Family socioeconomic position linked to eating disorder symptoms in adolescence

Family socioeconomic position linked to eating disorder symptoms in adolescence | Image Credit: © VectorMine - stock.adobe.com.

A prospective cohort study published in JAMA Network Open examined how socioeconomic factors in childhood influence the emergence of eating disorder symptoms throughout adolescence. Researchers found that lower parental education and financial hardship were significantly associated with higher odds of disordered eating behaviors, body dissatisfaction, and weight and shape concerns in youth.

The study analyzed data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a United Kingdom–based birth cohort that recruited more than 14,000 pregnant women between 1991 and 1992. Of the original cohort, 7824 adolescents (51.1% male) with complete socioeconomic exposure data were included in the final analysis. Data collection spanned from gestation to 18 years, with outcome assessments conducted at ages of 14, 16, and 18 years.

Primary exposures included parental income, education, occupation, reported financial hardship, and area-level deprivation. Mothers reported these measures during pregnancy and early childhood. Outcomes were self-reported disordered eating behaviors—binge eating, purging, or restrictive eating—along with weight and shape concerns and body dissatisfaction.

Key findings

At the age of 14 years, 7.9% of participants reported disordered eating, increasing to 15.9% by 16 years and 18.9% by 18 years. A 1-point increase in maternal-reported financial hardship score was associated with higher odds of disordered eating (OR, 1.06; 95% CI, 1.03-1.09), greater weight and shape concerns (coefficient, 0.02; 95% CI, 0.01-0.04), and higher body dissatisfaction (coefficient, 0.22; 95% CI, 0.06-0.37).

Educational attainment emerged as another significant predictor. Adolescents whose parents had completed only compulsory education had greater odds of disordered eating compared with those whose parents had university degrees (OR, 1.64; 95% CI, 1.24-2.16). The authors wrote, “Lower parental education was associated with higher odds of disordered eating.”

Although lower parental occupation and income categories were initially associated with increased risk, these associations were attenuated after adjusting for other socioeconomic indicators. However, the relationship between financial hardship and disordered eating remained significant after adjustment.

Analyses of specific behaviors showed that financial hardship and lower parental education were linked to restrictive eating whereas higher area-level deprivation was associated with binge eating and purging.

Interpretation

The findings diverge from those of previous register-based studies that often report higher rates of diagnosed eating disorders in more affluent groups.^2-9 The authors suggested that this discrepancy may reflect disparities in diagnosis and access to care rather than true differences in prevalence. They stated, “We hypothesize that the discrepancy between the socioeconomic patterning of clinical diagnoses and self-reported symptoms might be explained by inequalities in identification of eating disorders and access to services rather than measurement issues.”

These results add to evidence that deprivation in early life exerts a persistent influence on adolescent mental health, extending into the peak period of eating disorder onset. The study authors noted, “Greater financial difficulties and lower parental educational attainment have the strongest associations with eating disorder symptoms.”

The investigators acknowledged several limitations, including attrition among participants from deprived backgrounds, which may have biased estimates. In addition, the restrictive eating measure may not have captured the most severe forms of anorexia nervosa and data were collected primarily in the 1990s and 2000s, potentially limiting applicability to current socioeconomic conditions.

Conclusions

This study provides evidence that socioeconomic deprivation in childhood increases vulnerability to eating disorder symptoms in adolescence. The authors concluded, “Eating disorders are one of the few conditions in which an association with deprivation is either not observed or reversed when using clinical registers, suggesting that there might be eating disorder–specific barriers in access to care.”

They emphasized that addressing socioeconomic inequalities and improving identification of eating disorders in deprived populations may be important strategies for prevention and early intervention.

References

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