Obesity in Adolescents with Autism Spectrum Disorders

BRANDY STRAHAN, PHD, RNAssistant Professor

Introduction• Adolescent obesity has tripled in the

past three decades.• Contributes to serious health problems• Centers for Disease Control and

Prevention (CDC) defines obesity as:• 70% remain obese through adulthood• Vulnerability of children with

developmental disabilities such as ASD

Purpose• Provide a general background related to

obesity in adolescence with specific emphasis on obesity in the ASD population

• Illustrate in a case study the special challenges related to treating an obese adolescent with ASD

• Describe current interventions to address obesity in typically developing (TD) adolescents and discuss how these interventions could be used with adolescents with ASD

• Discuss suggestions for future research regarding the prevention and reduction of obesity in this vulnerable population

Obesity in TD Adolescents• Predominant health crisis in

America’s youth• Life expectancy rates • National Health and Nutrition

Examination Survey (NHANES)• Development of comorbidities• Complications magnified in

adolescents with ASD

Obesity in Adolescents with ASD • Autism – developmental disorder

under broad category of ASD• Hallmark characteristics include

impairments in the following areas:• Social interaction• Communication• Behavior control• Typically appear prior to age 3

Obesity in Adolescents with ASD • No cure• Treatment options may help with

day-to-day functioning• Caregivers focus on problematic

features• Less concern for adverse health

behaviors and weight, physical activity and eating patterns, and over consumption of junk food

Obesity in Adolescents with ASD • May not encourage exercise due to

motor impairments such as:• Poor motor skills• Uneven developmental

milestone acquisition• Low muscle tone• Postural instability

• Obesity in ASD population is 30.4% compared to 23.6% in TD adolescents.

• Important to understand unique challenges of adolescents

Case Study• Henry (pseudonym) is a 14 year-

old Caucasian adolescent diagnosed with ASD and is obese.

• Height – 69 inches• Weight – 247 lbs.• Tanner Stage IV• BMI – 36.5 (above 99th percentile

for sex and age)

Case Study• Attends public school with a daily

physical education class (PE, 30 minutes)

• No other active recreational activities

• Trouble performing skills necessary to successfully participate in class activities

• Watches television at home• No other playmates except

parents and younger brother (10 year old with ASD and is obese)

Case Study• Diet:• Variety of fruits and vegetables• Relies on favorites – chicken nuggets

and hot dogs• Parents offer lean proteins and complex

carbohydrates• New foods are refused• Exposure to new foods incites a tantrum

causing Henry to leave the table• Parents must choose-unhealthy,

uneventful dinner or healthy dinner accompanied by an argument and tantrum.

Case Study• Inactivity not the only contributor to

weight• Prescribed medication of Risperdal • Antipsychotic• Treats common features such as

aggression and mood swings• Side effect of weight gain

• Continual unhealthy weight gain• Parents encourage healthier food

choices and physical activity• No empirically based dietary/lifestyle

intervention for obese adolescents with ASD

• Potential to become obese adult with increased morbidity and mortality

Interventions for Obese Adolescents • Extensive body of literature on the

prevention and treatment of obesity in TD adolescents• Increased activity levels, reduced

television hours, and improved nutrition decrease obesity and improve health outcomes

• Mentoring adolescents in community and school based programs

• Nutrition and aerobic/strength training

• Active video gaming

Interventions for Obese Adolescents • All studies employed experimental

design with physical activity intervention aimed at:• Reducing weight or BMI• Decreasing the amount of weight

gained during the study• Decreasing body fat percentages

Interventions for Obese Adolescents • Randomized controlled trials

(RTCs, home or community based) used a variety of physical activity interventions:• Individual aerobic activity• Nutrition and strength training• Active video gaming• Group exercises• Activity combined with reduced

caloric intake and healthier choices

Limitations of Reviewed Studies • Standardized measures• Multiple points of comparison• Longitudinal studies since

maintaining weight loss is much more challenging

Implications of Future Research • Direct and adequate comparisons

are limited due to:• Wide range of methodologies• Various physical activities• Numerous physiological

measurements• Sample variety• Variation in study length• Confounding effects

Unique Challenges of ASD • Food selectivity• Schedule rigidity• Social impairments• Problematic features versus health

behaviors and weight gain• Motor impairment

Discussion• Findings represent a powerful way to

induce weight loss in obese adolescents with ASD.

• Active video gaming may be a solution since male adolescents with ASD spend 41% of free time playing video games.

• Combining community and home based interventions may prove to be the most promising avenue for research and long term effects.

• There exists a need for more research that accounts for unique challenges of adolescents with ASD and ensures success with this population.

Conclusion• Adolescent obesity is an epidemic.• Obesity present in adolescents

with developmental disabilities such as ASD.

• Parents, such as Henry’s, need to understand how to better manage the disorder as well as prevent further health related complications

• Research is needed that addressed the needs of this vulnerable population.