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Objectives: The objective of this study was to explore how people living with obesity who use obesity services perceive healthcare professionals' (HCPs) online representation of the disease on social media. By exploring their perspective, we aimed to develop a framework to inform good practice around social media use for HCPs., Design: This was a qualitative study using a phenomenological framework. Following in-depth semi-structured interviews, analysis was undertaken to identify superordinate themes relating to how HCPs portray living with obesity online., Setting: Patient advocacy organisation (The Irish Coalition for People Living with Obesity) and three clinical sites offering obesity treatment in Ireland., Participants: 15 adult participants comprising of 12 women and 3 men who use social media and are living with obesity and who use obesity services., Results: Three key themes of how people living with obesity who use obesity services perceive HCP's online representation of the disease. (1) Negative experiences of HCPs-participants describe encountering weight stigma and bias on social media from HCPs that they characterised as simplistic and outdated conceptualisations. These engender shame, fear and anger. (2) Positive experience of HCPs-participants report social media allows HCPs to educate and inform public perception of obesity. Positive online experiences lead to feelings of inclusion, understanding and encouragement. (3) Expectations of HCPs-qualifications, professional titles and academic association affected the perceived trustworthiness of information and its impact on readers. Participants feel there is a duty of care for HCPs in obesity medicine to advocate and be active online to provide accurate medical information., Conclusion: HCP's use of social media has a powerful impact on people with obesity who use healthcare and obesity services. Social media is a key tool in obesity awareness and education. We propose the '3E' framework-Empower, Evidence-Based and Educate and be educated to guide HCPs' social media use., Competing Interests: Competing interests: SM and MS conceptualised and designed the study including methodology. Recruitment was by SM who has no conflicts to report. MC reports consulting fees from Novo Nordisk and honoraria for lectures, presentations and educational resources from Novo Nordisk, Consilient Health and Obesity Canada. He is a member of Novo Nordisk Advisory board, the Irish Obesity National Clinical Programme Advisory Group and Association for the Study of Obesity in Ireland (ASOI). Michael is the co-founder and clinical lead of the 'My Best Weight Clinic'. JOC reports honoraria from Novo Nordisk for educational events and scientific meetings. She is a committee member of ASOI. SB reports consulting fees from the European Coalition for People Living with Obesity (EASO), Novo Nordisk and Boehringer Ingelheim and honoraria for lectures and educational events from National Institute for Prevention Cardiology, Diabetes Ireland, Apollo Endosurgery, and International Medical Press. She is a member of the Novo Nordisk and Boehringer Ingelheim Advisory Board as well as the Obesity Institute, Leeds Beckett. In the case of any COI declared, their professional relationships with these bodies did not influence methodology and recruitment nor did any participants receive any preferential services or offers of treatment from any of the named authors., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)