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ORIGINAL RESEARCH

Obesity in social media: a mixed methods analysis

Wen-ying Sylvia Chou, PhD, MPH,1 Abby Prestin, PhD,2 Stephen Kunath, MS,3
1
Health Communication and
Informatics Research Branch,
Behavioral Research Program,
Division of Cancer Control and
Population Sciences,
National Cancer Institute, National
Institutes of Health, 9609 Medical
Center Dr. 3E614, Rockville, MD
20892, USA
2
Health Communication and
Informatics Research Branch,
Behavioral Research Program,
Division of Cancer Control and
Population Sciences,
National Cancer Institute, National
Institutes of Health, 9609 Medical
Center Dr., Rockville, MD 20892,
USA
3
Department of Linguistics,
Georgetown University, 9609
Medical Center Dr. 3E614, Rockville,
MD 20892, USA
Correspondence to: W Chou
[email protected]

Cite this as: TBM 2014;4:314323

doi: 10.1007/s13142-014-0256-1

Abstract
The escalating obesity rate in the USA has made
obesity prevention a top public health priority. Recent
interventions have tapped into the social media (SM)
landscape. To leverage SM in obesity prevention, we
must understand user-generated discourse surrounding
the topic. This study was conducted to describe SM
interactions about weight through a mixed methods
analysis. Data were collected across 60 days through
SM monitoring services, yielding 2.2 million posts. Data
were cleaned and coded through Natural Language
Processing (NLP) techniques, yielding popular themes
and the most retweeted content. Qualitative analyses
of selected posts add insight into the nature of the
public dialogue and motivations for participation.
Twitter represented the most common channel. Twitter
and Facebook were dominated by derogatory and
misogynist sentiment, pointing to weight
stigmatization, whereas blogs and forums contained
more nuanced comments. Other themes included
humor, education, and positive sentiment countering
weight-based stereotypes. This study documented
weight-related attitudes and perceptions. This
knowledge will inform public health/obesity prevention
practice.
Keywords

Obesity, Weight stigma, Cyber aggression, Social

media, Health communication, Mixed methods,
Online social support
INTRODUCTION
Obesity control and prevention is an urgent public
health priority facing the USA today, as an estimated 69 % of US adults were overweight in 2011 [26].
In order for programs at multiple levels (from
individual education to environmental and policy
changes) to be effective, it is important to understand popular attitudes toward weight and obesity.
Recent behavioral science research has documented
widespread stigmatization and negative stereotyping
of overweight individuals in media and in public
discourse, and such stigma is found to be detrimental to those struggling with weight issues [23, 33].
The growth of social media offers another way to
document public attitudes about obesity, posing the
question of whether or not weight stigma may be
exacerbated in user-generated online interactions. A
systematic examination of social media interactions
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surrounding obesity-related topics will facilitate an

Implications
Practice: Public health practitioners and healthcare providers must be aware of the nature of
authentic online conversations surrounding obesity, including negative sentiment that could
drown out health messages as well as positive,
health-promoting sentiment, and consider ways
to leverage ongoing conversations to counter
weight-based stigma.

Policy: Broader efforts can be implemented to

curb online weight stigma, by partnering with
existing anti-cyberbullying efforts and online
inuencers such as celebrity gures to affect
the dialogue over time.
Research: This work offers insights into the
lived experience of obesity. It will inform
research investigating the efcacy and effectiveness of health promotion and weight control
interventions using social media.
understanding of how public attitudes inform obesity prevention efforts.

Weight stigma in the media

Despite the fact that being overweight has become
the norm in many regions of the USA, weight
stigmatization has persisted [30, 31, 50]. Negative
weight-based characterizations in the media have
been consistently documented, whereby obese
individuals are portrayed as unintelligent and
undisciplined architects of their own condition [1].
Furthermore, overweight people are underrepresented in entertainment programs, but those who do
appear are portrayed as unattractive, shown engaging in stereotypical eating behavior, and the target
of ridicule and derision [8, 10, 19]. The news media
also contribute to weight bias by portraying overweight individuals in stigmatizing ways [35, 36] and
by focusing primarily on individual-level causes
(e.g., diet) and solutions rather than on social or
genetic factors [18, 25]. Even in some obesity
prevention campaigns, fat shaming continues to
be a theme [35, 36].
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These negative media portrayals have reinforcing

