Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: a chart review

BACKGROUND: The condition of obesity has become a significant public health problem in the United States. In children and adolescents, the prevalence of overweight has tripled in the last 20 years, with approximately 16.0% of children ages 6–19, and 10.3% of 2–5 year olds being considered overweight. Considerable research is underway to understand obesity in the general pediatric population, however little research is available on the prevalence of obesity in children with developmental disorders. The purpose of our study was to determine the prevalence of overweight among a clinical population of children diagnosed with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). METHODS: Retrospective chart review of 140 charts of children ages 3–18 years seen between 1992 and 2003 at a tertiary care clinic that specializes in the evaluation and treatment of children with developmental, behavioral, and cognitive disorders. Diagnostic, medical, and demographic information was extracted from the charts. Primary diagnoses of either ADHD or ASD were recorded, as was information on race/ethnicity, age, gender, height, and weight. Information was also collected on medications that the child was taking. Body mass index (BMI) was calculated from measures of height and weight recorded in the child's chart. The Center for Disease Control's BMI growth reference was used to determine an age- and gender-specific BMI z-score for the children. RESULTS: The prevalence of at-risk-for-overweight (BMI >85th%ile) and overweight (BMI > 95th%ile) was 29% and 17.3% respectively in children with ADHD. Although the prevalence appeared highest in the 2–5 year old group (42.9%ile), differences among age groups were not statistically significant. Prevalence did not differ between boys and girls or across age groups (all p > 0.05). For children with ASD, the overall prevalence of at-risk-for-overweight was 35.7% and prevalence of overweight was 19%. CONCLUSION: When compared to an age-matched reference population (NHANES 1999–2002), our estimates indicate that children with ADHD and with ASD have a prevalence of overweight that is similar to children in the general population

The interaction between impulsivity and a varied food environment: its influence on food intake and overweight

Objective: The current study tests the influence of two factors, the obesogenic environment and impulsivity, on food intake in primary school children. Our current food environment offers a large variety of cheap and easily available sweet and fatty foods. This obesogenic environment is believed to be a cause of the recent obesity epidemic. Impulsive people are generally less successful at inhibiting prepotent responses and they are reward sensitive. We investigate whether the interaction between an obesogenic environment and an impulsive person leads to overeating. Design: A quasi- experimental 2 ( reward sensitive versus not reward sensitive) by 2 ( successful response inhibitors versus unsuccessful response inhibitors) by 2 ( monotonous versus varied food environment) between- subjects design with caloric intake during a taste test as the main dependent variable. The link between impulsivity and overweight was also examined. Subjects: 78 healthy primary school children ( age: 8 - 10 years). Measurements: We measured two aspects of impulsivity: reward sensitivity and deficient response inhibition. Subsequently, one aspect of the obesogenic environment was manipulated; half of the participants received monotonous food during a bogus taste test whereas the other half tasted food that was varied in colour, form, taste and texture. Results: As expected, reward sensitivity interacted with variety. In the monotony group there was no difference in food intake between the less and more reward- sensitive children ( 183 kcal +/- 23 s. d. versus 180 kcal +/- 21 s. d.). However, in the variety group the more reward- sensitive children ingested significantly more calories than the less reward- sensitive children ( 237 kcal +/- 30 s. d. versus 141 kcal +/- 19 s. d.). Reward sensitivity was not linked to overweight. Deficient response inhibition did not interact with variety, but it was linked to overweight. Conclusion: It is suggested that reward sensitivity could be a causal mechanism for overeating in an obesogenic environment whereas prepotent response inhibition may be a maintaining factor of the problem of overeating

Randomized Controlled Comparison of Two Cognitive Behavioral Therapies for Obese Children: Mother versus Mother-Child Cognitive Behavioral Therapy

BACKGROUND: Parent-child treatments have been shown to be superior to child-focused treatments of childhood obesity. Yet until now, the comparative effectiveness of parent-only and parent-child approaches has been little studied. METHOD: Fifty-six obese children and their families were randomly assigned to a 16-session cognitive behavioral therapy (CBT) for the parents only or for a combined treatment of parents and children. Children's percent overweight, the body mass index of their mothers, and behavioral and psychological problems of children and mothers were assessed. RESULTS: Both treatments reduced children's percent overweight significantly and equally by 6-month follow-up. Also both treatments provided similar results in reducing general behavior problems (externalizing and internalizing behavior problems), global and social anxiety, and depression. CONCLUSIONS: Our results point to a comparable efficacy of the two treatments. Further, psychological well-being of both mothers and children can be improved in a CBT for obese children and their parents. Future studies should focus on finding ways to improve the adherence of families to long-term treatment of obesity in childhood