Promoting a Healthy Body Image on Social Media: A Physiotherapist's Perspective

Summary: This document explores how the rapid evolution of social media and smartphone technology since the mid-2000s has profoundly affected mental health, particularly among children and young adults. Highlighting the shift from simple connection tools to platforms engineered for constant user engagement, it examines the resulting challenges such as social deprivation, disrupted sleep, and fragmented attention. Drawing on research and expert insights, the discussion situates these developments within wider societal changes and considers the consequences for well-being in a digitally dominated era.

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Introduction

Have you ever felt your phone vibrate in your pocket, only to realise you were imagining it? This is a common phenomenon known as "phantom vibration syndrome," and it’s a small symptom of the pervasive influx of notifications within our daily lives. While social media platforms were initially seen as simple tools for connection, a wealth of research has emerged over the last two decades to show their profound impact on our well-being, particularly for children and young adults.

As a Physiotherapist and YouTuber, I've spent a lot of time building connections between the digital and physical world and while we may think of the digital and physical worlds as separate, the reality is that one has a powerful influence on the other.

The Rise of the "Hooked" Generation

Since the mid-2000s, social media has undergone a massive shift, moving from platforms designed to connect people to systems designed to keep users hooked. 

The introduction of features like the "like" button, algorithmically curated feeds, and push notifications transformed these services. They evolved from social networking systems to public performance platforms where users are incentivised to seek validation not just from friends, but from strangers.

This shift is a key part of what author Jonathan Haidt calls the "Great Rewiring." Beginning around 2010, the widespread adoption of smartphones and social media led to a significant change in the environment that children and adolescents develop. Time once spent on free play, face-to-face interaction, and real-world independence was replaced with screen time, which led to a rise in mental health issues like anxiety and depression. While it could be argued that this is a coincidental correlation there is increasing evidence of the causation.

Haidt points to four fundamental harms linked to sudden excessive smart phone use. 

1. Social deprivation: Young people are spending less time socializing in person, which can lead to feelings of isolation and social anxiety  
2. Disrupted sleep: Constant digital stimulation and late-night scrolling interfere with sleep patterns, which are crucial for development, concentration and mood.
3. Attention fragmentation: The constant stream of notifications and new content makes it difficult to focus, leading to a loss of concentration and mental fatigue. 
4. Addiction: Social media platforms use psychological principles, like a variable ratio reinforcement schedule, to keep users engaged. Much like a gambling machine that offers an unpredictable reward, social platforms deliver likes and comments at random intervals, which makes the act of checking for feedback highly addictive.

Variable ratio reinforcement schedule: Was developed by Amercian Psychologist Burrhus Frederic Skinnerfollowing his research on animals. In his seminal work, Schedules of Reinforcement, Skinner and his colleague Ferster showed that the variable-ratio schedule—where a reward is given after an unpredictable number of responses—produces a high, steady rate of response that is highly resistant to extinction (that is to imply that it is highly addictive). This is why it is so effective when built into the design of social media apps where the next like, comment or entertaining post is always a possibility but never guaranteed. Just keep checking and scrolling and you will be randomly rewarded on a continual basis. 

This can be explained further using The Hook Model

hook model (explained in video)

The adolescent brain is particularly vulnerable to this cycle. With a reward system that is more active and responsive to dopamine, teenagers can develop habits and addictions much faster than adults. In part because their frontal lobes are less able to control impulsive behaviours. 

Social Media and Body Image: A Tale of Two Genders

The impact of social media on body image is one of the most critical concerns from a health perspective, but it manifests in distinctly different ways for men and women. Research has long focused on how social media harms young women's body image, but in recent years, a more nuanced picture has emerged that includes men.

Body Image Concerns in Women:

Historically, female body image research has been dominated by issues surrounding weight, shape, and thinness. On social media, this often translates to the pursuit of the "thin ideal" or a "fitspiration" ideal that emphasizes a lean, athletic physique with low body fat. 

Women are also more likely to engage in upward appearance comparison—comparing their bodies to the highly curated and often unrealistic images of influencers and peers. This, in turn, can lead to increased body surveillance, where a person constantly monitors their own appearance, driving body dissatisfaction and potentially contributing to eating disorders and poor physical and mental health.