effects. For instance, competitive weight loss reality
programs have been shown to promote individual
blame beliefs and contribute to weight stigma [6, 44,
49], and children exposed to greater amounts of
media express greater stigmatization toward overweight individuals [11, 21]. These stereotypes are
internalized by some overweight individuals and can
result in serious health consequences [47]. For
instance, whereas members of other stigmatized
groups engage in favorable ingroup bias that buffers
them against prejudice [37], overweight or obese
individuals commonly hold negative ingroup attitudes that indicate internalization of weight stigma
[47]. Victims of weight-based prejudice are at higher
risk for mental health comorbidities, including
depression, body dissatisfaction, loneliness, anxiety,
and low self-esteem [23, 41]. Weight-based teasing
and peer victimization can also contribute to
unhealthy behaviors such as disordered eating [42]
and decreased physical activity [41].

The role of social media in shaping attitudes about obesity

Over the past decade, social media have allowed
Internet users to interact with one another on
unlimited topics, including health and weight [2, 3].
Recent studies have noted the presence of weight
stigma in social media dialogue. On YouTube, for
example, personal causes of and responsibility for
obesity were dominant themes, and individual-level
behavioral changes were recommended most often
[50]. The user-generated videos frequently
contained weight-based teasing and ridicule, and
videos with a derogatory stance toward overweight
individuals received more views, ratings, and user
comments than those without a teasing tone. Indeed,
stigmatization in both the video content and user
comments has been repeatedly documented [13].
On the other hand, social media platforms can
provide safe havens against weight bias. There exist
supportive online communities that provide compassionate, nonjudgmental spaces for individuals to
share weight-related experiences and efforts. Over
time, these interactions may improve self-esteem
and resilience to stigma [5, 15, 22].
With the continued growth of social media and its
expanding impact, it is important to understand how
social media interactions reect and shape the
public discourse. Key questions requiring empirical
evidence from authentic social media discourse
include: Does the social media dialogue perpetuate
or curb weight stigmatization? How is obesity (and
affected individuals) portrayed in social media? Do
conversations about obesity or weight differ across
channels such as blogs, Twitter, and Facebook?
A comprehensive mixed methods investigation of
obesity-related communication across multiple social media channels will begin to answer these
questions. The present project capitalizes on the
accessibility of this dialogue while protecting conTBM

dentiality and anonymity. Incorporating innovative

Natural Language Processing (NLP) analytic techniques and qualitative sociolinguistic analysis, this
study presents one of the rst attempts to document
social media discourse surrounding obesity.

METHOD
Linguistic corpus
Social media data were extracted through a
commercial web-crawling search service that utilized a combination of data feeds and comment
crawlers to index publicly available data across
blogs, Twitter, Facebook, forums, Flickr, YouTube,
and comments (dened as user-generated responses
to content on all channels except Twitter). A set of
predetermined keywords was used for data mining,
including obese/obesity, overweight, and fat.
Data were mined at 12-h intervals between January
23, 2012, and March 23, 2012, and each extraction
pulled the rst 20,000 pieces of data available on
the server. For context, in March 2012, Twitter
reported that users made 340 million Tweets per
day [45], and on a given day, roughly 200,000
posts containing our keywords were available on
the server. Data les containing a total of approximately 2.2 million initial posts were retrieved, deduplicated, and saved into a shared le repository.
Individual records were de-serialized, moved to a
relational database (MySQL) for organization and
verication, and deposited in a searchable cloudbased web service.
Data cleaning was performed on the initial posts
by doing the following: (1) excluding excluded data
from Flickr and YouTube (which only captured text
comments on photos and videos, respectively),
leaving the following ve channels: Twitter,
Facebook, blogposts, forums, and website comments; (2) excluding non-English posts and posts
without a keyword; and (3) excluding irrelevant
posts through NLP-assisted machine-learning techniques. In this step, two trained human coders
evaluated a subsample for relevance. Irrelevance
was identied through the co-occurrence of keywords with modiers indicating reference to topics
other than human body weight (e.g., fat blunt, Gong
Hay Fat Choy, Fat Joe). A machine-learning, nave
Bayes classier was constructed to automatically
exclude irrelevant posts based on human-coded
training data. We spot-checked within the cleaned
data to conrm exclusion. The data-cleaning process
was iterative with classiers modied and reapplied
on the corpus as additional exclusion terms were
uncovered. The nal corpus contained approximately 1.37 million posts.
Mixed methods data analysis
We applied a mixed methods approach to capture a
broad sense of the data and also to delve into
specic ndings. In the initial exploratory phase, we
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generated descriptive statistics on relative distributions of each keyword and the distribution of posts
across channels. Team members also individually
reviewed the corpus and selected illustrative posts,
and convened multiple times to discuss noticeable
trends and themes. Subsequently, we generated lists
of linguistic bigrams and content/lexical words (e.g.,
excluding prepositions, conjunctions, and linguistic
llers) adjacent to each keyword. Bigrams are
typically used in computational linguistics to build
language models and identify frequencies of the
occurrence of linguistic elements (e.g., alphabets,
lexical items). Additionally, since Twitter data represented the majority of the corpus, the top 25 most
retweeted posts were identied and analyzed for
each keyword.
Next, we performed discourse analysis (an approach commonly used in sociolinguistics to interpret the meaning and context of naturally occurring
interactions) on a small portion of data excerpts
representing themes highlighted in quantitative
ndings. Two simultaneous procedures guided the
selection of paradigmatic data excerpts: (1) quantitative discoveries from bigram data (e.g., frequent cooccurrence of fat and girl prompted the selection of a post containing those two adjacent terms)
and top retweets and (2) purposeful selection by the
study team through a consensus process. Note that
to preserve the anonymity of posters, in our
presentation of excerpts and phrases, some exact
wording is modied, links to URLs are replaced
with [URL included], and users Twitter handles
are replaced with @USERNAME. All typos,
misspellings, and slang are retained to illustrate
authentic exchanges, while expletives are censored
with the rst letter of the word followed by asterisks
for each additional letter.

