Contrary to historical stereotypes, emerging research suggests eating disorders (EDs; e.g., anorexia nervosa, bulimia nervosa, binge-eating disorder) and disordered eating symptoms (e.g., body dissatisfaction, binge eating) may be elevated among people experiencing at least some forms of socioeconomic disadvantage. However, the relatively small body of research conducted on poverty and EDs thus far has generally focused on proximal and relatively narrow indices of disadvantage, such as food insecurity. Disadvantage is a multifaceted construct, and fully understanding the impact of disadvantage on disordered eating requires integration of both proximal (e.g., lower family income) and more distal (e.g., poverty and decreased resources in the neighborhood) aspects of the socioeconomic context. In addition, there has been little research on interactions between disadvantage and other risk factors for disordered eating (e.g., genetic risk), changes in the impact of disadvantage across development, or the “active ingredients” of more distal forms of disadvantage at the neighborhood level that most strongly contribute to disordered eating. The three studies included in this dissertation addressed these gaps in the literature. Study 1 conducted developmentally informed genotype x environment analyses to understand how proximal (family income) and distal (neighborhood disadvantage) forms of socioeconomic disadvantage may interact with genetic influences to impact risk for disordered eating in boys. These analyses built on prior work in girls by examining interactions between disadvantage and genetic influences across the developmental period most critical for emergence of genetic risk for disordered eating in boys (adrenarche, an early stage of puberty). Boys from disadvantaged neighborhoods or families showed earlier activation of genetic influences on disordered eating in early adrenarche, when genetic influences were minimal for boys living in more advantaged contexts. Boys living in disadvantaged contexts also reported greater phenotypic disordered eating symptoms in late adrenarche, suggesting earlier activation of genetic influences may increase later behavioral risk. Study 2 was the first longitudinal study investigating how initial levels and change in neighborhood disadvantage shape trajectories of disordered eating across the critical adolescent risk period in girls and boys. Both girls and boys who lived in more disadvantaged neighborhoods in middle childhood showed greater contemporaneous disordered eating, and this elevation relative to their more advantaged peers persisted into emerging adulthood even for youth who later transitioned to more advantaged neighborhoods. Study 3 examined lower neighborhood resource availability (e.g., recreational centers, green spaces, medical facilities) and exposure to community violence as potential “active ingredients” of associations between neighborhood disadvantage and disordered eating both cross-sectionally in middle childhood and mid/late adolescence and longitudinally across development. Greater community violence exposure was associated with greater contemporaneous disordered eating in girls and boys in both childhood and adolescence, and greater community violence exposure in childhood indirectly predicted greater disordered eating in adolescence through its association with childhood disordered eating. Although not associated with disordered eating cross-sectionally, fewer neighborhood resources in childhood predicted a greater increase in disordered eating from childhood to adolescence. Altogether, findings highlight the importance of considering broader contextual forms of disadvantage in etiologic models of disordered eating. Results also suggest early disadvantage during childhood may have a particularly profound and enduring impact on disordered eating risk, underscoring the importance of early screening and intervention for disadvantaged youth. Finally, findings point to the importance of public policy to increase access to care for under-resourced youth and help shape communities that support positive youth development.
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