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If Pixelfed were as popular as Instagram, it would have virtually the same effect on the mental health of young girls, especially. While an advertising-based business model does influence this, it's not the driving factor. Social comparison is in our genes, but never before have we been able to do it at this scale. This is guaranteed to have a negative effect on mental health. The issue however is not that social media is inherently bad; it's just incompatible with the way humans behave. It's like drugs.
literally no lol. the advertising (more accurately, the profit-seeking) model is certainly the driving factor, supported by engagement-maximizing algorithms. and remember it’s not just social media i’m criticizing. it’s a much larger media structure including also the show this post is about, and the discussion is much older than instagram, reaching back decades. here, for example, is a study of media exposure and body dissatisfaction from 2003: 7 years before instagram.