TikTok, Body Image Content, and User Wellbeing: User Engagement, Algorithmic Exposure, and Coping Strategies

Background: TikTok is a prominent platform for body image, diet, and fitness content. Its emphasis on short, visually engaging videos provides an impactful medium for conveying such content. This study explores user engagement with body image-related content, algorithmic exposure, and its potential impact on wellbeing, including pressure to conform and body dissatisfaction. Method: A mixed-method international study of 335 TikTok users (99 male, 231 female, 5 non-binary) explored: i). Whether users believe TikTok content promotes specific body ideals; ii). Whether users actively seek body image-related content or if it is passively presented to them by the algorithm; and iii). What strategies users employ to avoid and/or cope with distressing content. Findings: Over 99% of participants believed TikTok reinforces body ideals (thinness, muscularity, body purity, and/or body acceptance) and nearly 36% reported that TikTok had affected their own body perception. Regression analyses found that users exposed to thin or fit ideals felt greater pressure to conform to societal body standards; while those who viewed content depicting body acceptance felt less. Algorithmic exposure played a key role, with over half of users (51.7%) reporting not actively searching for content related to body image, diet, or fitness, but encountering it due to TikTok’s algorithm. Alarmingly, 33% of users had seen content promoting eating disorders (of whom only 6% had sought it out). Users exposed to this content scored higher for pressure to conform and reported greater impact on their own body image. Users were aware of algorithmic curation, but some expressed frustration over their lack of control over their content feed. To mitigate distress, they employed strategies such as engaging with alternative content to ‘shift the algorithm’ and attempting to ‘mindfully scroll’ to bypass unwanted content in a bid to prevent algorithm reinforcement. Conclusion: TikTok can offer community support and body positivity content; however, it can also perpetuate extreme body standards and facilitate exposure to harmful material, often beyond users' control. These findings highlight the need for platform-level interventions, including greater algorithm transparency and improved user tools to filter distressing content. For mental health professionals, these insights reinforce the importance of addressing social media exposure in discussions of body image concerns, particularly among vulnerable populations such as individuals experiencing body dissatisfaction, disordered eating or excessive exercise. Future policies should advocate for stronger safeguarding measures on social media platforms, including equipping users with practical tools to navigate and curate healthier digital experiences.