Racial and ethnic disparities in obesity and contributions of social determinants of health among boys with autism spectrum disorder

Children with autism spectrum disorders (ASD) are at greater obesity risk compared to typically developing peers. Although many potential risk factors for this relationship have been identified, the causal chain must be better understood, particularly modifiable social determinants of obesity risk in ASD, and especially for children with ASD from minoritized racial/ethnic groups. We aimed to: (1) examine racial/ethnic disparities in obesity status in boys with ASD; (2) assess associations between social determinants of health and obesity status; and (3) understand if social determinants of health factors mediate the relationship between race/ethnicity and obesity status for these youth. We used data for 124 boys, aged 9–10 with ASD enrolled in an ongoing longitudinal study. Social determinants of health explored included socioeconomic position, Area Deprivation Index, neighborhood safety, food and housing insecurity, and racial/ethnic discrimination. The racial/ethnic distribution was: 17.1% Black, 14.6% Latino, and 68.3% White; average age was 10 years. Both Black (PR 2.57, 95% CI: 1.26–5.26) and Latino boys (PR 2.08, 95% CI: 1.08–4.03) with ASD were more likely to be obese than their White peers. While there were significant differences in some social determinants of health by race/ethnicity, only food insecurity mediated associations between race/ethnicity (Black vs. White) and obesity. The striking disparities in obesity and differences in social determinants of health between Black and Latino children with ASD compared to White children emphasize the need to identify factors that contribute to healthy weight among these children and to address these factors in practice.

[1]  W. Dietz,et al.  Food Insecurity and Childhood Obesity: A Systematic Review. , 2022, Pediatrics.

[2]  Gang Chen,et al.  Combining education and income into a socioeconomic position score for use in studies of health inequalities , 2022, BMC Public Health.

[3]  Jihyun Lee,et al.  Environmental and social determinants of leisure-time physical activity in children with autism spectrum disorder. , 2022, Disability and health journal.

[4]  Catherine Wong,et al.  Barriers and facilitators to physical education, sport, and physical activity program participation among children and adolescents with psychiatric disorders: a systematic review. , 2021, Translational behavioral medicine.

[5]  T. Frazier,et al.  Food insecurity in the households of children with autism spectrum disorders and intellectual disabilities in the United States: Analysis of the National Survey of Children’s Health Data 2016–2018 , 2021, Autism : the international journal of research and practice.

[6]  C. Birken,et al.  Sex and gender differences in childhood obesity: contributing to the research agenda , 2020, BMJ nutrition, prevention & health.

[7]  C. Cubbin,et al.  Socioeconomic Status and Childhood Obesity: a Review of Literature from the Past Decade to Inform Intervention Research , 2020, Current Obesity Reports.

[8]  MinKyoung Song,et al.  Influence of Parent Stressors on Adolescent Obesity in African American Youth , 2019, Journal of obesity.

[9]  A. Mastergeorge,et al.  The risk of overweight and obesity in children with autism spectrum disorders: A systematic review and meta‐analysis , 2019, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[10]  Sandra Thompson-Hodgetts,et al.  Stigmatization of Children and Adolescents with Autism Spectrum Disorders and their Families: a Scoping Study , 2019, Review Journal of Autism and Developmental Disorders.

[11]  Evelyn Blumenberg,et al.  Severe housing-cost burden and obesity among preschool-aged low-income children in Los Angeles County , 2018, Preventive medicine reports.

[12]  Kammi K. Schmeer,et al.  Racial-ethnic Disparities in Inflammation: Evidence of Weathering in Childhood? , 2018, Journal of health and social behavior.

[13]  Youfa Wang,et al.  Ethnic disparities in childhood BMI trajectories and obesity and potential causes among 29,250 US children: Findings from the Early Childhood Longitudinal Study-Birth and Kindergarten Cohorts , 2018, International Journal of Obesity.

[14]  Sowmya R. Rao,et al.  Racial and Ethnic Disparities in Early Childhood Obesity , 2018, Pediatrics.

