An urban versus rural comparison of obesity between youth with and without autism spectrum disorder.
Where a child with autism lives does not predict obesity—services should be the same in rural and urban clinics.
01Research in Context
What this study did
The team asked a simple question: does living in the country or the city change obesity risk for kids with autism?
They compared youth with ASD to neurotypical peers across rural and urban zip codes. Height and weight came from medical charts.
What they found
Kids with ASD carried more extra weight overall, no matter where they lived. Rural or city address made no difference inside the ASD group.
The surprise: neurotypical kids did show the usual pattern—rural ones were heavier. Geography mattered for them, but not for autism.
How this fits with other research
Mouridsen et al. (2002) once found boys with infantile autism were actually thinner than average. The new data flip that picture—today’s ASD youth trend heavier.
González-Agüero et al. (2011) warned that standard BMI can hide true fat risk in Down syndrome. M et al. used the same simple BMI yet still caught the geography gap, so the method was enough here.
Scior et al. (2023) remind us feeding interventions work for ASD. Pair that with the new obesity numbers and you see a clear service gap: kids need food and fitness help no matter their zip code.
Why it matters
Stop blaming the countryside or the city. When you write care plans, target food routines, activity schedules, and caregiver training for every child with ASD. Rural clinics can offer tele-health nutrition, and urban teams can add in-home mealtime support. Geography is off the hook; our programming is not.
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02At a glance
03Original abstract
To examine obesity prevalence in youth with autism spectrum disorder (ASD) and neurotypical (NT) youth living in rural and urban areas. Data is from the 2019 National Survey of Children's Health, a national dataset that collected information on child health and well-being. Overweight/obesity status was based on parent/caregiver report of child height and weight. Urban and rural status was determined by whether children lived in/near a city. Chi-square tests were conducted to examine differences in obesity prevalence in youth with ASD and NT youth living in rural and urban areas. Overall, 43.9% of youth with ASD were overweight/obese compared to 30.6% of NT youth (p < 0.001). There was a significantly higher proportion of NT youth living in rural areas (36.44%) who were overweight/obese compared to urban NT youth (30.35%, p = 0.002). There were no significant differences in the proportion of overweight/obese youth with ASD living in rural areas (44.02%) compared to urban areas (44.44%, p = 0.96). Urban residence reduced the odds of overweight/obese compared to rural residence among NT youth (aOR = 0.77, 95%CI = 0.66-0.90) but urban/rural residence was not a significant factor in models for ASD youth (aOR = 1.25, 95%CI = 0.63-2.48). In contrast to NT youth, there were no differences in levels of overweight/obesity in youth with ASD living in rural areas compared to urban areas. Further research on how sociodemographic factors and geographic location affect obesity in youth with ASD is warranted.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1002/aur.2856