The Effects of Comparisons of Physical Appearance on Social Media and Social Approval on Eating Attitudes

Introduction

Eating Attitudes and Eating Disorders

Eating attitudes refer to eating practices, food preferences, meal programs, and eating patterns,¹ while eating disorders refer to negative ideas, beliefs, feelings, and activities related to food.² Disturbances in eating attitudes are an important risk factor in the development of feeding and eating disorders, such as pica, avoidant/restrictive food intake disorder, anorexia nervosa, and binge eating.³

The World Health Organization (WHO) reported that 14 million people, including approximately 3 million children and adolescents, had eating disorders in 2019.⁴ Eating disorders cause high mortality and morbidity rates and healthcare costs and a low quality of life.⁵ The literature shows that eating disorders such as anorexia and bulimia nervosa can lead to medical complications or suicide.⁶ At the same time, the WHO reported that disordered eating behavior increases the risk of non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, and diabetes, and 74% of all deaths worldwide are caused by NCDs.⁷

The literature underlines that disordered eating attitudes have become one of the world’s biggest problems⁸ and have increased significantly among young people, including university students.² Recent studies showed that students have a high prevalence of disordered eating attitudes, ranging from 5.6% to 46.2%.^9–11

In order to combat eating disorders during the university period, when important transitions are experienced, it is very important to determine the factors that affect them.¹² Disordered eating attitudes are an important factor causing eating disorders. Eating attitudes are also affected by social media and social approval. Social media and social approval cause body anxiety and dissatisfaction by creating idealized body perceptions that are difficult to achieve in individuals (thinness in women, a muscular body appearance in men, etc). The results of previous studies showed that the prevalence of concerns about body shape and dissatisfaction is quite high, ranging from 58.2% to 76.7%.^13,14 An individual’s anxiety and dissatisfaction with their body can cause irregular eating behaviors or attitudes, increasing the risk of developing an eating disorder.¹⁵

Comparisons of Physical Appearance on Social Media and Eating Attitudes

Social media use is increasing with digitalization worldwide and in Turkey.^16,17 According to the Digital 2024 Global Overview Report, Turkey ranks 20th in the world in the time spent using the internet, with 6 h and 57 min. This figure is 17 min above the world average.¹⁸ According to the results of the TUIK (Turkish Statistical Institute) Household Information Technologies Usage survey in 2023, the internet usage rate was found to be 97.5% in the young population in the age group of 16–24 years.¹⁹ The average time spent on social media per day in Turkey is 2 h and 44 min. When the time spent on the internet in 2024 was ranked by age, the highest usage was by people aged 16–24 years.¹⁸ Social media is a form of communication through electronic platforms with the aim of sharing information, knowledge, opinions, messages, and other content through virtual communities and networks.²⁰

These social media platforms allow users to share photos and videos of their physical appearance and to follow the visual representations of others (peers, celebrities, and models).²¹ These photos and videos often feature thin women, men with a high muscle mass, or images of ultra-thin people to promote weight loss.²² The increase in sharing photos and videos on social networks has facilitated and increased the comparison of physical appearances in terms of, for example, height, weight, beauty, and attractiveness. These comparisons on social networks can cause an individual to be constantly exposed to an ideal body shape and internalize perfect body standards.²³ Internalizing ideal body standards can also lead to a negative body image²³ and body dissatisfaction.²¹

The ideal body image promoted by the media leads young people to focus on their own BMI, weight and shape in an unhealthy way.²⁴ Young people have exaggerated expectations about their appearance by focusing on themselves, negatively affecting their self-esteem and satisfaction with their bodies. Studies show that comparing oneself to body images promoted on social media increases body dissatisfaction.^25,26 Studies have also found an increased risk of eating disorders in people who are dissatisfied with their bodies or who frequently compare themselves to others on social media.^27–29

Need for Social Approval and Eating Attitudes

Another important factor that negatively affects eating attitudes during the university period is the need for social approval.⁷ The need for social approval, defined as the need to attach importance to the expectations and judgments of others (family, peers, teachers, etc). and to gain their admiration/appreciation,³⁰ plays an important role in body image. The social environment’s approval of an ideal body shape may cause an individual to evaluate their own body and be dissatisfied with it. Studies have found that focusing on body-related conversations with peers, appearance-related discussions, and daily conversations that encourage uniformity in views about the body have effects on negative evaluations of one’s appearance.^23,31 As a result, the perception of a negative appearance resulting from social pressure leads to irregular eating habits.³²

