Maternal and Child Health Journal

, Volume 18, Issue 8, pp 1964–1975

Prevalence and Impact of Unhealthy Weight in a National Sample of US Adolescents with Autism and Other Learning and Behavioral Disabilities

  • Keydra L. Phillips
  • Laura A. Schieve
  • Susanna Visser
  • Sheree Boulet
  • Andrea J. Sharma
  • Michael D. Kogan
  • Coleen A. Boyle
  • Marshalyn Yeargin-Allsopp


We estimated the prevalence of obesity, overweight, and underweight among US adolescents with and without autism and other learning and behavioral developmental disabilities (DDs) and assessed the health consequences of obesity among adolescents with DDs. From the 2008 to 2010 National Health Interview Survey, we selected 9,619 adolescents ages 12–17 years. Parent respondents reported weight, height, presence of DDs and health conditions. We calculated body mass index (BMI) and defined obesity, overweight, and underweight as ≥95th, ≥85th to <95th, and <5th percentiles, respectively, using established criteria. We created mutually-exclusive DD subgroups using the following order of precedence: autism; intellectual disability; attention-deficit-hyperactivity-disorder; learning disorder/other developmental delay. We compared BMI outcomes among adolescents in each DD group versus adolescents without DDs using multivariable logistic regression. Socio-demographic factors and birthweight were included as confounders. Estimates were weighted to reflect the US population. Both obesity and underweight prevalences were higher among adolescents with than without DDs [adjusted prevalence ratios (aPR) 1.5 (1.25–1.75) and 1.5 (1.01–2.20), respectively]. Obesity was elevated among adolescents with all DD types, and was highest among the autism subgroup [aPR 2.1 (1.44–3.16)]. Adolescents with either a DD or obesity had higher prevalences of common respiratory, gastrointestinal, dermatological and neurological conditions/symptoms than nonobese adolescents without DDs. Adolescents with both DDs and obesity had the highest estimates for most conditions. Obesity is high among adolescents with autism and other DDs and poses added chronic health risks. Obesity prevention and management approaches for this vulnerable population subgroup need further consideration.


Obesity Overweight Underweight Developmental disability Children Concurrent medical conditions Autism 


