"What We Know About Body Image" Literature Review

Raw text

Transcribed text as recorded, including headers and formatting fragments.

Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 1 of 13 AMENDED Exhibit 126 PLAINTIFFS' OMNIBUS OPPOSITION TO DEFENDANTS' MOTIONS FOR SUMMARY JUDGMENT Case No.: 4:22-md-03047-YGR MDL No. 3047 In Re: Social Media Adolescent Addiction/Personal Injury Products Liability Litigation Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 2 of 13 https://fb.workplace.com/notes/justin-cheng/what-we-know-about-body-image-literature- review/679698019450854 Justin Cheng, Moira Burke, Shruti Bhutada, and Elena Davis In an international survey last year, over half of Instagram users reported body dissatisfaction. Mass media has long been blamed for body dissatisfaction; what is social media’s impact? In this note, we summarize past internal and external research on body image to understand Instagram’s and Facebook’™™s roles and inform design changes. Summary Body image issues are common, affect women more than men, don’t stop at adulthood, and may be worse in East Asia and among vulnerable populations. 33% of Instagram users and 11% of Facebook users think the platform makes their own body image issues worse. Substantial evidence suggests that experiences on Instagram or Facebook make body dissatisfaction worse, particularly viewing attractive images of others, viewing filtered images, posting selfies, and viewing content with certain hashtags. Interventions for reducing body image issues are likely to be more effective for certain populations; their potential unintended negative impact should also be considered. The Instagram Mental Health team is working to better understand specific concerns within social comparison and body image, especially among teenage girls, to inform product changes. What is body image? Body image is a person’s perceptions and feelings about their body or physical appearance. This encompasses a person’™™s overall appearance, as well as specific features such as face shape, skin tone, weight, or muscularity. There are three orthogonal pieces: Body dissatisfaction (or negative body image) occurs when people view their body (or physical appearance) negatively. This negative view arises when people perceive a discrepancy between their actual and ideal body (or physical appearance). Body appreciation (or positive body image) occurs when people accept and appreciate their (body’s) appearance. Body appreciation is not simply the opposite of body dissatisfaction; a person can be dissatisfied with their body, yet accept it for what it is. Body concern (or appearance orientation) is whether appearance is psychologically important to the individual and whether their thoughts and behavior center around appearance. A person can be dissatisfied with their appearance but not be concerned about it. To learn more about how body image is measured (and for additional definitions), check out our previous note on defining body image. In the sections that follow, dots (â-) beside numbered references indicates research that is longitudinal or experimental, while triangles (â-2) indicate meta-analyses. Why should we care? CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253852 META3047MDL-037-00007064 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 3 of 13 Body image issues are common. While estimates vary, several sources point towards body image issues being a normative concern. In an international off-platform YouGov survey, 15% of people reported body dislike (18% among women and 11% among men) (1). A recent on-platform Instagram survey found that 53% of users experienced frequent body dislike (60% among women and 46% among men) [2]. External surveys have estimated the prevalence of body dissatisfaction at around 13-32% of U.S. women and 9-28% of U.S. men [3]. In the US, prevalence estimates of anorexia, bulimia, and binge-eating are 0.9%, 1.5%, and 3.5% among women, and 0.3%, 0.5% and 2.0% among men in the US (4). For body dysmorphia, it is 2.4% (2.5% among women and 2.2% among men) [5]. Body dissatisfaction is linked to several physical and mental health problems. Body dissatisfaction can lead to eating disorders (e.g., anorexia, bulimia, and binge eating), mood disorders (e.g., depression), unhealthy weight control behaviors, and lower self-esteem [â-6, â-27,â-8, â-9,â-10]. The media is generally blamed for poor body image. In a majority of prior work, the media, primarily TV and magazines, has typically been considered the “most influential and pervasive cause†[â-211]. Meta-analyses and experiments confirmed a link between media exposure and subsequent body dissatisfaction among women, though this association is likely stronger for vulnerable subpopulations [â-212,â-213,â-214,â- 15]. The relationship for men is less clear. There is also growing evidence of Instagram’s and Facebook’s potential negative impact (see below, as well as [â- 211,â-216]). People perceive that their Instagram and Facebook use contributes to their body image issues. In the YouGov survey, 