Some studies in the literature generally emphasized that social media and the pressure created by the social environment to achieve an idealized body image can make students vulnerable to eating disorders. At the same time, some studies emphasized that eating attitudes are an important factor that increases the risk of eating disorders. However, no studies that directly evaluated the effect of appearance comparisons on social media, which are common among students, and social approval, which significantly affects their attitudes and behaviors, on eating attitudes have been found. Therefore, this study aimed to investigate the effects of the frequency of comparisons of physical appearance on social media and the need for social approval on eating attitudes.

The findings of this study will guide studies to shape university policies, develop mental health resources and improve eating attitudes by revealing the positive and negative effects of physical appearance comparison and social approval on eating attitudes. In line with these findings, increasing social media use and awareness campaigns in universities, adopting policies that promote positive body perception, developing digital media literacy programs, expanding healthy nutrition education, and creating programs that address the link between mental health and nutrition can support both psychological and physical health by ensuring that social media effects less harm students.

Methods

Study Sample

This study is a descriptive, cross-sectional study. The research population consisted of a total of 674 students studying at Recep Tayyip Erdoğan University, Faculty of Health Sciences, Department of Nursing and the Güneysu School of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation. No sample selection was made, and the aim was to reach all department students. The study was completed with 131 students from the Department of Nursing and 240 students from the Department of Physiotherapy and Rehabilitation who voluntarily agreed to participate; 55% of the participants completed the study.

Research Hypotheses

H1: There is a significant difference between socio-demographic variables and physical appearance comparison on social media.

Data Collection Process

Data collection took place between March 16 and May 30, 2023. The data were collected through an online survey created on an online platform (Google Forms) that was accessible from any device. The survey link was sent to the students via WhatsApp through the student representatives of the relevant faculties and vocational schools of the university where the study was conducted. When participants completed the survey on Google Forms, each survey was sent to a database where it could be downloaded as a Microsoft Excel file.

To prevent self-report bias during the completion of the questionnaire, the participants were informed that the survey would be conducted entirely anonymously and that no personal information (such as name, address, phone number) would be collected in any way. They were also assured that their responses would only be used for research purposes and that their confidentiality would be fully protected. With this information, the participants felt safe and comfortable to give their answers freely and honestly”.

A cover letter informed participants about the purpose of the study, the voluntary nature of participation, and the anonymity of the information. They were asked to continue with the survey if they agreed to participate. The Declaration of Helsinki conducted this study.

Data Collection Tools

The data were collected using the “Descriptive Form”, “Physical Appearance Comparison on Social Media Scale (PACSM)”, “Need for Social Approval Scale (NSA)”, and “Eating Attitude Scale (EAT-26)”.

Descriptive Form

A form was developed by the researchers consisting of questions on age, gender, section, income status, self-reported height and weight (which were later converted into BMI), hours of internet and social media usage per day (self-reported), years of social media use, perception of having enough friends in daily life and on social media, frequency of image sharing on social media, the use of programs/filters that change one’s body image in photos shared on social media, whether it was more important to be liked online than in everyday life, dieting status, and having someone dieting at home.

Physical Appearance Comparison on Social Media Scale

Schaefer developed this scale in 2013 to measure individuals’ tendency to compare their physical appearance with that of others.³³ A Turkish validity and reliability study was conducted by Acar in 2020. The scale consists of 10 questions. The scale items are organized using “0 = never, 4 = always” with a five-point Likert-type scaling method. The lowest score is 0, and the highest score is 40. The higher the score obtained on the scale, the higher the frequency of comparisons of physical appearance on social media.^34,35 Cronbach’s Alpha value in this study was calculated to be 0.97.

Need for Social Approval Scale

This scale was developed by Karasar and Ögülmüs (2016) to determine the need for social approval. The scale consists of 25 questions. The scale items are organized using “1 = strongly disagree, 5 = totally agree” with a five-point Likert-type scaling method. The lowest score is 25 points, and the highest is 125 points. The higher the score obtained on the scale, the higher the need for social approval.³⁶ Cronbach’s Alpha value in this study was calculated to be 0.97.

