Elsevier

Academic Pediatrics

Volume 14, Issue 4, July–August 2014, Pages 408-414
Academic Pediatrics

Children at Risk: Autism Spectrum Disorder
Prevalence of Overweight and Obesity in a Large Clinical Sample of Children With Autism

https://doi.org/10.1016/j.acap.2014.04.004Get rights and content

Abstract

Background

Overweight and obesity are major pediatric public health problems in the United States; however, limited data exist on the prevalence and correlates of overnutrition in children with autism.

Methods

Through a large integrated health care system's patient database, we identified 6672 children ages 2 to 20 years with an assigned ICD-9 code of autism (299.0), Asperger syndrome (299.8), and control subjects from 2008 to 2011 who had at least 1 weight and height recorded in the same visit. We calculated age-adjusted, sex-adjusted body mass index and classified children as overweight (body mass index 85th to 95th percentile) or obese (≥95th percentile). We used multinomial logistic regression to compare the odds of overweight and obesity between groups. We then used logistic regression to evaluate factors associated with overweight and obesity in children with autism, including demographic and clinical characteristics.

Results

Compared to control subjects, children with autism and Asperger syndrome had significantly higher odds of overweight (odds ratio, 95% confidence interval: autism 2.24, 1.74–2.88; Asperger syndrome 1.49, 1.12–1.97) and obesity (autism 4.83, 3.85–6.06; Asperger syndrome 5.69, 4.50–7.21). Among children with autism, we found a higher odds of obesity in older children (aged 12–15 years 1.87, 1.33–2.63; aged 16–20 years 1.94, 1.39–2.71) compared to children aged 6 to 11 years. We also found higher odds of overweight and obesity in those with public insurance (overweight 1.54, 1.25–1.89; obese 1.16, 1.02–1.40) and with co-occurring sleep disorder (obese 1.23, 1.00–1.53).

Conclusions

Children with autism and Asperger syndrome had significantly higher odds of overweight and obesity than control subjects. Older age, public insurance, and co-occurring sleep disorder were associated with overweight or obesity in this population.

Section snippets

Methods

We evaluated prevalence of overweight and obesity for patients with autism, Asperger syndrome, and control subjects assessed at a large integrated health care system in eastern Massachusetts and compared prevalence among children with autism and Asperger syndrome to children without ASD. We also documented factors associated with overweight and obesity in children with autism.

Characteristics of the Study Population

We identified 2976 children aged 2 to 20 years with an ICD-9 code of autism (299.00) or Asperger syndrome (299.8) seen at Partners HealthCare and who had a weight and height listed at the same primary care visit (Table 1). Subjects were mostly white (80.8%) and male (79.3%), with 5% black and 7% Hispanic. Controls were more evenly distributed by gender (50.1% male) and race/ethnicity (51.1% white, 24.3% Hispanic). Age distribution varied by study group. Control children were younger than both

Discussion

In this study, we found a high prevalences of overweight and obesity in a cohort of patients with autism and Asperger syndrome compared to control subjects. Of children with autism and Asperger syndrome, 23.2% and 25.3% were obese, respectively. To our knowledge, this is the first study showing higher prevalence of overweight and obesity in children with autism or Asperger syndrome compared to control children using anthropomorphic measurements.

These findings are consistent with previous work

Conclusions

The prevalence of overweight and obesity in a population of children with autism is much higher than those without autism. These findings are important to future public health initiatives addressing overweight and obesity for several reasons. First, development of future prevention and treatment interventions should take into account this special and growing population7 of patients and consider how they can best be included. Second, because differences in overweight and obesity emerged in the

Acknowledgments

Supported in part by the APA Resident Investigator Award.

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      Given the increased risk of obesity and many co-occurring conditions in youth with ASD, research on potential associations between obesity and co-occurring conditions in this population is warranted. For example, one study found an increased risk of obesity in youth with ASD who had co-occurring sleep disorder (Broder-Fingert, Brazauskas, Lindgren, Iannuzzi, & Van Cleave, 2014). As obesity and co-occurring conditions may worsen health outcomes for youth with ASD, there is a need to investigate such associations in this population using recent, nationally representative data.

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    The authors declare that they have no conflict of interest.

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