Eating disorders are often associated with affluent families, but a new review suggests that stereotype may be misleading.
Researchers analyzed 60 studies of adolescents in Western countries and found that eating-disorder symptoms were often more common among teens from lower-income or less-educated households. The pattern was not consistent in every study, and the effects were generally small, but the findings suggest socioeconomic disadvantage may be one piece of eating-disorder risk rather than a reason to rule it out.
The review, published in the International Journal of Eating Disorders, focused on community-based studies rather than only teens already in treatment. That matters because clinical samples can miss people who never receive a diagnosis or do not have access to care.
The researchers searched six major databases and ultimately included 60 studies. Most were rated good or fair in quality. The review looked at a wide range of eating-disorder symptoms, including binge eating, restrictive eating, dieting, body dissatisfaction and weight-control behaviors, along with a smaller number of diagnosed eating disorders.
The clearest pooled finding involved parents' education.
In the meta-analysis, teens whose parents had higher levels of education had lower odds of eating-disorder symptoms. The main analysis found about 20% lower odds, and a sensitivity analysis produced a similar result.
But the individual studies were far from uniform.
Of the 31 studies examining parental education, 11 found fewer eating-disorder symptoms with higher parental education, four found the opposite, 11 found no significant relationship and one found mixed results. When effect sizes were reported, they were generally small.
Household income showed a somewhat more consistent pattern.
Eight of 12 studies found that lower household income was linked with more eating-disorder symptoms, while four found no significant association. None found a significant relationship in the opposite direction. Several studies specifically linked lower income with binge eating or binge-eating disorder.
That does not mean low income causes an eating disorder.
The review was based on observational studies, and socioeconomic status was measured in different ways across the research. Income, education, neighborhood disadvantage, parents' jobs and financial hardship do not necessarily capture the same pressures or resources.
The authors also emphasize that socioeconomic status is unlikely to be a major risk factor on its own. Instead, it may interact with other influences during adolescence.
One of the most important findings may be the difference between symptoms reported in the community and what appears in medical records.
Several studies using health records found eating-disorder diagnoses or treatment were more common among teens from higher socioeconomic groups. At the same time, community studies often found more symptoms among lower-income or less-educated families.
That gap could matter because a diagnosis depends on more than whether someone has symptoms. Access to health care, recognition by clinicians and willingness or ability to seek treatment can all affect who gets counted.
The review notes that people from lower socioeconomic backgrounds can face greater barriers to care, including financial and geographic obstacles. Previous research cited by the authors also suggests they may be less likely to receive an eating-disorder diagnosis or be viewed as needing treatment.
That is one reason the stereotype of eating disorders as a problem of affluence can be harmful.
If parents, teachers or health professionals assume a teen is unlikely to have an eating disorder because of their family's income or background, warning signs may be easier to miss.
The review also discusses possible reasons socioeconomic disadvantage could be connected with disordered eating, including food insecurity and chronic family stress. But those explanations were not directly tested in this study, so they should be considered possible pathways rather than proven causes.
Food insecurity, for example, has been linked in other research to cycles of restriction and binge eating. But this review did not show that food insecurity explains the relationship between income and eating-disorder symptoms.
There are other important limits.
The studies were conducted in North America, Europe and Australia or New Zealand, and the samples that reported race or ethnicity were mostly White or European. That makes it difficult to know whether the same patterns apply across more diverse populations.
The studies also differed widely in how they measured both socioeconomic status and eating problems. Some focused on diagnosed eating disorders, while others measured individual symptoms such as dieting, body dissatisfaction or binge eating. That variation makes it harder to draw one simple conclusion.
The authors also found hints that the relationship may differ depending on the eating disorder or symptom being studied. Binge eating appeared more consistently connected with lower household income, while findings involving anorexia nervosa and parental education were more mixed.
For now, the review's strongest message is not that one socioeconomic group is uniquely at risk.
It is that eating disorders and disordered eating can affect teens across the socioeconomic spectrum, and assuming otherwise may leave some adolescents overlooked.
The research was supported by UK Research and Innovation through the EDIFY program and by a Novo Nordisk Foundation Laureate Grant. One author reported receiving an honorarium from Wiley as an associate editor for Mental Health Science, and another receives an honorarium as an associate editor for European Eating Disorders Review.