Teenagers from lower-income and less highly educated households may be more likely to experience eating disorders and disordered eating, according to a new study co-led by UCL researchers. The findings challenge the long-standing stereotype that eating disorders primarily affect young people from affluent, well-educated families.

Published in the International Journal of Eating Disorders, the study was conducted with researchers at Copenhagen University Hospital. Researchers reviewed data from 51 studies involving 26,174 adolescents in Western countries across North America, Europe and Australia, examining links between socioeconomic circumstances and eating disorder symptoms.

The review found that teenagers from lower-income and lower-education households were more likely to show signs of disordered eating. Senior author Dr Nora Trompeter of the UCL Great Ormond Street Institute of Child Health said eating disorders are often stereotyped as a problem associated with affluence, but the evidence shows a different picture. She said prevention and treatment efforts need to reach families experiencing financial and social disadvantage.

Researchers examined diagnosed eating disorders, including anorexia, bulimia and binge eating disorders, as well as early warning signs of disordered eating. These included behaviours such as restricting food or fasting, along with poor body image and pressure to become thinner. The broader approach allowed researchers to consider symptoms that may appear before a formal diagnosis.

Family income showed the strongest and most consistent association with disordered eating. About two-thirds of the studies found that teenagers from lower-income families were more likely to experience eating disorder symptoms, while none found the opposite pattern. Parental education was also associated with risk: teenagers whose parents had higher levels of education were generally less likely to report symptoms.

For example, teenagers whose parents had not attended university were about 25% more likely to report eating disorder symptoms than those whose parents had a university-level education. However, other socioeconomic measures — including neighbourhood deprivation, parents’ occupations, financial difficulties and receipt of government benefits — produced more mixed and inconsistent findings.

The researchers warn that stereotypes about who develops eating disorders could contribute to young people from disadvantaged backgrounds being overlooked, under-screened or not recognised as being at risk. They are calling on clinicians, healthcare professionals and school counsellors to broaden their understanding of who may be affected. Challenging outdated assumptions, Trompeter said, could reduce missed diagnoses and help young people receive appropriate support and treatment earlier.

The researchers noted several limitations. Most of the studies involved predominantly White adolescents from Western countries, limiting how widely the findings can be generalised. Studies also measured socioeconomic status in different ways, making firm comparisons difficult. The research was supported by grants from UK Research and Innovation and the Novo Nordisk Foundation.

More information: Lea Steinstad et al, Research Update: A Systematic Review of the Relationship Between Eating Disorder Symptoms and Parental Socioeconomic Status (SES) Among Adolescents, International Journal of Eating Disorders. DOI: 10.1002/eat.70178

Journal information: International Journal of Eating Disorders Provided by University College London