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Elevated Prevalence of Overweight and Obesity Among Children with Autism Spectrum Disorders
Pediatric overweight and obesity are a significant public health concern. Although many of the risk factors for unhealthy weight are likely the same among children with ASD as in the general population, children with ASD may be vulnerable to additional risk factors including atypical eating patterns, food selectivity, and limited opportunities for social/physical activity. The presence of these additional risk factors raises the question of whether children with ASD are more likely to be overweight or obese compared to children without ASD.
Objectives:
To determine if the prevalence of unhealthy weight overall and obesity specifically is significantly higher in individuals with ASD (available through the Autism Speaks Autism Treatment Network [ATN]) versus those from a general population sample (available through the National Health and Nutrition Examination Survey [NHANES]).
Methods:
Children with ASD (n = 5053; ages 2-17) enrolled in the ATN were compared to children in an age-matched sample available through NHANES (n = 8844). In both samples, weight and height were measured during a standardized physical exam and were used to calculate BMI percentiles; classifications of overweight (OWT; 85th percentile ≤ BMI < 95th percentile) and obesity (OBY; BMI ≥ 95th percentile) were according to CDC guidelines for BMI for sex and age. Children in the ATN sample had confirmed ASD diagnoses according to DSM-IV-TR (American Psychiatric Association, 2000) criteria and supported by administration of the ADOS (Lord et al., 2000). Following NHANES analysis guidelines, prevalence estimates were calculated after applying the mobile examination center 6-year sample weights to take into account the complex sampling design. Estimates were compared using two-proportion z-tests across all ages (2-17) as well as by age group (2-5, 6-11, 12-17) for unhealthy weight status (OWT or OBY) as well as only obese weight status (OBY). Further analyses were conducted for boys and girls separately, as well as by the following racial/ethnic groups: Non-Hispanic white, Non-Hispanic black, Hispanic.
Results:
In this study, 33.6% of children with ASD (2-17 years) were an unhealthy weight and 18% were obese. Compared to the NHANES general population sample, prevalence estimates for unhealthy weight overall and for obesity only were significantly higher among children with ASD than in the general population for those ages 2-5 and 12-17, regardless of gender.
Conclusions:
Our results indicate that the prevalence of unhealthy weight status is significantly greater among children with ASD compared to the general population, which is consistent with several recent reports based on measured height and weight values in individuals with confirmed ASD diagnoses (Broder-Fingert, Brazauskas, Lindgren, Iannuzzi, & Van Cleave, 2014; Egan, Dreyer, Odar, & Beckwith, 2013). We also found that these differences are present as early as ages 2-5. Since obesity is more prevalent among older children in the general population (Ogden, Carroll, Kit, & Flegal, 2014), these findings raise the question of whether there are different trajectories of weight gain among children with ASD, possibly beginning at a very early age.