Eating Attitude Test-26 (EAT-26)

This test was developed by Garner and Garfinkel (1979) to measure possible disorders in eating attitudes and behaviors and was then revised by Garner et al (1982) to create a short form with 26 questions.^37,38 A Turkish validity and reliability study was conducted by Erguney-Okumus and Sertel-Berk in 2019. In the EAT-26, the participants were asked 7 questions about their demographic information and 26 questions about their eating habits; then, they were asked to assess 5 statements about their eating behaviors, resulting in a total of 3 sections (A-B-C). The scale was a six-point Likert-type scale. This study was conducted using part B of the scale. Part B of the scale was organized using “3 = Always, 2 = Very often, 1 = Frequently, 0 = Other answers (Sometimes, rarely, never)”. Question 26 was scored in reverse using “1 = Sometimes, 2 = Rarely and 3 = Never”, and the other options were scored as 0. The cut-off value for the EAT-26 is 20 points, and scores of 20 and above indicate a deterioration in eating attitudes.³⁹ Cronbach’s Alpha value in this study was calculated to be 0.93.

Analysis of the Data

Statistical Package for Social Sciences (SPSS) 22.0 was used for data analysis. Quantitative data are given as the percentage, mean, and standard deviation. Normal distributions were checked with the Shapiro–Wilk test (p < 0.001). Student’s t-test was used to analyze normally distributed independent variables with two groups, ANOVA was used to analyze variables with three or more groups, and the Tukey post hoc test was used to determine the group that made a difference. The Kruskall–Wallis test was used in the BMI analysis on the eating attitude scale, which did not show a normal distribution. The Tamhani 2 post hoc test was used to determine the group that made a difference, and the chi-square test was used for categorical evaluation. Spearman correlation and binary logistic regression analysis were used to evaluate the relationships between variables. In the correlation analysis, a value of 0–0.19 was considered to indicate no correlation; 0.20–0.39 was considered to indicate a weak correlation; 0.40–0.69 indicated a moderate correlation; 0.70–0.89 indicated a strong correlation; and 0.90–1.00 indicated a robust correlation. The significance value was p < 0.05.⁴⁰

The study’s findings can also be validated for populations other than university students, as the methodology and universal concepts make the research applicable to a wide audience.

Ethics Statement

Approval from the ethics committee was secured from the Recep Tayyip Erdoğan University’s “Social and Human Sciences Ethics Committee” on 1 March 2023 under reference number 2023/070.

Results

In this study, 80.3% of the participants were female, and the mean age was 21.10 ± 1.75 years.

The descriptive data of the students are shown in Table 1.

Table 1 Descriptive Data of the Participants

When analyzing the purposes of the participants’ social media use, it was found that 88.1% used it for entertainment, 80.9% used it for information, 42.3% used it for information sharing, 12.1% used it to make new friends, 62.3% used it for communication, 43.7% used it to follow friends, 26.7% used it to follow celebrities/phenomena, 40.7% used it to share images, 9.4% used it to follow food posts, and 0.5% used it for shopping. The scores of the participants in the study are shown in Table 2.

Table 2 Participants’ Scores on the PACSM, NSA, and EAT-26 Scales

Participants’ scores on the PACSM scale were low, their scores on the NSA scale were above average, and their scores on the EAT-26 scale were low (Table 2).

No significant differences in the PACSM scale in terms of gender, department, income level, or hours of daily internet use were found (p = 0.377, p = 0.215, p = 0.445, p = 0.712). The PACSM score was significantly higher among those who thought that they did not have enough friends in daily life and social media, those who used filters, those who considered being liked in the virtual environment more important than being liked in daily life, those who dieted, those who had someone who dieted at home, and those who lived alone than among those who lived with their families and in apartments/dorms; the scores were also higher among those who were overweight/obese than those who were thin and regular and those who always shared images on social media (p = 0.021, p = 0.045, p = 0.000, p = 0.004, p = 0.000, p = 0.011, p = 0.010, p = 0.014, p = 0.000) (Table 3).

Table 3 Analysis of Independent Variables with the PACSM, NSA, and EAT-26 Scales

In this study, no significant differences were found in the NSA scale in terms of gender, income level, hours of daily internet use, considering being liked in the virtual environment more important than being liked in daily life, dieting, BMI, or frequency of sharing images on social media (p = 0.551, p = 0.922, p = 0.565, p = 0.721, p = 0.054, p = 0.198, p = 0.162). Those who thought that they did not have enough friends in daily life and social media, those who used filters, and those who had a dieter at home had significantly higher NSA scores (p = 0.012, p = 0.017, p = 0.016, p = 0.002, respectively) (Table 3).

