Scientists have dispelled the myth of eating disorders
Eating disorders (EDS) have long been associated primarily with affluent families and parents' high level of education. However, a new systematic review showed the opposite pattern: adolescents from families with lower incomes and education were more likely to report symptoms of such disorders. Why a common stereotype could make it difficult to notice a problem in time and what the analysis of data from more than 26 thousand teenagers showed is in the Izvestia article.
RPP is not just anorexia and bulimia
Eating disorders are often presented as a problem of teenagers who are overly focused on weight loss and appearance. That is why they have long been associated with a certain social image — a well-off family, high education of parents and access to various resources.
However, a new study shows that this picture is incomplete. Scientists from University College London, together with colleagues from the University Hospital of Copenhagen, analyzed 51 studies involving 26,174 adolescents from North America, Europe and Australia. The work was published in the International Journal of Eating Disorders (IJoED).
Nora Trompeter, lead author of the study from the Institute of Child Health at University College London, emphasized that eating disorders are often stereotypically perceived as a well-being problem. At the same time, the conducted review, according to her, shows that this is not the whole picture.
Eating disorders are a group of mental disorders related to a person's attitude to food, nutrition, weight, and their own body. These include, in particular, anorexia, bulimia and compulsive overeating. But the problem can manifest itself even before the diagnosis is made, for example, in food restriction, regular fasting, dissatisfaction with one's own body, or a strong desire to become thinner. These early symptoms were also taken into account in the new review.
Where did the myth of the "disease of the rich" come from
The idea of RPP as a disease of wealthy people could be fixed, among other things, due to the peculiarities of medical observations. Researchers often receive data from people who have already sought help or have been admitted to specialized clinics. Therefore, such samples do not always reflect the prevalence of violations among the entire population.
As a result, the social group that more often receives access to diagnostics and specialized care may be better represented in medical statistics. And if a teenager from a family with fewer resources seeks help less often or his symptoms are not recognized, he simply does not get into such data. The authors of the new review believe that this is why it is especially important to test established beliefs through studies of the general population.
Nora Trompeter
Our study has shown that teenagers from low-income and low-education families are actually more likely, not less likely, to show signs of eating disorders. This tells us that eating disorders are a problem for all socio-economic segments of the population, and prevention and treatment efforts should include financially and socially disadvantaged families who may currently be neglected.
Thus, the absence of a diagnosis in a certain social group does not necessarily mean the absence of the disease itself. If experts initially do not expect to see RPP in a teenager from a less affluent family, the violation may go unnoticed.
Scientists have tested the relationship between RPP and family income
The researchers found the most consistent relationship with family income. Approximately two-thirds of the analyzed studies showed that adolescents from lower-income families were more likely to have symptoms of eating disorders. At the same time, none of the reviewed studies found the opposite pattern — a higher prevalence of symptoms among adolescents from high-income families.
Another factor is the education of parents. A study published in the journal JAMA Network Open found that teenagers whose parents did not go to university were about 25% more likely to report symptoms of RPP compared to their peers whose parents received university education.
However, scientists have not found the same clear pattern for all indicators of socio-economic status. Data on the disadvantage of the area of residence, the profession of the parents, the financial difficulties of the family or the receipt of government benefits gave significantly more mixed results.
The researchers also emphasize that it wasn't just about diagnosed diseases. The review included signs of impaired eating behavior, including food restriction, starvation, body dissatisfaction, and a sense of pressure to strive for leanness. Therefore, the results show not only differences in the number of official diagnoses, but also a broader picture of symptoms in adolescents.
Why low income can be associated with RPP
The study does not prove that low income directly causes an eating disorder. Scientists have found a statistical link, but they cannot determine the only reason based on it.
RPP are formed under the influence of many factors. These may include biological characteristics, mental health, attitudes towards one's own body, family environment, social pressure, and stress. Therefore, the socio-economic situation cannot be considered separately from other circumstances of a teenager's life.
In addition, different indicators of family well-being produced different results. If the relationship with the family income and education of the parents turned out to be quite consistent, then the indicators of financial difficulties, the profession of the parents and the conditions of the area of residence were much less unambiguous. This means that scientists have yet to figure out exactly what mechanisms may be behind the discovered pattern. The very fact of a higher prevalence of symptoms among adolescents from lower-income families does not explain why it occurs.
Why stereotypes can interfere with treatment
Scientists see the main practical significance of the study in the need to rethink the ideas of who may encounter RPP. If a specialist considers such violations to be primarily a problem of affluent adolescents, a child from a low-income family may be less likely to undergo appropriate screening or receive a referral to a specialist.
Nora Trompeter
Eating disorders do not depend on income or education level. On the contrary, the available evidence indicates the opposite, and treating them as a "privileged" condition risks leaving adolescents who need support the most without diagnosis and treatment.
At the same time, the authors do not propose to replace one stereotype with another: eating disorders do not become "diseases of poverty." They can occur in adolescents with different socio-economic backgrounds, and family income or parental education do not allow them to independently determine whether a particular person has a disorder.
According to the researchers, doctors, other medical professionals, and school counselors need to broaden their understanding of the risk group.
Nora Trompeter
Refuting outdated stereotypes can help reduce the number of misdiagnoses and provide timely treatment to those young people who need it most.
However, the researchers emphasized that the analysis had significant limitations. According to their data, most of the studies included in the review were conducted among predominantly white teenagers from Western countries. In addition, scientists have used different ways to assess the socio-economic situation of families, so the results cannot be automatically distributed to all countries and population groups.
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