Obesity and Severe Obesity in Children With Autism Spectrum Disorder

Prevalence and Risk Factors

Du Pham, MD; Sofia Silver, MD; Sierra Haq, MD; S. Shahrukh Hashmi, MD, PhD; Mona Eissa, MD, PhD


South Med J. 2020;113(4):168-175. 

In This Article

Abstract and Introduction


Objective: Research suggests a high prevalence of obesity in children with autism spectrum disorders (ASDs), but the prevalence of severe obesity and its association with risk factors unique to this population remain undetermined. This study sought to compare the prevalence of severe obesity in children with ASDs to that of the general population and investigated associated risk factors for obesity in this population.

Methods: A chart review was done on 592 patients with ASDs seen between 2013 and 2017 at a center in Houston, Texas. The prevalence of obesity in the study population was compared with 2013–2016 national data. Univariable, multivariable, and stratified analyses were performed to determine the association between risk factors and body mass index.

Results: The prevalence of obesity and severe obesity in our study population was similar to those reported in the general population. When stratified by age, children with ASDs ages 6 to 11 years had a significantly higher prevalence of severe obesity than the general population.

Conclusions: The prevalence of severe obesity in children with ASDs was higher with increasing age, and in the 6- to 11-year-old age group, was significantly higher than in the general population. Healthcare providers should address diet and exercise early as part of a comprehensive management plan for children with ASDs.


Pediatric obesity has become a health concern in the United States as its prevalence has increased during the past 30 years.[1] According to National Health and Nutrition Examination Surveys data reported by Ogden et al between 2013 and 2016, among children ages 2 to 19 years, 33.4% were overweight (defined as body mass index [BMI] ≥85th percentile), 17.8% were obese (BMI ≥95th percentile), and 5.8% were severely obese (BMI ≥120% of the 95th percentile).[2] Childhood obesity is associated with several cardiometabolic and psychological comorbidities[3–6] and often leads to bullying and isolation.[7] Pediatric overweight and obesity increase the risk for adult overweight and obesity,[8] putting patients at risk for future health complications.[3,9,10]

Children with autism spectrum disorders (ASDs) may have a higher prevalence of obesity than the general pediatric population;[11] however, there has been insufficient investigation into the unique characteristics of children with ASDs that could be associated with these increased obesity rates. Studies have reported dietary preferences[12–15] and sensory abnormalities[12,15] as potential contributing factors to obesity in children with ASDs. Children with ASDs also may have disrupted sleep,[16] causing weight gain,[17] and they may be taking psychotropic medications, with weight gain as an adverse effect. These children may demonstrate social impairment and stereotypical behaviors, leading to less structured physical activities and participation in sports.[18] They are commonly delayed in developing motor skills and often have decreased muscle tone, limiting their ability to perform physical activities and exercise.

Limited data exist on the contribution of these factors to unhealthy weight in children with ASDs. The primary purpose of this study was to describe the prevalence of obesity and severe obesity in a population of children with ASDs and compare it with that of the general pediatric population. In addition, we aimed to examine potential relations between obesity and risk factors specific to children with ASDs, as mentioned above. We hypothesized a higher obesity prevalence in this ASDs population and that this increased prevalence would be associated with the factors studied.