Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity

Abstract

Background Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) experience eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research among those of lower SES, this study examined (1) the overall association between SES and ED prevalence, and (2) ED prevalence in the context of four relevant social identities (i.e. SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk. Methods A sample of 120 891 undergraduate/graduate students from the Healthy Minds Study self-reported family SES with a single-item question, gender identity, sexual orientation, and race/ethnicity, and were screened for ED risk. Results Participants of lower SES had 1.27 (95% CI 1.25–1.30) times greater prevalence of a positive ED screen than those of higher SES. Substantial heterogeneity was observed across the four social identities beyond the association with SES. For example, positive ED screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive. Conclusions Although positive ED screens were more common among undergraduate/graduate students of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating multi-layered constructs of identity when identifying groups at disproportionate risk.

The alarms should no longer be ignored: A Survey of the Demand, Capacity and Provision of Adult Community Eating Disorder Services in England and Scotland before COVID-19

“…Even though both men and women could benefit from treatment, 92% of the referrals were female. This is consistent with earlier studies 16 and has further implications for improving access and funding for ACEDS.…”

Toward inclusivity: A systematic review of the conceptualization of sexual minority status and associated eating disorder outcomes across two decades

“…In addition, the most recent studies tended to employ assessment methods that were better able to capture the fluid and layered nature of sexuality. Assessments that positioned heterosexuality at the end of a continuum have tended to provide findings that are consistent with the increased risk experienced by minoritized individuals (e.g., Burke et al, 2022). A growing body of literature suggests that sexual orientation identity is more closely tied to experiences of marginalization and discrimination compared to sexual behavior or attraction, and thus, may be most relevant in research conducted from a minority stress framework (National Academies of Sciences, Engineering, and Medicine, 2022).…”

“…Although SM status may be uniquely related to ED risk, it converges with other dimensions of identity including gender, race/ethnicity, and others in ways that may further exacerbate or decrease risk. Existing studies that have incorporated an intersectional lens have successfully revealed more complex patterns of ED incidence and risk than studies focused on sexual orientation alone (Austin et al, 2013; Beccia et al, 2021; Brownstone et al, 2021; Burke et al, 2022). Intersectionality in future research will allow for a deeper understanding of the experiences of individuals who hold multiple minoritized identities, but requires purposeful sampling and reporting.…”

Acceptability and perceived harm of calorie labelling and other obesity policies: a cross-sectional survey study of UK adults with eating disorders and other mental health conditions

“…Other limitations of this study included the sampling method used which resulted in a prominently White, well-educated, and female participant sample. Given that ED are typically more common amongst lower socioeconomic status and minority groups (Burke et al, 2022), further research may benefit from exploring acceptability and perceptions of calorie labelling amongst these populations. In addition, current diagnostic status relied upon self-report which may have been inaccurate or self-diagnosis.…”