When eating attitudes were analyzed with the chi-square test, no significant differences were found according to gender, department, income level, frequency of sharing images, use of filters, finding it more important to be liked in a virtual environment than being liked in daily life, dieting at home, frequency of sharing images on social media, or daily internet usage hours (p = 0.536, p = 0.459, p = 0.761, p = 0.119, p = 0.119, p = 0.241, p = 0.231, p = 0.098, p = 0.320, p = 0.119, p = 0.784). Those who thought that they did not have enough friends in daily life (8.4%) and social media (9.4%) were found to have greater EAT scores than those who thought they had enough friends (32.7%, 25.5%), and those who dieted (17.7%) were found to have greater EAT scores than those who did not (7.0%) (X² =24.443, p < 0.001; X² =11.149, p = 0.001; X² =10.096, p = 0.001).

BMI made a significant difference in the EAT scale. Those who were overweight and obese had more disordered eating attitudes than those with average weight (p = 0.004) (Table 3).

The correlations between the participants’ EAT-26, NSA, and PACSM scores are shown in Table 4.

Table 4 Correlations Between Participants’ EAT-26, NSA, and PACSM Scores

There was a weak positive correlation among the EAT-26, NSA (Figure 1), and PACSM (Figure 2) scores (rs = 0.312, p < 0.001; rs = 0.264, p < 0.001). A moderate positive correlation existed between the NSA and PACSM (Figure 3) scores (rs = 0.503, p < 0.001) (Table 4).

Figure 1 Correlation between EAT-26 and NSA scores.

Figure 2 Correlation between EAT-26 and PACSM scores.

Figure 3 Correlation between NSA and PACSM scores.

In a logistic regression analysis that was performed by including the independent variables and other significant scales as a result of the study into the model, it was seen that all of the independent variables explained 40.3% of the independent variables. NagelKerke’s R2 value was 0.403, and Cox and Snell’s R2 value was 0.207. When the significance of the coefficients was examined, the variables of the PACSM score, NSA score, and having enough friends in daily life were independent risk factors (p < 0.001, p = 0.012, p = 0.025). When there was a one-unit increase in the PACSM scores, there was an increase in the log odds value by 0.080; when there was a one-unit increase in the NSA scores, there was an increase of 0.025 in the log odds value (Table 5).

Table 5 Binary Logistic Regression Analysis Between Eating Attitudes and Some Variables

Discussion

In this study, in which the effects of the frequency of comparisons of appearance on social media and the need for social approval on eating attitudes were evaluated, the frequency of comparisons of appearance was found to be low, and the need for social approval was found to be moderate. Although the mean disordered eating attitude score (9.95 ± 13.14) was low, 11.6% of the students had a disordered eating attitude (EAT-26 ≥ 20). Similarly to this study, in the literature, the mean total score of disordered eating attitudes was found below 20,⁴¹ while others found mean total scores of 20 and above (≥ 20).^2,11 In addition, studies have shown that students have a high risk of disordered eating attitudes, ranging from 5.6% to 35.7%.^9,10 These findings show that disordered eating attitudes are significantly prevalent in the university period. In this period, eating attitudes may be related to the frequency of comparing one’s appearance on social media and the need for social approval.

This study found a significant positive correlation between the frequency of comparisons of appearance on social media and the EAT score. At the same time, the regression analysis revealed that, as the frequency of comparing physical appearances on social media increased, disordered eating attitudes also increased. These findings suggest that students’ comparisons of their appearance on social media make them vulnerable to disordered eating attitudes. Individuals who frequently compare their physical appearance with idealized appearances on social media may experience body dissatisfaction.²³ Body dissatisfaction may also cause them to develop unrealistic expectations for their appearance and eating habits, consequently leading to disordered eating attitudes.⁴² In this study, a positive relationship was also found between disordered eating attitudes and the need for social approval. At the same time, as a result of the regression analysis, it was found that disordered eating attitudes increased as the need for social approval increased. A recent study showed that body dissatisfaction, self-oriented and socially determined perfectionism, being compared with peers, and being under pressure to lose weight are influential in the emergence of disordered eating attitudes.⁴¹ It is thought that the sociocultural pressure created by peers regarding body image and being thin may increase the need for social approval; as a result, eating disorders increase. In addition, this study found a positive relationship between the frequency of comparisons of appearance on social media and the need for social approval. The fact that these two factors are related to each other and disordered eating attitudes shows that both factors should be included together in interventions to develop positive eating attitudes on campuses.

