Journal of Autism and Developmental Disorders

, Volume 48, Issue 7, pp 2408–2417 | Cite as

Prevention and Management of Obesity in Children with Autism Spectrum Disorder Among Primary Care Pediatricians

  • Morgan Walls
  • Sarabeth Broder-Fingert
  • Emily Feinberg
  • Mari-Lynn Drainoni
  • Megan Bair-Merritt
Original Paper


Children with autism spectrum disorder (ASD) are at high risk for being overweight and obese. Little is known about how obesity in children with ASD is being addressed in primary care. This article reports findings from a survey completed by 327 general pediatricians, which included a fictional clinical vignette and Likert-scales assessing attitudes, practices, self-efficacy, and barriers to obesity management. Although the majority of respondents agreed pediatricians should be the main providers to manage obesity in children with ASD, few reported receiving adequate training to do so. Pediatricians were more likely to refer to developmental-behavioral pediatricians and dietitians for a child with ASD compared to a child without ASD. Higher self-efficacy was associated with increased weight-related counseling frequency by pediatricians.


Autism spectrum disorder Obesity Overweight Weight management Primary care 


Author Contributions

MW conceived of the study, participated in its design, interpreted the data and drafted the manuscript; SB assisted in the conception of the study, study design and revision of the manuscript; EF participated in the study design, interpretation of the data and revision of the manuscript; MD participated in the design of the study, interpretation of the data and revision of the manuscript; MB assisted in the conception of the study, study design, interpretation of the data and revision of the manuscript. All authors read and approved the final manuscript.


Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH) under Award Number R25DK096944, and the Academic Pediatric Association (APA). The content is solely the responsibility of the authors, and does not necessarily represent the official views of NIH or the APA. Morgan Walls previously reported the findings of this study in May 2017 as part of her oral Master’s thesis. The findings were submitted as part of her written Master’s thesis; however, the thesis has been embargoed from access until October 2019.

The authors have no financial relationships relevant to this article to disclose.

Compliance with Ethical Standards

Conflict of Interest

The authors have no conflicts of interest relevant to this article to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10803_2018_3494_MOESM1_ESM.docx (136 kb)
Supplementary material 1 (DOCX 135 KB)