33% of Instagram users perceived that Instagram had a negative impact on their body image. They perceived body image as the problem that Instagram worsened the most, more than when they end a relationship or lose a job. By contrast, 11% of Facebook users perceived that Facebook had a negative impact on their body image (ranked 10th out of 22). People who use social media may be particularly vulnerable to negative outcomes. Self- objectification (i.e., viewing oneself as an object for use, typically for visual pleasure) is associated with more frequent Instagram and Facebook use (17,18,19], and it can lead to body dissatisfaction [â-220,â-21]. What causes it? Two primary factors lead to body dissatisfaction: Pressure to conform to body ideals. Various research has connected pressure from others (e.g., being thin for women and being muscular for men) to subsequent body dissatisfaction [â-22,â-23]. This pressure can originate from the media (including social media), peers, parents, as well as significant others. Research suggests two mechanisms that mediate the relationship between this pressure and body dissatisfaction: the internalization of body ideals (e.g., thin or muscular) and appearance comparison [â-24; â-25]. Among women, self-objectification also mediates this relationship [â-220,â-21]. Being overweight. Studies have also connected obesity and high body-mass index (BMI) with subsequent body dissatisfaction [â-26]. In particular, early-onset obesity is a strong predictor of body dissatisfaction, likely due to the impact of being teased about one’s weight [27]. Obesity may be a contributing factor also because (Western) society favors thinness [28]. Other factors such as negative affectivity (i.e., a propensity to become emotionally distressed) and dieting may also contribute to body dissatisfaction [â-29,â-230], though evidence is limited. CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253853 META3047MDL-037-00007065 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Who experiences it? Page 4 of 13 Women experience more body dissatisfaction than men. Women experience more body dissatisfaction and feel less positively about their body compared to men [â-31, 32]. In the YouGov survey previously mentioned, 18% of women reported body dislike, compared to 11% of men; the on-platform Instagram survey found that 60% of women reported body dislike, compared to 46% of men. Other work found that by adolescence, 63% of girls are trying to lose weight, compared to 16% of boys [33]. Several factors may explain the gender difference. Women may be affected more than men by cultural norms of physical attractiveness [34; 35; â-31); relatedly, the relationship between exposure to media and body dissatisfaction is stronger among women than for men [â-236]. The relationship between self-esteem and body image is also stronger among women than men [37]. Lower appearance satisfaction among women than men may also arise because a woman’s appearance may be more important from an evolutionary perspective [34]. Body dissatisfaction affects both teens and adults. Body dissatisfaction also tends to persist over one’s life, among both men and women (34; 38]. Internal research is mixed: the YouGov survey found that adults were slightly more likely to report body dislike than teens (16% vs. 14%), while the on-platform Instagram survey found prevalence of body image higher among teen girls than women (66% vs. 60%). Nonetheless, a focus on younger people may be warranted: while older women were as dissatisfied as younger women with their bodies, they were less concerned [39]; correlates such as self-objectification and disordered eating may also be more prevalent among younger women [40]. Body dissatisfaction may be greater in East Asia. One study found that Korean girls and boys reported more body dissatisfaction than American girls and boys (41), while another found that women in Korea and China experienced greater body dissatisfaction than those in the US [â-242]. The adoption of Western standards of beauty may partially explain these differences [â-243]. Other vulnerable subpopulations. People who have pre-existing body image issues (e.g., greater body dissatisfaction, body concern) or who internalize thin ideals to a greater degree tend to be affected more by media exposure [â-236,44,â-45). People who compared themselves to others more were also more likely to report worse body image [â-46,â- 47,â-25]. What is Instagram’s and Facebook’s impact? Overall, there is substantial evidence to suggest that Instagram and Facebook use can increase body dissatisfaction. Overall use. Several studies point towards overall social media use increasing body dissatisfaction. A longitudinal study of a Dutch social network involving adolescents found that more frequent use led to increased body dissatisfaction; on the other hand, increased body dissatisfaction did not lead to more frequent social media use [â-48]. In an experiment, women who were assigned to spend time on Facebook reported greater shape and weight concern compared to a control