He is one of the most talented and recognizable athletes on earth. He is also one of the most well paid, earning £25 m ($30 m) per year playing soccer for Manchester United. Yet by endorsing an array of brands and businesses, including Coca-Cola, LiveScore, Free Fire, Nike, Herbalife Nutrition, and Tag Heuer, on his Instagram account, Christiano Ronaldo nearly doubles his soccer salary. With approximately 460 million followers, he is Instagram’s most influential celebrity—more popular than Justin Bieber, Ariana Grande, Kim Kardashian, Dwayne “The Rock” Johnson, and Taylor Swift.

Ronaldo, by anyone’s definition, is an “influencer”—that is, someone with “the power to affect the purchasing decisions of others because of his/her authority, knowledge, position, or relationship with their audience.” Social media now pervades every aspect of modern culture. Hence, partnering with an online “fitness influencer” has become a fundamental part of brand marketing (Schouten et al. 2020). Although most high-profile athletes and other fitness influencers cannot demand the approximately $1.6 m per sponsored post like Ronaldo, it can be a highly lucrative vocation for those with a sizable online following.

Young people increasingly obtain health-related information through social media (Wartella et al. 2016), and so fitness influencers fill a niche. Obtaining good advice from trusted online sources can have several benefits. For example, fitness influencers motivate many followers to increase their physical activity levels, and with much online content oriented around food and healthy eating, many followers are inspired to pay more attention to their dietary habits. Influencers also strive to create long-term partnerships with their followers to enact change over time, and there are even fitness influencers, albeit in the minority, who promote body positivity. In a society with soaring rates of obesity (Boutari and Mantzoros 2022) and type II diabetes (Lin et al. 2020), any cultural emphasis on physical activity and healthy eating is a positive one. Of course, this all assumes that fitness influencers are promoting realistic outcomes and that their advice is accurate and correct.

Bad Influence

Many fitness influencers are neither professionally trained nor qualified to be administering the advice on which their accounts are built. The advice they dispense is often, therefore, based on mere opinions—personal views that lack technical nuance, are motivated by sponsorship, and/or do not agree with expert consensus. For instance, an audit of nearly 500 Instagram posts from fitness influencers in South America revealed that less than 3 percent of posts were supported by a valid scientific reference (Marocolo et al. 2021). The study also found that fitness influencers with the least qualifications tended to have more followers.

Another study from the United Kingdom found similarly concerning results when examining weight management blogs hosted by verified social media influencers (Sabbagh et al. 2020). Advice was evaluated against evidence-based recommendations and criteria that included “trustworthiness” and “bias.” Of the influencers audited, most of them dispensed dietary advice that did not conform to official federal guidelines, and most blogs were not deemed credible sources of information.

Fad diets and other dietary restrictions are just some of the strategies commonly advocated by fitness influencers (Sabbagh et al. 2020). In fact, 20 percent of young women have tried fad diets such as Atkins or South Beach diets instead of following national, evidence-based weight loss recommendations (Malinauskas et al. 2006). By and large, fad diets do not work. They usually lead to “yo-yo dieting” characterized by rapid weight loss and regain (Dulloo and Montani 2015), often causing weight to rebound beyond baseline levels. Yo-yo dieting may actually increase the risk of heart disease, particularly in women and lead to life dissatisfaction and binge eating (Brownell and Rodin 1994). According to the American Heart Association, fad diets such as the ketogenic diet and intermittent fasting “fail to promote any aspect of heart health” (Lichtenstein et al. 2021).

Data like these are a grave concern because, more than any other resource, young people use social media to access content on diet, nutritional supplements, recipes, exercise, workouts, and body transformations (Goodyear et al. 2019). In addition, 41 percent of young people would trust a “healthy eating blogger” for advice, regardless of the blogger’s qualifications.

Fitness Influencers Are Endorsing Complementary and Alternative Medicine (CAM)

The wellness industry is largely unregulated and leans heavily on testimonials, anecdotal evidence, and positive thinking. This emphasis on subjective experience and intuition leads to the widespread use of “placebo products” (Tiller 2020). Many influencers directly advocate CAM due to an ideological belief or a monetary stake. However, alternative medicines are also pervasive in high-performance sport, and many athletes thus become unwitting proponents of CAM. There are countless examples: Michael Phelps endorsed the ancient Chinese therapy of cupping; LeBron James and Floyd Mayweather publicly endorsed cryotherapy; soccer player Robin Van Persie endorsed massage with horse placenta; and Tom Brady … well, don’t get me started.

But widespread use of CAM in high-profile athletes could have profound implications for population health and clinical practice. This is because, on the perception that they are “experts” in health and wellness, revered athletes are considered to have pioneered rising trends in the use of CAM among the wider population (White 1998). It is impossible and unrealistic to restrict alternative products to exercise training alone. A sincere belief in a product’s “healing” or “anti-inflammatory” effects will eventually see it used to treat potentially serious conditions, such as in the case of the Alberta parents who tried to treat their son’s life-threatening meningitis with naturopathic remedies with tragic consequences. There are many such reports, and online databases such as Whatstheharm.net have documented at around 370,000 deaths and approximately $3 billion of economic damages over the years attributable to the use of unproven and unregulated alternative therapies.

