JMIR Publications

ABSTRACT

Background:

YouTube’s algorithmically curated participatory environment can amplify and insulate extreme-diet communities. Despite growing concerns, little is known about how channel characteristics and framing strategies coalesce in pro-anorexia (pro-ana) echo chambers.

Objective:

This study aimed to examine the distribution of pro-ana advocacy, anti-pro-ana, and recovery-oriented frames across different YouTube channel types and investigate how these frames shape community structures through user-commenter networks.

Methods:

We collected a sample of 489 Korean-language YouTube videos between January 2020 and August 2024 using keyword queries (“Pro-Ana,” “Pro-Ana Diet,” “Bone-Thin,” “Ultra-Thin”) and related-video scraping. The channels were categorized into six types based on operator identity (elite vs. personal) and subscriber scale (mega, meso, and micro). A validated content-analysis schema was used to code each video for three major frames: Pro-Ana Advocacy, Anti-Pro-Ana Critique, and Recovery. We constructed a backbone network based on commenter overlap and conducted a social network analysis (SNA) to examine the temporal dynamics. We further applied exponential random graph models (ERGMs) to assess how channel type, frame, and their interaction influence the formation of ties.

Results:

The Pro-Ana Advocacy frames were primarily concentrated on meso- and micro-personal channels, while the Anti-Pro-Ana Critique frame appeared mostly on elite-operated channels. Recovery narratives were found predominantly in the micropersonal content. Over time, network density decreased, whereas modularity increased, suggesting intensification of the echo chambers. The ERGM results showed that mid-tier personal channels using the Anti-Pro-Ana and Recovery frames played a bridging role within otherwise fragmented networks.

Conclusions:

Findings suggest that mid-tier personal channels, particularly those that use critical or recovery frames, can act as gatekeepers and disrupt insular pro-ana networks. Public health communication strategies should consider leveraging mid-tier influencers and participatory formats to counteract the echo-chamber effects and foster a more balanced discourse on eating disorders.