RESULTS
Study ndings are presented in the following order:
overall prevalence of keywords across social media
channels, linguistic bigrams (list of most commonly
appearing content words associated with each keyword), content of the top ve retweeted posts (a
small number due to space constraint) for each
keyword, and nally, qualitative illustrations of
selected posts.

Distribution of keywords across media channels

Among the keywords, fat was most commonly
used both overall and across different channels
(92 % of the entire corpus). By comparison,
obese/obesity appeared in 6 % of the data,
followed by overweight (2 %). Table 1 presents
post count by keyword and by channel.
Across three keywords, the majority of the
dialogue took place on Twitter (approximately 1.25
million posts or 91 % of the corpus). In comparison,
the keywords were more evenly distributed on
blogs, forums, and comments. For instance,
obese/obesity appears in 24 % of forum posts,
and overweight appears in 6 % of forum posts,
suggesting more varying themes in these channels as
compared to Twitter and Facebook.
Linguistic bigrams and top retweeted posts: toward
emerging themes
To glean the overall sentiment surrounding our
keywords, NLP techniques helped produce linguistic bigrams on the content words most commonly
adjacent to the keywords (Table 2). The lists of
words reveal a few striking patterns: rstly, compared to obesity and overweight, fat is most
closely associated with words with negative connotations, including derogatory and misogynist terms.
Secondly, and not surprisingly, fat is more likely to
be found in colloquial conversations compared to
the other two keywords. For example, notice that
the word children is more frequently associated
with obesity and overweight, whereas kid is
associated with fat. Finally, dialogues containing
the terms obesity and overweight often include
more information, such as hyperlinks to news
articles or health-care agency websites (e.g., http
appears in the bigrams for both keywords).
Twitter provides over 90 % of all interactions
about obesity in this corpus; as such, its use pattern
deserves special attention. Of note, Twitters
retweet feature is a unique aspect of this channel
that provides insight into the common sentiments in
the corpus. When users retweet a message, they
share it with their followers and promote it as
content of interest. To understand how Twitter
stimulates conversation, we identied the most
frequently shared tweets, noting their retweet count
(Table 3).

Table 1 | Distribution of each term (count and proportion within each channel) by social media channel

SM channel

Search term
Fat
(N=1,252,648)

Twitter
Facebook
Blogs
Forums
Comments
a

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1,156,338
51,090
25,438
13,616
6,166

(92
(90
(79
(69
(79

%)
%)
%)
%)
%)

Obese/obesity
(N=88,204)
74,797
3,595
3,957
4,754
1,101

(6 %)
(6 %)
(12 %)
(24 %)
(14 %)

Overweight
(N=32,295)
25,580
2,220
2,684
1,262
549

(2
(4
(8
(6
(7

%)
%)
%)
%)
%)

