Pre-teen (10-12) boy sitting at desk and eating salad

Healthy Weight Management for Youth on the Autism Spectrum: What We Know and How to Help

With obesity a growing epidemic in the United States, much attention has been placed on weight loss and healthy weight management. Unfortunately, research has shown that individuals with Autism Spectrum Disorder (ASD) are at an increased risk of struggling to maintain a healthy weight (Tyler, McDonald & Menear, 2014). As a result, such individuals are at an increased risk of developing serious health problems including diabetes, sleep apnea, asthma, and heart disease, in addition to social difficulties such as isolation, discrimination, and low self-esteem.

Shana Nichols, PhD

Shana Nichols, PhD

Danielle Zito, PsyD

Danielle Zito, PsyD

Get Moving and Eat Right: Risk Factors for Weight Issues

One major cause of weight-related issues in ASD is limited physical activity, compared to both suggested guidelines and that typical of their peers (Sorensen & Zarrett, 2014). Why do youth with ASD move less?

  • Motor skill difficulties are common for youth on the spectrum (McCody, Jakicic & Gibbs, 2016).
  • Appropriate interpersonal skills are required for successful participation in recreational physical activity with playmates and peers (Strahan & Elder, 2013).
  • Youth with ASD are more likely than typically-developing peers to engage in sedentary activities, such as watching television and playing video games.

Essentially, physical activity tends to be less rewarding and more challenging for children with ASD. Given what we know about what motivates all human behavior, it’s no surprise that playing a sport or turning off the computer does not generally appeal to many youth on the spectrum.

If these factors weren’t enough, individuals with ASD experience other barriers to maintaining a healthy weight. These include:

  • unusual or restricted diets (de Vinck-Baroody et al., 2015); studies have found that those with ASD often prefer low-nutrition, energy-dense foods (e.g., French fries, cake).
  • food related sensory challenges such as aversions or preferences for particular food textures, smells, colors, temperatures, or presentations (McCoy, Jakicic & Gibbs, 2016).
  • medical issues which are associated with weight gain such as genetic conditions, metabolic disorder, and gastrointestinal problems (de Vinck-Baroody et al., 2015).
  • weight gain side effects of psychotropic medications usually prescribed to individuals with ASD, such as atypical antipsychotics (Broder-Fingert et al., 2014).

2017 ASPIRE

What Can We Do? Tips for Parents and Professionals

Although many people are thankfully focusing on effective interventions for weight management, not much has been done regarding ASD-specific programs. The US Center for Disease Control and Prevention (2015) recommends at least 60 minutes of aerobic activity and muscle and bone strengthening activities per day for children and adolescents. Physical activity should be moderate to vigorous; it should increase heart rate and rate of breathing. It is recommended that the chosen activities appeal to and accommodate a child’s interests. This is particularly important for youth with ASD. For example, for a child fascinated with insects, a nature hike might be appropriate and engaging. In addition to increasing physical activity levels, it is recommended that youth engage in no more than 2 hours of sedentary “screen time” per day (McCoy, Jakicic & Gibbs, 2016). However, because video gaming is a major hobby among ASD youth, one particularly creative intervention that has recently gained attention is to substitute typical video games for active video games in which the player must physically move around in order to control the game (Strahan & Elder, 2013). Not only does exercise lead to effective weight management, it also has been shown to enhance self-regulation and motor skills (Sorensen & Zarrett, 2014), strengthen executive functioning skills (Tan, Pooley & Speelman, 2016), and improve mood. Exercise is also cost-effective, because it can be performed in one’s home or community with minimal equipment (Bremer, Crozier & Lloyd, 2016).

Another avenue of intervention is improved nutrition (Strahan & Elder, 2013). Weight gain prevention programs would be wise to include basic education about healthy food choices and awareness of hunger and fullness cues. It is also a good idea for parents to consult with a qualified health professional, such as a nutritionist or dietician with specific experience in working with youth with ASD, should food selectivity be a particular issue. Furthermore, primary care physicians should be actively involved in addressing any weight-related difficulties and coordinating treatment among providers. Parents and medical professionals would benefit from discussing the early risk of unhealthy weight in children with ASD with each other so that supports and strategies can be put into place as early as possible (Hill, Zuckerman & Fombonne, 2015). Finally, it can be very helpful to work with a psychologist, since his/her background in behavior change and teaching skills can help support the child or adolescent and caregivers in making and maintaining healthy lifestyle changes.

Furthermore, research with adults has shown that those who track their exercise and diet are more likely to lose and maintain weight than those who do not (Kruger, Michels Blanck & Gillespie, 2006). Such programs use engaging visual supports that are appealing to youth with ASD. Given that many youth have access to cell phones and because several of the activity trackers come in fun shapes and colors, older youth and teens are likely to enjoy the experience and be motivated to interact with the technology. Recommended apps and fitness trackers include: MyFitnessPal, Lose It!, Fitbit®, and Misfit.

In all, weight management is an important topic that will likely gather greater attention in the ASD community as rates of obesity continue to rise. Although this can be a difficult issue, parents and caregivers can work with professionals to implement meaningful strategies such as early prevention, proper education, and opportunities for fun exercise.

 Danielle Zito, PsyD, is Psychology Post-Doctoral Fellow, and Shana Nichols, PhD, is Licensed Psychologist, Owner, Director, and Researcher at ASPIRE Center for Learning and Development. For more information, please visit our website at www.aspirecenterforlearning.com or contact the ASPIRE team at info@aspirecenterforlearning.com.

References

Bremer, E., Crozier, M., & Lloyd, M. (2016). A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism, 1-17.

Broder-Fingert, S., Brazauskas, K., Lindgren, K., Iannuzzi, D., & Van Cleave, J. (2014). Prevalence of overweight and obesity in a large clinical sample of children with autism. Academic Pediatrics, 14(4), 408-414.

Centers for Disease Control and Prevention (2015). Physical activity basics. Retrieved from https://www.cdc.gov/physicalactivity/basics/index.htm

de Vinck-Baroody, O., Shui, A., Macklin, E.A., Hyman, S.L., Leventhal, J.M., & Weitzman, C. (2015). Overweight and obesity in a sample of children with autism spectrum disorder. Academic Pediatrics, 15(4), 396-403.

Hill, A.P., Zuckerman, K.E., & Fombonne, E. (2015). Obesity and autism. Pediatrics, 136(6), 1 11.

Kruger, J., Michels Blanck, H., & Gillespie, C. (2006). Dietary and physical activity behaviors among adults successful at weight loss maintenance. International Journal of Behavioral Nutrition and Physical Activity, 3(17).

McCoy, S.M., Jakicic, J.M., & Barone Gibbs, B. (2016). Comparison of obesity, physical activity, and sedentary behaviors between adolescents with autism spectrum disorders and without. Journal of Autism and Developmental Disorders, 46, 2317-2326.

Sorensen, C. & Zarrett, N. (2014). Benefits of physical activity for adolescents with autism spectrum disorders: A comprehensive review. Review Journal of Autism and Developmental Disorders, 1, 344-353.

Strahan, B.E. & Elder, J.H. (2013). Obesity in adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 7, 1497-1500.

Tan, B.W., Pooley, J.A., & Speelman, C.P. (2016). A meta-analytic review of the efficacy of physical exercise interventions on cognition in individuals with autism spectrum disorder and ADHD. Journal of Autism and Developmental Disorders, 46, 3126-3143.

Tyler, K., MacDonald, M., & Menear, K. (2014). Physical activity and physical fitness of school-aged children and youth with autism spectrum disorders. Autism Research and Treatment, 1-6.

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