Understanding body dysmorphic disorder through WhatsApp profiles of obese people

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

Profile photos that show pets, family members, landscapes, flowers and cartoon characters may indicate that a person has body dysmorphic disorder, says Dr. Antonella Franceschelli of the 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 dissatisfied with their appearance, may experience shame or anxiety about their body and, in the case of obese people, believe they are heavier than they really are.

This excessive preoccupation with appearance can be exacerbated by social media, where unrealistic standards of beauty and fitness are often broadcast.

"People with body dysmorphic disorder may be especially sensitive to these influences, constantly comparing themselves to idealized images and feeling not good enough in comparison." - Dr. Antonella Franceschelli, Unicamillus International Medical University, Rome, Italy

To explore the link between obesity and body dysmorphia, Dr. Franceschelli and her colleagues conducted a qualitative study of WhatsApp profile images 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 behavior, such as choosing to show one's face but not one's body, or choosing to show 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 pictures of pets, family members, landscapes, cartoon characters, or objects such as flowers. Others used photos in which their face was almost completely covered, their body was not visible, old photos or images edited to look thinner.

Dr Franceschelli said: “They may have chosen these photographs to control how they appeared to others and to avoid criticism of their body.

“Photos 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 did not include a control group, so the researchers could not compare the images with those used by people of normal weight, for example. However, the finding that people with higher degrees of obesity are more likely to use photos that do not represent their physical reality strongly suggests that obesity influences the choice of profile photos, the researchers said.

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

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

“It is critical to identify body dysmorphic disorder in the treatment of 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 patients' overall well-being.”