website [â-49]. A similar experiment found that women who were assigned to spend 10 minutes on Facebook reported more body concern compared to those assigned to spend 10 minutes on a control website, but only if they were high in appearance comparison tendency [â-50]. Still, other research suggests that time spent on photo-based activities rather than overall site use is the cause of the overall effect [51, 17). Viewing attractive images may be particularly problematic several experiments have demonstrated that women who were exposed to Instagram photos of attractive models reported increased body dissatisfaction [â-52]. In one experiment, when people were assigned to view appearance-focused Instagram profiles for a week, body dissatisfaction increased for women (and also men, though the difference was not significant) [â-53]. Selfies and filters. An experiment found that taking and posting a selfie on Instagram CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253854 META3047MDL-037-00007066 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 5 of 13 or Facebook caused worse mood and body image among women compared to a control group that browsed a travel website [â-54]. Women exposed to enhancement-free images also reported lower facial dissatisfaction than those exposed to standard Instagram images [â-55]. A cross-sectional study similarly found that girls who uploaded selfies tended to report more body dissatisfaction, and that those who spent more effort editing these photos reported even more body-related and eating concerns [56]. One experiment not only found that adolescent girls exposed to edited selfies reported worse body image than those exposed to unedited selfies, but also that there were no differences in how much edited or unedited images were perceived as “a representative view of reality†[â-47]. (See this post by for examples of filters and the policies that are currently in place to allow (or disallow) their use.) Hashtags. Some hashtags may also be more problematic than others. Women who were exposed to #fitspo (i.e., fitspiration, which promotes exercise and dieting, typically for the goal of attaining an ideal body) images on Instagram reduced self-compassion, while exposure to #loveyourself images resulted in more positive body image [a-57]. A cross-sectional study found that men who viewed more “fitspiration†content reported greater body dissatisfaction [58]. Hashtags such as “#nomakeup†can also undo the positive benefit of seeing enhancement-free images [â-55]. Like and comments. Viewing images with a large number of likes led to reduced facial dissatisfaction; people who placed more importance on likes were also more likely to report more body dissatisfaction [â-59]. (Relatedly, some of our internal work also demonstrated an association between seeing content with many likes (or comments) and increased social comparison [60].) Another study found that people with a “negative feedback-seeking style†who received a high number of comments on Facebook were more likely to later report disordered eating concerns [â-61]. Other associations. Viewing attractive profiles people reported greater body dissatisfaction after being exposed to the Facebook profiles of attractive users [â-62]. Seeing positive appearance comments seeing such comments (e.g., “you look great!â€) on Instagram photos can lead to greater body dissatisfaction [â-63]. These findings on the effects of social media, interpreted alongside the broader literature, suggest that social media use can lead to greater body dissatisfaction, but that certain populations are likely more affected than others. These effects may be bidirectional. For instance, appearance comparison (the tendency to compare one’s physical appearance) can lead to internalization of media ideals, which in turn leads to even more appearance comparison [â-64]. Another longitudinal study found that the internalization of appearance ideals led to increased surveillance of attractive peers on Facebook, which in turn predicted self-objectification and increased body concern [â-65]. While indicative, many previous studies tend to be correlational, small-scale, and reliant on self-reported social media use; experimental studies may not reflect typical social media use. And as a majority of studies focus on younger women, less is known about effects on men or older adults. More research is needed to identify the specific social media behaviors associated with worse body image, how social media’s effects vary by demographic, as well as understand the situations where use may improve body image. What can we do about it? Based on prior work, what are potential interventions that may work? Alter the types of content that people see. Here are several ways that the type of content presented on social media can be altered to reduce body dissatisfaction. However, many of these suggestions come with caveats: CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253855 META3047MDL-037-00007067 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 6 of 13 Show more