  1. 1.
    Singh, G. K., & Kogan, M. D. (2010). Childhood obesity in the United States, 19762008: Trends and current racial/ethnic, socioeconomic, and geographic disparities (pp. 1–8). A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, MD: U.S. Department of Health and Human Services.Google Scholar
  2. 2.
    Bandini, L. G., Curtin, C., Hamad, C., Tybor, D. J., & Must, A. (2005). Prevalence of overweight in children with developmental disorders in the continuous national health and nutrition examination survey (NHANES) 1999–2002. The Journal of Pediatrics, 146, 738–743.PubMedCrossRefGoogle Scholar
  3. 3.
    Chen, A. Y., Kim, S. E., Houtrow, A. J., & Newacheck, P. W. (2009). Prevalence of obesity among children with chronic conditions. Obesity, 18, 210–213.PubMedCrossRefGoogle Scholar
  4. 4.
    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, 48–54.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    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, 11–15.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Rimmer, J., Yamaki, K., Davis, B., 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.PubMedCrossRefGoogle Scholar
  7. 7.
    Van Cleave, J., Gortmaker, S. L., & Perrin, J. M. (2010). Dynamics of obesity and chronic health conditions among children and youth. JAMA, 303(7), 623–630.PubMedCrossRefGoogle Scholar
  8. 8.
    Yamaki, K., Rimmer, J., Lowry, B. M., & Vogel, L. C. (2011). Prevalence of obesity-related chronic health conditions in overweight adolescents with disabilities. Research in Developmental Disabilities, 32, 280–288.PubMedCrossRefGoogle Scholar
  9. 9.
    Fryar, C. D., & Ogden, C. L. (2012). Prevalence of underweight among children and adolescents aged 2–19 years: United States, 1963–1965 through 2007–2010. Division of Health and Nutrition Examination Surveys. Health E-Stat (pp. 1–3).Google Scholar
  10. 10.
    Centers for Disease Control and Prevention. (2013). Division of Health Interview Statistics NCHS. National Health Interview Survey (NHIS) public use data release: NHIS survey description. National Center for Health Statistics. Accessed October 30, 2013.
  11. 11.
    Bloom, B., Cohen, R. A., & Freeman, G. (2009). Summary health statistics for U.S. children: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Statistics, 10(244), 1–81.Google Scholar
  12. 12.
    Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., et al. (2002). 2000 CDC growth charts for the United States: Methods and development. Vital Health Statistics, 11, 1–190.Google Scholar
  13. 13.
    Ogden, C. L., Kuczmarski, R. J., Flegal, K. M., Mei, Z., Guo, S., Wei, R., et al. (2002). Centers for Disease Control and Prevention 2000 growth charts for the United States: Improvements to the 1977 National Center for Health Statistics version. Pediatrics, 109, 45–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Bloom, B., Cohen, R. A., & Freeman, G. (2010). Summary health statistics for U.S. children: National Health Interview Survey, 2009. National Center for Health Statistics. Vital Health Statistics, 10(247), 1–82.Google Scholar
  15. 15.
    Bloom, B., Cohen, R. A., & Freeman, G. (2011). Summary health statistics for U.S. children: National Health Interview Survey, 2010. National Center for Health Statistics. Vital Health Statistics, 10(250), 1–80.Google Scholar
  16. 16.
    Centers for Disease Control and Prevention. (2013). Basics about childhood obesity. Accessed October 30, 2013.
  17. 17.
    Daniels, S. R. (2006). The consequences of childhood overweight and obesity. The Future of Children, 16, 47–67.PubMedCrossRefGoogle Scholar
  18. 18.
    Daniels, S. R., Jacobson, M. S., McCrindle, B. W., Eckel, R. H., & Sanner, B. M. (2009). American Heart Association childhood obesity research summit report. Circulation, 119, e489–e517.PubMedCrossRefGoogle Scholar
  19. 19.
    Dietz, W. H., & Robinson, T. N. (1993). Assessment and treatment of childhood obesity. Pediatrics in Review, 14, 337–343.PubMedCrossRefGoogle Scholar
  20. 20.
    Dietz, W. H. (1998). Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics, 101(Suppl), 518–525.PubMedGoogle Scholar
  21. 21.
    Freedman, D. S., Mei, Z., Srinivasan, S. R., Berenson, G. S., & Dietz, W. H. (2007). Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. The Journal of Pediatrics, 150(1), 12–17.PubMedCrossRefGoogle Scholar
  22. 22.
    Han, J. C., Lawlor, D. A., & Kimm, S. Y. (2010). Childhood obesity. Lancet, 375(9727), 1737–1748.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Sutherland, E. R. (2008). Obesity and asthma. Immunology and Allergy Clinics of North America, 28(3), 589–602.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Swartz, M. B., & Puhl, R. (2003). Childhood obesity: A societal problem to solve. Obesity Reviews, 4(1), 57–71.CrossRefGoogle Scholar
  25. 25.
    Taylor, E. D., Theim, K. R., Mirch, M. C., Ghorbani, S., Tanofsky-Kraff, M., Adler-Wailes, D. C., et al. (2006). Orthopedic complications of overweight in children and adolescents. Pediatrics, 117(6), 2167–2174.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Whitlock, E. P., Williams, S. B., Gold, R., Smith, P. R., & Shipman, S. A. (2005). Screening and interventions for childhood overweight: A summary of evidence for the US Preventive Services Task Force. Pediatrics, 116(1), e125–e144.PubMedCrossRefGoogle Scholar
  27. 27.