Total postsa
(N=1,373,147)
1,256,715
56,905
32,079
19,632
7,816

Twitter posts make up roughly 91 % of total posts, followed by Facebook (4 %), blogs (2 %), and forums (1 %) and comments (<1 %)

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Fat a**
Fat people
Fat girl
Fat so
Fat b******
Fat kid
Big fat
Fat city
Fat b****
Getting fat
Look fat
Fat fat
Fat person
Fat boy
Fat loss
Fat guy
Fat lady
Fat chick
Like fat

100,632
61,724
74,168
51,233
39,897
36,371
27,861
26,915
24,037
18,455
18,244
17,358
16,923
15,910
14,269
13,097
12,180
11,968
10,968

0.08
0.05
0.06
0.04
0.03
0.03
0.02
0.02
0.02
0.02
0.02
0.02
0.01
0.01
0.01
0.01
0.01
0.01
0.01

Childhood obesity
Obese maybe
Kids obese
Obesity http
Morbidly obese
Obesity epidemic
Obese people
Obesity runs
Children obese
Obesity online
Obese probably
Obese guy
Child obesity
Obesity rates
Anti obesity
Except obesity
Obese by
Being obese
Becoming obese

Content word
6,348
5,443
5,242
3,878
3,397
3,217
2,740
2,243
2,139
1,820
1,152
1,149
1,131
1,116
1,006
930
894
813
773

Count

Obese/obesity (total N=74,797)

%

Content word

Count

Fat (total N=1,156,338)

Table 2 | Table of top 20 words co-occurring with keywords: linguistic word bigrams

0.08
0.07
0.07
0.05
0.05
0.04
0.04
0.03
0.03
0.02
0.02
0.02
0.02
0.02
0.01
0.01
0.01
0.01
0.01

Overweight people
Overweight http
Only overweight
Overweight thing
System overweight
Overweight women
Becoming overweight
Overweight guy
Overweight children
Just overweight
Pounds overweight
Overweight bodies
Stands overweight
Overweight person
Overweight man
Slightly overweight
Very overweight
Overweight Barbie
Overweight obese

Content word

Overweight (total N=25,580)

1,121
789
532
513
474
449
314
314
272
271
265
251
250
247
224
223
211
207
200

Count

0.04
0.03
0.02
0.02
0.02
0.02
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01
0.01

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Table 3 | Top ve most retweeted posts by keyword

Retweet count
Keyword: fat
6,994
6,328
6,165
6,039
5,728
Keyword: obese/obesity
4,658
1,611
1,462
533
445
Keyword: overweight
295
163
137
72
36

Retweeted content
RT @USERNAME: Fat City B****. Fat Fat City B****Ten Ten Doughnuts and a
Twinky B****. VIP Micky Ds No Guest List.
RT @USERNAME: That awkward moment when someone skinnier than you calls
themself fat So what I am then, a pig?
RT @USERNAME: Fat b****** on Twitter calling themselves Barbies: B****, you
aint no damn Barbie you a care bear
RT @USERNAME: I said to a fat girl today, Youre a big girl! She replied, Tell me
something I dont know. I said, Salad tastes good.
RT @USERNAME: #NeverTellAGirl she is ugly or fat. This is what happens. [URL
omitted]
RT @USERNAME: Why are kids obese? Maybe because burgers are $0.99 & salads
are $4.99.
RT @USERNAME: Its a recipe for disaster when your country has an obesity
epidemic & a skinny jeans fad.
RT @USERNAME: People who remain calm in stressful situations have higher
rates of depression and obesity, a study nds.
RT @USERNAME: My brother died from childhood obesity. a fat kid ate him.
RT @USERNAME: Not eating breakfast increases your risk of becoming obese by
450 % according to a UMass study! #JumpstartYourDay
RT @USERNAME: The only overweight thing about Adele is her paycheck
RT @USERNAME: I think they should create an overweight Barbie to prove all shapes
and sizes are beautiful.
RT @USERNAME: You should probably stop trash talking the overweight dancer
because shes better than you and has more passion. #DancerProbz
RT @USERNAME: Eating quickly doubles your likelihood of becoming overweight. Slow
down when you chew & other quick tips: [URL omitted]
RT @USERNAME: Difference between overweight & normal-weight Americans? Only
100 cal/day! Burn it off: Go for a brisk walk [URL omitted]

Over one third of the top retweets across three

keywords suggest the popularity of fat jokes/
teases, including lyrics parodying a rap song (Rack
City) that celebrates the rappers afuent lifestyle
and objectication of women. The lyrics promote
the stereotype that overweight women eat junk food
and cast them as outgroup members relegated to
Fat City. On the other hand, popular retweets also
contain positive information about weight management, links to photos and information about disorders, and comments about healthy eating, stress, and
exercise. Finally, the top retweeted content containing the keyword overweight refuted weight stigma
or promoted healthy behavior.