body-positive Instagram posts. Having a more positive body image can protect against body dissatisfaction [66]. In an experiment, women were exposed to body- positive Instagram posts reported increased body satisfaction and appreciation [â-67]. In fact, such body-positive content already exists on Instagram and exemplifies “core theoretical components of positive body image†[68]. Still, this comes with a caveat exposure to these posts also led to increases in self-objectification [â-67]. Show average-sized or larger models, as opposed to thinner models. For example, exposure to average-sized models led to better body image, and were rated as equally effective or appealing for advertising, compared to thin models [â-69]. Still, viewing larger models can also lead to increases in restricted eating [â-70]. Show posts that focus on body functionality (e.g., health and internal processes) over body appearance. In experiments where people took part in multi-week body functionality programs, body image improved (â-Alleva, et al. 2015). On the other hand, experiments have shown that exposure to “body-as-process†images can produce even greater dissatisfaction (â-Mulgrew & Tiggemann 2018, â-69]. Show posts that promote body acceptance (e.g., inspirational quotes). In an experiment, women preferred body acceptance images and messages the most, followed by athletic, curvy, and then thin-ideal messages [â-70]. Further, the body acceptance condition was also the only condition which did not increase self-objectification. Exposure to #loveyourself quotes on Instagram also increased people’s self-compassion [â-57]. Show more humorous content. Women who were shown parody images of Instagram celebrity posts reported increased body satisfaction and positive mood, compared to those shown the original celebrity posts they were based on [â-71]. Show non-body/appearance-related content. The control condition in many studies was travel images, suggesting that travel images create less body dissatisfaction. Nonetheless, travel may be a major source of social comparison on social media [72]. Instead, images of nature may be better an experiment found that nature scenery increased women’™™s body appreciation [â-73]. Show more close friend content. A correlational study found that the link between Facebook use and body image concerns was stronger when comparing oneself to acquaintances and celebrities than to close friends (74). In fact, images of attractive unknown peers have similar negative effects to images of attractive celebrities [â-75]. At the same time, selfies posted by peers were judged more negatively than selfies posted by celebrities [â-76]. Discourage filter use and encourage the sharing of unfiltered images. As previously noted, viewing unedited images resulted in less body dissatisfaction than viewing standard Instagram images. However, this effect is cancelled out by including a hashtag such as #nomakeup or #noedit [â-55]. In some sense, this illustrates the difficulty of creating a different sharing norm on Instagram, as someone who uploads an unedited photo would likely want to indicate to others in some way that the photo looks “worse†because it is unedited. Reduce negative comments from others. People who received negative comments in response to personally-revealing status updates were more likely to report disordered eating concerns four weeks later [â-61]. Make positive appearance comments on others’™™ posts less salient. While positive appearance comments (i.e., “you look greatâ€) are likely intended as helpful and supportive, seeing these comments on others’™™ posts increases body dissatisfaction [â- 63]. Showing PSAs. In an experiment where some participants were shown a message reminding them that social media is a highlight reel prior to browsing Instagram, post-browsing negative affect was reduced compared to when no message was shown, but only for people who also reported more negative comparison [â-77]. CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253856 META3047MDL-037-00007068 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 7 of 13 Promote media literacy. Experiments have found that providing people with educational material on media literacy (e.g., knowing that what you see isn’t necessarily real) can decrease body dissatisfaction [â-78] and social comparison [â-79]. However, the long-term efficacy of such interventions is less known [â-280]. Hiding or capping like and comment counts. Prior research also suggests that Project Daisy may reduce body dissatisfaction. As mentioned previously, work has demonstrated a causal link between viewing content with a large number of likes and subsequent body dissatisfaction [â-59], and a cross-sectional association between viewing content with a large number of likes or comments and social comparison [60]. Other suggestions. Here, we list suggestions and recommendations made in previous research, but that are not necessarily backed by any specific findings: Campaigns campaigns directed at young adult women are more likely to be effective if women who