Developmental and Behavioral Pediatricians Evaluation and Management of Overweight and Obesity in Children

with Autism Spectrum Disorder: A Collaboration between the HWRN and DBPNet
Sarabeth Broder-Fingert, MD, MPHa, Morgan Walls, MDa, Sarah Phillips, MS, MPHb, Carissa Jackel, MDc, Marie Reilly, MDd, Aviva Must, PhDb,
bd
Linda Bandini, PhD , Carol Curtin, PhDb

aDepartment of Pediatrics, Boston University; bHealthy Weight Research Network, E.K. Shriver Center, University of Massachusetts Medical School; cDepartment of Developmental and Behavioral
Pediatrics, Children's Hospital Of Philadelphia; dDepartment of Developmental and Behavioral Pediatrics, Children's Hospital Boston; dSargent College of Health & Rehabilitation Sciences, Boston University

Background Results Results

Children with Autism Spectrum Disorder (ASD) have a Table 1. Sample Characteristics at Youngest Age in Dataset 36.5% of children with ASD were overweight or obese
higher prevalence of overweight and obesity than at first visit and 38.5% at any visit
N=4,542 n (%)
children without ASD
Sex
Male 3,747 (82.5) Only 8% of overweight/obese children had
Developmental-behavioral pediatricians (DBPs) are documented ICD-9 code for weight- related concern at
Age (years), mean (SD) 8.1 (4.2)
often the primary providers of diagnostic and their visits during the 2 year time period
treatment services for children with ASD Medication Use
Atypical Antipsychotics 428 (9.4) Children were more likely to have documented ICD-9
The role of DBPs in managing weight-related issues in Stimulants 643 (14.1) code if taking antipsychotic or alpha agonist
children with ASD has not been well-described medications or if they were older
Anti-depressants (SSRIs) 549 (12.1)
Alpha Agonists 387 (8.5) There were no significant differences in weight coding
Study Objective
th
by child sex, SSRI or stimulant use
Using data from DBPNet sites, the objective of this study Overweight/Obese (BMI>85 percentile) 1656 (36.5)
was to examine developmental-behavioral pediatricians th th Limitations
Overweight (85 percentile-94 percentile) 702 (15.5)
practices in coding for weight or nutrition-related issues in
th Use of ICD-9 codes may underestimate actual practices
overweight and obese children with ASD Obesity ( 95 percentile) 954 (21.0)
by DBPs and may vary among providers
th
Severe Obesity (120% of 95 percentile) 284 (6.3)

Methods Visit-Level Data (n=9,672) 2 year period of data limits ability to examine trends or
No. of Visits with Overweight 1,552 (16.0) changes in weight status or coding over time
Study Design: Retrospective chart review with
longitudinal measurements No. of Visits with Obesity 2,167 (22.4) Conclusions
No of. Visits with Overweight/Obese 3,719 (38.5) Despite high prevalence of overweight and obesity in
Data source: Visit-level data of children with ASD from 3
children with ASD, few DBPs are coding for the issue in
outpatient DBPNet clinics January 2010- December 2011 Presence of Any Weight Codes (278, 783.1,
their practice
V85.54)
Variables Weight codes for overweight visits 13 (0.8)
DBPs are more likely to code if children are on some
Independent Variables:
Weight codes for obese visits 283 (13.1) types of medications or are older
o Overweight: 85th %tile > BMI z-score 95th %tile
o Obese: BMI z-score > 95th %tile Weight codes for overweight/obese visits 296 (8.0)
Increased awareness and training in obesity
Outcomes: Documented weight and or
Table 2. Logistic Regression: Weight Codes among Overweight/Obese Children management can help support DBPs to manage weight
nutrition/related ICD-9 Codes
N= 1,858 Having Weight Code (aOR, 95% CI) in children with ASD
o 278 Overweight, obesity, hyperalimentation
o 783.1- Abnormal weight gain Age
2-5 years Reference Funding and Acknowledgements
o V85.54 BMI > 95th percentile
6-11 years 2.61 (1.23, 5.53) We acknowledge the Healthy Weight Research Network (HW and the Developmental
and Behavioral Pediatrics Research Network (DBPNet). HWRN is supported by
Analysis: Among those with overweight/obesity, we 12-15 years 6.7 (3.13, 14.33) UA3MC25735-01-00 from the Maternal and Child Health Bureau (MCHB). DBPNet is
used multivariable logistic regression to assessed for 16-19 years 7.04 (2.97, 16.7) supported by cooperative agreement UA3MC20218 from the MCHB, Health
Resources and Services Administration, U.S. Department of Health and Human
predictors of nutrition-related coding Medication Use (Ref= Not taking med) Services. This information or content and conclusions are those of the author and
For those with multiple visits, random visit was selected Atypical Antipsychotics 1.71 (1.04, 2.82) should not be construed as the official position or policy of, nor should any
endorsements be inferred by HRSA, HHS or the U.S. Government.
to assess for predictors Alpha-agonists 1.89 (1.12, 3.2)