In this study, the frequency of comparisons of appearance on social media, the need for social approval, and disordered eating attitudes were significantly higher among those who thought they did not have enough friends in daily life and on social media. Socially lonely individuals use social media to compensate for the lack of personal support⁴³ and to interact socially.⁴⁴ However, although social media is used for these purposes, some users may use it passively, ie, silently browsing their friends’ status updates and rarely interacting with them.⁴⁵ The passive use of social networking sites encourages social comparisons.⁴⁶ In light of this information, it is thought that students use social media to be approved of and to interact. Still, due to their passive use, the frequency of comparing appearances on social media may have increased. In addition, the university period is when different groups of friends are encountered, a new social environment is acquired, and it is essential to be accepted and approved by them. The need for social approval is expected to be higher in those who think they do not have enough friends. The results of the regression analysis showed that the risk of disordered eating attitudes was approximately four times higher in those who thought that they did not have enough friends in daily life. This finding suggests that having enough friends in daily life affects eating attitudes more than social media does.

In this study, the frequency of comparing appearances on social media was significantly higher in dieters and those with the presence of a dieter in their family. The need for social approval was higher only among those who had a dieter in the family. Students likely compare their appearances with those of their peers to evaluate their progress with their body and diet and for inspiration. However, constant comparison of progress and appearance can lead to unattainable standards, unrealistic representations, and negative feelings of inadequacy and disappointment. These feelings may interfere with weight loss and lead to harmful dieting behaviors and the deterioration of eating attitudes. In addition, in this study, disordered eating attitudes were found to be higher in dieters. It is thought that the frequency of comparing appearances on social media causes an increase in disordered eating attitudes in dieters. Although social media is a valuable tool for support and motivation in the dieting journey, it is essential to be aware of its potential negative impact. For these reasons, dieters should be informed about the dangers of comparisons made on social media. Dieters should also be encouraged to choose realistic and achievable diet messages and body positivity.

In this study, those who were overweight/obese had a significantly higher frequency of image comparison on social media than those who were underweight and of normal weight. It is thought that these students were exposed to weight discrimination and stigmatization due to obesity. Therefore, the frequency of image comparisons on social media increased. A previous study also showed that having a high BMI could cause the perception of weight discrimination.⁴⁷ Therefore, it is recommended that students in this group be taught media literacy skills to interpret messages about underweight ideals and the stigmatization of obesity on social media.⁴⁸ Another study showed that media literacy protects against the negative impacts of exposure to idealized images on social media.⁴⁹ At the same time, in this study, disordered eating attitudes were found to be more frequent among overweight and obese individuals than among normal-weight individuals. In studies supporting this finding, it has been found that students who are overweight and obese or who perceive themselves as overweight are more likely to have unhealthy eating attitudes and behaviors.^11,50 The prevalence of eating attitude disorders in overweight and obese students can be explained by the increased frequency of comparing appearances on social media among these students. Frequent comparisons of appearance on social media may increase body dissatisfaction and the urge to be thin and cause unrealistic weight loss goals. The desire to achieve these unrealistic goals may also lead to a disordered eating attitude. More disordered eating attitudes make students more vulnerable to eating disorders. As weight increases, the desire to lose weight increases, and it becomes challenging to control overeating.³²

In this study, it was determined that the use of programs/filters to change the body’s appearance in photographs had an impact on comparisons of appearance on social media and the need for social approval. It was determined that always sharing images on social media and giving importance to being liked in the virtual environment only had an effect on comparisons of appearance on social media.

It is essential to determine the factors affecting comparisons of appearance on social media and the need for social approval and to include them in intervention programs to prevent disordered eating attitudes. In this study, comparisons of appearance on social media were significantly more prevalent among those who always shared images and those who considered being liked in the virtual environment more important. A study found that women who participated in appearance-related photo activities on social media more frequently were more likely to compare their appearance with that of female ideals.⁵¹ The desire to gain approval, attention, status, and popularity in the virtual environment, as well as the fast and rewarding likes and comments on posts, may increase the frequency of image comparison. Encouraging careful social media use and focusing on real-life experiences rather than virtual experiences may help reduce the prevalence of image comparisons and aid in developing a healthier online environment.

