This research summary shares some of what we know so far about how socioeconomic status can shape people’s experiences of eating disorders.
Compiled for Beat by Dr Nora Trompeter
Socioeconomic status (SES) refers to a person’s position of power within the social hierarchy, based on specific markers including income, wealth, occupation, and educational attainment.
It is an important social determinant of health, including the risk and experience of eating disorders (Reiss, 2013). For many years, it was believed that eating disorders are a ‘disease of affluence’, affecting mainly people from higher SES backgrounds. We now know that this view is outdated - eating disorders occur across all socioeconomic groups, and people from lower SES backgrounds may face additional and unique challenges (Huryk et al., 2021).
Unfortunately, many people still believe in this stereotype leading to stigma and treatment barriers. Breaking down stereotypes about SES and eating disorders and understanding barriers linked to socio-economic disadvantage are therefore vital steps toward earlier recognition and better access to care.
One of the key findings from the last decades in eating disorders is dispelling the myth of eating disorders as ‘diseases of affluence’. Moreover, there is now emerging evidence that people from lower SES background might be at heightened risk to experience eating disorders.
This elevated risk can stem from multiple factors, such as food insecurity, chronic stress, and exposure to ongoing adversity.
Food insecurity describes the limited or uncertain access to nutritious food to support a healthy lifestyle. In the UK, 17% of households were classed as ‘food insecure’ in 2023 and primarily impacts those from low SES backgrounds.
People who experience food insecurity are almost twice as likely to meet criteria for binge eating disorder compared to those not experiencing food insecurity, and are more likely to experience other eating disorder symptoms as well (Nagata et al., 2023).
Importantly, this does not seem to be limited to current food insecurity. Adolescents who experienced food insecurity during childhood are also at increased likelihood to experience binge eating and compensatory behaviours compared to those who had food secure childhoods (Trompeter et al., 2025). This suggests that food insecurity can shape not only immediate eating behaviours and thoughts about food but also leave a lasting impact on a person’s relationship with eating.
One potential explanation for this relationship is the so-called ‘fast or famine’ hypothesis (Hazzard et al., 2020). When food availability fluctuates, people may alternate between periods of restriction (fasting) and overconsumption (feasting), a pattern that mirrors the restrict–binge cycle commonly seen in eating disorders.
Ongoing financial strain can contribute to interpersonal stress, trauma, and negative affect, which are in turn all linked to the development and maintenance of eating disorders (Sturgeon et al., 2016).
That means that people who experience financial difficulties may also experience difficulties with their social relationships as a result (e.g., arguments with partner about money), or they might find themselves thinking negatively about their future because of their current situation.
This in turn can make them more vulnerable to disordered eating, especially if someone has a history of an eating disorder. High levels of stress also trigger physiological responses that promote binge eating (Naish et al., 2019).
People with lower SES are often more likely to face adversity or traumatic experiences, such as domestic violence or discrimination (Adjei et al., 2022). These experiences can increase vulnerability to developing an eating disorder (Trottier & MacDonald, 2017).
Early-life adversity, in particular, can disrupt the ability to manage emotions or control behaviours, leading to patterns such as dissociation, impulsivity, or compulsivity. These difficulties may make some individuals more likely to turn to disordered eating as an attempt to cope with distressing emotions (Trompeter et al., 2021).
Beyond disrupting healthy emotion regulation, adversity can also foster negative self-beliefs (e.g., “something is wrong with me”), which may further heighten vulnerability to eating disorders.
There are several structural barriers for people from low SES backgrounds that impact their diagnosis and healthcare experiences. This includes limited financial resources for healthcare expenses, inability to take time off work for health reasons, lower perceived need for treatment, and experiences of discrimination. Such barriers can delay help-seeking or disrupt ongoing care.
Recent research on family-based therapy highlighted that traditional treatment structure placed significant strains on low SES families, such as having parents attend therapy sessions with their adolescents, travel to access treatment, and providing meals for renourishment with limited financial resources (Sauerwein et al., 2024).
Notably, these barriers are particularly heightened for people with multiple minority identities, for example ethnic minorities from low SES backgrounds (Burke et al., 2023).
There are several important implications from this research. Firstly, this research highlights the need to reduce socioeconomic inequalities to prevent mental health problems, including eating disorders. Policies that promote food security, affordable housing, and equitable access to education and healthcare are crucial parts of prevention.