Qualitative data illustrations and analysis

The following examples illustrate discourse across
social media platforms and explicate key ndings.
Particular excerpts are selected from the major
themes noted in the lists of bigrams or retweets.
Negative weight stigmatizationThe most prevalent
theme in the corpus, as conrmed by bigrams and
top retweets, is derogation and stigma against
overweight individuals.
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Example 1: Ewwwwww fat people disgust me!!!

[Twitter]
Example 2: I hate when your on the bus or train and
a fat person tries to squeeze in a seat that they have
no business squeezing into. Fat people should only
get one seat like everyone else. [Facebook]
Example 3: Fat person: The problem is, obesity runs
in our family. Doctor: No, the problem is, no one
runs in your family. [Twitter]
In addition to the mean-spirited attack on ones
physical appearance, these examples show overweight individuals (fat people/person) as
outgroup members. Moreover, these posts are
characterized by negative emotion. The expression of the disgust in ex 1 denotes a sense of
moral repugnance toward overweight people [46],
and irritation or anger is indicated in ex 2, where
the poster is annoyed by the inconvenience he
believes overweight people cause him. Ex 3
displays a fat joke playing on stereotype that
overweight people do not exercise.
Personal attacksAnother form of weight stigma is
directed toward specic individuals through weightrelated insults and verbal attacks.
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Example 4: @USERNAME, youre an ugly fat

b****. kill yourself. [Twitter]
These more extreme cases of stigmatization take the
form of weight-based aming, aggressive online
interactions [40], and cyberbullying. Dened as
willful and repeated harm inicted via the use of
information technology, cyberbullying includes
harassing messages, derogatory comments, physical
threat, or intimidation [12]. Tweets such as ex 4,
where aggressors directly and publicly attack other
users with weight-related insults, are unfortunately
common.
Sexism and misogynyMisogyny represents a strong
undercurrent in the corpus [7]. Indeed, as Table 2
indicates, many of the words associated with fat
reference women (e.g., girl, chick, lady), including a
number of derogatory terms (e.g., b****).
Example 5: ATTENTION FAT B*****S: Stop
wearing tight a** pants and leggings, that s*** is
nasty! Wear baggy jeans or overalls [Twitter]
Example 6: I hate when a FAT chick cant cook....
Umm ok b**** you just fat for no reason at all
[Twitter]
Both examples strongly reinforce gender and weight
stereotypes. The ridicule and criticism of womens
clothing choices are accompanied by prescribing
sartorial dos and donts for overweight women.
Self-derogationMany derogatory posts are selfreferential, especially with respect to diet and
perception of ones own weight.
Example 6: I just ate McDonalds. full as hell!
coca cola, 2 cheeseburgers and of course medium frieswhat a fat a** i m! [Facebook]
Example 7: Im Not Fat! My Stomach Is Just 3D.
[Twitter]
Ex 6 shows a confessional where the poster
discloses regretted dietary choices. Such coming
out as fat is particularly common on Facebook in
our observation. Ex 7 illustrates a self-deprecating
jokecommon and frequently retweetedindicating
that this lighthearted self-disclosure resonates with
others, potentially serving to build camaraderie with
followers who are also dissatised with their weight.
Informational contentThere was frequent provision
of information related to weight and obesity, primarily with regard to the keywords obese/obesity
and overweight.
Nexus of responsibility for obesityThe question of
who/what is to blame for obesity is commonly
discussed, and posts range from the individual level
to societal factors.
Example 8: Two thirds of the country are
overweight or obese and 30,0000 people will die
this year from the complications of obesity,. The
main causes of obesity are increased consumption
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of high calorie foods, lack of exercise, genetics,

