Andrea Heyman, MS, RD, LDN

Andrea Heyman, MS, RD, LDN

Understand overweight and obesity classification Understand basic trends in overweight and obesity prevalence Understand risks of overweight and obesity Understand factors attributing to overweight and obesity in children wit ASD Understand process for improving nutritional status of children with ASD and overweight or obesity

Expected Growth Proportionality BMI percentile BMI= weight (kilograms) height (meters 2 ) Plotted on percentile chart

Category Underweight Healthy weight Overweight Obese BMI Percentile Range <5 th 5 th -<85 th 85 th -<95 th 95 th

Year %Overweight 6-11Year Olds 1963-l970 4% 1976-1980 7% 1988-1994 11% 1999 12% Troiano, R and Flegal, KM, Overweight children and adolescents: Description, epidemiology, and demographics. Pediatrics 1998; 101(3): 497-504

BMI percentile % 2-19 Year Olds 85 th percentile 32% 95 th percentile 17% Data from NHANES 2009-2010

Study Curtin, et. al, 2010 National Survey of Children s Health Egan, et. al, 2013 Retrospective chart reviews Prevalence 30.4%obese 39.0%overweight & obese 21.9% obese Hill, et. al, 2015 51.6%overweight & obese 18.0% obese differences present 2-5 years of age

Food selectivity and nutrition quality of diet Mobility limitations & decreased activity Medications that increase appetite Difficulties in regulating appetite and processing satiety Parents may be over-permissive with food US lifestyle

Curtin, et. al, 2014 children with food selectivity (often energy dense foods within food groups) Evans, et. al, 2012 children with ASD do not consume adequate F&V and is associated with obesity Children with ASD are more often described as picky eaters and have aversions to specific textures, colors, smells, temperatures and brand names of foods 50-90% of children with ASD have food problems

Motor-skill difficulties (unevenness of aquiring developmental milestones, low muscle tone, postural instability) May affect endurance, balance, motor planning May result in exclusion from activity, reduced motivation Social skill & communicative difficulties

Children with special needs may have fewer opportunities for physical activity because of a need for constant supervision or for adaptive equipment Parents report children with ASD participate in fewer types of activities Physical activity declines with age in children with ASD Parents may not feel comfortable allowing their child to be physically active on their own

30-60% of children with ASD use one or more psychotropic medication Anticonvulsant medications: Depakene Anti-inflammatory medications: Prednisone, Naprosyn, Tolectin Antidepressant/antipsychotic medications: Aripiprazole, Melloril, Valium, Zyprexa, Seroquel, Risperdol, Clozapine Antihistamine: Periactin Hormones: Birth control pills, Depoprovera, Megace, growth hormone Stimulants: may suppress appetite, then leave child overly hungry when effect dissipates

No research findings exploring the relationship between appetite regulation and ASD Anecdotally, this appears to be common in children with ASD

Parents may try to compensate for their child for his/her medical diagnosis by allowing them whatever they want to eat Parents may be confused about how and when to set limits for a child with ASD

Sedentary lifestyle Children with ASD spend more time on screen media Children with ASD start using screen media at a younger age Labor saving devices Media messages, food advertisements On the go, fast paced lifestyle Convenience

Bullying, teasing Research on Health Related Quality of Life and children with developmental disabilities has shown progressive decreases in quality of life scores as BMI s rise. Coronary artery disease Type II diabetes High blood pressure High cholesterol and high triglyceride levels Stroke Obstructive sleep apnea Osteoarthrisis

Early pubertal age Asthma Cancer Suffer from negative societal bias Overweight children and adolescents are more likely to become overweight or obese adults

Barlow, 2007 AAP publication proving guidelines for preventing and treating overweight and obesity for children No recommendations for children with ASD Adaptations to existing programs Enhance accessibility Inclusivity engagement

Parent-child feeding relationship Set a good example Serve meals and snacks at regular times No short order cook Behavior modifications to address barriers to specific behaviors Additional resources to manage eating patters and develop interest to participate in physical activity

Develop inclusive physical activity programs that are meaningful to maximize participation by children with ASD Nutrition concepts may be abstract and adapted curricula may be needed to apply in real world contexts

Adaptive sports programs Community gardens Special Olympics

Early intervention Additional resources/programs Nutritionist Feeding program Physical activity Behavior therapist Involve entire family Establish new behaviors Make new behaviors attainable

BMI percentile screening Promote diet rich in fruits and vegetables Limit consumption of sugar sweetened beverages Limit screen time to 2 hours daily Promote moderate to vigorous physical activity Promote diet rich in low fat dairy, whole grains and lean protein Encourage consumption of age appropriate food portion sizes Regular meals and snack consumption (including breakfast)

Balance Variety Moderation Changing nutrient needs based on age/developmental stage

EH is a 12 year 2 month old male with history of ASD, PDD, sleep disturbance, anxiety disorder. He is a selective eater who rarely eats vegetables or fruits, consumes juice and soda (no water), spends his free time on his tablet, family relies on fast food several times per week. BMI is at the 99 th percentile for age and gender. What interventions can we try at the family, school and community levels?