Prevention and Management of Obesity in Children with Autism Spectrum Disorder Among Primary Care Pediatricians
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.
KeywordsAutism spectrum disorder Obesity Overweight Weight management Primary care
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.
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.
- 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. https://doi.org/10.1542/peds.2010-1466K.Google Scholar
- 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. https://doi.org/10.1186/1471-2431-10-11.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1016/j.ahj.2012.02.025.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.rasd.2011.06.014.CrossRefPubMedPubMedCentralGoogle Scholar
- 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). https://doi.org/10.1542/peds.2016-2176.
- 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. https://doi.org/10.3109/17518423.2013.830231.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1111/obr.12112.CrossRefGoogle Scholar
- 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. https://doi.org/10.1089/chi.2012.0119.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1123/jpah.2013-0271.CrossRefGoogle Scholar
- 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. https://doi.org/10.1177/1362361309348943.CrossRefGoogle Scholar
- 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. https://doi.org/10.1001/jama.2017.0332.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1111/j.1440-1754.2007.01199.x.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1367/A04-104R.1.CrossRefGoogle Scholar
- 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. https://doi.org/10.1007/s10995-014-1442-y.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1542/peds.2014-1880.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1186/1472-6963-13-400.CrossRefPubMedPubMedCentralGoogle Scholar
- 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
- 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. https://doi.org/10.1001/jamapediatrics.2017.1325.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1001/jama.2017.6803.CrossRefGoogle Scholar
- 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. https://doi.org/10.1016/S0738-3991(00)00195-6.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1177/0009922814553432.CrossRefPubMedGoogle Scholar