In this study, the frequency of image comparisons on social media was significantly higher among students who used programs/filters that changed their body image in the photos that they shared. A study showed that photo-editing behavior was positively related to comparisons of physical appearances.⁵² Users’ comparisons of their appearance with idealized beauty standards during photo editing may cause them to think that it is necessary to change their photos. Therefore, it is also likely that those who use filters in photos are more likely to compare images on social media. If students are discouraged from comparing themselves with unrealistic and idealized images presented on social media, it is thought that body satisfaction will be maintained,⁵³ and, indirectly, eating attitudes will be positively affected. However, it is essential to realize that this comparison may lead to negative emotions and negatively affect self-esteem, self-confidence, and body image.^53,54 Therefore, it can be said that students need interventions in which acceptance and appreciation of all bodies and appearances are encouraged to challenge idealized images and promote body positivity.⁵⁵ At the same time, the need for social approval was significantly higher among filter users in this study. This may be because students’ unrealistic presentation of themselves in the virtual environment may have caused them to see their flaws or perceive themselves as flawed over time, thus causing appearance anxiety. To overcome appearance anxiety, the need to be appreciated, accepted, and approved by others in daily life may have increased. Another study supported this finding and showed that social appearance anxiety predicts the need for social approval.⁵⁶ In this context, media literacy programs will help young people understand and evaluate idealized and unrealistic photographs and the messages intended to be conveyed through them in order to make the right decisions. In addition, in this study, those who thought that they did not have enough friends in daily life used filters more than those with enough friends. A study showed that filtered photos are 21% more likely to be viewed and 45% more likely to be commented on than unfiltered photos.⁵⁷ Based on this previous finding, it is thought that those who do not have enough friends use filters to be noticed by others, to enable others to communicate with them, and to increase their number of friends.

In a study conducted among university students, disordered eating attitudes were found in 26.5% of the students.¹⁰ In a study conducted among students studying in a nursing department, disordered eating attitudes were found in 8.0% of the students.⁵⁸ In this study, disordered eating attitudes were detected in 11.6% of the students. Having health courses such as nutrition for students studying in a health department such as nursing may have been effective in developing positive eating attitudes. Therefore, the findings of this research cannot be generalized to all departments of universities.

Although the prevalence of disordered eating attitudes was below average, a difference was found between the students studying in a health-related department (nursing, etc). in the city where this study was conducted and in different cities (11.6%, 5.6%, and 8.0%).^9,58 Therefore, the findings of this study cannot be generalized to other universities in the country.

In this study, the perception of having enough friends in daily life and on social media, the frequency of sharing images on social media, and the durations of internet and social media use were evaluated according to students’ self-reports. It was emphasized in another study that self-reports can be affected by many factors, such as emotional state, selective or erroneous recall, and contextual search factors. Therefore, self-reported responses to questions cannot be generalized to validated measures.⁵⁹ Additionally, comparisons of physical appearance on social media, the need for social approval, and eating attitudes were not evaluated with qualitative data that included the opinions of the researchers. Both qualitative and quantitative methods can be used simultaneously to improve the quality of this research.⁶⁰ It is recommended to use quantitative and qualitative data together to examine the variables more deeply. Bu çalışmanın bazı sınırlamaları bulunmaktadır. Bunlar;

• This research was conducted with students from a health department and cannot be generalized to all departments of the university. It also cannot be generalized to people of the same age who did not attend university.
• This research is limited to the province in which it was conducted and cannot be generalized to other university students in the country.
• The data obtained are limited to the Descriptive Form, Physical Appearance Comparison on Social Media Scale, Need for Social Approval Scale, and Eating Attitude Test-26.

The findings were collected from participants’ self-reports, and there were no validated measurements.

Future studies should use methods such as cross-checking and validation questions to increase the accuracy and validity of the findings. They should also consider different age groups, genders, ethnicities, and socioeconomic status to increase the applicability of the findings to a broader population. This may increase the reliability of the findings and improve their applicability to different populations.