medical treatments and psychological problems.
[Blog]
Example 9: Very important #infographic on portion
sizes and the #obesity epidemic [URL included]
#health #diet #food [Twitter]
In contrast to the negative sentiment found in the
bigram data for fat, the top content words
associated with obese/obesity in the bigrams have
clinical or scientic connotations (e.g., obesity
epidemic, obesity rates). These examples demonstrate the type of information related to obesity that
is found on social media platforms. Such posts
typically point to the consequences and causes of
obesity, as well as efforts to address the problem. As
shown in ex 9, informational Tweets often contain
links out to other sources, as well as hashtagged
terms (e.g., #health, #diet, and #food) that include
the post in the larger stream of conversation on
Twitter.
Example 10: Should Happy Meals be blamed for
rising obesity among US children? http: [Twitter]
Example 11: I started dieting a week before
Christmas and have dropped 21 lb went shopping
yesterday to buy all my healthy goodies and end up
spending $250 dollars. I understand why there are
overweight people, because everything that is good
and healthy for you is so damn expensive.
[Facebook]
As these examples illustrate, in contrast to individual-blaming attitudes and perceptions associated
with fat, posts containing obesity tend to place
more emphasis on macro-level factors. Opinions
expressed run the gamut from stressing the role of
parenting, to debunking the impact of policies such
as menu labeling and food pricing, to blaming the
fast food industry.
Countering weight-based stereotypesAnother theme
directly contrasting the pervasive negative sentiment
is seen in posts that counter weight stigma and
advocate acceptance of overweight individuals.
Example 12: Some people are so cruel and
shallow. Just because Im overweight doesnt mean
Im less of a person. Im beautiful the way I am
and I dont care what some loser on facebook has
to say about it. [Facebook]
Example 13: I think they should create an overweight
barbie. To prove all shapes and sizes are beautiful.
[Twitter]
Ex 12 shows the poster challenging the common
weight stigmatization and stereotypes, particularly
against women. This Facebook user, who selfidenties as overweight, asserts her belief in her
own beauty and her disregard of strangers criticisms. Moreover, there are pockets of positivity and
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self-acceptance among the most retweeted content,

particularly surrounding the term overweight. In
ex 13, for instance, the poster expresses an appreciative and protective attitude toward overweight
individuals. Typically, other attributes not related to
weight (e.g., talent, intelligence) are highlighted to
downplay weight and validate a nuanced identity.
Help/advice seeking and provisionFinally, personal
weight management experiences are frequently
shared coupled with advice-seeking and supportive
sentiment.
Example 14: Im on a diet. Im still overweight but
Ive gone from 230 lb to 210. Its going wellI
feel tremendous, but Im not so sure I look it?
Im afraid I will always see my self as fat (like I
do now). is there any advice? Suggestions.
anything ps. [Forum post]
Example 15: I started dieting a week before
Christmas and have dropped 21 lb went shopping
yesterday to buy all my healthy goodies and end up
spending $250 dollars. I understand why there are
overweight people, because everything that is good
and healthy for you is so damn expensive.
[Facebook]
In ex 14, the poster shares her self-doubt about body
image and weight loss effort and asks the forum
members for advice. Whereas self-disclosure is also
a prevalent theme in posts containing fat, we do
not observe the same humorous, self-deprecating
undertone in dialogues surrounding overweight.
Instead, those on social media use blogs and forums
to share their weight loss struggles, seek support,
and express personal opinions. Ex 15 shows frustrations about the challenges of eating healthy economically. The poster identies the high cost of
healthy foods as a barrier to weight loss and a
contributing factor to the obesity epidemic.

DISCUSSION
The study identies pervasive negative stereotypes,
jokes, and alienation of overweight people, as well
as self-deprecating humor. Contrary to individualoriented blame or responsibility, there are also
abundant socially oriented discussions. In the following section, we highlight a few emerging key
points from this mixed methods inquiry.

Weight stigmatization on social media

An abundance of stream-of-consciousness observations about overweight people is observed across
authentic social media channels, marked with sentiments of anger, disgust, and alienation. Of note, this
derogatory content is often reected in fat jokes;
though perhaps intended to entertain, these jokes
position overweight individuals as targets of ridicule
and as members of an outgroup. In fact, fat jokes
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were among the most frequently retweeted content.

