Author Contributions: Gunner Parent, Liza-Ann Whitaker, Reece M. Anderson: Writing - Original Draft; Caroline Markey: Writing - Review & Editing, Clinical advising; Micah Hartwell: Conceptualization; Methodology, Formal analysis, Data Curation, Writing - Review & Editing.
Acknowledgments: The authors would like to thank Cierra Parent who aided in the development of the research question and provided invaluable assistance with the development of this project.
Financial Disclosure: This research did not receive any specific grant from public, commercial, or not-for-profit funding agencies.
Ethical Statement: This study was submitted to ethics review by the Oklahoma State University Institutional Review Board and was determined to be of exempt status. This study adhered to STROBE reporting guidelines.
Conflict of Interest: No financial or other sources of support were provided during the development of this manuscript. Dr. Hartwell reports receiving funding from the National Institute of Justice for work unrelated to the current subject.
Abstract
Background: Television is an effective outlet to disseminate public health information. The reality television series My Big Fat Fabulous Life and Teen Mom featured a discussion of polycystic ovary syndrome (PCOS). Our primary objective was to investigate the effect of discussion regarding PCOS within the context of reality television on public awareness and interest.
Methods: We used Google Trends to capture monthly relative search interest (RSI; 0-100) in “Polycystic ovary syndrome” and “PCOS” from January 2004 through November 2021. An autoregressive integrated moving average (ARIMA) modeling technique was used to compare relative search interest for the disorder compared to the forecasted data trend. We then used an integral function to summate continued interest encompassing the subsequent disclosures.
Results: Our analysis showed a significantly increased RSI for the term “Polycystic ovary syndrome” following a discussion of the condition on My Big Fat Fabulous Life. The peak RSI was 58.55% higher than expected. Additional peaks in RSI corresponded to disclosures of PCOS diagnoses by other celebrities, resulting in a cumulative RSI increase of 1297 (95% CI: 1292.00 - 1302.24) – an average of 15.76 points (95% CI: 5.71 - 25.80) higher interest than forecasted.
Conclusion: Our results suggest that discussions of PCOS among celebrities on reality television shows are strongly associated with an increased public interest. Celebrity depictions of PCOS may have a positive effect on raising awareness and funding for PCOS research – a valuable insight for health professionals to consider.
Introduction:
Television is one of the most effective outlets for disseminating health information, particularly concerning public health issues including safer sex practices, mental health, and substance abuse.1 Previous studies have revealed an individual’s healthcare interpretation and perception may be influenced by television portrayals of patients, nurses, and physicians.2,3 Yet medical dramas often poorly represent medical conditions due to the prioritization of entertainment over medical accuracy.4 However, reality television offers a unique–and often widely viewed–forum to describe the effect medical conditions can have on daily life. Such is the case with Whitney Thore, Maci Bookout, and Kailyn Lowry, stars of My Big Fat Fabulous Life, Teen Mom OG, and Teen Mom 2, respectively—whose diagnoses, symptoms, and complications with polycystic ovary syndrome (PCOS) were exhibited on their respective programming.
PCOS is one of the most frequently diagnosed endocrine disorders affecting women and adolescents of reproductive age. Worldwide estimates of PCOS prevalence range between 6% and 13%, depending on the country and varying diagnostic criteria.5 The negative effects of PCOS are vast and can adversely affect multiple systems including the metabolic, reproductive, and psychological systems.6 Additionally, PCOS symptoms vary from vague to severe such as irregular menstrual cycles, depression, anxiety, and hyperinsulinemia.7 Despite clear diagnostic criteria, precise treatment options have yet to be established for PCOS—as the etiology is unknown.
Due to the potentially severe effects—and the gaps in medical knowledge surrounding the etiology of PCOS—public coverage of individuals with PCOS may serve to raise awareness and research funds. Previous research has illustrated that prominent figures in the media have been able to raise public awareness surrounding specific topics, such as cleidocranial dysplasia,8 Asperger syndrome,9 and colorectal cancer.10,11 Thus, our primary objective was to investigate the potential increase in public awareness of PCOS following the disclosures of PCOS diagnosis on the television series My Big Fat Fabulous Life, Teen Mom OG, and Teen Mom 2.
Methods:
On November 18th, 2021, we used Google Trends (https://trends.google.com/trends/?geo=US) to retrospectively analyze monthly search interest in “Polycystic ovary syndrome” from January 2004 through November 2021 to capture a 17-year trend in search interest for the disorder. Relative search interest (RSI) data from Google Trends is presented as a percentage relative to the highest volume (0-100%) of any compared topic within the searched timespan. Our search was limited to the United States, using Google’s query categorization of “disease.” An autoregressive integrated moving average (ARIMA) modeling technique was used to compare relative search interest for the disorder compared to a forecasted trend had Thore not spoken out about her diagnosis on My Big Fat Fabulous Life. We then used an integral function to summate continued interest encompassing the subsequent disclosures on Teen Mom OG and Teen Mom 2. This study did not constitute human subject research and, therefore, was exempt from ethics review.
Table 1: Original air date month and description of My Big Fat Fabulous Life, Dancing with the Stars, Teen Mom OG, this is Us, and Teen Mom 2 episodes that featured discussion of Polysistic Ovarian Syndrome (PCOS).
