Weill Cornell Medicine, Individuals with eating disorders from low-income backgrounds often face significant challenges in obtaining accurate diagnoses and accessing effective treatment, according to a recent study by researchers at Weill Cornell Medicine and Columbia University Vagelos College of Physicians and Surgeons.
Published on February 19 in The Cognitive Behaviour Therapist, the study identifies the barriers low-income patients encounter and provides recommendations for therapists to enhance care and improve diagnostic accuracy.
Approximately 30 million people in the United States suffer from eating disorders, which can lead to severe medical complications and an increased risk of premature death. While eating disorders can affect individuals across all income levels, the high cost of treatment—averaging $11,800 annually per patient—places it out of reach for many.
The study highlights that low-income patients with eating disorders represent a particularly vulnerable and often overlooked demographic. Research indicates these individuals may experience more severe symptoms but are less likely to receive accurate diagnoses. Even when diagnosed correctly, they are unlikely to receive evidence-based treatments.
Dr. Suzanne Straebler, a research associate in psychiatry at Weill Cornell Medicine and clinical director of the Center for Eating Disorders Outpatient Specialty Clinic at NewYork-Presbyterian/Weill Cornell Medical Center, emphasized the need for improved education among healthcare providers to better identify eating disorders and assist patients in overcoming treatment barriers. Factors such as lower educational attainment, identification as a sexual or gender minority, membership in historically marginalized ethnic or racial groups, and limited English proficiency often intersect to create additional challenges for these patients.
“We aim to disseminate essential information that empowers providers to feel more confident in identifying these cases and making appropriate treatment referrals,” said Dr. Deborah R. Glasofer, co-author of the study and associate professor of clinical medical psychology at Columbia University.
Low-income patients encounter numerous obstacles in their battle against eating disorders. For example, individuals facing food insecurity may not find suitable options at food banks or pantries. “Patients often receive foods that they cannot consume due to being classified as ‘feared’ or ‘avoided’ items, or the quantities provided may be insufficient to meet their nutritional needs,” Dr. Straebler noted.
To address these systemic shortcomings, the authors propose several strategies. Therapists could assist patients in accessing local or governmental food resources and collaborate with food banks to educate staff about the specific needs of individuals with eating disorders, thereby enhancing recovery prospects.
Moreover, providing treatment materials in multiple languages and ensuring access to interpreters during therapy sessions would significantly benefit patients. Cultural humility—an openness to learning about and understanding diverse cultures—is also essential for therapists to effectively support patients and their families throughout the treatment process.
Less apparent challenges include inadequate access to electricity for cooking meals and the lack of technology or private spaces for telehealth appointments. Therapists can help by directing patients to relevant governmental, community, or charitable support resources.
“Our study underscores the importance of therapists recognizing their role in normalizing and regulating eating patterns, irrespective of an individual’s specific eating disorder or financial circumstances,” Dr. Glasofer said. By equipping healthcare professionals with the necessary information, they can implement accommodations that help patients navigate the barriers to recovery.
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