minutes per week for physical activity during travel at follow up for control group (761.52 min to 1036.52 min) and intervention group (298.18 min to 496.35 min) (not statistically significant). |
| West et al. (2016) [37] | USA |
N = 58 (81% Female); 19% Male) Mean Age (SD) = 21.6 (2.2) Ethnicity = 90% white; other ethnicities not reported Target Group = Students who were registered for undergraduate courses in health |
CBA (Controlled Quasi-experimental Study) | Weight (self-reported through Wi-Fi scales provided), Physical activity (physical activity tracker for steps and miles walked), BMI (digital scales), Behavioural Weight Control Practices (28 item checklist) |
Medium: Facebook Type of Social Media: Interaction and Information- content related to how to maintain a healthy weight content was shared and posted, and group members interacted with one another. Control Group: Used Facebook but did not receive information on healthy weight maintenance. Duration: 9 Weeks |
A significant increase in weight control strategies postintervention was observed for intervention group (− 1.1 ± 3.4; P = .003). These included self-weighing (P = .005), cutting out snacking (P = .001), reducing carbohydrate intake (P = .02), graphing weight (P = .01), reducing calorie intake (P = .02), reducing fat intake (P = .02), and increasing exercise (P = .02) Overweight students in the intervention group lost 1.8 ± 0.7 kg over 9 weeks in comparison to overweight students in the control group who lost 1.4 ± 1.7 kg (not statistically significant). |
| Mabe et al. (2014) [40] | USA |
Study 1 N = 960 (100% Female) Mean Age (SD) (Autumn) = 18.44 (0.85) Mean Age (SD) (Spring) = 19.10 (1.11) Ethnicity = 18.5% Hispanic; 86.5% White *Note: these are the percentages reported in the paper; N of participants in each ethnic group not reported. Study 2 N = (Study 2) = 84 (100% Female) Mean Age (SD) = 18.39 (SD) Ethnicity: White = 77.4%; 15.5% Hispanic; 7.1% African American Target group = Female College Students who used Facebook weekly |
Cross-Sectional (Study 1) and CBA (Study 2) |
Study 1 Eating attitudes and behaviours (EAT-26), duration of Facebook use (amount of time spent on Facebook per week). Study 2 Eating attitudes (EAT-26). |
Study 1 Medium: Facebook Type of Social Media: cross sectional study exploring duration of Facebook use Study 2 Medium: Facebook Type of Social Media: General -participants were asked to spend 20 min on Facebook Control Group: 20 min on Wikipedia researching the Ocelot and related YouTube videos. Duration: 20 min |
Study 1 – Significant positive correlation between duration of Facebook use and disordered eating for participants in fall (r(623) 5 .11, p < .01) and spring (r(334) 5.16, p < .01). Study 2 –EAT-26 scores were significantly associated with several Facebook items; participants with greater disordered eating were shown to endorse importance of receiving comments on status (r(83) 5 .32, p < .01), photos (r(83) 5 .29, p 5 .01), and receiving likes (r(83) 5 .29, p < .01), comparing their photos with female friends’ photos more often (r(83) 5 .22, p 5 .04). The urge to exercise significantly decreased for those spending 20 min on the internet (p < .001, d 5 .26), with the effect not dependent on the condition (p = .46), suggesting that this is for general internet use only and not Facebook use. |
| Raggat et al. (2018) [42] | Australia |
N = 180 (84% Female; 15% Male; 1% Other) Median Age = 23.0 (IQR 19.0, 28.5) Ethnicity = Not reported Target Group = Aged > 16, residing in Australia, engaged with fitspiration content |
Cross-Sectional | Disordered Eating Behaviours (Eating Attitudes Test-26), compulsive exercise behaviours (Exercise Addiction Inventory), perceived influence of fitspiration on health and well-being (online survey). |
Medium: Any Social Media Platform Type of Social Media: Information and Interaction – participants were surveyed on the fitspiration* content they accessed, posted about or discussed with other users. Control Group: N/A Duration: 6 weeks |
Fitspiration content inspired participants (n = 159, 90.3%) to exercise or eat healthy. Fitspiration content influenced health behaviours and beliefs through setting the ‘healthy ideal’, failure to achieve the ‘ideal’, being part of a community, and access to reliable health information. |
| Wicks and Keel (2020) [38] | USA |
Study 1 N = 2485 (76% Female; 24% Male) Mean Age (SD) = 19.01(1.80) Ethnicity = White (77%), Black (10%), Asian (4%), Hispanic (23%), Other (2%) Target Group = Male and Female College Students Study 2 N = 89 (93% Female, 7.5% Male) Mean Age (SD) = 18.71(.97) Ethnicity = White (91%), Black (8%), Asian (6%), Hispanic (24%), Other (1%) Target Group = Individuals who endorsed posting edited photos in Study 1. |
Cross-Sectional (Study 1) and CBA (Study 2) |
Study 1 Questionnaire to assess if Instagram is used and if photo editing applications are used to edit photos, Eating Attitudes Test-26 for disordered eating. Study 2 Participants viewed their own photo (taken by researchers) for 1 min then completed Visual Analogue Scales before and after being assigned to one of four group conditions. Participants also completed a post- questionnaire battery (EAT-26, Body Shape Questionnaire, Trait Subscale of the State-Trait Anxiety Inventory, Centre for Epidemiological Studies Depression Scale and Instagram Survey). After 24 h, participants completed VAS and Follow-up Social Media Questionnaire. |
Study 1 Medium: Instagram Type of Social Media: Interaction through posting their own photo to Instagram Study 2 Medium: Instagram Type of Social Media: Interaction Group Conditions: (1) Edited and posted photos as normal); (2) Edited photo but did not post; (3) Completed neutral questionnaire and posted unedited photos; (4) Completed neutral questionnaire and did not post photo. Duration – 24 Hours |
Study 1 Participants who posted edited photos significantly differed on gender (X2[2] = 146.93, p < .001),where women endorsed posting editing photos compared to men, and race (X2[5] = 26.22, p < .001) where white and Asian individuals endorsed posting and editing photos compared to black individuals. Those who posted edited photos had a significantly higher likelihood of scoring above EAT-26 cut off for probable eating disorders compared to those who don’t (10.0 vs. 5.5% X2[1] = 12.63, p < .001). Study 2 There were significant increases in eating disorder cognitions for those who posted photos (t[40] = 2.00, p = .05; d = .64).The posted edited photos conditions caused significant increases in eating disorder cognitions (t [18] = 2.36, p = .03); d = 1.11); the edit only condition caused significant decreases in eating disorder cognitions (t [20] = − 1.24, p = .03; d = .56). For disordered eating urges, significant post x time interaction where urges decrease significantly in those who did not post photos (t[40] = 1.22, p = .04; d = .39). From baseline to 24 h follow-up, there were significant decreases in eating disorder cognitions for participants (F[1, 76] = 7.36, p =. 008; partial n2 = .09) and significant decreases in anxiety (F[1,76] = 32.68, p < .001; partial n2 = .30) regardless of condition. |
*SD Standard deviation, IQR inter-quartile range, ED-NP Energy Dense, Nutrient Poor, BMI Body Mass Index, LDL Low Density Lipoprotein, HDL High Density Lipoprotein, SSB Sugar-Sweetened Beverage, CRC Colorectal Cancer, Fitspiration is a popular social media trend containing images, quotes and advice for healthy eating and exercise, FFQ Food Frequency Questionnaire