Family Socioeconomic Position and Eating Disorder Symptoms Across Adolescence

Adolescents who experienced childhood socioeconomic deprivation report more eating disorder symptoms compared with their counterparts with higher socioeconomic status but may have more barriers in receiving diagnoses and accessing eating disorder services.

To investigate the associations of childhood socioeconomic indicators with eating disorder symptoms across adolescence.

This prospective cohort study used a population-based sample from the Avon Longitudinal Study of Parents and Children (ALSPAC). ALSPAC recruited pregnant women in the former region of Avon, United Kingdom, with expected delivery dates from April 1, 1991, to December 31, 1992. This study used follow-up data of the mother-offspring collected until 2010. The final analytical sample included children who were alive at 1 year of age and who had complete exposures, retaining 1 twin at random. Data were analyzed from October 1, 2022, to November 25, 2024.

The main exposures were parental income, education, occupation, financial hardship (range, 0-15; higher score indicates more hardship), reported by mothers between 32 weeks' gestation and 47 months postpartum, and area-level deprivation, derived from the Office for National Statistics indicators linked to the participant's residential post code at 32 weeks' gestation.

Primary outcomes were disordered eating, weight and shape concerns, and body dissatisfaction at ages 14, 16, and 18 years. Individual disordered eating behavior was a secondary outcome.

The sample included 7824 participants (4003 [51.1%] male). A 1-point increase in financial hardship was associated with increased odds of disordered eating (odds ratio [OR], 1.06; 95% CI, 1.04-1.10), an increase in weight and shape concerns (coefficient, 0.02 (95% CI, 0.01-0.04), and an increase in body dissatisfaction (coefficient, 0.22 (95% CI, 0.06-0.37). Lower parental education was associated with higher odds of disordered eating (OR, 1.80; 95% CI, 1.46 to 2.23).

This cohort study using ALSPAC data found that eating disorder symptoms were more common in individuals experiencing socioeconomic deprivation. Potential socioeconomic inequalities in eating disorder presentation and diagnosis in clinical settings require further investigation. Reducing population-level socioeconomic inequalities could also aid eating disorder prevention.