Eating disorder symptoms in teens can be traced back to family hardship, new study shows

Eating disorders can affect anybody, no matter their age, gender, ethnicity, socioeconomic status or body size. Yet the myth that eating disorders are “diseases of affluence” persists, and can mean those from wealthier backgrounds are more likely to receive a diagnosis and be able to access treatment.

In fact, people who experience socioeconomic disadvantage may be more at risk of developing eating disorder symptoms, such as excessive dieting, fasting or binge eating.

A new study from the United Kingdom followed 7,824 children, roughly half male and half female, from birth to 18 years. It found those born into financial hardship were more likely than others to later experience eating disorder symptoms as teens.

This means the stereotype that eating disorders only affect the rich is simply not true. And it shows we need to better understand the risk for children from lower-income families, so we can recognise and treat their symptoms earlier.

What the study looked at

Previous research has shown eating disorders can affect people from all socioeconomic backgrounds, not just those with higher economic status. But this new study is one of the first to show deprivation in childhood could be a risk factor for eating disorder symptoms in adolescence.

This new large, long-term study collected data from thousands of people over an 18-year period to investigate the impact of social and financial hardship.

Researchers looked at parents’ education, job type and where they lived. They also examined income, which was split into five groups from low to high. These were more aspects of social studies than previous research had considered.

To assess financial hardship, mothers rated how much they struggled to afford daily expenses such as food, heating, clothing, rent and baby items. They used a scale from 0-15, with higher scores indicating greater hardship.

When the children grew up to be teenagers, researchers assessed eating disorder symptoms in all the young people across the study.

Patterns of disordered eating included excessive dieting, binge eating, vomiting or using laxatives to get rid of food, and fasting. The teens were also asked how they felt about their bodies – for example, how satisfied they were with their appearance, weight and shape.

What the study found

Eating disorder symptoms were higher in young people aged 14–18 whose parents had suffered greater financial hardship when they were babies. For patterns of disordered eating, this meant a 6% higher likelihood for every one point increase between 0 and 15 on the financial-hardship scale.

The study also found teens whose parents completed less formal education (meaning only compulsory schooling) were 80% more likely to experience disordered eating patterns than those whose parents went to university. For teens with parents in the lowest fifth and fourth income band, the risk was 34–35% higher than those in the top band of income.

These results are different to other studies on eating disorders, because they show people from low socioeconomic backgrounds have a higher chance of developing eating disorder symptoms.

The researchers suggest this difference may be because other studies only included participants with a diagnosis or who have sought help. Research has shown those experiencing financial hardship are less likely to be formally diagnosed or access treatment.

While this study is impressive in its size and results, it has a few limitations. Only around half the participants (55.9%) completed the full study, which may have affected the results.

Among those who did complete the study, some of their data was missing. This may also have influenced the findings.

The study also did not measure whether young people had a diagnosed eating disorder – only whether they had symptoms.

So, it may have captured a wider range of eating disorder experiences, including from those who wouldn’t seek formal support. But it means more research is needed to understand the link between socioeconomic status and formal diagnosis.

What does this mean?

People who are born into financial hardship may be more likely to struggle with disordered eating and body image issues in their teenage years than those who are not.

This not only debunks the stereotype that eating disorders occur only in people from affluent backgrounds, it shows disadvantage can be a risk factor.

The study sheds light on the inequalities and barriers in recognising and treating eating disorders.

Rates of people seeking help for an eating disorder are already low – and even lower among people from disadvantaged backgrounds.

The researchers suggested this could be because people from lower socioeconomic backgrounds may also believe eating disorders mainly affect people from wealthier backgrounds.

Another reason may be that lower income is linked to higher rates of obesity and being overweight, and this might limit referrals for eating disorder symptoms.

Eating disorders not associated with thinness, such as bulimia and binge eating disorder, are often less visible and go undetected.

Better education about eating disorders – in schools and for families and health-care professionals – may help us recognise and treat them earlier.

But treatment also needs to be more affordable. In Australia, people can access eating disorder treatment sessions under Medicare, but this typically still involves a gap fee which can be up to A$100 or more, depending on the service. More no- or low-cost services are needed to reach everyone who needs them.

If you have a history of an eating disorder or suspect you may have one, you can contact the Butterfly Foundation’s national helpline on 1800 334 673 (or via their online chat).