previously suffered from eating disorders are chosen as spokespersons [81]. Behind the scenes encourage people to post before/after photos of themselves with/without makeup [â-82] NUX include a disclosure when opening an Instagram account that reminds viewers that images on Instagram are often edited [47] Take a break some work concluded that the best thing to do is to reduce social media use and screen time, given the difficulty of limiting exposure to body dissatisfaction- inducing content [46] Which interventions are unlikely to work? Showing labels or disclaimers on images is particularly ineffective, as they end up directing visual attention to the model’s body. In some experiments, labels had no effect on body image [â-83], and in others, increased appearance comparison and body dissatisfaction [â-84]. (And as above, adding hashtags indicating that an image is enhancement-free cancels out any benefits from viewing such images.) Displaying body-positive captions on images increases body appreciation when images are of averaged-sized women, but can decrease body appreciation when images are of thin women [â-52]. Encouraging people to compliment each other’s appearances may improve mood, but also leads to increased body shame [â-85]. Overall, prior research suggests that solutions to body image issues are rarely one- size-fits-all. While some interventions are more likely to benefit everyone (e.g., inspirational quotes), others may only benefit certain subpopulations (e.g., PSAs may only benefit people who engage in more social comparison) or potentially harm others (e.g., larger-sized models may make restricted eaters feel worse about themselves if they perceived that they were similar to the models). People may sometimes prefer interventions that have worse outcomes (e.g., athletic-ideal may be preferred to thin- ideal images, but the former causes more body dissatisfaction). Interventions may also be double-edged (e.g., decreasing body dissatisfaction but increasing self- objectification). Finally, the relative effectiveness of these different interventions also remains unknown. The Instagram Mental Health team is working to better understand social comparison and body image, especially among teenage girls. To better understand the specific concerns that our users have, we have conducted qualitative deep dives with teen girls who report experiencing these problems in the United States and are planning similar work in South Korea where body dissatisfaction among teen girls may be worse. We are also planning to launch on-platform surveys, and subsequently combine survey and behavioral data to understand common triggers, surfaces most commonly associated with negative comparisons and body image issues and behaviors that correlate with it. This research CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253857 META3047MDL-037-00007069 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 8 of 13 will inform the interventions that the team is developing and testing. Do reach out to the team if you’re interested in learning more! Notes and References In fall 2019, the Facebook Well-Being Team (POC: ) ran an international off- platform survey using YouGov on aspects of well-being, including the prevalence of 22 behaviors and experiences correlated with well-being (including body dislike). The body dislike prevalence estimates represent the proportion of people who endorsed having the following experience within the last month: “disliked the way your body looked so much that it got in the way of your ability to concentrate or enjoy activities.†We also asked about perceived impact of Facebook or Instagram on each of these behaviors and experiences: “Overall what impact, if any, did [Facebook/Instagram] have on this experience?†ranging from very positive to very negative impact. The varying prevalence estimates may be due to differences in how the questions were asked. For example, the YouGov survey asked about body dislike that created interference in concentration/daily activities, while the on-platform Instagram survey asked about frequent body dislike. Fallon, E. A., Harris, B. S., & Johnson, P. (2014). Prevalence of body dissatisfaction among a United States adult sample. Eating behaviors, 15(1), 151-158. Hudson, J. I., Hiripi, E., Pope Jr, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61(3), 348-358. Koran, L. M., Abujaoude, E., Large, M. D., & Serpe, R. T. (2008). The prevalence of body dysmorphic disorder in the United States adult population. CNS spectrums, 13(4), 316-322. Stice, E., Hayward, C., Cameron, R. P., Killen, J. D., & Taylor, C. B. (2000). Body- image and eating disturbances predict onset of depression among female adolescents: a longitudinal study. Journal of abnormal psychology, 109(3), 438. Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual review of psychology, 53(1), 187-213. Paxton, S. J., Neumark-Sztainer, D., Hannan, P. J., & Eisenberg, M. E. (2006). Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. Journal of clinical child and adolescent psychology, 35(4), 539-549. Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of adolescent health, 39(2), 244-251. Tiggemann, M. (2005). Body dissatisfaction and adolescent self-esteem: Prospective findings. Body image, 2(2), 129-135. Holland, G., & Tiggemann, M. (2016). A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body image, 17, 100-110. Grabe, S., Ward, L. M., & Hyde, J. S. (2008). The role of the media in body image concerns among women: a meta-analysis of experimental and correlational studies. Psychological bulletin, 134(3), 460. Want, S. C. (2009). Meta-analytic moderators of experimental exposure to media portrayals of women on female appearance satisfaction: Social comparisons as automatic CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253858 META3047MDL-037-00007070 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 9 of 13 processes. Body Image, 6(4), 257-269. Ferguson, C. J., Muñoz, M. E., Garza, A., & Galindo, M. (2014). Concurrent and prospective analyses of peer, television and social media influences on body dissatisfaction, eating disorder symptoms and life satisfaction in adolescent girls. Journal of youth and adolescence, 43(1), 1-14. Frederick, D. A., Daniels, E. A., Bates, M. E., & Tylka, T. L. (2017). Exposure to thin-ideal media affect most, but not all, women: Results from the Perceived Effects of Media Exposure Scale and open-ended responses. Body image, 23, 188-205. Fardouly, J., & Vartanian, L. R. (2016). Social media and body image concerns: Current research and future directions. Current opinion in psychology, 9, 1-5. Cohen, R., Newton-John, T., & Slater, A. (2017). The relationship between Facebook and Instagram appearance-focused activities and body image concerns in young women. Body Image, 23, 183-187. Fardouly, J., Pinkus, R. T., & Vartanian, L. R. (2017). The impact of appearance comparisons made through social media, traditional media, and in person in women’s everyday lives. Body image, 20, 31-39. Hanna, E., Ward, L. M., Seabrook, R. C., Jerald, M., Reed, L., Giaccardi, S., & Lippman, J. R. (2017). Contributions of social comparison and self-objectification in mediating associations between Facebook use and emergent adults' psychological well- being. Cyberpsychology, Behavior, and Social Networking, 20(3), 172-179. Moradi, B., & Huang, Y. P. (2008). Objectification theory and psychology of women: A decade of advances and future directions. Psychology of women quarterly, 32(4), 377- 398. Tiggemann, M. (2011). Mental health risks of self-objectification: A review of the empirical evidence for disordered eating, depressed mood, and sexual dysfunction. Stice, E., Maxfield, J., & Wells, T. (2003). Adverse effects of social pressure to be thin on young women: An experimental investigation of the effects of “fat talkâ€. International Journal of Eating Disorders, 34(1), 108-117. Agliata, D., & Tantleff-Dunn, S. (2004). The impact of media exposure on males' body image. Journal of Social and Clinical Psychology, 23(1), 7-22. Keery, H., Van den Berg, P., & Thompson, J. K. (2004). An evaluation of the Tripartite Influence Model of body dissatisfaction and eating disturbance with adolescent girls. Body image, 1(3), 237-251. Betz, D. E., Sabik, N. J., & Ramsey, L. R. (2019). Ideal comparisons: Body ideals harm women’s body image through social comparison. Body image, 29, 100-109. Bucchianeri, M. M., Arikian, A. J., Hannan, P. J., Eisenberg, M. E., & Neumark- Sztainer, D. (2013). Body dissatisfaction from adolescence to young adulthood: Findings from a 10-year longitudinal study. Body image, 10(1), 1-7. Wardle, J., Waller, J., & Fox, E. (2002). Age of onset and body dissatisfaction in obesity. Addictive behaviors, 27(4), 561-573. Graber, J. A., Brooks-Gunn, J., Paikoff, R. L., & Warren, M. P. (1994). Prediction of eating problems: An 8-year study of adolescent girls. Developmental psychology, 30(6), 823. Bearman, S. K., Presnell, K., Martinez, E., & Stice, E. (2006). The skinny on body CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253859 META3047MDL-037-00007071 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 10 of 13 dissatisfaction: A longitudinal study of adolescent girls and boys. Journal of youth and adolescence, 35(2), 217-229. Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of psychosomatic research, 53(5), 985-993. Mellor, D., Fuller-Tyszkiewicz, M., McCabe, M. P., & Ricciardelli, L. A. (2010). Body image and self-esteem across age and gender: A short-term longitudinal study. Sex roles, 63(9-10), 672-681. Tylka, T. L., & Wood-Barcalow, N. L. (2015). The Body Appreciation Scale-2: item refinement and psychometric evaluation. Body image, 12, 53-67. Rosen, J. C., & Gross, J. (1987). Prevalence of weight reducing and weight gaining in adolescent girls and boys. Health psychology, 6(2), 131. A...lgars, M., Santtila, P., Varjonen, M., Witting, K., Johansson, A., Jern, P., & Sandnabba, N. K. (2009). The adult body: how age, gender, and body mass index are related to body image. Journal of aging and health, 21(8), 1112-1132. Polce-Lynch, M., Myers, B. J., Kilmartin, C. T., Forssmann-Falck, R., & Kliewer, W. (1998). Gender