Support, Comparison, and Surveillance: Implications of Social Media in Weight Management Interventions

In China, an estimate of 32.3% of the adult population were overweight or obese in 2016. Obesity is associated with a number of non-communicable diseases and chronic conditions. By losing 5% to 10% of initial body weight, obese and overweight adults can decrease risk factors for obesity-related illnesses even if they are still within the overweight or obese range. Weight management requires lifestyle modifications and thus often faces challenges of low adherence, low retention, non-clinically significant weight loss, limited long-term effects, and a tendency to regain weight. To promote sustainability, researchers have advocated the use of social media technology to enhance the continuity of overweight and obese adults’ healthy weight practices. The trend of using social media as a platform for delivery of weight management interventions has been substantial. However, little is known about the underlying processes of social media interactions and ways through which online interactions exert social influences on weight management. This study provided a qualitative inquiry into the dynamics of social media interactions in shaping overweight and obese adults’ weight control behavior. Three aspects of social media interactions— social support, social comparison, and surveillance, and two sources of social media influences— medial professionals and peers were explored to present a comprehensive analysis of the cybersocial influences of social media interactions.

The studied context involved a social media-based weight management program launched by a tertiary hospital in charge of regional disease prevention and control in a southeastern province in China. WeChat is the most popular social media app in China and has exceeded a penetration rate of 93% in large cities and 80% across the population. In the professionally-led and free-of-charge weight management program, each patient joined one WeChat group with 10-12 members based on the time he or she joined the program. Within each group, members reported their weight and dietary intake on a regular basis and received individual feedback from nutritionists and endocrinologists. Members can also freely interact with each other and with medical professionals through question posting and information sharing. A purposive sample of 32 members were interviewed with variations in age, gender, and weight loss outcomes. The average duration of participant membership was 1.5 years.

Results of thematic analysis identified three themes: professionally-led support in the form of capacity building, reaction and resistance to surveillance, and co-presence of peer support and peer comparison. The first theme delineated support from medical professionals that helped enhance participants’ capacity to perform healthy dietary and exercise behaviors. The second theme addressed public surveillance and social surveillance on WeChat and participants’ reaction to the panopticon gaze. The third theme revealed peer influences in the forms of support and comparison that motivated participants’ self-control of weight in both positive and negative ways. Findings highlighted the mutually reinforced relations among social interaction factors and their fluctuant influences on weight management. Implications of the study concern improved strategies for maintaining the positive dynamics of social media interactions.