    Schieve, L. A., Gonzalez, V., Boulet, S. L., Visser, S. N., Ric, C. E., Braun, K. V., et al. (2012). Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006–2010. Research in Developmental Disabilities, 33(2), 467–476.PubMedCrossRefGoogle Scholar
  28. 28.
    Bieler, G. S., Brown, G. G., Williams, R. L., & Brogan, D. J. (2010). Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data. American Journal of Epidemiology, 171(5), 618–623.PubMedCrossRefGoogle Scholar
  29. 29.
    Schreck, K. A., Williams, K., & Smith, A. F. (2004). A comparison of eating behaviors between children with and without autism. Journal of Autism and Developmental Disorders, 34(4), 433–438.PubMedCrossRefGoogle Scholar
  30. 30.
    Schreck, K. A., & Williams, K. (2006). Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Research in Developmental Disabilities, 27, 353–363.PubMedCrossRefGoogle Scholar
  31. 31.
    Yamaki, K., & Fujiura, G. T. (2002). Employment and income status of adults with developmental disabilities living in the community. Mental Retardation, 40(2), 132–141.PubMedCrossRefGoogle Scholar
  32. 32.
    Rurangirwa, J., Van Naarden Braun, K., Schendel, D., & Yeargin-Allsopp, M. (2006). Healthy behaviors and lifestyles in young adults with a history of developmental disabilities. Research in Developmental Disabilities, 27(4), 381–399.PubMedCrossRefGoogle Scholar
  33. 33.
    MacDonald, M., Esposito, P., & Ulrich, D. (2011). The physical activity patterns of children with autism. BMC Research Notes, 4, 422–426.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Weeden, M., Ehrhardt, K., & Poling, A. (2010). Psychotropic drug treatments for people with autism and other developmental disorders: A primer for practicing behavior analysts. Behavior Analysis in Practice, 3(1), 4–12.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Doyle, C. A., & McDougle, C. J. (2012). Pharmacologic treatments for the behavioral symptoms associated with autism spectrum disorders across the lifespan. Dialogues in Clinical Neuroscience, 14(3), 263–279.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Rimmer, J. H., & Yamaki, Y. (2006). Obesity and intellectual disability. Mental Retardation and Developmental Disabilities Research Reviews, 12, 22–27.PubMedCrossRefGoogle Scholar
  37. 37.
    Reinehr, T., Dobe, M., Winkel, K., Schaefer, A., & Hoffmann, D. (2010). Obesity in disabled children and adolescents. An overlooked group of patients. Deutsches Ärzteblatt International, 107(15), 268–275.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Rurangirwa, J., Van Naarden Braun, K., Schendel, D., & Yeargin-Allsopp, M. (2006). Healthy behaviors and lifestyles in young adults with a history of developmental disabilities. Research in Developmental Disabilities, 27(4), 381–399.PubMedCrossRefGoogle Scholar
  39. 39.
    Waring, M. E., & Lapane, K. L. (2008). Overweight in children and adolescents in relation to attention-deficit/hyperactivity disorder: Results from a national sample. Pediatrics, 122(1), e1–e6.PubMedCrossRefGoogle Scholar
  40. 40.
    Kim, J., Mutyala, B., Agiovlasitis, S., & Fernhall, B. (2011). Health behaviors and obesity among US children with attention deficit hyperactivity disorder by gender and medication use. Preventive Medicine, 52(3–4), 218–222.PubMedGoogle Scholar
  41. 41.
    Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M., & Flegal, K. M. (2010). Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA, 303(3), 242–249.PubMedCrossRefGoogle Scholar
  42. 42.
    Ogden, C. L., Flegal, K. M., Carroll, M. D., & Johnson, C. L. (2002). Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA, 288, 1728–1732.PubMedCrossRefGoogle Scholar
  43. 43.
    Hedley, A. A., Ogden, C. L., Johnson, C. L., Carroll, M. D., Curtin, L. R., & Flegal, K. M. (2004). Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA, 291, 2847–2850.PubMedCrossRefGoogle Scholar
  44. 44.
    Akinbami, L. J., & Ogden, C. L. (2009). Childhood overweight prevalence in the United States: The impact of parent-reported height and weight. Obesity (Silver Spring), 17(8), 1574–1580.CrossRefGoogle Scholar
  45. 45.
    Yu, Z. B., Han, S. P., Zhu, G. Z., Zhu, C., Wan, X. J., Cao, X. G., et al. (2011). Birth weight and subsequent risk of obesity: A systematic review and meta-analysis. Obesity Reviews, 12(7), 525–542.PubMedCrossRefGoogle Scholar
  46. 46.
    Gilliland, F. D., Berhane, K., Islam, T., McConnell, R., Gauderman, W. J., Gilliland, S. S., et al. (2003). Obesity and the risk of newly diagnosed asthma in schoolage children. American Journal of Epidemiology, 158, 406–415.PubMedCrossRefGoogle Scholar
  47. 47.
    Gold, D. R., Damokosh, A. I., Dockery, D. W., & Berkey, C. S. (2003). Body-mass index as a predictor of incident asthma in a prospective cohort of children. Pediatric Pulmonology, 36(6), 514–521.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Keydra L. Phillips
    • 1
  • Laura A. Schieve
    • 1
  • Susanna Visser
    • 1
  • Sheree Boulet
    • 1
  • Andrea J. Sharma
    • 2
  • Michael D. Kogan
    • 3
  • Coleen A. Boyle
    • 1
  • Marshalyn Yeargin-Allsopp
    • 1
  1. 1.National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaUSA
  2. 2.National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Maternal and Child Health BureauHealth Resources and Services AdministrationRockvilleUSA

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