Conclusions

The frequency of comparing appearances on social media and the need for social approval among students were found to be moderate. The prevalence of disordered eating attitudes was found to be low, but a significant proportion of students had disordered eating attitudes. There was a positive correlation between eating attitudes, comparisons of appearance on social media, and the need for social approval. At the same time, it was found that as the frequency of comparing appearances on social media and the need for social approval increased, disordered eating attitudes also increased. Disordered eating attitudes were found to be more prevalent in those who thought that they did not have enough friends in real life and on social media, dieters, and those who were overweight and obese.

Both social media appearance comparisons and the need for social approval were found to be high among those who thought that they did not have enough friends in real life and on social media, those who used different tools to manipulate their bodily appearance in the photos that they shared on social media, and students who knew someone on a diet at home. Comparisons of appearance on social media were found to be excessive among those who considered being liked in a virtual environment more important than being liked in daily life, dieters, those who lived alone, those who were overweight and obese, and those who always shared images on social media.

Recommendations and Relevance to Future Public Health Practice

Since students constitute a large group of the society on campuses, it is very important to determine the eating attitudes of this group and the factors that are effective in improving the eating attitudes and nutritional health of the society.

The findings of this study will contribute to the planning of interventions to improve the positive eating attitudes and nutritional health of the society by revealing the effects of image comparison and social approval needs through social media in developing negative eating attitudes. In the light of all these findings, we recommend the following interventions on campuses:

• Raising awareness about the frequency of comparing appearances on social media and the need for social approval which have effects on disordered eating attitudes.

Training modules: Workshops can be organised to help individuals understand the effects of social media use on body image and nutrition attitudes. Through media literacy training, individuals can learn to recognise manipulated content on social media and reduce its impact on their perceptions.

Cognitive behavioural interventions: Cognitive behavioural therapy techniques that promote self-efficacy and intrinsic motivation to reduce the need for social approval can be applied. These techniques help reduce the emotional impact of media messages and increase critical thinking skills.

Self-image enhancement programs: Self-value development activities can be carried out that enable individuals to focus on their internal values instead of social approval. In this process, support groups can be formed to share body positivity content and enable individuals to focus on their strengths.

• Developing intervention programs to prevent disordered eating attitudes with the aim of reducing both the need for image comparisons on social media and the need for social approval.

Regulating social media use: Users should be taught ways to reduce time spent on social media, content filtering techniques and ways to increase engagement with positive content.

Mindfulness-based interventions (Mindfulness) can help individuals accept their bodies and compare themselves less with the images they see on social media.

Psiko-eğitim programları: Medyada ideal beden algısını şekillendiren faktörler ve medya manipülasyon teknikleri hakkında farkındalık artırıcı eğitimler düzenlenebilir.

• Organizing programs that develop media literacy skills to understand and evaluate idealized and unrealistic photos and messages stigmatizing obesity on social media, as well as choosing realistic and accessible dietary messages to inform decision-making.

Media content analysis workshops: Workshops can be organised to teach participants how to analyse the creation of body image-related content on social media.

Promoting realistic dietary messages: Healthy eating messages should emphasise a balanced diet and sustainable lifestyle.

Digital literacy training: Training can be offered to help people recognise media manipulations (eg, the use of Photoshop or filters).

Organizing educational programs on actual body images and idealized sociocultural body standards.

Campaigns showing real body diversity: Encourage more media images representing different body types, age groups and physical characteristics.

Body perception workshops: Workshops can be organised to help individuals build a healthier relationship with their body perception.

• Planning interventions that promote body positivity, where acceptance and appreciation of all bodies and appearances are encouraged.

Body positivity groups: In schools and communities, groups can be established to promote body positivity and empower individuals.

Psychological support programs: Professional support and group therapies can be offered, especially for individuals with low self-esteem.

To better assess disordered eating attitudes, we recommend conducting studies with an expanded population.

Diversified sample groups: Studies should include participants from different socioeconomic, cultural and age groups.

In general, this research data;

It will help young people and society to realize the negative effects of image comparison and need for social approval on eating attitudes in social media.

It will help administrators, health policy makers and governments to understand the factors affecting the eating attitudes of students, who constitute a large group of society, in social media. It will also guide the planning of interventions to be made in this direction.

It will contribute to the planning and evaluation of studies to be conducted with a larger sample group.