Journal of Autism and Developmental Disorders

, Volume 44, Issue 7, pp 1708–1719 | Cite as

Overweight and Obesity: Prevalence and Correlates in a Large Clinical Sample of Children with Autism Spectrum Disorder

  • Katharine E. ZuckermanEmail author
  • Alison P. Hill
  • Kimberly Guion
  • Lisa Voltolina
  • Eric Fombonne
Original Paper


Autism Spectrum Disorders (ASDs) and childhood obesity (OBY) are rising public health concerns. This study aimed to evaluate the prevalence of overweight (OWT) and OBY in a sample of 376 Oregon children with ASD, and to assess correlates of OWT and OBY in this sample. We used descriptive statistics, bivariate, and focused multivariate analyses to determine whether socio-demographic characteristics, ASD symptoms, ASD cognitive and adaptive functioning, behavioral problems, and treatments for ASD were associated with OWT and OBY in ASD. Overall 18.1 % of children met criteria for OWT and 17.0 % met criteria for OBY. OBY was associated with sleep difficulties, melatonin use, and affective problems. Interventions that consider unique needs of children with ASD may hold promise for improving weight status among children with ASD.


Autism spectrum disorder Obesity Overweight Children 



This research was conducted using data collected as part of the Autism Treatment Network (ATN). The ATN is funded by Autism Speaks and a cooperative agreement (UA3 MC 11054) from the Health Resources and Services Administration to Massachusetts General Hospital. Dr. Zuckerman’s effort was funded by K23MH095828 from the U.S. National Institute of Mental Health.


