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. 2023 Jul;53(9):4255-4265.
doi: 10.1017/S0033291722001015. Epub 2022 May 16.

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

Natasha L Burke  1 , Vivienne M Hazzard  2   3 , Lauren M Schaefer  4   5 , Melissa Simone  2   3 , Jennifer L O'Flynn  6   7 , Rachel F Rodgers  6   8
Affiliations

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

Natasha L Burke et al. Psychol Med. 2023 Jul.

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.

Keywords: Disparities; eating disorders; gender identity; intersectionality; multiply marginalized; prevalence; race/ethnicity; screening; sexual orientation; socioeconomic status.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1.
Figure 1.
Age-adjusted prevalence estimates of positive SCOFF based on intersectional model
Figure 2.
Figure 2.
Age-adjusted prevalence estimates of positive SCOFF based on additive and intersectional models Note. Evidence for a departure from additive risk is observed when prevalence estimates across additive and intersectional models differ and confident intervals do not overlap.
See this image and copyright information in PMC

References

    1. Advisory Committee on Student Financial Assistance. (ACSFA, 2001). Access denied: Restoring the nation’s commitment to equal educational opportunity Washington, D. C. https://files.eric.ed.gov/fulltext/ED453770.pdf
    1. Arcelus J, Haslam M, Farrow C, & Meyer C (2013). The role of interpersonal functioning in the maintenance of eating psychopathology: A systematic review and testable model. Clin Psychol Rev, 33(1), 156–167. 10.1016/j.cpr.2012.10.009 - DOI - PubMed
    1. Austin SB, Nelson LA, Birkett MA, Calzo JP, & Everett B (2013). Eating disorder symptoms and obesity at the intersections of gender, ethnicity, and sexual orientation in US high school students. American Journal of Public Health, 103(2), e16–22. 10.2105/ajph.2012.301150 - DOI - PMC - PubMed
    1. Bauer GR (2014). Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science & Medicine, 110, 10–17. 10.1016/j.socscimed.2014.03.022 - DOI - PubMed
    1. Beale F (1970). Double Jeopardy: To be Black and Female. In Cade T (Ed.), The Black woman: An anthology (pp. 90–100). Signet.

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