  1. Allen, S. G., Berry, A. D., Brewster, J. A., Chalasani, R. K., & Mack, P. K. (2010). Enhancing developmentally oriented primary care: An Illinois initiative to increase developmental screening in medical homes. Pediatrics, 126(Suppl 3), S160-164. Scholar
  2. Broder-Fingert, S., Brazauskas, K., Lindgren, K., Iannuzzi, D., & Van Cleave, J. (2014). Prevalence of overweight and obesity in a large clinical sample of children with autism. Academic Pediatrics, 14(4), 408–414. Scholar
  3. Broder-Fingert, S., Ferrone, C. F., Giauque, A., & Connors, S. L. (2014). Residents’ knowledge and comfort with caring for children with autism spectrum disorder. Clinical Pediatrics, 53(14), 1390–1392. Scholar
  4. Chassiakos, Y. R., Radesky, J., Christakis, D., Moreno, M. A., Cross, C., Media, C. & Council on Communications and Media (2016). Children and adolescents and digital media. Pediatrics, 138(5), e20162593. Scholar
  5. Cho, Y. I., Johnson, T. P., & VanGeest, J. B. (2013). Enhancing surveys of health care professionals: A meta-analysis of techniques to improve response. Evaluation & the Health Professions, 36(3), 382–407. Scholar
  6. 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(1), 11. Scholar
  7. Curtin, C., Jojic, M., & Bandini, L. G. (2014). Obesity in children with autism spectrum disorder. Harvard Review of Psychiatry, 22(2), 93–103. Scholar
  8. Daniels, S. R., Hassink, S. G., & Nutrition, C. O. (2015). The role of the pediatrician in primary prevention of obesity. Pediatrics, 136(1), e275–e292. Scholar
  9. de Vries, H., Dijkstra, M., & Kuhlman, P. (1988). Self-efficacy: the third factor besides attitude and subjective norm as a predictor of behavioural intentions. Health Education Research, 3(3), 273–282. Scholar
  10. Eagle, T. F., Sheetz, A., Gurm, R., Woodward, A. C., Kline-Rogers, E., Leibowitz, R., … Eagle, K. A. (2012). Understanding childhood obesity in America: Linkages between household income, community resources, and children’s behaviors. American Heart Journal, 163(5), 836–843. Scholar
  11. Evans, E. W., Must, A., Anderson, S. E., Curtin, C., Scampini, R., Maslin, M., & Bandini, L. (2012). Dietary patterns and body mass index in children with autism and typically developing children. Research in Autism Spectrum Disorders, 6(1), 399–405. Scholar
  12. Golnik, A., Ireland, M., & Borowsky, I. W. (2009). Medical homes for children with autism: A physician survey. Pediatrics, 123(3), 966–971. Scholar
  13. Hill, A. P., Zuckerman, K. E., & Fombonne, E. (2015). Obesity and autism. Pediatrics, 136(6), 1051–1061. Scholar
  14. Jain, A., Sherman, S. N., Chamberlin, L. A., Carter, Y., Powers, S. W., & Whitaker, R. C. (2001). Why don’t low-income mothers worry about their preschoolers being overweight? Pediatrics, 107(5), 1138–1146.CrossRefPubMedGoogle Scholar
  15. Kolagotla, L., & Adams, W. (2004). Ambulatory management of childhood obesity. Obesity Research, 12(2), 275–283. Scholar
  16. Larson, K., Cull, W. L., Racine, A. D., & Olson, L. M. (2016). Trends in access to Health Care Services for US Children: 2000–2014. Pediatrics, 138(6).
  17. Lee, A., Lang, R., Davenport, K., Moore, M., Rispoli, M., van der Meer, L., … Chung, C. (2015). Comparison of therapist implemented and iPad-assisted interventions for children with autism. Developmental Neurorehabilitation, 18(2), 97–103. Scholar
  18. Liao, Y., Liao, J., Durand, C. P., & Dunton, G. F. (2014). Which type of sedentary behaviour intervention is more effective at reducing body mass index in children? A meta-analytic review. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 15(3), 159–168. Scholar
  19. Liptak, G. S., Stuart, T., & Auinger, P. (2006). Health care utilization and expenditures for children with autism: Data from U.S. National Samples. Journal of Autism and Developmental Disorders, 36(7), 871–879. Scholar
  20. Lowenstein, L. M., Perrin, E. M., Campbell, M. K., Tate, D. F., Cai, J., & Ammerman, A. S. (2013). Primary care providers’ self-efficacy and outcome expectations for childhood obesity counseling. Childhood Obesity, 9(3), 208–215. Scholar
  21. Mazurek, M. O., Brown, R., Curran, A., & Sohl, K. (2017). ECHO autism: A new model for training primary care providers in best-practice care for children with autism. Clinical Pediatrics, 56(3), 247–256. Scholar
  22. Mazurek, M. O., & Wenstrup, C. (2013). Television, video game and social media use among children with ASD and typically developing siblings. Journal of Autism and Developmental Disorders, 43(6), 1258–1271. Scholar
  23. Must, A., Phillips, S., Curtin, C., & Bandini, L. G. (2015). Barriers to physical activity in children with autism spectrum disorders: Relationship to physical activity and screen time. Journal of Physical Activity & Health, 12(4), 529–534. Scholar
