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Equitable access to evidence-based treatment for eating disorders for patients with low-income: identifying barriers and exploring solutions

Published online by Cambridge University Press:  19 February 2024

Suzanne Bailey-Straebler Open the ORCID record for Suzanne Bailey-Straebler [Opens in a new window] ,
Deborah R. Glasofer ,
Jessica Ojeda  and
Evelyn Attia
Suzanne Bailey-Straebler*
Affiliation:
Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA Columbia University Irving Medical Center, New York, USA
Deborah R. Glasofer
Affiliation:
Columbia University Irving Medical Center, New York, USA New York State Psychiatric Institute, New York, USA
Jessica Ojeda
Affiliation:
Columbia University Irving Medical Center, New York, USA New York State Psychiatric Institute, New York, USA
Evelyn Attia
Affiliation:
Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA Columbia University Irving Medical Center, New York, USA New York State Psychiatric Institute, New York, USA
*
Corresponding author: Suzanne Bailey-Straebler; Email: sus9111@nyp.org
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Abstract

Abstract

Eating disorders are equally prevalent across socioeconomic status, and yet individuals facing socioeconomic adversity are far less likely to receive evidence-based treatments. A range of barriers contribute to this disparity, including limited awareness and provider training about eating disorders leading to underdiagnosis; a shortage of available services and long waitlists due to a lack of trained therapists, associated treatment costs (e.g. transportation expenses and costly treatment materials) and an insufficient understanding of the impact of an individual’s cultural context. While these barriers are experienced by many individuals with eating disorders, those with low income are particularly vulnerable. To ensure equitable access to effective eating disorder treatment, therapists should actively consider and address the barriers faced by these patients. In this paper, we share guidance based on our experience treating a socioeconomically diverse patient population, on factors to consider when extending the reach of recommended psychological treatments for eating disorders and suggest areas of future research. We emphasize the opportunities available to therapists to improve equity in eating disorders treatment by making accommodations that enhance access to existing evidence-based approaches rather than by making modifications to the treatments.

Key learning aims

  1. (1) To identify obstacles experienced by individuals with eating disorders and low income in accessing and engaging in treatment.

  2. (2) To learn practical strategies to reduce or eliminate barriers preventing the uptake of evidence-based psychological eating disorder interventions for individuals with low income.

  3. (3) To appreciate the intersectionality of low income with other factors impacting equity of eating disorder treatment access.

Keywords

DisseminationEating disordersEquityLow incomeTreatment accessTreatment barriers
Type
Empirically Grounded Clinical Guidance Paper
Information
the Cognitive Behaviour Therapist , Volume 17 , 2024 , e5
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies

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Footnotes

*

Joint first authors.

References

Further reading

Finegan, M., Firth, N., Wojnarowski, C., & Delgadillo, J. (2018). Associations between socioeconomic status and psychological therapy outcomes: a systematic review and meta-analysis. Depression and Anxiety, 35, 560–573. https://doi.org/10.1002/da.22765 CrossRefGoogle ScholarPubMed
Huryk, K. M., Drury, C. R., & Loeb, K. L. (2021). Diseases of affluence? A systematic review of the literature on socioeconomic diversity in eating disorders. Eating Behaviors, 43, 101548. https://doi.org/10.1016/j.eatbeh.2021.101548 CrossRefGoogle ScholarPubMed
Moreno, R., Buckelew, S. M., Accurso, E. C., & Raymond-Flesch, M. (2023). Disparities in access to eating disorders treatment for publicly-insured youth and youth of color: a retrospective cohort study. Journal of Eating Disorders, 11, 10. https://doi.org/10.1186/s40337-022-00730-7 CrossRefGoogle ScholarPubMed

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