Secondly, reducing stigma and treatment barriers for people from lower SES backgrounds is needed to improve access to timely treatment. This includes increasing awareness among healthcare providers about how socioeconomic disadvantage can shape eating disorder risk and presentation.
Research into possible treatment adaptations is scarce, however, emerging findings report that clinicians adapt treatment models for low SES families to provide adequate treatment in light of structural barriers such as offering telehealth, or linking up other resources (e.g., food banks) (Sauerwein et al., 2024).
We asked people with lived experience what this research means to them. Read what two people said below
Person 1:
“This is a great start to making people aware how SES can affect people, many times in negative ways, more than others realise. We need more of this type of research, and then educating people, which will hopefully leads to reducing the stigma, and providing better resources to people in need.”
Person 2:
"This really hits home, no pun intended. I remember growing up, my mum wouldn't eat properly so that me and my sister could, and we were always aware of not eating 'too much'. We didn't experience much variety in food, and I started avoiding certain types. I was also very aware of our financial difficulties, the debt we were in, and the adversity my mum faced. I developed an eating disorder in my late teens."
Adjei, N. K., Schlüter, D. K., Straatmann, V. S., Melis, G., Fleming, K. M., McGovern, R., Howard, L. M., Kaner, E., Wolfe, I., & Taylor-Robinson, D. C. (2022). Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study. The Lancet Regional Health - Europe, 13. https://doi.org/10.1016/j.lanepe.2021.100279
Burke, N. L., Hazzard, V. M., Schaefer, L. M., Simone, M., O’Flynn, J. L., & Rodgers, R. F. (2023). Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity. Psychological Medicine, 53(9), 4255–4265. https://doi.org/10.1017/S0033291722001015
Hazzard, V. M., Loth, K. A., Hooper, L., & Becker, C. B. (2020). Food Insecurity and Eating Disorders: a Review of Emerging Evidence. Current Psychiatry Reports, 22(12), 74. https://doi.org/10.1007/s11920-020-01200-0
Huryk, K. M., Drury, C. R., & Loeb, K. L. (2021). Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders. Eating Behaviors, 43, 101548. https://doi.org/10.1016/j.eatbeh.2021.101548
Nagata, J. M., Chu, J., Cervantez, L., Ganson, K. T., Testa, A., Jackson, D. B., Murray, S. B., & Weiser, S. D. (2023). Food insecurity and binge-eating disorder in early adolescence. International Journal of Eating Disorders, 56(6), 1233–1239. https://doi.org/https://doi.org/10.1002/eat.23944
Naish, K. R., Laliberte, M., MacKillop, J., & Balodis, I. M. (2019). Systematic review of the effects of acute stress in binge eating disorder. European Journal of Neuroscience, 50(3), 2415–2429. https://doi.org/10.1111/EJN.14110;CTYPE:STRING:JOURNAL
Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine, 90, 24–31. https://doi.org/10.1016/J.SOCSCIMED.2013.04.026
Sturgeon, J. A., Arewasikporn, A., Okun, M. A., Davis, M. C., Ong, A. D., & Zautra, A. J. (2016). The psychosocial context of financial stress: Implications for inflammation and psychological health. Psychosomatic Medicine, 78(2), 134–143. https://doi.org/10.1097/psy.0000000000000276
Trompeter, N., Bussey, K., Forbes, M. K., & Mitchison, D. (2021). Emotion Dysregulation within the CBT-E Model of Eating Disorders: A Narrative Review. Cognitive Therapy and Research. https://doi.org/10.1007/s10608-021-10225-5
Trompeter, N., Opitz, M. C., Rabelo-da-Ponte, F. D., Sharpe, H., Desrivieres, S., Schmidt, U., & Micali, N. (2025). Childhood food insecurity trajectories and adolescent eating disorder symptoms: a UK cohort study. Social Psychiatry and Psychiatric Epidemiology 2025, 1–9. https://doi.org/10.1007/S00127-025-03022-Y
Trottier, K., & MacDonald, D. E. (2017). Update on Psychological Trauma, Other Severe Adverse Experiences and Eating Disorders: State of the Research and Future Research Directions. Current Psychiatry Reports, 19(8), 45-. https://doi.org/10.1007/S11920-017-0806-6/METRICS