The social media stigma of NAFLD
18 Oct 2021
In 21st Century, scientific communication collides inexorably with modern means of communication and with the spread of social media. In fact, their capability to provide enormous quantities of information of all kinds, even without the correct verifiability of the same, represents a challenge in conveying scientific messages correctly. One of the areas in which this issue is most evident is that relating to physical appearance and lifestyle. Today’s society often proposes very rigid lifestyle models, the achievement of which sometimes involves incorrect information in the field of health.
Non-alcoholic fatty liver disease (NAFLD) is probably one of the areas where this problem is most evidently reflected. In fact, NAFLD is estimated to affect 25% of the global population [Ref 1], and is associated to unhealthy lifestyle: unbalanced diet, sedentary lifestyle, obesity [Ref 2]. Considering that at present time the only possible intervention in NAFLD management is related to diet and physical activity [Ref 3], the psychological impact of this condition is certainly very heavy. In fact, it is well known how weight stigma, which affects obese patients both in social and medical settings [Ref 4], can affect them in many different ways. In fact, it can increase psychosocial stress and aggravate metabolic and sleep disorders, leading to a vicious circle of weight gain and consequent progression of NAFLD [Ref 2, Ref 5]. Moreover, it impairs self-regulation and self-esteem and weakens stress coping mechanisms, increasing risk of depression in these patients [Ref 6]. All these factors are nowadays emphasized by the role of social media. A recent paper by Lazarus J et al tried to investigate the role of stigma and negative feelings concerning NAFLD/NASH and obesity on Twitter [Ref 7]. In their study the authors retrieved 16835 tweets for NAFLD and 2376 tweets for NASH. They manually labelled 1130 NAFLD and 535 NASH tweets and found that among the NAFLD tweets, 245 (21.7%) shared unverified information while only 75 (6.6%) shared scientific studies. Among the 535 NASH tweets, 274 (51.2%) contained unverified information, 160 (29.9%) contained references to NAFLD, 183 (34.2%) contained references to scientific studies, 106 (19.8%) references to other diseases and 63 (11.8%) to obesity; 36 (6.7%9 came from a medical professional and 25 (4.7%) from a society or Nongovernmental organization. Moreover, the authors found that both NAFLD and NASH tweets were often shared inappropriate contents and medical misinformation, such as ‘quick cures’, ‘super smoothies’ or herbal/natural cures for fatty liver.
In conclusion, this study shows how both NASH and NAFLD are still relatively unknown in social media platforms. However, when they are considered, they are often referred in a negative context, perpetrating the stigma that already affects patients with obesity. Moreover, many of the tweets related to ANSH and NAFLD come from unofficial and unverified channels that propose unapproved theories and remedies, thus leading to two different negative results. On the one hand, in fact, they contribute to further worsen the opinion regarding these pathologies themselves. Furthermore, they contribute to further burden on the patients themselves both from a psychological and clinical point of view. If the issue of the stigma around NAFLD and NASH is to emerge, it could closely mimic the obesity social media stigma that is currently well known. Therefore, pre-emptive measures to reduce the stigma around NAFLD and NASH should be considered, maybe starting from the existing obesity messaging and possibly implementing the role of official channels to provide useful and reliable information for patients and all web users.
- Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016 Jul;64(1):73-84.
- Younossi Z, Tacke F, Arrese M, Chander Sharma B, Mostafa I, Bugianesi E et al. Global Perspectives on Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis. Hepatology. 2019 Jun;69(6):2672-2682.
- Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M et al. the diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Associatiobn for the Study of Liver Disease. Hepatology 2018;67(1):328-57.
- Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4):319-326.
- Bellentani S, Saccoccio G, Masutti F, Crocè LS, Brandi G, Sasso F et al. Prevalence of and risk factors for hepatic steatosis in Northern Italy. Ann Intern Med. 2000 Jan 18;132(2):112-7.
- Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017;66(6):1138-1153.
- Lazarus JV, Kakalou C, Palayew A, Karamanidou C, Maramis C, Natsiavas P et al. A Twitter discourse analysis of negative feelings and stigma related to NAFLD, NASH and obesity. Liver Int. 2021 Oct;41(10):2295-2307.