Cross-cultural comparisons of obesity and growth in Prader-Willi syndrome.
Growth hormone therapy and early diagnosis predict BMI in Prader-Willi syndrome better than country of residence.
01Research in Context
What this study did
Dudley et al. (2008) compared body size in people with Prader-Willi syndrome across three countries. They looked at medical charts from France, the UK, and the US. The team drew growth curves for kids and checked obesity rates in adults.
What they found
French adults with PWS were more likely to be obese than those in the UK or US. Growth charts for children lined up across all three nations. The big news: getting growth hormone and an early diagnosis mattered more for BMI than which country the person lived in.
How this fits with other research
The French pattern looks like the wider ID group. Bégarie et al. (2013) found about 3 in 10 French special-ed students with any ID were overweight or obese. Yuan et al. (2021) saw the same trend in Chinese students with ID. Together these papers show country-specific diets or care systems shape weight more than the syndrome itself.
Doughty et al. (2015) found US Special Olympians with ID were heavier than Chinese peers. That seems to clash with O et al., who saw the US group lighter than the French. The gap disappears when you look at the details: O et al. studied only PWS, while H et al. mixed all ID causes. Different genes, different hunger drives.
Lloyd et al. (2012) surveyed Special Olympics youth worldwide and also flagged North American girls as the heaviest. The message across studies: watch for high BMI in wealthy regions, but remember growth hormone access can override geography.
Why it matters
When you assess a client with PWS, ask about growth hormone shots and age at diagnosis before you blame culture or food. Push for hormone referral if the client lacks it. Use the shared growth curves to show parents that their child's height path is normal for PWS, but keep an eye on weight no matter which passport they hold.
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02At a glance
03Original abstract
Introduction The present study reports cross-cultural comparisons of body mass index (BMI) and growth in Prader-Willi syndrome, a neurodevelopmental disorder associated with obesity, growth restriction and mild learning disability. Our objectives were to: (1) compare rates of obesity in adults with Prader-Willi syndrome (PWS) in France, with data available from Belgium, the UK and the USA; (2) compare growth of French children with PWS with their counterparts in Germany and the USA; and (3) evaluate the contribution of genetic, medical and social parameters to obesity outcome in French children and adults with PWS. Method (1) Cross-sectional comparison of BMI of 40 French adults, 38 Belgian adults, 46 British adults and 292 North American adults; (2) Construction of growth curves for French children aged 2-20 years from longitudinal data for 150 individuals with PWS, and comparison with published growth curves from Germany and the USA; and (3) Longitudinal regression analysis of 141 French children and adults to determine the factors contributing to obesity outcome. Results A total of 82.5% French adults with PWS have BMI > 30 compared with 65.8% in Belgium (n.s.), 58.2% in the USA (P < 0.005), and 54.3% in the UK (P < 0.01). Higher rates of obesity in females vs. males were found in the USA sample (P < 0.001) but not in the other samples. In contrast to adults, growth curves for French children with PWS show similar rates of growth compared with children with PWS in Germany and the USA. The principal determining factors of BMI status in the French PWS population are age (P < 0.0001), cohort (born within the last 15 years vs. born over 15 years ago, P < 0.0002) and growth hormone replacement therapy (P < 0.0002). Significant subsidiary effects include domestic situation (P < 0.0001), genetic diagnosis (P < 0.0001) and age of diagnosis (P < 0.0001). Conclusions French adults with PWS have significantly higher rates of obesity than adults in the UK and the USA, but growth in French children with PWS is similar to the USA and Germany. Clinical management has a greater impact on obesity outcome in PWS than cultural factors.
Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2008.01044.x