Warning: Looking and Lamenting May be Lethal

By Sandra Wartski, PsyD, CEDS

Eating disorders are biopsychosocial disorders with multifactorial causes. While science continues to unveil insights into the genetic predisposition and biological influences related to EDs, any clinician working in this field knows that the social influences cannot be ignored. We regularly experience socially constructed ideas of beauty that are negatively impacting body image, eating, and a myriad of other areas in people already vulnerable to or struggling to recover from an ED.

We know it’s harmful. Numerous studies have connected the unrealistic thin ideal so widely portrayed in social media to body dissatisfaction, internalization of an unrealistic body image, and disordered eating. Even the American Medical Association condemned the practice of retouching ad images at their annual meeting in 2011, citing the literature linking “exposure to media-propagated images of unrealistic body image to eating disorders and other child and adolescent health problems.” And now, with technological advances allowing 24/7 contact with powerful visual messages, it is even more difficult for our clients to turn away. Despite the fact that clients know that some of the messages are mythical or only flashy marketing mishmash, the commanding impact of such external stimuli is formidable.

Why Warnings Are Warranted

Educational campaigns have advanced our society in various ways. The slogan “Smoking Kills” is now widely known, and as a result fewer teens are smoking and pregnant women don’t smoke as routinely as they had only a few decades ago. “Don’t drink and drive” messages don’t prevent all of the deaths associated with driving under the influence (DUIs) each year, but DUI numbers – especially for youth – have dropped. A change in mindset can and does happen.

We see warnings on almost everything in our daily life–from antennae to zippers –but such disclaimers are missing from some of the most lethal influences in our current culture. Americans today are much more often engaged in continual comparisons of their bodies, size, attractiveness, and even good fortune by the continual click and scroll on their computers and other devices. We don’t yet have any far-reaching warnings about the fact that constantly looking at certain ads, compulsive body competitiveness, and self-degrading lamenting can damage emotional well-being and psychological stability. But, as President Franklin D. Roosevelt wisely proclaimed, “Comparison is the thief of joy.” ED clinicians often include some therapeutic focus for helping clients approach media influences with a more critical eye. However, without more formalized parameters, we often are a small minority prospectively pushing against a powerful cultural current.

We need more warnings about the toxic social factors that negatively impact social-emotional health. Such warnings can be informative. Warnings currently available with everyday products can be categorized into three primary types: (1) warnings that point out the obvious, (2) warnings that inform, and (3) warnings that provide assistance. ED prevention education could be incorporated effectively in any of those arenas.

Warnings That Point out the Obvious

Warnings we see on everyday objects that point out the obvious include messages such as: “Do not eat the antennae” and “This zipper may harm your penis. Zip with caution.” Although these notifications may seem a bit obvious, or may reflect the individual company’s sense of humor, or may be related to our litigious society, they do catch one’s attention and present the notion of proceeding carefully.

If we were to apply a similar approach for toxic images, there would be some straightforward ways to proceed. With some of the images and advertisements that abound, perhaps warnings that point out the obvious might read, “This model is not real. She has been Photoshopped in 368 ways prior to printing,” or “This claim, ‘lose 20 pounds in 5 days,’ has not been proven, researched or substantiated but is intended only as marketing enticement.” It is not clear that the reader would heed this warning or even consider it, but it might lead to a pause. Individuals might even be helped to create their own periodic reminder alerts when frequenting social media sites, such as, “Remember: people tend to post only the best photo” or “I promise to exit if I start to feel bad.”

Warnings That Inform

When consumers read warnings such as “Made in a factory that processes peanuts,” or “This product contains wheat,” they can proceed with a full awareness of what they are ingesting. Reading “Do not operate machinery while taking this medication” allows the consumer to have informed consent. Seeing “This product contains saccharin, which has been determined to cause cancer in laboratory animals,” is sobering. Knowledge is power.

Similarly, it might be helpful for individuals to know facts such as how engaging in continual social comparisons increases negative thinking and decreases self-confidence. Viewers of a pop-up ad might appreciate knowing that study results have shown that only a few moments of looking at airbrushed fashion models lowers feelings of self-worth and self-respect. Instead of body parts being objectified and criticized, perhaps we could create more visuals of body parts being celebrated and imperfections being exonerated. We might, for instance, post photos showing real bodies with arrows pointing to the fleshy abdominal area, reminding the viewer that this is the powerful area where food is magically transformed into energy, or we might post videos about the strength involved when someone is learning to walk again after an amputation (perhaps with accompanying text about how achieving a thigh gap is no longer a priority).

