Effect of autism on overweight in children from a socio-ecological perspective

Although autism spectrum disorder (ASD) is known to be correlated with chronic physical conditions such as gastrointestinal disorders, musculoskeletal problems, and sensory processing disorders, a nationwide nonclinical sample of overweight children with ASD is limited. We aimed to use a large nationally representative non-clinical sample to explore the relationship between ASD and childhood adjusted for socio-ecological factors. This cross-sectional data analysis from the 2021 National Survey of Children’s Health was conducted with the modified ecological systems theory model as the guiding framework. A propensity-score matching analysis helped isolate the factors affecting the weight status (i.e., being overweight) in children with ASD, controlling demographic characteristics, physical activity habits, and familial and environmental circumstances. Among the 20,091 individuals (mean age, 13.77 years; girls, 48.59%; equivalent to 32,211,963 individuals in the general population) identified for this study, 1,348 individuals (mean age, 13.94 years; girls, 22.55%; representing 1,904,381 individuals from the general population) were examined in our final matched model to determine the link between ASD and being overweight in children. ASD had a statistically significant effect on being overweight. Notably, children with ASD and those with similar socio-ecological factors showed a higher risk of being overweight if they were Hispanic, had less healthy parents, or were involved in more structured activities (all p-values < .05). Our findings underscore a pronounced association between autistic children and being overweight. This underscores the necessity for careful attention towards preventing excessive weight gain and for tailored management in children who experience the neuropsychological difficulties associated with ASD.