  1. Achenbach, T., & Rescorla, L. (2000). Manual for ASEBA preschool forms & profiles, research center of children. Burlington, VT: University of Vermont Research Center for Children, Youth, & Families.Google Scholar
  2. Achenbach, T., & Rescorla, L. (2001). Manual for ASEBA school-age forms & profiles, research center of children. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
  3. Autism and Developmental Disabilities Monitoring Network Surveillance Year 2008 Principal Investigators (2012). Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, 14 sites, United States, 2008. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 61(3), 1–19.Google Scholar
  4. Bethell, C., Simpson, L., Stumbo, S., Carle, A. C., & Gombojav, N. (2010). National, state, and local disparities in childhood obesity. Health Affairs (Project Hope), 29(3), 347–356. doi: 10.1377/hlthaff.2009.0762.CrossRefGoogle Scholar
  5. Bixler, E. O., Vgontzas, A. N., Lin, H. M., Liao, D., Calhoun, S., Vela-Bueno, A., et al. (2009). Sleep disordered breathing in children in a general population sample: Prevalence and risk factors. Sleep, 32(6), 731–736.PubMedCentralPubMedGoogle Scholar
  6. Bjorge, T., Engeland, A., Tverdal, A., & Smith, G. D. (2008). Body mass index in adolescence in relation to cause-specific mortality: A follow-up of 230,000 Norwegian adolescents. American Journal of Epidemiology, 168(1), 30–37. doi: 10.1093/aje/kwn096.PubMedCrossRefGoogle Scholar
  7. Blumberg, S. J., Bramlett, M. D., Kogan, M., Schieve, L. A., Jones, J. R., & Lu, M. C. (2013). Changes in parent-reported prevalence of autism spectrum disorder in school-aged U.S. children: 2007 to 201112. (No. 65). Hyattsville, MD: National Health Statistics Reports.Google Scholar
  8. Chen, A. Y., Kim, S. E., Houtrow, A. J., & Newacheck, P. W. (2010). Prevalence of obesity among children with chronic conditions. Obesity, 18(1), 210–213.PubMedCrossRefGoogle Scholar
  9. Curtin, C., Anderson, S. E., Must, A., & Bandini, L. (2010). The prevalence of obesity in children with autism: A secondary data analysis using nationally representative data from the National Survey of Children’s Health. BMC Pediatrics, 10, 11.PubMedCentralPubMedCrossRefGoogle Scholar
  10. Curtin, C., Bandini, L. G., Perrin, E. C., Tybor, D. J., & Must, A. (2005). Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: A chart review. BMC Pediatrics, 5, 48.PubMedCentralPubMedCrossRefGoogle Scholar
  11. de Vinck-Baroody, O., Shui, A., Macklin, E., Hyman, S., Leventhal, J. M., & Weitzman, C. (2013) Overweight and obese status in a sample of children with autism spectrum disorders. In Abstract presented at pediatric academic societies conference, Washington, D.C.Google Scholar
  12. Dev, D. A., McBride, B. A., Fiese, B. H., Jones, B. L., & Cho on behalf of the Strong Kids Research Team. (2013). Risk factors for overweight/obesity in preschool children: An ecological approach. Childhood Obesity (Print), 9(5), 399–408. doi: 10.1089/chi2012.0150.Google Scholar
  13. Dietz, W. H., & Robinson, T. N. (2005). Clinical practice. Overweight children and adolescents. The New England Journal of Medicine, 352(20), 2100–2109. doi: 10.1056/NEJMcp043052.PubMedCrossRefGoogle Scholar
  14. Dreyer, M., Egan, A., Kippes, C., Andrews, J., & May, M. (2008). Obesity and overweight among patients diagnosed with autism spectrum disorders. Obesity, 16(1), 284.Google Scholar
  15. Egan, A. M., Dreyer, M. L., Odar, C. C., Beckwith, M., & Garrison, C. B. (2013). Obesity in young children with autism spectrum disorders: Prevalence and associated factors. Childhood Obesity (Print), 9(2), 125–131. doi: 10.1089/chi.2012.0028.Google Scholar
  16. Evans, E. W., Must, A., Anderson, S. E., Curtin, C., Scampini, R., Maslin, M., et al. (2012). Dietary patterns and body mass index in children with autism and typically developing children. Research in Autism Spectrum Disorders, 6(1), 399–405. doi: 10.1016/j.rasd.2011.06.014.PubMedCentralPubMedCrossRefGoogle Scholar
  17. Faraone, S. V., Biederman, J., Morley, C. P., & Spencer, T. J. (2008). Effect of stimulants on height and weight: A review of the literature. Journal of the American Academy of Child and Adolescent Psychiatry, 47(9), 994–1009. doi: 10.1097/CHI.ObO13e31817eOea7.PubMedGoogle Scholar
  18. Fishman, L., Lenders, C., Fortunato, C., Noonan, C., & Nurko, S. (2004). Increased prevalence of constipation and fecal soiling in a population of obese children. The Journal of Pediatrics, 145(2), 253–254. doi: 10.1016/j.jpeds.2004.04.022.PubMedCrossRefGoogle Scholar
  19. Friedemann, C., Heneghan, C., Mahtani, K., Thompson, M., Perera, R., & Ward, A. M. (2012). Cardiovascular disease risk in healthy children and its association with body mass index: Systematic review and meta-analysis. BMJ (Clinical Research Ed.), 345, e4759. doi: 10.1136/bmj.e4759.Google Scholar
