Autism and Obesity

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A 2014 study of more than 6,000 children and teenagers on the spectrum found that they are more than twice as likely to be overweight and nearly five times as likely to be obese as their typical peers. Those statistics translate to higher rates of a host of associated health issues. A 2016 analysis of Taiwan’s National Health Insurance Research Database revealed that teens with autism are nearly three times more likely to have type 2 diabetes than their typical peers. A 2016 review of medical records from 48,762 children with autism in the United States showed that they also have significantly higher rates of other obesity-related conditions, such as hypertension, high cholesterol and nonalcoholic fatty liver disease.

“We live in an obesogenic environment,” says Carol Curtin, associate professor of family medicine and community health at the University of Massachusetts Eunice Kennedy Shriver Center in Worcester. “It’s still not clear whether these kids are more susceptible to this environment, or if there are unique risk factors; we haven’t been able to do the longitudinal studies that might tell us.”

The research so far hints that obesity in people with autism is different than in the general population. For one thing, weight problems in autism seem to follow a specific course: The pounds start to pile on at a younger age, and persist into adulthood more often. Many people on the spectrum have heightened senses, plus a fondness for routine, which makes them averse to new tastes and textures and susceptible to unhealthy eating patterns. And motor and social impairments, along with an affinity for screens, can limit physical activity.

Unfortunately for children like Nicholas, there is little appreciation of these differences as yet, and weight management programs are almost exclusively geared toward typical children. “If you have special education every day after school, how are you going to fit in sports?” asks Sarabeth Broder-Fingert, a pediatrician at Boston University. “If you have a kid who’s nonverbal, having a conversation about nutrition isn’t going to work.”

Larger studies later confirmed the pattern. In a 2015 study, researchers reported that weight issues begin early among children on the spectrum: 16 percent are overweight and another 16 percent are obese between ages 2 and 5. A study last year revealed that unlike many typical children, who outgrow weight problems as teenagers, those with autism usually do not. These results came as no surprise to Curtin, who had been trying to raise awareness about obesity in autism since her 2005 analysis. When Curtin had applied for funding to get more data, though, she had been roundly rejected. “No one believed it was an issue,” she says. “In autism, the focus is mostly on behavior; physical health is largely ignored.”

Compared with behavioral issues such as aggression, the physical consequences of autism or its treatment may seem less urgent — and yet nearly all increase the risk for obesity. The vast majority of children with autism have sleep issues or gastrointestinal problems, both of which can contribute to weight issues. Many take drugs for epilepsy, anxiety or depression that can also cause them to pack on pounds. And weight gain is a common side effect of antipsychotics such as risperidone and aripiprazole, the only medications approved by the U.S. Food and Drug Administration for treating issues related to autism.

In addition, some children with autism have a genetic susceptibility to obesity. “In kids like this, it could be differences in hormones and biochemistry that contribute to obesity, rather than too much screen time,” says Broder-Fingert.

In 2010, two groups of scientists found that individuals with a deletion of 25 genes on chromosome 16 are much more likely to have autism, developmental delay and obesity than controls are. The deletion, known as 16p11.2, affects only 0.5 percent of people with autism, but nearly 3 percent of individuals with this deletion are also obese. More evidence that these genes play a role in body weight came the following year. Some of the same scientists found that the opposite scenario — a duplication along this region of chromosome 16 — increases the risk of extreme thinness. Children with the duplication often have autism and intellectual disability, plus a low birth weight. In contrast to children with the deletion, who tend to be hungry all the time, those with the duplication may be easily sated and have trouble gaining weight.

A large deletion on chromosome 11, associated with autism and attention deficit hyperactivity disorder, falls within a stretch of genes linked to intellectual disability and obesity. And a large deletion on chromosome 15 leads to Prader-Willi syndrome; this syndrome is characterized by intellectual disability and, in some cases, autism. As early as toddlerhood, children with the syndrome are prone to severe overeating, which leads to extreme obesity from an early age.

These rare chromosomal deletions linked to autism all appear to affect the body’s drive to eat and ability to sense when it’s full. But the innate regulation of appetite and eating may also be altered in children with autism who don’t have one of these deletions, says Paula Krakowiak, a research scientist at the University of California, Davis. Krakowiak notes that studies have associated autism with inflammation, which can interfere with metabolism, the body’s ability to balance food eaten with energy burned. “Immune dysregulation can create a positive feedback loop of inflammation, weight gain, then more inflammation and so on,” she says. “These two systems interact and overlap.”

Inflammatory conditions such as diabetes, hypertension, celiac disease and rheumatoid arthritis are also more common in women who have children with autism. In a 2016 study, Krakowiak and her colleagues found that women with gestational diabetes sometimes produce anti-fetal antibodies — molecules thought to attack the fetal brain and increase the child’s autism risk. These antibodies were especially prevalent in women with children at the severe end of the spectrum. Obesity in the mother produces high levels of certain immune molecules, which in turn may lead to the production of these antibodies.

I'm about 250 pounds. I gained a lot of that weight when I was taking Abilify (which I recently started again over the past year). I know a lot of medications can cause weight gain (or loss in some cases).

Another factor in my situation is the food-texture issues. I eat a lot of pasta and things that are high in carbs and not the healthiest for me. I've tried to eat more fruits and vegetables, but the textures of most of them bother me. I wonder if this is common for people with ASD and it could be a factor for others too. I'm not a doctor though.