Body Image Concerns in Men:

While men also face pressures related to leanness, a growing body of research, including a doctoral dissertation by Christopher Bell (Bell 2025), highlights that their primary concern is often muscularity. The ideal male body portrayed on social media is typically a "muscular ideal" characterized by a lean physique with a v-shaped torso and visible abs. This can lead to a condition known as muscle dysmorphia, where an individual views themselves as small and weak even when they are muscular. For physically active men, social media use, particularly passive browsing, is strongly linked to a heightened awareness of their appearance and a greater drive to achieve an unattainable level of muscularity. Bell’s research further shows that this appearance-driven motivation for exercise is often associated with lower psychological well-being.

In short, while both genders are vulnerable to the negative impacts of social media, the specific body ideals they are pressured to attain are different. Women often internalize a pressure to be thin or lean, while men feel a pressure to be muscular.

The Link Between Body Image and Eating Disorders

The relationship between negative body image and mental health, particularly eating disorders, has long been a central area of study. Body image research first emerged in the mid-20th century as part of a push to understand and treat eating disorders, largely in response to high-profile cases like that of singer Karen Carpenter.

Today, we know that social media's influence on body image is a significant contributing factor to these conditions. When individuals engage in constant upward comparison and body surveillance, it can foster a profound dissatisfaction with their own physical appearance. This dissatisfaction is a well-established risk factor for the development of disordered eating patterns. Research has consistently shown that an appearance-focused approach to exercise, driven by a desire to change one's body shape or size, can be harmful. For example, a motivation to lose weight or gain muscle for purely aesthetic reasons may undermine the positive psychological benefits of physical activity and, in some cases, can even lead to exercise addiction or other unhealthy behaviors. The constant exposure to idealized bodies on social media normalizes extreme and often unhealthy standards, making it easier for vulnerable individuals to adopt restrictive eating patterns, over-exercise, or other dangerous behaviors such as steroid use in an attempt to achieve those ideals.

Social Media and Body Image Research: A Glimpse at the Evidence

A growing body of research is shedding light on the specific mechanisms and outcomes of social media's impact on body image. 

 A systematic review and meta-analysis of 83 studies, published in Body Image (Fardouly & Vartanian 2016), found a significant correlation between higher online social comparison and greater body image concerns. The study also found a link between social comparison and eating disorder symptoms, highlighting the need for interventions and policies to minimize appearance comparisons on social media.

Recommendations for a Healthier Digital Life

As we navigate this digital landscape, it's clear that we need to be more intentional about how we engage with social media. The solution isn't simply to avoid it but to build better habits and promote a healthier perspective.

1. Reframe the body's purpose:Instead of focusing on aesthetics, try to promote the body through a functional lens. Appreciate what the body can do—how it allows you to walk, run, lift, and play—rather than how it looks. This shift in perspective can improve your motivation for exercise and promote a more positive body image.
2. Practice media literacy:While research shows that general media literacy isn't always protective, it is still a vital skill. We can learn to be critical of what we see online and remember that many images are highly curated and edited. We can understand the psychological principles at play and how social platforms are designed to hold your attention.
3. Curate your feed:Be intentional about the accounts you follow. Actively seek out content that celebrates strength, movement, health, and diverse body types, rather than just aesthetics. Remember, you have the power to create a digital environment that is supportive and inspiring.
4. Set boundaries:Social media is often designed to have no clear "off-ramp," making it easy to fall into a cycle of endless scrolling. Be mindful of your consumption and set clear limits on screen time. Schedule specific times to check your phone and make a conscious effort to engage with the real world without digital distraction.

By taking these steps, we can work to reclaim a healthier relationship with our bodies and with the digital world. The goal is not to disconnect completely but to build a more conscious and mindful connection that supports our mental and physical well-being.

Before we finish. One final observation, while social media may be pushing people into gyms around the world it is also stopping them from exercising, heres why. 