and age patterns in emotional expression, body image, and self-esteem: A qualitative analysis. Sex Roles, 38(11-12), 1025-1048. Ferguson, C. J. (2013). In the eye of the beholder: Thin-ideal media affects some, but not most, viewers in a meta-analytic review of body dissatisfaction in women and men. Psychology of Popular Media Culture, 2(1), 20. Furnham, A., Badmin, N., & Sneade, I. (2002). Body image dissatisfaction: Gender differences in eating attitudes, self-esteem, and reasons for exercise. The Journal of psychology, 136(6), 581-596. Slevec, J. H., & Tiggemann, M. (2011). Predictors of body dissatisfaction and disordered eating in middle-aged women. Clinical psychology review, 31(4), 515-524. Tiggemann, M. (2004). Body image across the adult life span: Stability and change. Body image, 1(1), 29-41. Tiggemann, M., & Lynch, J. E. (2001). Body image across the life span in adult women: the role of self-objectification. Developmental psychology, 37(2), 243. Jung, J., Forbes, G. B., & Lee, Y. J. (2009). Body dissatisfaction and disordered eating among early adolescents from Korea and the US. Sex Roles, 61(1-2), 42-54. Pike, K. M., & Dunne, P. E. (2015). The rise of eating disorders in Asia: a review. Journal of eating disorders, 3(1), 33. Holmqvist, K., & Frisén, A. (2010). Body dissatisfaction across cultures: Findings and research problems. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 18(2), 133-146. Hargreaves, D. A., & Tiggemann, M. (2009). Muscular ideal media images and men's body image: Social comparison processing and individual vulnerability. Psychology of Men & Masculinity, 10(2), 109. Halliwell, E., & Dittmar, H. (2004). Does size matter? The impact of model's body size on women's body-focused anxiety and advertising effectiveness. Journal of Social and Clinical Psychology, 23(1), 104-122. CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253860 META3047MDL-037-00007072 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 11 of 13 Tiggemann, M., & Zaccardo, M. (2015). “Exercise to be fit, not skinnyâ€: The effect of fitspiration imagery on women's body image. Body image, 15, 61-67. Kleemans, M., Daalmans, S., Carbaat, I., & Anschutz, D. (2018). Picture perfect: the direct effect of manipulated Instagram photos on body image in adolescent girls. Media Psychology, 21(1), 93-110. de Vries, D. A., Peter, J., de Graaf, H., & Nikken, P. (2016). Adolescents’ social network site use, peer appearance-related feedback, and body dissatisfaction: Testing a mediation model. Journal of youth and adolescence, 45(1), 211-224. Mabe, A. G., Forney, K. J., & Keel, P. K. (2014). Do you “likeâť my photo? Facebook use maintains eating disorder risk. International Journal of Eating Disorders, 47(5), 516-523. Fardouly, J., Diedrichs, P. C., Vartanian, L. R., & Halliwell, E. (2015). Social comparisons on social media: The impact of Facebook on young women's body image concerns and mood. Body image, 13, 38-45. Meier, E. P., & Gray, J. (2014). Facebook photo activity associated with body image disturbance in adolescent girls. Cyberpsychology, Behavior, and Social Networking, 17(4), 199-206. Tiggemann, M., et al. (2020). #Loveyourbody: The effect of body positive Instagram captions on women’s body image Casale, S., Gemelli, G., Calosi, C., Giangrasso, B., & Fioravanti, G. (2019). Multiple exposure to appearance-focused real accounts on Instagram: Effects on body image among both genders. Current Psychology, 1-10. Mills, J. S., Musto, S., Williams, L., & Tiggemann, M. (2018). “Selfie†harm: Effects on mood and body image in young women. Body Image, 27, 86-92. Tiggemann, M., & Zinoviev, K. (2019). The effect of# enhancement-free Instagram images and hashtags on women’s body image. Body image, 31, 131-138. McLean, S. A., Paxton, S. J., Wertheim, E. H., & Masters, J. (2015). Photoshopping the selfie: Self photo editing and photo investment are associated with body dissatisfaction in adolescent girls. International Journal of Eating Disorders, 48(8), 1132-1140. Slater, A., Varsani, N., & Diedrichs, P. C. (2017). #fitspo or #loveyourself? The impact of fitspiration and self-compassion Instagram images on women’s body image, self-compassion, and mood. Body Image, 22, 87-96. Fatt, S. J., Fardouly, J., & Rapee, R. M. (2019). #malefitspo: Links between viewing fitspiration posts, muscular-ideal internalisation, appearance comparisons, body satisfaction, and exercise motivation in men. New Media & Society, 21(6), 1311-1325. Tiggemann, M., Hayden, S., Brown, Z., & Veldhuis, J. (2018). The effect of Instagram “likes†on women’s social comparison and body dissatisfaction. Body image, 26, 90- 97. Burke, M., Cheng, J., & (2020). Social Comparison and Facebook: Feedback, Positivity, and Opportunities for Comparison. CHI 2020. https://fb.workplace.com/groups/593343327843013/permalink/809593392884671/ Hummel, A. C., & Smith, A. R. (2015). Ask and you shall receive: Desire and receipt of feedback via Facebook predicts disordered eating concerns. International Journal of Eating Disorders, 48(4), 436-442. CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253861 META3047MDL-037-00007073 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 12 of 13 Haferkamp, N., & Krämer, N. C. (2011). Social comparison 2.0: Examining the effects of online profiles on social-networking sites. Cyberpsychology, Behavior, and Social Networking, 14(5), 309-314. Tiggemann, M., & Barbato, I. (2018). “You look great!