The Full Range of Weight Status by Race and Ethnicity in Children with and without Autism in the United States: A Cross-Sectional Study

Abstract

Objective

To identify and characterize how race and ethnicity influence the relationship between autism and weight status, across all categories of weight from underweight to severe obesity.

Study design

We developed a propensity score-matched cross-sectional dataset of children with and without parent-reported autism in the National Survey of Children Health (2016-2022) and Adolescent Brain and Cognition Development Study (2016-2018). We included non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, and Hispanic children aged 6-17 years. Prevalence ratios for autistic and nonautistic children were estimated with multinomial regression models across Centers for Disease Control-defined categories for underweight, healthy weight, overweight, mild-to-moderate obesity, and severe obesity, based on parent-reported height and weight and measured heights and weights (Adolescent Brain and Cognition Development Study).

Results

Prevalence disparities across racial and ethnic groups were evident and the pattern of prevalence ratios (autistic: nonautistic) showed remarkably consistent U- or J-shaped prevalence ratios. Prevalence ratios were elevated in underweight and severe obesity for autistic Asian, Black, White, and Hispanic children compared with their nonautistic peers of the same race or ethnicity, with the exception of underweight prevalence where autistic and nonautistic Asian children did not differ.

Conclusions

The largely consistent pattern of prevalence ratios comparing autistic and nonautistic children for underweight and severe overweight in the 4 major racial and ethnic groups in the US suggests that health care and other providers should be aware of these risks in autistic children, actively monitor their weight status, and intervene early to prevent excess weight loss or weight gain.