How a Weight-Loss Trend on TikTok Might Encourage Eating Disorders

Social media is full of gut health hacks. Shots of olive oil, prebiotics, probiotics and green powders are touted as remedies for digestive malaise. Now TikTok’s gut health evangelists are praising substances that have been dangerous mainstays of the weight-loss world: laxatives.

Recent news reports have claimed that laxatives are being used as a cheaper alternative to popular weight-loss drugs such as Wegovy. Laxatives often appear on the TikTok hashtag #guttok. It’s a place where people share their experiences with chronic gut conditions and where dubious remedies are also commonplace. Some videos claim that laxatives help people slim down and feel less bloated, but research finds no evidence that laxatives cause sustained weight loss. Experts are concerned that the proliferation of laxative misinformation could lead to disordered eating. “It absolutely is reason for concern,” says Kristen Harrison, an expert on the effects of media on disordered eating at the University of North Carolina at Chapel Hill Hussman School of Journalism and Media. “It’s presented as a sort of legit and healthful lifestyle choice as opposed to something that could become pathological or difficult to give up or could lead to an eating disorder over time.”

Laxatives and Eating Disorders

Laxatives have been used for centuries for important and legitimate medical uses, such as treating constipation or clearing the bowels before surgery. The misuse of laxatives, however, has been associated with eating disorders such as anorexia nervosa and bulimia nervosa—often as a compensatory behavior for binge eating.

“There could be physical discomfort or psychological discomfort just knowing that the patient has just consumed a lot of calories,” says Janet Lydecker, a psychiatrist who focuses on youth eating disorders. In other words, a binge-eating episode often leads people to “purge” with laxatives, she says.

The laxative circulating on TikTok is primarily one that contains polyethylene glycol 3350 (PEG). It’s an osmotic laxative: it works by attracting water molecules to the colon, causing more-watery stool to form. Basically, it makes pooping easier. Most calories are absorbed higher in the digestive tract, long before food reaches the bowels, says David Levinthal, an assistant professor of medicine and a practicing gastroenterologist at the University of Pittsburgh Medical Center. “The main effect of laxatives really is in the colon,” he says. So the idea that taking a laxative can somehow speed up digestion and help keep pounds off is misguided.

Only a handful of studies—mostly from the 1980s—have looked into the caloric effects of purging through laxative misuse. All of them have concluded that it has a negligible effect. One study found that extreme laxative use only reduced caloric absorption by about 12 percent, and it resulted in up to 200 fluid ounces of diarrhea. This is dangerous because severe diarrhea can cause dehydration, which disrupts organ function in the long term. When taken at levels beyond their recommended amounts, osmotic laxatives can also affect the balance of electrolytes—they strip the body of the essentials it needs to function. Misusing laxatives over long periods of time can permanently damage the digestive system, leaving users with chronic constipation. “Over time you discover that it’s kind of a devil’s bargain,” Harrison says.

The medical reason why laxatives don’t work for weight loss might not be intuitive, especially for someone with an eating disorder, Lydecker explains. Psychologically, these individuals want the stomach to be completely empty—for instance, after a binge-eating episode—which can lead them to think, “Laxatives will do that; therefore, it must work,” Lydecker says. She says that explaining that the drugs don’t work in this way is usually enough to deter her patients.

Estimates suggest that the number of people with an eating disorder in the U.S. who have ever misused laxatives varies from 10 to 60 percent. The range is so large because almost all the investigations rely on self-reported data and use different criteria to determine what constitutes laxative misuse.

Melissa Freizinger, associate director of the eating disorder program at Boston Children’s Hospital and an assistant professor of psychology at Harvard Medical School, has treated people in the past who have told her they would use the laxative as a way to punish themselves for eating because the drug would cause painful stomach cramps. Most knew that it was not a good way to lose weight,” Freizinger says. She adds that some patients who used the medications would experience side effects of increased fluid retention and bloating, which could lead to a “dangerous cycle” of using more laxatives.

Laxative Popularity on Social Media

The number of adolescents seeking care for an eating disorder at least doubled during the pandemic, and some research has found that social media could be a major contributor. In one study, participants reported more frequent binge eating and laxative use in 2022 than before the start of the COVID pandemic. These behaviors were associated with a greater exposure to weight loss–related content.

Eating very little or doing unusually rigorous exercise routines are dangerous behaviors that are common on social media platforms, says Diana Thiara, an assistant clinical professor of medicine at the University of California, San Francisco. “We’re seeing what teens have always talked about among each other,” she says, adding that behaviors that were limited to more isolated communities in the past are becoming increasingly normalized.

In recent years laxatives have had a mainstream makeover: skinny teas and candies containing senna—an herbal laxative—were popular on Instagram several years ago. Fatima Syed, an internist at Duke University School of Medicine who focuses on weight management and primary care, says that anecdotally, some of her younger patients have asked about laxative teas after seeing advertisements for them on Instagram. The proliferation of ads for such products prompted the social media platform to crack down on their promotion in 2019. But the content spilled over to other platforms, including TikTok. “We used to say, ‘Be aware of Dr. Google,’ and now you have to be aware of Dr. TikTok, too,” Syed says.

Laxatives are alluring—almost anyone can buy one over the counter, and they’re cheap. But it’s a “fake weight loss” that isn’t sustainable, says Fahad Zubair, medical director of obesity medicine at the Allegheny Health Network. “Most of the patients who are doing this, they start early in life, and they end up realizing later that it damaged their body.”

Some evidence suggests laxative use can lead to more severe disordered eating in the future. In a study using data from 1998 to 2009, before social media was widely used, people who used laxatives were almost three times more likely to report an eating disorder five years later compared with those not using the drugs.

“A lot of it stems from this society’s pathologic desire for thinness,” Thiara says. “And obviously, social media has accelerated that.”

Reducing Exposure to Harmful Content

Not everyone who watches and reads this type of social media content will develop an eating disorder, Harrison says. But when health overlaps with weight loss on social media, it can be hard to separate what’s good for mental health from what’s not. Experts say if the content makes someone feel bad, no matter how entertaining it is, they should question whether it’s something they should be consuming.

If you’re watching a video and thinking, ‘I need to go on a diet,’” maybe this content isn’t something that’s healthy for you,” says Paula Edwards-Gayfield, regional assistant vice president at the Renfrew Center for Eating Disorders. “Some behaviors can start to creep in and become more disordered eating behaviors, even if it’s not a diagnosable eating disorder.”

When we see something all the time, we become habituated to it, Harrison says. She says social media users should try to “recalibrate their brain” to what is healthy behavior: “Get back outside; see your regular friends; remind yourself what’s normal in your sphere of the world.”

Part of that practice is to deliberately try to change what social media algorithms are delivering to you by seeking out different content. Do a gut-check of your social media feeds: if you are feeling overwhelmed by the number of videos featuring quick-fix weight-loss hacks, such as laxatives, there are ways to take back control over what you view, Harrison says. If the content you are consuming begins to take a toll your mental health or mood, she says, try reading or watching content on happier topics. “Tweak the algorithm to give you something that makes you leave the house feeling good about yourself.”

If you or someone you know is struggling with an eating disorder, you can contact the National Association of Anorexia Nervosa and Associated Disorders helpline by calling (888) 375-7767. For crisis situations, you can text “NEDA” to 741741 to connect to a trained volunteer at Crisis Text Line.

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