  24. Myers, S. M., & Johnson, C. P. (2007). Management of children with autism spectrum disorders. Pediatrics, 120(5), 1162–1182. Scholar
  25. Nadon, G., Feldman, D. E., Dunn, W., & Gisel, E. (2011). Mealtime problems in children with autism spectrum disorder and their typically developing siblings: A comparison study. Autism: The International Journal of Research and Practice, 15(1), 98–113. Scholar
  26. O’Connor, E. A., Evans, C. V., Burda, B. U., Walsh, E. S., Eder, M., & Lozano, P. (2017). Screening for obesity and intervention for weight management in children and adolescents: Evidence report and systematic review for the US preventive services task force. JAMA, 317(23), 2427–2444. Scholar
  27. Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the united states, 2011–2012. JAMA, 311(8), 806–814. Scholar
  28. Pagnini, D. L., Wilkenfeld, R. L., King, L. A., Booth, M. L., & Booth, S. L. (2007). Mothers of pre-school children talk about childhood overweight and obesity: The weight of opinion study. Journal of Paediatrics and Child Health, 43(12), 806–810. Scholar
  29. Peabody, J. W., Luck, J., Glassman, P., Dresselhaus, T. R., & Lee, M. (2000). Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA, 283(13), 1715–1722.CrossRefPubMedGoogle Scholar
  30. Perrin, E. M., Flower, K. B., Garrett, J., & Ammerman, A. S. (2005). Preventing and treating obesity: Pediatricians’ self-efficacy, barriers, resources, and advocacy. Ambulatory Pediatrics: The Official Journal of the Ambulatory Pediatric Association, 5(3), 150–156. Scholar
  31. Phillips, K. L., Schieve, L. A., Visser, S., Boulet, S., Sharma, A. J., Kogan, M. D., … Yeargin-Allsopp, M. (2014). Prevalence and impact of unhealthy weight in a national sample of US adolescents with autism and other learning and behavioral disabilities. Maternal and Child Health Journal, 18(8), 1964–1975. Scholar
  32. Polfuss, M., Johnson, N., Bonis, S. A., Hovis, S. L., Apollon, F., & Sawin, K. J. (2016). Autism spectrum disorder and the child’s weight–related behaviors: A parents’ perspective. Journal of Pediatric Nursing, 31(6), 598–607. Scholar
  33. Resnicow, K., McMaster, F., Bocian, A., Harris, D., Zhou, Y., Snetselaar, L., … Wasserman, R. C. (2015). Motivational interviewing and dietary counseling for obesity in primary care: An RCT. Pediatrics, 135(4), 649–657. Scholar
  34. Schellart, A. J. M., Zwerver, F., Anema, J. R., & van der Beek, A. J. (2013). Relationships between the intention to use guidelines, behaviour of insurance physicians and their determinants. BMC Health Services Research, 13, 400. Scholar
  35. Story, M. T., Neumark-Stzainer, D. R., Sherwood, N. E., Holt, K., Sofka, D., Trowbridge, F. L., & Barlow, S. E. (2002). Management of child and adolescent obesity: Attitudes, barriers, skills, and training needs among health care professionals. Pediatrics, 110(Supplement 1), 210–214.PubMedGoogle Scholar
  36. Taveras, E. M., Marshall, R., Sharifi, M., Avalon, E., Fiechtner, L., Horan, C., … Slater, D. (2017). Comparative effectiveness of clinical-community childhood obesity interventions: A randomized clinical trial. JAMA Pediatrics, 171(8), e171325. Scholar
  37. US Preventive Services Task Force, Grossman, D. C., Bibbins-Domingo, K., Curry, S. J., Barry, M. J., Davidson, K. W., … Tseng, C.-W. (2017). Screening for obesity in children and adolescents: US Preventive Services Task Force Recommendation Statement. JAMA, 317(23), 2417–2426. Scholar
  38. van Es, S. M., Nagelkerke, A. F., Colland, V. T., Scholten, R. J. P. M., & Bouter, L. M. (2001). An intervention programme using the ASE-model aimed at enhancing adherence in adolescents with asthma. Patient Education and Counseling, 44(3), 193–203. Scholar
  39. Welsh, J. A., Nelson, J. M., Walsh, S., Sealer, H., Palmer, W., & Vos, M. B. (2015). Brief training in patient-centered counseling for healthy weight management increases counseling self-efficacy and goal setting among pediatric primary care providers: results of a pilot program. Clinical Pediatrics, 54(5), 425–429. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PediatricsBoston University School of Medicine, Boston Medical CenterBostonUSA
  2. 2.Department of PediatricsCarolinas Healthcare SystemCharlotteUSA
  3. 3.Department of PediatricsBoston University School of MedicineBostonUSA
  4. 4.Department of Community Health SciencesBoston University School of Public HealthBostonUSA
  5. 5.Department of Health Law, Policy and ManagementBostonUSA
  6. 6.Department of MedicineBoston University School of MedicineBostonUSA

Personalised recommendations