The teens most likely to struggle with an eating disorder may live in the households that get overlooked.
A systematic review published September 7, 2026 in the International Journal of Eating Disorders found that adolescents from lower-income, lower-education families were consistently more likely to show disordered eating symptoms than peers from wealthier homes.
Researchers at the UCL Great Ormond Street Institute of Child Health and Copenhagen University Hospital pooled data from 51 studies covering 26,174 adolescents across North America, Europe, and Australia.
In roughly two-thirds of the studies, teens from lower-income households showed significantly more eating disorder symptoms. Not a single study found the opposite pattern.
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Family education tracked the same way. Adolescents whose parents had not attended university reported about 25% higher rates of eating disorder symptoms than teens with university-educated parents, according to the review team.
Why the "privileged illness" idea persists
The image of anorexia or bulimia as a middle-class problem has shaped everything from movie storylines to clinical intuition. Senior author Dr. Nora Trompeter of UCL argues that assumption has real costs.
"Eating disorders don't discriminate by income or education. If anything, the evidence points the other way, and treating them as a 'privileged' condition risks leaving adolescents most in need of support undiagnosed and untreated," Trompeter said.
The review looked broadly at disordered eating, including food restriction, fasting, poor body image and perceived pressure to lose weight, alongside diagnosed anorexia, bulimia and binge eating disorders.
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Other measures of disadvantage, like neighborhood deprivation, parental unemployment and financial hardship, produced more mixed results, which the authors attribute in part to inconsistent definitions across studies.
What might drive the link
The review does not test mechanisms, but a separate line of research offers a plausible explanation.
A 2020 review in Current Psychiatry Reports described a "feast-or-famine cycle" in food-insecure households, where intake drops when food runs short and spikes when it becomes available again.
That pattern is linked to preoccupation with food, emotional reactivity and a tendency toward binge eating.
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The same review reported that among food-insecure US adolescents, 15.7% used fasting for weight control compared with 11.0% of food-secure peers, and 32.6% skipped meals compared with 26.3%. Chronic stress and weight stigma add further pressure.
What parents and clinicians should watch for
The signals do not change with a family's income. Skipping meals, sudden rules about "good" and "bad" foods, secret eating, frequent bathroom trips after meals, excessive exercise, and rapid shifts in weight or body image concerns all warrant a conversation with a pediatrician or primary care doctor.
Adolescents with concerns about their eating, weight or body should be seen by a clinician who can assess them properly.
The review is limited by its focus on Western, predominantly white adolescent populations and by the varied ways individual studies measured socioeconomic status.
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Even so, the direction of the evidence was consistent enough for the authors to argue that screening tools and outreach should not skip lower-income schools and clinics.
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This article is made and published by Ida-Marie Palm Varbæk, who may have used AI in the preparation.