The prevalence of obesity among children with autism spectrum disorders (ASD) is twice that of neurotypical children. Potential causes include abnormal feeding patterns, poor or insufficient food choices, inadequate exercise, disordered sleep, and obesogenic medications.While we have previously noted that screening for obesity-related metabolic complications is common among our neurotypical patients, we have no comparable data regarding our patents with ASD.
We performed a chart review of a cohort of children with ASD to determine if there was evidence of screening for comorbidities of obesity, when indicated. The specific comorbidities addressed included fatty liver, hypercholesterolemia, hypertriglyceridemia, glucose intolerance, and hypertension
We reviewed the charts of 648 patients with ASD (M=77%) and noted that 52% of the patients were overweight or obese. Among patients >10 years of age in this cohort, the following screening tests were performed: oral glucose tolerance test (10%), diabetes/HbA1C screen (16%), cholesterol (32%), and triglycerides (18%). In contrast, liver enzymes were obtained for 49% of patients, primarily among those receiving psychotropic medications. While virtually all patients had blood pressure measurements, there were wide variations in the results.
Although our EMR automatically calculates BMI for every encounter, we were unable to find documentation that providers were consistently screening for, and addressing, potential comorbidities for their overweight and obese patients with ASD. It seems that there are significant barriers in either focusing on metabolic complications in such children, or actual difficulties in obtaining laboratory tests and imaging.