â€: The effect of viewing appearance-related Instagram comments on women’s body image. Body image, 27, 61-66. Rodgers, R. F., McLean, S. A., & Paxton, S. J. (2015). Longitudinal relationships among internalization of the media ideal, peer social comparison, and body dissatisfaction: Implications for the tripartite influence model. Developmental psychology, 51 (5), 706. Vandenbosch, L., & Eggermont, S. (2016). The interrelated roles of mass media and social media in adolescents’ development of an objectified self-concept: A longitudinal study. Communication Research, 43(8), 1116-1140. Andrew, R., Tiggemann, M., & Clark, L. (2015). The protective role of body appreciation against media-induced body dissatisfaction. Body image, 15, 98-104. Cohen, R., Fardouly, J., Newton-John, T., & Slater, A. (2019). # BoPo on Instagram: An experimental investigation of the effects of viewing body positive content on young women’s mood and body image. New Media & Society, 21(7), 1546-1564. Cohen, R., Irwin, L., Newton-John, T., & Slater, A. (2019). # bodypositivity: A content analysis of body positive accounts on Instagram. Body image, 29, 47-57. Mulgrew, K. E., Schulz, K., Norton, O., & Tiggemann, M. (2020). The effect of thin and average-sized models on women’s appearance and functionality satisfaction: Does pose matter?. Body Image, 32, 128-135. Betz, D. E., & Ramsey, L. R. (2017). Should women be “All About That Bass?â€: Diverse body-ideal messages and women’s body image. Body Image, 22, 18-31. Slater, A., Cole, N., & Fardouly, J. (2019). The effect of exposure to parodies of thin-ideal images on young women’s body image and mood. Body image, 29, 82-89. Krasnova, H., Wenninger, H., Widjaja, T., & Buxmann, P. (2013). Envy on Facebook: a hidden threat to users' life satisfaction?. Williamson, G., & Karazsia, B. T. (2018). The effect of functionality-focused and appearance-focused images of models of mixed body sizes on women’s state-oriented body appreciation. Body image, 24, 95-101. Fardouly, J., & Vartanian, L. R. (2015). Negative comparisons about one's appearance mediate the relationship between Facebook usage and body image concerns. Body image, 12, 82-88. Brown, Z., & Tiggemann, M. (2016). Attractive celebrity and peer images on Instagram: Effect on women's mood and body image. Body image, 19, 37-43. Vendemia, M. A., & DeAndrea, D. C. (2018). The effects of viewing thin, sexualized selfies on Instagram: Investigating the role of image source and awareness of photo editing practices. Body image, 27, 118-127. Weinstein, E. (2017). Adolescents' differential responses to social media browsing: Exploring causes and consequences for intervention. Computers in Human Behavior, 76, 396-405. McLean, S. A., Wertheim, E. H., Masters, J., & Paxton, S. J. (2017). A pilot evaluation of a social media literacy intervention to reduce risk factors for eating disorders. International Journal of Eating Disorders, 50(7), 847-851. CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253862 META3047MDL-037-00007074 Case 4:22-md-03047-YGR Document 2885-53 Filed 03/26/26 Page 13 of 13 Posavac, H. D., Posavac, S. S., & Posavac, E. J. (1998). Exposure to media images of female attractiveness and concern with body weight among young women1. Sex roles, 38 (3- 4), 187-201. Grabe, S., Ward, L. M., & Hyde, J. S. (2008). The role of the media in body image concerns among women: a meta-analysis of experimental and correlational studies. Psychological bulletin, 134(3), 460. Perloff, R. M. (2014). Social media effects on young women’s body image concerns: Theoretical perspectives and an agenda for research. Sex Roles, 71(11-12), 363-377. Fardouly, J., & Rapee, R. M. (2019). The impact of no-makeup selfies on young women’s body image. Body image, 28, 128-134. Frederick, D. A., Sandhu, G., Scott, T., & Akbari, Y. (2016). Reducing the negative effects of media exposure on body image: Testing the effectiveness of subvertising and disclaimer labels. Body image, 17, 171-174. Tiggemann, M., Brown, Z., & Thomas, N. (2019). (Don’t) look here!: The effect of different forms of label added to fashion advertisements on women’s visual attention. Body image, 31, 88-95. Tiggemann, M., & Boundy, M. (2008). Effect of environment and appearance compliment on college women's self-objectification, mood, body shame, and cognitive performance. Psychology of Women Quarterly, 32(4), 399-405. This note summarizes this living document, where we’re collecting research (both internal and external) related to body image. Contributions are welcome! CONFIDENTIAL - PROTECTED BY CONFIDENTIALITY AGREEMENT HIGHLY CONFIDENTIAL (COMPETITOR) MT-IG-AG-00253863 META3047MDL-037-00007075