This is consistent with a recent study that conrmed
the prevalence and popularity of weight-based
teasing on YouTube [50]. Taken together, usergenerated content on social media reects and
reinforces weight stigma.
Even more alarmingly, this negative sentiment
extends to verbal aggression, with unchecked instances of aming and cyberbullying against overweight individuals, particularly women. This
aggression is rampant on Twitter, where users can
obscure their identities, and this anonymity and
reduced social cues (e.g., eye contact) may increase
aggressive responses both ofine [51] and online [4,
48], leading to more acts of toxic disinhibition [20,
40, 43]. It is notable that in this study, the
determination of tone of posts is based upon the
authors perspective as observers and not participants with access to shared message meaning.
Future studies should incorporate the perspectives
and interpretations of social media participants to
ascertain the impact of such sentiment on psychological and physical well-being [27]. To understand
weight-based cyberbullying, it is imperative that we
carefully examine unsupervised peer victimization
in online communities.
Positive sentiment
Our data also reveal discourse of encouragement
and acceptance for individuals with excess body
weight on social media. Forums and blogs are
particularly common channels for the exchange of
social support in weight loss efforts [16], echoing
research on weight loss and physical activity communities on social media channels where participation is associated with encouragement for healthy
behaviors [14, 17, 28] and receipt of social support
can buffer against weight stigma [32].
Our data also document a theme of fat acceptance on social media. These pockets of acceptance
counteract the prevailing negative sentiment and
may help overweight individuals to resist and
respond proactively to weight stigma. Supportoriented blogs and forums are health-promoting
communities that offer a safe place where members
bodies are accepted, and allow participants to
understand, negotiate, and, at times, reject the
marginalized identity ascribed to them in their
ofine environment [38]. This type of supportive
dialogue can be empowering [5]. As such, social
media must not be viewed simply as breeding
grounds for weight stigma, but also environments
that can insulate overweight individuals from stigma.
Not all social media are equal
This study represents one of the rst social media
analyses to examine multiple social media channels.
These observed differences in frequency and types
of conversation across social media channels suggest
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that discrete channels may facilitate dissimilar types

of discussions surrounding weight issues. It is
possible that channels with predened audience
networks and implicit or explicit limitations on
length (e.g., Facebooks typically brief status update
and Twitters 140-character limit), and those that are
more amenable to stream-of-consciousness sharing, encourage discourse about fat, presumably
because of its more casual and quotidian nature. On
the other hand, social media channels with no length
limits (e.g., forums and blogs) that typically support
ongoing conversation among a smaller number of
participants may better enable discussions related to
weight management and healthy lifestyle choices.
Compared side by side, channels carry very different conversations. Twitter and Facebook attract a
much larger volume of participation and contain the
most negative sentiments regarding obesity; in
comparison, blogs and forums produce a smaller
volume of posts but support in-depth, sustained
exchanges surrounding weight-related topics.
Moreover, many Facebook posts are self-referential, in that users update and comment on their own
diet and exercise activities. In contrast, Twitter
appears to be a unique channel that potentially
perpetuates and enables terse and insensitive aming or aggressive cyberbullying. Our analysis suggests the importance of considering the uniqueness
of each social media channel in future research and
intervention design.

Emerging analytic methods for social media interactions

This study combines quantitative (computational
linguistics/NLP tools) with qualitative (discourse
analysis) approaches to address a set of research
questions. The NLP-assisted, broader scan allows a
data-driven approach not limited by a priori
assumptions. On the other hand, the qualitative
analysis of examples allowed us to dig into actual
communicative exchanges to examine the posters
intent and meaning-making in these conversations.
With the massive amount of available public
discourse and the rapid and constant evolution of
social media, innovative scientic methods are
urgently needed to study perceptions and attitudes
as well as behavioral ramications of health-related
conversations online. Even within our corpus, we
see the potential for numerous next steps integrating
cutting-edge NLP techniques, including network
analysis of the diffusion of content, sentiment
analysis, coding of prevalent themes, mapping of
ecologic models of obesity control to discourse, and
analysis of conversations along the energy balance
continuum (e.g., mentions of diet vs. physical
activity).
Finally, this methodology presents a novel way to
look at issues related to obesity prevention and
weight stigma, which has traditionally been explored through surveys, implicit association tests,
and interviews. In many ways, this type of direct
TBM

observation allows us to examine authentic perspectives on the issue and observe communication in
action, thus circumventing weaknesses inherent in
self-report measures, such as social desirability bias.

