Update: Socioeconomic Barriers to Youth with Eating Disorders

Symptoms of eating disorders may go undiagnosed among middle-class Americans, but socioeconomic barriers to treatment are often higher among racially and ethnically disadvantaged youth. The cost of services and lack of treatment facilities are but a few of these barriers.

A study of Medicare claims of primary or secondary eating disorders diagnoses from 2010 to 2014 found that only a fourth of 8075 publicly insured youth with eating disorders in California were diagnosed with any eating-disorders-related medical complications. Dr. Amanda E. Downey and colleagues at the University of California, San Francisco, noted that diagnostic criteria for AN require malnutrition as a diagnosis for youth with AN, yet malnutrition was diagnosed in only 8% of youths with AN in this population (J Adolescent Health. 2023). Hematologic abnormalities were the most commonly diagnosed medical complications.

A second article, by Dr. Erin C. Accurso and colleagues, also from the University of California, San Francisco, found that about half of the Medicare claims from 2010 to 2014 involved Latinex youths (58.5%, n=2634), and about half of eating disorder diagnoses were unspecified (Am Acad Child Adolesc Psychiatry. 2023. 23: 02193-7). Additional analyses compared youth with eating disorders who were continuously enrolled across all 3 years (n = 4,500) to random subsamples of continuously enrolled youth diagnosed with a mood or anxiety disorder (n = 4,128), a disruptive behavior disorder (n = 4,599), or a psychotic disorder (n = 4,290).

Spanish language and Latinex ethnicity were significantly more common among youth with eating disorders than among those with other diagnoses. The results highlighted the structural barriers to equitable medical and behavioral healthcare. Limited access to evidence-based eating disorders treatments and specialized treatment providers further contributes to disparities in medical outcomes and worsening of the significant public health burden of these illnesses. During nutritional rehabilitation, an appropriate amount of fat and protein is crucial for nutrient density, energy source, muscle maintenance, hormonal balance, satiety, and brain function (Nutr Clin Prac. 2010. 122).

The two studies emphasized the need to train community medical providers to recognize and treat people with eating-disorders-related medical complications. The authors stress that early and accessible psychotherapy with medical oversight from an eating disorders-informed medical professional may help to prevent or reduce morbidity and mortality rates.

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