[15]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[16]  Terry L. Jernigan,et al.  Demographic, physical and mental health assessments in the adolescent brain and cognitive development study: Rationale and description , 2017, Developmental Cognitive Neuroscience.

[17]  M. Delgado-Rodríguez,et al.  Systematic review and meta-analysis. , 2017, Medicina intensiva.

[18]  Youfa Wang,et al.  Influence of neighbourhood safety on childhood obesity: a systematic review and meta‐analysis of longitudinal studies , 2017, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[19]  Y. Paradies,et al.  Interpersonal discrimination and markers of adiposity in longitudinal studies: a systematic review , 2017, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[20]  Thao M. Doan,et al.  Integrating Social Determinants of Health With Treatment and Prevention: A New Tool to Assess Local Area Deprivation , 2016, Preventing chronic disease.

[21]  L. Small,et al.  Child Obesity and Mental Health: A Complex Interaction. , 2016, Child and adolescent psychiatric clinics of North America.

[22]  N. Menachemi,et al.  Obesity, Physical Activity and Sedentary Behaviors in Children with an Autism Spectrum Disorder , 2016, Maternal and Child Health Journal.

[23]  E. Fombonne,et al.  Obesity and Autism , 2015, Pediatrics.

[24]  Michelle A. Suarez,et al.  Food Choices of Children With Autism Spectrum Disorders , 2015 .

[25]  L. Bandini,et al.  A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children. , 2014, Journal of the Academy of Nutrition and Dietetics.

[26]  Megan MacDonald,et al.  Physical Activity and Physical Fitness of School-Aged Children and Youth with Autism Spectrum Disorders , 2014, Autism research and treatment.

[27]  L. Bandini,et al.  Comparison of sedentary behaviors between children with autism spectrum disorders and typically developing children , 2014, Autism : the international journal of research and practice.

[28]  L. Schieve,et al.  Prevalence and Impact of Unhealthy Weight in a National Sample of US Adolescents with Autism and Other Learning and Behavioral Disabilities , 2014, Maternal and Child Health Journal.

[29]  P. Braveman,et al.  What are Health Disparities and Health Equity? We Need to Be Clear , 2014, Public health reports.

[30]  D. Geschwind,et al.  Sex differences in autism spectrum disorders. , 2013, Current opinion in neurology.

[31]  L. Bandini,et al.  Food selectivity in children with autism spectrum disorders and typically developing children. , 2010, The Journal of pediatrics.

[32]  Erik Stolterman,et al.  Complex interaction , 2010, TCHI.

[33]  Lisa Simpson,et al.  National, state, and local disparities in childhood obesity. , 2010, Health affairs.

[34]  S. Daniels,et al.  Complications of obesity in children and adolescents , 2009, International Journal of Obesity.

[35]  Kathryn M Neckerman,et al.  Effect of individual or neighborhood disadvantage on the association between neighborhood walkability and body mass index. , 2009, American journal of public health.

[36]  J. Frazier,et al.  An Overview of Obesity in Children with Psychiatric Disorders Taking Atypical Antipsychotics , 2008, Harvard review of psychiatry.

[37]  A. Must,et al.  Adolescent Obesity and Risk for Subsequent Major Depressive Disorder and Anxiety Disorder: Prospective Evidence , 2007, Psychosomatic medicine.

[38]  A. Must,et al.  Risks and consequences of childhood and adolescent obesity , 1999, International Journal of Obesity.

[39]  C. Foster,et al.  Age differences in the association of childhood obesity with area-level and school-level deprivation: cross-classified multilevel analysis of cross-sectional data , 2012, International Journal of Obesity.

[40]  E. Taveras,et al.  Lifecourse approach to racial/ethnic disparities in childhood obesity. , 2012, Advances in nutrition.

[41]  Lester R Curtin,et al.  Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. , 2002, Pediatrics.

[42]  Developmental Cognitive Neuroscience Recruiting the ABCD sample: Design considerations and procedures , 2022 .