  20. Ghaziuddin, M., & Butler, E. (1998). Clumsiness in autism and Asperger syndrome: A further report. Journal of Intellectual Disability Research, 42(1), 43–48.PubMedCrossRefGoogle Scholar
  21. Goodman, E., & Whitaker, R. C. (2002). A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics, 110(3), 497–504.PubMedCrossRefGoogle Scholar
  22. Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705. doi: 10.1007/s10803-008-0674-3.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Hellings, J. A., Zarcone, J. R., Crandall, K., Wallace, D., & Schroeder, S. R. (2001). Weight gain in a controlled study of risperidone in children, adolescents and adults with mental retardation and autism. Journal of Child and Adolescent Psychopharmacology, 11(3), 229–238. doi: 10.1089/10445460152595559.PubMedCrossRefGoogle Scholar
  24. Ho, H. H., Eaves, L. C., & Peabody, D. (1997). Nutrient intake and obesity in children with autism. Focus on Autism & Other Developmental Disabilities, 12(3), 187–192.CrossRefGoogle Scholar
  25. Hus, V., Gotham, K., & Lord, C. (2012). Standardizing ADOS domain scores: Separating severity of social affect and restricted and repetitive behaviors. Journal of Autism and Developmental Disorders,. doi: 10.1007/s10803-012-1719-1.PubMedCentralPubMedGoogle Scholar
  26. Hyman, S. L., Stewart, P. A., Schmidt, B., Cain, U., Lemcke, N., Foley, J., et al. (2012). Nutrient intake from food in children with autism. Pediatrics, 130(Suppl 2), S145–S153. doi: 10.1542/peds.2012-0900L.PubMedCrossRefGoogle Scholar
  27. Katz, T. F., Goldman, S. E., Malow, B. A., Shui, A., Ashgar, S., Byars, K. et al. (2013). The Child Sleep Habits Questionnaire in Children with Autism Spectrum Disorders. In Abstract presented at international meeting for autism research, San Sebastian, Spain.Google Scholar
  28. Kipping, R. R., Jago, R., & Lawlor, D. A. (2008). Obesity in children. Part 1: Epidemiology, measurement, risk factors, and screening. BMJ (Clinical Research Ed.), 337, a1824. doi: 10.1136/bmj.a1824.
  29. Krebs, N. F., Himes, J. H., Jacobson, D., Nicklas, T. A., Guilday, P., & Styne, D. (2007). Assessment of child and adolescent overweight and obesity. Pediatrics, 120(Suppl 4), S193–S228. doi: 10.1542/peds.2007-2329D.PubMedCrossRefGoogle Scholar
  30. Kuczmarski, R. J., Ogden, C. L., Grummer-Strawn, L. M., Flegal, K. M., Guo, S. S., Wei, R., et al. (2000). CDC growth charts: United States. Advance Data, 314, 1–27.PubMedGoogle Scholar
  31. Lee, L. C., Harrington, R. A., Louie, B. B., & Newschaffer, C. J. (2008). Children with autism: Quality of life and parental concerns. Journal of Autism and Developmental Disorders, 38(6), 1147–1160. doi: 10.1007/s10803-007-0491-0.PubMedCrossRefGoogle Scholar
  32. Lord, C., Rutter, M., DiLavore, P., & Rissi, S. (1999). Autism Diagnostic Observation Schedule. Los Angeles, CA: Western Psychological Services.Google Scholar
  33. Maenner, M. J., & Durkin, M. S. (2010). Trends in the prevalence of autism on the basis of special education data. Pediatrics, 126(5), e1018–e1025. doi: 10.1542/peds.2010-1023.PubMedCrossRefGoogle Scholar
  34. Miller, D. T., Nasir, R., Sobeih, M. M., Shen, Y., Wu, B. & Hanson, E. (2009). 16p11.2 Microdeletion, [in GeneReviews™, Seattle (WA): University of Washington, Seattle; 1993–2013.]. Retrieved Sept 25, 2013, from
  35. Ming, X., Brimacombe, M., & Wagner, G. C. (2007). Prevalence of motor impairment in autism spectrum disorders. Brain and Development, 29(9), 565–570. doi: 10.1016/j.braindev.2007.03.002.PubMedCrossRefGoogle Scholar
  36. Minihan, P. M., Fitch, S. N., & Must, A. (2007). What does the epidemic of childhood obesity mean for children with special health care needs? Journal of Law, Medicine & Ethics, 35(1), 61–77.CrossRefGoogle Scholar
  37. Mullen, E. M. (1995). Mullen Scales of Early Learning. Circle Pines, MN: American Guidance Service Inc.Google Scholar
  38. Must, A., Phillips, S. M., & Naumova, E. N. (2012). Occurrence and timing of childhood overweight and mortality: Findings from the third Harvard growth study. The Journal of Pediatrics, 160(5), 743–750. doi: 10.1016/j.jpeds.2011.10.037.PubMedCentralPubMedCrossRefGoogle Scholar
  39. Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA, the Journal of the American Medical Association, 307(5), 483–490. doi: 10.1001/jama.2012.40.CrossRefGoogle Scholar
  40. Owens, J. A., Spirito, A., & McGuinn, M. (2000). The Children’s Sleep Habits Questionnaire (CSHQ): Psychometric properties of a survey instrument for school-aged children. Sleep, 23(8), 1043–1051.PubMedGoogle Scholar
  41. Pinhas-Hamiel, O., Dolan, L. M., Daniels, S. R., Standiford, D., Khoury, P. R., & Zeitler, P. (1996). Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. The Journal of Pediatrics, 128(5 Pt 1), 608–615.PubMedCrossRefGoogle Scholar