The widespread endorsement of alternative therapy by fitness influencers further blurs the line between information and mis- and disinformation for which social media is notorious. In recent years, there has been a rapid proliferation of so-called “alternative health influencers” who have built large online followings by appealing to “the utopian discourses of early web culture and the underlying principles of wellness culture” (Baker 2022). This notion of “conspirituality” undermines public trust in science and poses a major threat to science policy because alternative therapy influencers are a gateway that leads directly from the wellness industry to right wing extremism and conspiratorial thinking (Ward and Voas 2011)—two subcultures united by political disillusionment and alternative world views. As Eva Wiseman from The Guardian newspaper (UK) describes: “While the overlap of left-wing, magazine-friendly wellness and far-right conspiracy theories might initially sound surprising, the similarities in cultures, in ways of thinking—the questioning of authority, of alternative medicines, the distrust of institutions—are clear.”

Fitness Influencers, ‘Fitspiration,’ and Psychopathology

So-called “fitspiration” is a broad term that describes how digital media is used to inspire the pursuit of physical fitness through rigorous diet and exercise. However, owing to its emphasis on unrealistic and/or unhealthy body ideals, there are negative consequences to this seemingly positive movement. Fitness influencers often promote extreme exercise and dietary behaviors that are contrary to safe, long-term interventions usually prescribed by exercise professionals. “Fitspiration” is also associated with unrealistic outcomes. To maintain high standards of self-presentation, most fitness influencers spend many hours arranging their photo shoots (e.g., with professional lighting and photographers), cherry-picking from multiple images, using filters and image enhancers to produce unauthentic depictions of themselves (Dumas et al. 2017), and even taking dangerous supplements like anabolic steroids. Unsurprisingly, various studies of online “fitspiration” reveal more posts by females than males, and females are significantly more likely to appear in sexualized images (Carrotte et al. 2017). In addition, social media users (especially women) have significantly lower self-esteem on days where they are exposed to more “fitspiration” images.

The relationship between influencer and follower is often not a healthy one, nor is it an easy one to disrupt. With “fitspiration,” influencers promote diet and exercise as factors to be controlled to attain body perfection, which in turn is the implied key to happiness. Followers tend to identify with the roles and ideals of influencers, and, because their needs are satisfied in several ways, it creates “a relationship of dependency between influencers and their followers” (Pilgrim and Bohnet-Joschko 2019).

How Can We Engage with Online Fitness Content in a ‘Healthy’ Way?

Most people will forever be tethered to their social media accounts, but studies show that limiting use to just thirty minutes per day can lead to significant improvements in mental health and wellbeing, specifically improving loneliness and depression (Hunt et al. 2018). Nevertheless, if you are using social media to engage with fitness content, following are some pointers to help you do so safely and effectively.

1. Filter out superficial content. Fitness influencers who care about the health of their followers will provide meaningful, informative, and well-researched content rather than simply posting idealized images of their bodies. Avoid accounts that prioritize style over substance.

2. Look at the influencer’s qualifications. There is no regulation on self-professed titles such as “fitness coach” or “nutritionist.” Moreover, social media algorithms generate content based on popularity and engagement rather than quality. You must therefore act as your own content regulator. Disregard content that is not from trusted organizations and individuals not qualified to be disseminating health-related advice.

3. Consider the motives. Online fitness content is characterized by glossy images often posted alongside questionable advice. What is not always clear is the “sponsorships, book deals, paid appearances and businesses behind these posts.” Marketing firm Mediakix looked at Instagram accounts of the fifty most-followed celebrities, finding that 93 percent of posts that promoted a brand were not labeled in a way that made them compliant with the FTC (Federal Trade Commission) guidelines. Another analysis found that one-third of sponsored posts were not labeled as such and were, therefore, in breach of the rules. All this lack of transparency regarding online sponsorship has the potential to undermine advice administered by fitness influencers. Look at all content through a skeptical lens: scrutinize the influencer’s page for “affiliate links” to businesses or investments, and do not assume the account has your best interests at heart.

4. Avoid the quick fixes. Any meaningful health and fitness outcome takes time to achieve, often months or years, in addition to careful planning and consideration. As a rule, you should sidestep accounts that promote miracle cures and rapid results; they are usually trying to exploit your ingrained bias for economy. There is a reason an intervention may seem too good to be true.

5. Judge the advice on merit and check whether it conforms to scientific consensus. Rarely is online health and fitness advice supported by references to high-quality scientific literature—or any literature for that matter. Check advice against expert guidance. If in doubt, defer to a qualified professional. In general, avoid anyone promoting fad diets, expensive supplements, detoxes, energy medicine, or individuals who make extravagant claims in relation to exercise training. These are rarely (if ever) the views of professionals who are informed by scientific values.

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