Quality and Reliability of Social Media Videos on Weight-Loss Interventions for Obstructive Sleep Apnea: A Multi-Platform Cross-Sectional Study.

PURPOSE: This study aimed to evaluate the quality and reliability of social media videos addressing weight loss for OSA across three major platforms (YouTube, TikTok, Bilibili) and to identify key determinants of trustworthy content. METHODS: We conducted a cross-platform content analysis of publicly available videos on weight loss for OSA from YouTube, TikTok, and Bilibili, representing major video-sharing platforms with different regional audiences and content formats. The top 100 default search results from each platform were screened using predefined criteria, yielding 235 eligible videos. Video and uploader characteristics, engagement metrics, and quality scores were extracted. Videos were assessed using PEMAT, VIQI, GQS, mDISCERN, and JAMA benchmarks. The primary outcome was overall video quality assessed by the Global Quality Score (GQS), while other assessment tools were considered secondary outcomes. For TikTok, we used English-language search terms ("obstructive sleep apnea and weight loss" and "OSA and weight loss") to capture content comparable with YouTube. The Chinese-language TikTok counterpart (Douyin) was not included because it operates under a distinct platform ecosystem with different content algorithms, regional audience, and moderation policies. RESULTS: YouTube videos scored significantly higher in understandability, actionability, and overall quality compared with TikTok and Bilibili. Content from verified institutions and healthcare professionals consistently received higher ratings across all tools. Engagement metrics (likes, shares, comments) showed weak correlations with information quality. In regression models, production quality (VIQI) and source transparency (JAMA benchmarks) emerged as the strongest predictors of content reliability, while video duration had minimal effect. CONCLUSION: Within digital health environments, popular engagement does not equate to informational quality for OSA-related weight-loss content. Platform- and uploader-level characteristics-particularly verification status and production standards-are key markers of reliability. These findings underscore the need for platform-level governance that prioritizes verified health sources, algorithmic transparency, and integrated digital health literacy efforts to safeguard patients navigating lifestyle advice for OSA online.