  42. Reynolds, A. M., & Malow, B. A. (2011). Sleep and autism spectrum disorders. Pediatric Clinics of North America, 58(3), 685–698. doi: 10.1016/j.pcl.2011.03.009.PubMedCrossRefGoogle Scholar
  43. Richdale, A. L. (1999). Sleep problems in autism: Prevalence, cause, and intervention. Developmental Medicine and Child Neurology, 41(1), 60–66.PubMedCrossRefGoogle Scholar
  44. Rimmer, J. H., Yamaki, K., Lowry, B. M. D., Wang, E., & Vogel, L. C. (2010). Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities. Journal of Intellectual Disability Research, 54(9), 787–794. doi: 10.1111/j.1365-2788.2010.01305.x.PubMedCrossRefGoogle Scholar
  45. Roid, G. (2003). Stanford Binet Intelligence Scales (5th ed.). Itasca, IL: Riverside Publishing.Google Scholar
  46. Schreck, K. A., Mulick, J. A., & Smith, A. F. (2004). Sleep problems as possible predictors of intensified symptoms of autism. Research in Developmental Disabilities, 25(1), 57–66.PubMedCrossRefGoogle Scholar
  47. Sjoberg, R. L., Nilsson, K. W., & Leppert, J. (2005). Obesity, shame, and depression in school-aged children: A population-based study. Pediatrics, 116(3), e389–e392. doi: 10.1542/peds.2005-0170.PubMedCrossRefGoogle Scholar
  48. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales: Second edition (Vineland II) survey interview form/caregiver rating form. Livonia, MN: Pearson Assessments.Google Scholar
  49. Taylor, E. D., Theim, K. R., Mirch, M. C., Ghorbani, S., Tanofsky-Kraff, M., Adler-Wailes, D., et al. (2006). Orthopedic complications of overweight in children and adolescents. Pediatrics, 117(6), 2167–2174. doi: 10.1542/peds.2005-1832.PubMedCentralPubMedCrossRefGoogle Scholar
  50. Unger, R., Kreeger, L., & Christoffel, K. K. (1990). Childhood obesity. Medical and familial correlates and age of onset. Clinical Pediatrics, 29(7), 368–373.PubMedCrossRefGoogle Scholar
  51. van Dam, R. M., Willett, W. C., Manson, J. E., & Hu, F. B. (2006). The relationship between overweight in adolescence and premature death in women. Annals of Internal Medicine, 145(2), 91–97.PubMedCrossRefGoogle Scholar
  52. Verhulst, S. L., Schrauwen, N., Haentjens, D., Suys, B., Rooman, R. P., Van Gaal, L., et al. (2007). Sleep-disordered breathing in overweight and obese children and adolescents: Prevalence, characteristics and the role of fat distribution. Archives of Disease in Childhood, 92(3), 205–208. doi: 10.1136/adc.2006.101089.PubMedCentralPubMedCrossRefGoogle Scholar
  53. Wardle, J., & Cooke, L. (2005). The impact of obesity on psychological well-being. Best Practice & Research Clinical Endocrinology & Metabolism, 19(3), 421–440. doi: 10.1016/j.beem.2005.04.006.CrossRefGoogle Scholar
  54. Wechsler, D. (2002). Wechsler Preschool and Primary Scale of Intelligence (3rd ed.). San Antonio, TX: Psychological Corporation.Google Scholar
  55. Williams, D. P., Going, S. B., Lohman, T. G., Harsha, D. W., Srinivasan, S. R., Webber, L. S., et al. (1992). Body fatness and risk for elevated blood pressure, total cholesterol, and serum lipoprotein ratios in children and adolescents. American Journal of Public Health, 82(3), 358–363.PubMedCentralPubMedCrossRefGoogle Scholar
  56. Windham, G. C., Anderson, M. C., Croen, L. A., Smith, K. S., Collins, J., & Grether, J. K. (2011). Birth prevalence of autism spectrum disorders in the San Francisco bay area by demographic and ascertainment source characteristics. Journal of Autism and Developmental Disorders, 41(10), 1362–1372. doi: 10.1007/s10803-010-1160-2.PubMedCrossRefGoogle Scholar
  57. Zimmer, M. H., Hart, L. C., Manning-Courtney, P., Murray, D. S., Bing, N. M., & Summer, S. (2012). Food variety as a predictor of nutritional status among children with autism. Journal of Autism and Developmental Disorders, 42(4), 549–556. doi: 10.1007/s10803-011-1268-z.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Katharine E. Zuckerman
    • 1
  • Alison P. Hill
    • 2
    • 4
  • Kimberly Guion
    • 3
    • 4
  • Lisa Voltolina
    • 4
    • 5
  • Eric Fombonne
    • 4
    • 6
  1. 1.Division of General Pediatrics and Child and Adolescent Health Measurement Initiative, Department of PediatricsOregon Health & Science UniversityPortlandUSA
  2. 2.Center for Spoken Language UnderstandingOregon Health & Science UniversityPortlandUSA
  3. 3.Division of Child PsychologyOregon Health & Science UniversityPortlandUSA
  4. 4.Institute of Development and DisabilityOregon Health & Science UniversityPortlandUSA
  5. 5.Department of Behavioral NeuroscienceOregon Health & Science UniversityPortlandUSA
  6. 6.Department of PsychiatryOregon Health & Science UniversityPortlandUSA

Personalised recommendations