Teenagers who come from households with a lower income and lower level of education are more likely to have an eating disorder, finds a new study co-led by UCL researchers.
The study, published in International Journal of Eating Disorders and in collaboration with researchers at Copenhagen University Hospital, reviewed data from 51 studies involving 26,174 adolescents from Western countries across North America, Europe and Australia.
It found that, contrary to common stereotypes, eating disorders don't just affect wealthy and well-educated families, and that this assumption can lead adolescents from lower-income backgrounds to be overlooked, under-screened, or not recognised as at risk.
Senior author, Dr Nora Trompeter (UCL Great Ormond Street Institute of Child Health), said: "Eating disorders are often stereotyped as a problem of affluence but this review shows that this is not the full picture.
"Our review has found that teenagers from lower-income, lower-education households are actually more likely to show signs of disordered eating, not less.
"This tells us that disordered eating is a concern across the socioeconomic spectrum, and prevention and treatment efforts need to reach families facing financial and social disadvantage, who may currently be overlooked."
Alongside diagnosed anorexia, bulimia and binge eating disorders, the review also included early warning symptoms of disordered eating, such as restricting food, fasting, poor body image and feeling a pressure to become thinner.
Family income showed the strongest and most consistent correlation. About two-thirds of the studies found that teenagers from lower-income families were more likely to have eating disorder symptoms, and no studies found the opposite.
The analysis also found that teenagers whose parents had more education were less likely to have symptoms of an eating disorder.
For example, teenagers whose parents didn't attend university were around 25% more likely to report eating disorder symptoms than teenagers whose parents did go to university*.
However, other measures of social and economic background, such as how deprived a neighbourhood is, parents' jobs, financial difficulties, or receiving government benefits, gave much more mixed and inconsistent results.
Dr Trompeter said: "Eating disorders don't discriminate by income or education. If anything, the evidence points the other way, and treating them as a 'privileged' condition risks leaving adolescents most in need of support undiagnosed and untreated."
As a result of their findings, the researchers are now calling for clinicians, healthcare professionals, and school counsellors to broaden their assumptions about who is at risk of an eating disorder, to improve early identification.
Dr Trompeter added: "Challenging outdated stereotypes could help reduce missed diagnoses and ensure that those young people who are most in need receive timely treatment."
The study was supported by grants from UK Research and Innovation and the Novo Nordisk Foundation.
Study limitations
Most studies involved mainly White adolescents from Western countries. The studies that were analysed also used different ways of measuring family socioeconomic status, making it difficult to draw firm conclusions.
*Education was measured in different ways across studies but broadly maps onto whether parents had a university-level education or not.
