Mirror, motivate, or mislead? How fitspiration on RedNote affects health behaviors through appearance comparisons and self-esteem

Fitspiration content has become increasingly popular on visual social media platforms like RedNote (Xiaohongshu), presenting exercise, self-care, and body positivity as forms of health communication in the new media era. Despite these positive intentions, growing evidence suggests that such content may also be linked to psychological distress and unhealthy behaviors by reinforcing narrow appearance standards and encouraging social comparison. Guided by the Stimulus–Organism–Response framework and Social Comparison Theory, this study investigated associations between fitspiration exposure on RedNote and body dissatisfaction, compulsive exercise behavior, and eating disorder symptoms among 527 Chinese women aged 18 to 44. Using partial least squares structural equation modeling, we examined the mediating roles of appearance comparison and state self-esteem. Results indicated that fitspiration exposure was significantly associated with compulsive exercise and eating disorders, but not directly with body dissatisfaction. While appearance comparison partially explained these associations with behavioral outcomes, it did not account for body dissatisfaction patterns. State self-esteem emerged as a stronger mediator across all outcomes than comparison alone. These findings suggest that seemingly health-oriented social media content may be related to diminished wellbeing and highlight the complex ways in which new media environments are linked to health behaviors. The study underscores how digital platforms may be connected with self-evaluative processes that co-occur with problematic behaviors, raising important considerations for health communication in algorithm-driven contexts. • Fitspiration exposure on RedNote relates to compulsive exercise and eating disorders, but not body dissatisfaction. • State self-esteem is a stronger mediator than appearance comparison across health-related outcomes. • Body dissatisfaction shows no direct or mediated link with fitspiration exposure. • A dual mediation model reveals distinct psychological pathways linking health content to maladaptive behaviors.