Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders

Huryk, Kathryn M.; Drury, Catherine R.; Loeb, Katharine L.

doi:10.1016/j.eatbeh.2021.101548

Cited by 70 publications

(46 citation statements)

References 121 publications

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“…For example, we would argue that socio-economic and educational diversity will become increasingly relevant in ED etiology and treatment. Although at present there are no clear links between diversity in terms of socio-economic background and the prevalence of EDs (21), level of education, and other factors associated with socioeconomic status have been linked to food insecurity during the Covid-19 pandemic (86). Food insecurity, in turn, has been repeatedly linked to ED pathology (87), suggesting that future ED populations may disproportionally stem from lower-income and lower-education households.…”

Section: Anticipating Diversity Challengesmentioning

confidence: 99%

“…In fact, recent years witnessed an unprecedented increase in ED incidence among men (11,12), older adults (13,14), gender and sexual minority individuals (15), underrepresented ethnic groups (16,17), and adults with intellectual disabilities (18)(19)(20). Although wealthier individuals are more likely to receive ED treatment (9), the existing data suggest that EDs present equally across different socio-economic backgrounds (21). The changing demographics of the ED population point to a critical role of diversity in ED etiology, broadly defined in terms of any social or individual identity features that lead to the perception of differences between people (22), with possible implications for ED presentation and assessment, and the necessity for adjustments according to diverse treatment needs.…”

Section: Introductionmentioning

confidence: 99%

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A Plea for Diversity in Eating Disorders Research

2022

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Eating disorders (EDs) are often stereotyped as affecting the SWAG, that is, as affecting mostly skinny, White, affluent girls. Over the last decade, however, significant progress has been made toward increasing diversity in ED research. There is consensus that EDs affect individuals of all genders, ages, sexual orientations, ethnic, and socio-economic backgrounds, with recent studies exploring social determinants of ED etiology, ED presentation, and developing diversity-affirming ED assessments. This article provides a brief summary of current developments related to diversity as a research theme, and proposes different perspectives toward further improving diversity in ED research. Specifically, we argue for exploring the role of diversity in ED treatment settings and outcomes, for pursuing diversity-oriented research pro-actively rather than as a reaction to issues of under-representation, and for integrating diversity across different areas of medical education and trainings in psychotherapy. Limitations with respect to the paucity of research, and the link between diversity as a research theme and ED-related workforce diversity are discussed.

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Section: Anticipating Diversity Challengesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Plea for Diversity in Eating Disorders Research

2022

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“…This suggests that broadly speaking, FI is not routinely considered by patients or clinicians as a factor that impacts transdiagnostic ED treatment. Recent findings suggest that EDs are often seeing as diseases of affluence (Huryk, Drury, & Loeb, 2021), and thus, clinicians may not be in the mindset to assess for socioeconomic status and possibly resulting FI. Perhaps more importantly, these findings represent a call to action for clinicians; participants in this study reported feeling uncomfortable bringing up FI to their therapists, even when it was treatment interfering.…”

Section: Resultsmentioning

confidence: 99%

Patient perceptions of the relationship between food insecurity and eating disorder treatment: A qualitative exploration

Frayn

Trainor

Lin

et al. 2021

Intl J Eating Disorders

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Introduction: Independently, food insecurity (FI) and binge-spectrum eating disorders (B-ED) are widespread problems; moreover, FI is associated with elevated binge-eating symptoms. However, extant research has not explored how FI may contribute to the development of B-ED symptoms, nor potential impacts of FI on eating disorder treatment. Method: This study aimed to qualitatively examine (1) mechanisms by which FI impacts B-ED development and maintenance, (2) effects of past and/or present FI on ED treatment, and (3) participant recommendations for addressing FI in future B-ED treatment. Fourteen individuals who completed B-ED treatment and endorsed FI completed a 30-min interview about their experiences.Results: Participants reported that FI contributed to binge eating by maintaining dietary restraint-binge-eating cycle and by leading them to use food as a coping mechanism or for emotional comfort, both in past and present situations. Present FI interfered with treatment, particularly with adhering to treatment recommendations and food purchasing choices, however, participants did not report any impact of past FI on B-ED treatment.Participants reported that rarely was FI addressed as part of treatment; most participants suggested that future treatments work to (1) assess and problem solve present FI to minimize interference and (2) assess and understand the influence of past FI on current symptoms to validate the function of behavior.Discussion: These findings provide qualitative support that FI may reinforce B-ED symptoms and present FI may interfere with treatment. This study emphasizes the need for assessment and consideration of FI as a factor when treating individuals with B-EDs.

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“…Our sample matched the demographic characteristics of the general population in age, sex, ethnicity and state of residence, but appears to be more highly educated than the general population. Although education does not appear to be associated to the prevalence of EDs (Huryk et al, 2021; Mitchison & Hay, 2014), some evidence suggests that higher education is associated with greater prevalence of positive ED screens levels (Yao et al, 2021). It is possible that the higher education level of our sample contributed to the high number of positive screens in our study.…”

Section: Discussionmentioning

confidence: 99%

Estimated prevalence of eating disorders in Malaysia based on a diagnostic screen

Chua

Fitzsimmons‐Craft

Austin

et al. 2022

Intl J Eating Disorders

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Eating disorders (EDs) are debilitating health conditions and common across cultures. Recent reports suggest that about 14.0% of university students in Malaysia are at risk for developing an ED, and that prevalence may differ by ethnicity and gender. However, less is known about the prevalence of EDs in nonuniversity populations. Objective The current study seeks to (1) estimate the prevalence of EDs and ED risk status among adults in Malaysia using an established diagnostic screen; (2) examine gender and ethnic differences between ED diagnostic/risk status groups; and (3) characterize the clinical profile of individuals who screen positive for an ED. Method We administered the Stanford‐Washington University Eating Disorder Screen, an online ED screening tool, to adults in Malaysia in September 2020. Results ED risk/diagnostic categories were assigned to 818 participants (ages 18–73 years) of which, 0.8% screened positive for anorexia nervosa, 1.4% for bulimia nervosa, 0.1% for binge‐ED, 51.4% for other specified feeding or ED, and 4.8% for avoidant/restrictive food intake disorder. There was gender parity in the high risk and the overall ED categories. The point prevalence of positive eating pathology screening among Malays was significantly higher than Chinese but no different from Indians. Discussion This is the first study to estimate the prevalence of EDs using a diagnostic screen in a population‐based sample of Malaysians. It is concerning that over 50% of Malaysians reported symptoms of EDs. This study highlights the need to invest more resources in understanding and managing eating pathology in Malaysia. Public Significance This study estimates the prevalence of EDs among adults in Malaysia using an online EDs screen. Over 50% of Malaysians report symptoms of EDs. The study highlights the need for more resources and funding to address this important public health issue through surveillance, prevention, and treatment of EDs in Malaysia.

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Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders

Cited by 70 publications

References 121 publications

A Plea for Diversity in Eating Disorders Research

A Plea for Diversity in Eating Disorders Research

Patient perceptions of the relationship between food insecurity and eating disorder treatment: A qualitative exploration

Estimated prevalence of eating disorders in Malaysia based on a diagnostic screen

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