1. Obesity in Adolescents with Autism Spectrum Disorders BRANDY STRAHAN, PHD, RN Assistant Professor

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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 99 th percentile for sex and age)

9. 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)

10. 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.

11. 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

12. 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

13. 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

14. 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

15. Limitations of Reviewed Studies Standardized measures Multiple points of comparison Longitudinal studies since maintaining weight loss is much more challenging

16. 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

17. Unique Challenges of ASD Food selectivity Schedule rigidity Social impairments Problematic features versus health behaviors and weight gain Motor impairment

18. 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.

19. 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.