In many fitness centers, a common sight is individuals slumping over their smartphones, seemingly oblivious to their surroundings. This behavior, far from being a harmless habit, is a scientifically documented phenomenon with significant implications for physical health and workout effectiveness. The "Great Rewiring" of our digital lives is spilling over into the physical world, even in spaces dedicated to physical well-being.

Sedentary Behaviour in an Active Environment

A number of studies have established a clear link between excessive smartphone use and increased sedentary behavior. A systematic review and meta-analysis published in the Journal of Psychiatric Research (2025) found a significant association between smartphone addiction and reduced physical activity among younger populations. Prolonged smartphone use within the gym effectively transforms an active environment into a sedentary one, particularly during rest periods between sets. The slumped posture often observed is a direct manifestation of this trend: a sedentary posture in a space designed for activity.

Impact on Workout Performance and Efficiency

Beyond the sedentary aspect, research shows that smartphone use in the gym can directly hinder the effectiveness of a workout. A study published in Quality in Sport (2024) highlighted that smartphone-induced mental fatigue can increase the perceived effort required for exercise, leading to a reduction in performance. The constant barrage of new information from scrolling through social media diverts cognitive resources, leaving a person mentally drained before they even begin their next set. This mental fatigue can lead to lower volume-load and endurance during resistance training. In short, the time spent "slumped over" a phone is not merely wasted time; it actively sabotages the workout itself.

The Link to Posture and Musculoskeletal Health

From a physiotherapist's perspective, this observation is particularly concerning due to its impact on posture and respiratory function. Prolonged smartphone use is associated with poor posture, including "forward head posture" and rounded shoulders. A study in the Journal of Physical Therapy Science (2016) demonstrated that the craniovertebral angle and scapular index—key indicators of head, neck, and shoulder posture—were significantly worse in individuals who used smartphones for prolonged periods. When an individual is slumped over their phone in the gym, they are reinforcing this poor posture and having a negative impact on respiratory function. 

Conclusion: As we navigate an era where the boundaries between our digital and physical lives grow ever thinner, it becomes increasingly important to recognise both the opportunities and the hazards of this new landscape. The evolution of social media and smartphone technology has indisputably reshaped how we interact, rest, and perceive ourselves—often in ways we are only beginning to understand. For children and young adults, whose development is so deeply entwined with social connection and sleep, these changes are especially profound.

Addressing these challenges calls for a thoughtful balance: fostering digital literacy and self-awareness, advocating for mindful technology use, and protecting spaces for genuine human connection. Ultimately, our well-being in the digital age will depend not on resisting technology outright, but on learning to harness its power while remaining attentive to its impact on our minds and relationships.

References

Bell, C., 2025. The relationship between social media, body image and exercise motivation in physically active men(Doctoral dissertation, Brunel University London).

Fardouly, J. and Vartanian, L.R., 2016. Online social comparison is a key driver of body dissatisfaction: A systematic review and meta-analysis of 83 studies. Body Image, 17, pp.10-18.

Ferster, C.B. and Skinner, B.F., 1957. Schedules of reinforcement.

Haidt, J., 2024. The anxious generation: How the great rewiring of childhood is causing an epidemic of mental illness. Penguin.

Jung, S.I., Lee, N.K., Kang, K.W., Kim, K. and Lee, D.Y., 2016. The effect of smartphone usage time on posture and respiratory function. Journal of Physical Therapy Science, 28(1), pp.186-189.

Maciąg, M., Bieńko, M., Bieńko, M., Marchaj, M., Putra, A., Korta, K., Król, T., Toborek, M., Niedziela, N. and Bednarz, K., 2024. Impact of Smartphone-Induced Mental Fatigue on Resistance Training Performance and Efficiency-The Role of Smartphone Use During Workout. Quality in Sport, 28, pp.54966-54966.

Nambirajan, M.K., Vidusha, K., Kailasam, J.G., Kannan, S., Govindan, D., Ganesh, K., Priyan, S. and Krishnamoorthy, Y., 2025. Association between smartphone addiction and sedentary behaviour amongst children, adolescents and young adults: A Systematic Review and meta-analysis. Journal of Psychiatric Research.

Daniel Lawrence - Adapted Script - @ThePhysioChannel