Implications for public health and behavioral medicine

These ndings have implications for obesity prevention practice and research. First, it is crucial for
public health practitioners to acknowledge the true
nature of authentic online conversations about
obesity. The social media landscape is cluttered with
messages and opinions about weight issues. The
negative sentiment that dominates this communication may drown out public health messages
intended to alter obesogenic behaviors. This hostile
online environment also promotes weight stigmatization, which has been shown to have serious public
health consequences [34]. Health-care providers will
also be better poised to support patients when they
have a better understanding of the potentially
damaging effect of social media discourse on
overweight individuals psychosocial well-being.
Broader efforts may be implemented to curb
weight stigma online. Communication science can
help in reframing the public discourse, raising
awareness of cyberbullying, and countering weightbased stereotypes and misogyny. As we have
witnessed, grassroots conversations are occurring
to criticize and counter stigmatization. These posters
may be agents for sociocultural change as opinion
leaders and inuencers [29], and recent research
has documented personality characteristics (e.g.,
empathy, extroversion) associated with anti-bullying
intervention behavior on social media [9].
It is also possible for public health and behavioral
medicine to leverage public gures and celebrities to
affect the dialogue. Pop stars such as Lady
Gagawho had more than 40 million Twitter
followers as of December 2013already use social
media to oppose bullying and promote self-acceptance. Specic moments in popular culture may also
spark interaction that promotes positive sentiment.
To illustrate, the singer Adele won six Grammy
awards in 2012, igniting positive dialogue on Twitter
about her talent and beauty. When some users
insulted her weight, others refuted these attacks
(The only thing overweight about Adele is her
paycheck!) and shamed the original posters. These
cultural gures and events offer opportunities to
provide a more positive dialogue with regard to
weight and obesity. Public health practitioners may
partner with inuencers and leverage ongoing
conversations to counter weight-based stigma. Gradually changing the pervasive negative attitudes
about obesity is an important step to improving
public health.
This research also offers insight into the lived
experience of obesity, from individual-oriented
causes and solutions to supportive communities,
and reects on the individual, social, and environpage 321 of 323

ORIGINAL RESEARCH

mental factors contributing to obesity. Interventions

could build upon existing sentiment and peer
support and strategically highlight causes and solutions without victimizing or blaming individuals.
Furthermore, they may help to enhance body
satisfaction, which has been linked to self-efcacy
and sustained healthy behavior [39]. Any social
media-based obesity prevention efforts require careful presentation of the issue in a balance that avoids
individual-oriented stigma and blame while still
enabling individuals to maintain the locus of control. After all, obesity prevention efforts at the
individual level must focus on empowering those
endeavoring to make behavioral change.
Study limitations
This study describes conversations about obesity
and weight on social media. While contributing
broadly to our understanding of weight-related
public dialogue, it consequently sacrices some
depth of understanding in any particular area of
inquiry beyond interpretations of selected posts.
Subsequent in-depth analyses based on this corpus
will examine specic issues, such as the assignment
of responsibility and blame for obesity on multiple
levels (based on a multilevel ecological framework),
emotional themes, humor, and the link between
obesity and other chronic conditions.
We were also limited by the inability to systematically compare across social media channels, given
differential privacy settings and drivers of engagement. The fact that only publicly accessible posts
were mined means a signicant portion of online
activities were left out of the corpus. For instance, a
recent survey of Facebook users found that 58 %
restricted access to their proles [24]. Not only did
we not include restricted posts, we also do not
capture any information about message posters in
order to protect privacy and anonymity. The lack of
poster information limits our ability to address some
pertinent research questions (i.e., Were the majority
of posts containing sexist language posted by males
or females? How does the follower base of individual posters affect whats being retweeted?). Finally,
this work does not analyze social media conversations, only initial posts and comments; yet, interactivity is a hallmark of social media. Future studies
can explore complete interactions between users to
gain further insight into the construction of weightrelated communication in digital spaces.

CONCLUSION
The study complements existing knowledge of
obesity by identifying the nature and scope of usergenerated social media conversations on this topic.
The mixed methods analysis addresses a key issue
facing behavioral medicine and obesity prevention,
namely the nature of public attitudes and perceptions about the issue as expressed on social media
page 322 of 323

channels. The analysis conrms hostility and stigmatization toward overweight individuals (particularly women). Yet, pockets of acceptance and
discussion about societal and environmental contributors are present as well, although they generate
less volume of content. Our analysis also noted the
distinct ways in which social media channels function, pointing to the need for those designing health
interventions to consider the accessibility and feasibility of particular channels.
Acknowledgments: Data collection for this project was enabled through
the support of the National Institute on Minority Health and Health
Disparities and the National Cancer Institute.

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