Warnings That Provide Assistance

Lottery commercials now routinely give the site for the “Gambling Helpline” at the end of the ad, acknowledging that a percentage of consumers struggle with compulsive gambling. Cleaning products prominently point out the command to call Poison Control if the product has been ingested. There is even growing movement of guidance for those self-identifying as addicted to smoking with the “1-800-QUIT-NOW” campaign.

With EDs, we could focus on the message of helping consumers to “seek out professional help if negative body dissatisfaction is affecting your mood, relationships, and daily living,” supporting the mission of destigmatizing mental health services. Instead of the consumer being left to wonder whether the answer to a depressing image or negative comparisons is to diet, give up, or pile on more self-hatred, perhaps instead there might be a list of helpful hotlines or websites. Catching individuals prior to them spiraling into ED thinking and behaviors is invaluable. We have lived through the decades of public health education geared towards the prevention of various physical diseases, such as how safe sex practices can prevent the spread of HIV; perhaps we now can also support the infusion of more attention to prevention of psychological illnesses.

Initial Research Highlights Complexity

Research is being conducted on the impact of warning labels and disclaimers, and psychologists Marika Tiggemann and Belinda Bury are among the leaders in the field. 1-3 Initial findings are somewhat contrary to what might be expected, with subjects showing an increase rather than a decrease in body dissatisfaction after viewing ads with warning labels. The researchers conjectured that the subjects may have believed that if these seemingly perfect models needed digital alterations, then any normal human would need even more alterations. It was also hypothesized that the labels may have drawn more, rather than less, attention to the models’ bodies, thus increasing the comparative process. More research in this realm is naturally needed, but these initial findings highlight the complexity of the problem and the ingenuity that will be required for solutions.

Good News: Things Are Changing

Some celebrities are bravely stepping up to oppose digital alterations, and some companies are making a commitment to stop the excessive Photoshopping trend. Documentaries and blogs of people speaking out against this unhealthy social media comparative craze are emerging. For example, last year, the US Senate passed key provisions from the Anna Westin Act, referencing the need for improved information and public service announcements on eating disorders, including the aim of promoting truth in advertising and educating the public on the harmful effects of altered body images in ads. The bipartisan cooperation in passing this bill was a historic event for the eating disorders community (and was among President Obama’s final tasks before leaving office as he signed this bill into law in December 2016). And, this spring, France passed a new law requiring clear indications with any images of models that have been digitally altered. This will not be a panacea, especially given the conflicting research results, but the country is taking a bold stand on this lethal influence.

The Future

Warning labels of the obvious, informational, and assistance types might be only one small step toward interrupting the compulsion to compare. Unlike the straightforward labeling of other products, developing effective social media disclaimers will be much more complex. However, EDs are a serious health hazard that deserves as much consumer awareness as all the other serious and sometimes ridiculous warnings currently out there.

ED clinicians are in ideal positions to lead the way. We see the impact of some of the toxic cultural influences each day and are well suited to assist in this preventative action. As cultural anthropologist Margaret Mead said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”


  1. Tiggermann M, Brown Z, Zaccardo M, Thomas N. “Warning: This image has been digitally altered”: The effect of disclaimer labels added to fashion magazine shots on women’s body dissatisfaction. Body Image. 2017; 21:107.
  2. Bury B, Tiggemann M, Slater A. Disclaimer labels on fashion magazine advertisements: Impact on visual attention and relationship with body dissatisfaction. Body Image. 2016; 16:1.
  3. Tiggemann M, Slater A. Facebook and body image concern in adolescent girls: A prospective study. Int J Eat Disord. 2017; 50:80.
Sandra Wartski, PsyD, CEDS

Sandra Wartski, PsyD, CEDS, has been working with clients with eating disorders for the past 25 years. She is a licensed psychologist who works as an outpatient therapist at Silber Psychological Services, Raleigh, NC. She enjoys providing presentations and writing articles on a variety of mental health subjects, particularly ED-related topics.

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