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August 28, 2023

Pediatric Obesity Research Update | Autism Spectrum Disorder and Obesity in Children: A Systematic Review and Meta-Analysis

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Image of a woman with a child in her lap wearing headphones. Both are painting at a table in front of them, smiling at the artwork.

Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s update addresses Autism Spectrum Disorder and obesity in children.

Autism Spectrum Disorder and Obesity in Children: A Systematic Review and Meta-Analysis

Article Summary

This article is a systematic review and meta-analysis of twenty studies evaluating whether children with Autism Spectrum Disorder (ASD) have a greater prevalence of obesity. Read the full article.

Article Review

One in five children have childhood obesity. Children with developmental disabilities, including Autism Spectrum Disorder (ASD), appear to be at higher risk for weight gain due to selective eating practices. Many children with ASD exhibit a preference for energy-dense foods and have low intake of vegetables. In addition, some medications used for behavior modification in children with ASD, are weight-promoting (e.g., atypical antipsychotics). The aim of this systematic review and meta- analysis was to examine 1) whether children with ASD have a greater prevalence of obesity and 2) whether the prevalence of ASD is higher in children with obesity. To accomplish their aim, the authors searched in PubMed, Scopus, and PsychINFO databases in May 2021. Twenty articles met criteria for quantitative synthesis. Children in all studies were below the age of 18 years. Of note, studies without a control group were excluded.

The review found that the prevalence estimate of obesity among children with ASD was 17% (95% confidence interval[CI]: 13–22). Children with ASD had a 58% greater risk of developing obesity compared to children without ASD. Prevalence estimates increased with age, with children 13-17 years having a higher prevalence compared to their younger counterparts. Prevalence findings from the present study were consistent with previous meta-analyses.

Of the twenty studies, 85% included children from the United States. The three remaining studies were from Europe (i.e., Ireland, Netherlands, Spain). No European studies showed a significant difference in obesity prevalence between the ASD group and the control group. One study was very small (possibly inadequately powered) and a second had a control group of patients with alternate psychiatric diagnoses rather than typically developing without known mental health diagnoses. Psychiatric diagnoses in general can also be associated with heightened risk of obesity. A previous systematic review noted that living in the USA was a positive moderator of the association between ASD and overweight/obesity. In order to further analyze whether the obesity prevalence trend is similar in European children with ASD, larger studies are needed.

One potential study limitation cited by authors was that eleven studies utilized anthropometric data based on parental report and not in-clinic measurement. As such, a secondary analysis divided the studies into subgroups, based on how anthropometric data was obtained. The prevalence estimates and relative risk did not differ between the subgroups.

Lastly, the present study was also aimed at looking at the prevalence of ASD in children with obesity. No analysis could be performed for this part of the aim, as no controlled prevalence studies were found. This identified knowledge gap opens the way for additional studies in the area.

Additional Resources

Find more resources, curated by OMA’s Pediatric Committee, on our Pediatric Resources page. There you’ll find additional article reviews on various topics related to obesity as well as public resources for clinicians and families.

Sammels O, Karjalainen L, Dahlgren J, Wentz E. Autism Spectrum Disorder and Obesity in Children: A Systematic Review and Meta-Analysis. Obes Facts. 2022;15(3):305-320. doi: 10.1159/000523943. Epub 2022 Mar 9. PMID: 35263756; PMCID: PMC9210004.