Understanding dysmorphophobia through the WhatsApp profiles of obese people

A new study presented at the European Congress on Obesity (ECO) in Venice, Italy (12-15 May) has found that many people living with obesity hide their bodies in their WhatsApp profile photos.

Profile photos that feature pets, family members, landscapes, flowers and cartoon characters may indicate a person has body dysmorphic disorder, says Dr Antonella Franceschelli of Unicamillus International Medical University, Rome, Italy.

Body dysmorphic disorder is a condition in which a person has a distorted perception of their body. They feel unhappy with their appearance, may feel ashamed or anxious about their body and, in the case of obese people, believe that they are heavier than they actually are.

This excessive concern with appearance can be exacerbated by social media, which often broadcasts unrealistic standards of beauty and fitness.

"People with body dysmorphic disorder may be particularly sensitive to these influences, constantly comparing themselves to idealized images and feeling inadequate in comparison." - Dr. Antonella Franceschelli, Unicamillus International Medical University, Rome, Italy

To investigate the link between obesity and body dysmorphia, Dr Franceschelli and her colleagues conducted a qualitative study of WhatsApp profile pictures of people living with obesity.

The study included 59 patients (49 women, 10 men, mean age 53 years, mean BMI 32 kg/m²), each of whom provided one WhatsApp profile photo.

The content of the photographs was then examined for the presence of dysmorphic behaviour, such as choosing to show one's face but not one's body, or choosing to show an image of something else.

The analysis provided clear evidence of body dysmorphic disorder: 90% of men and 86% of women used profile photos that did not match their physical reality.

Some people used images of pets, family members, landscapes, cartoon characters, or objects like flowers. Others used photos in which their face was almost completely covered, their body was not visible, old photos, or images edited to make them look slimmer.

Dr Franceschelli said: 'They may have chosen these photos to control how they looked to others and to avoid criticism about their bodies.

“Photographs can also reflect a desire to be seen and accepted for who they are, rather than because of their appearance, and provide a source of comfort when using social media.”

The likelihood of using a profile photo that did not represent physical reality increased with the degree or severity of obesity.

The study didn't include a control group, so the researchers couldn't compare the images to those used by normal-weight people, for example. But the finding that people with higher levels of obesity were more likely to use photos that didn't represent their physical reality strongly suggests that obesity influences profile photo choices, the researchers say.

Because this was a qualitative study, data on the strength of associations are not available.

Dr Franceschelli said: 'This study suggests that something as simple as a WhatsApp profile photo could give doctors valuable information about whether an obese person has body dysmorphic disorder.

"It is vital to identify body dysmorphic disorder when treating obesity. Once identified, patients can be provided with psychological treatments such as cognitive behavioral therapy, along with medical treatments such as pharmacological therapy and nutritional programs.

"This holistic approach to obesity treatment increases the chance of weight loss and improves the overall well-being of patients."