Results:
Observational analysis of the trends showed RSI in “Polycystic ovary syndrome” increased significantly following Thore’s disclosure and continued to increase as PCOS was featured on multiple shows thereafter. The peak RSI (94) following Thore’s disclosure resulted in a 34.72 (95% CI: 27.82-41.61) higher RSI compared to the forecasted model—a 58.55% increase (Figure 1). From January 2015 through November 2021 multiple peaks occurred that extended beyond the predicted confidence interval, coinciding with additional diagnosis disclosures by the celebrities mentioned, in addition to a performer on “Dancing with the Stars,” resulting in a cumulative RSI increase of 1297 (95% CI: 1292.00-1302.24)—an average 15.76 points (95% CI: 5.71-25.80) higher interest than monthly forecasted data (Figure 1).
Figure 1. Relative search interest (RSI) for polycystic ovarian syndrome (PCOS) from Google Trends with comparative forecasted values had PCOS not become a topic featured on reality television in 2015.
Discussion:
Our results suggest that Thore, Bookout, and Lowry’s reality television appearances have been strongly associated with a continued increase in PCOS public awareness. Following Thore’s initial disclosure of her PCOS diagnosis in January 2015, the search trend for PCOS has remained above the forecasted values through November 2021. Additional spikes in search interest were observed following the release dates of Teen Mom 2 and Teen Mom OG episodes which featured firsthand discussion of PCOS from individuals experiencing symptoms and side effects. Relative search interest spikes were also observed corresponding to other PCOS-related television events including Dancing with the Stars when contestant Sasha Pieterse discussed her diagnosis and symptomology, and the This is Us season 3 premiere, which featured a portrayal of a woman diagnosed with PCOS.
While research demonstrates associations between PCOS and co-morbidities such as obesity, insulin resistance, infertility, cancer, and mental health disorders, little is still known about the etiology of PCOS itself.12,13 Studies have indicated that mass media and social media are low-cost tools that can garner public interest in health-related topics.14,15 Aside from Thore, Bookout, and Lowry being on reality television series, all are active on other media platforms, including podcasts and social media – which expands the availability of content regarding their mention of PCOS. This could contribute to a broader audience engaging with or being introduced to this women’s health topic, and potentially reducing PCOS-related stigma. One potential drawback to the expanded influence of non-medical professionals discussing health-related topics is the risk of unintentional misinformation.4,8 One example of this occurred following the Season 3 premiere of This is Us, where social media platforms were inundated with viewers who expressed dissatisfaction regarding the misrepresentation of individuals with PCOS.16 However, evidence has shown that increased public awareness and interest in health topics can positively shift health behavior change4,8 and potentially increase research funding.
Implications & Recommendations
Given the prominent increase in public awareness of PCOS following reality television episodes—Teen Mom Series, My Big Fat Fabulous Life, and Dancing with the Stars— timing may be crucial to acquire funding for increased research to improve the screening for and treatment of PCOS. Currently, the International Guideline for the Assessment and Management of PCOS provides 166 recommendations for the treatment and management of PCOS—however, evidence for these recommendations was considered of low/moderate quality.6 Therefore to improve patients' experience and management of PCOS—studies should focus on research quality and extensive collaboration between researchers, practitioners, and patients. Additional factors that may improve PCOS research include increased stakeholder representation including patients, their families, and physicians—and an accurate understanding of PCOS symptoms.
The appearances of Thore, Bookout, and Lowry on reality television series may have a positive impact on raising awareness for PCOS. Further, Bookout – along with other celebrities and women diagnosed with PCOS – gathered at Capitol Hill demanding and succeeding in having lawmakers support PCOS advocacy and funding through the PCOS Awareness and Research Act.17,18 This act provides a national framework to increase awareness and funding for PCOS by recognizing the month of September as PCOS Awareness Month and supporting PCOS Advocacy Day. As much remains unknown regarding the etiology of PCOS, increased awareness and research funding into this topic may have profound benefits on the quality of life for affected individuals.
Strengths & Limitations
Google Trends was the sole data source used in this study. While Google Trends data is a valuable tool to gauge interest in a subject, it cannot determine search intent. PCOS is a common diagnosis and peaks in search interest could be affected by a litany of factors such as specialty-specific conferences which may confound the results of Google Trend analyses. Thus, the interpretation and generalizability of this study are limited. While extrapolating these results beyond the study context may be limited, the ARIMA model aims to account for potential confounders and provide context for the influence that media can have on public awareness of medical conditions including PCOS. Further, Google Trends is a reliable gauge of public interest in many health conditions.9,19
Conclusion
Since the initial airing of an episode of My Big Fat Fabulous Life, in which its central figure, Whitney Thore, revealed her PCOS diagnosis, our data indicate a sustained increase in public interest in this topic. Search interest was further increased when PCOS was discussed by participants on Teen Mom OG and Teen Mom 2. These results reflect the potential positive and lasting impact of television and celebrity influence on curiosity regarding health topics in the general population. In understanding these trends, advocating platforms for underfunded and underrepresented health issues may seek out similar publicity to increase research focus and funding.
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