The prevalence and risk factors for overweight/obesity among Turkish children with neurodevelopmental disorders.
Using food as a reinforcer quadruples obesity risk in kids with ASD—swap to non-edible rewards.
01Research in Context
What this study did
Köse et al. (2021) asked parents of Turkish children with autism, intellectual disability, or ADHD to fill out a survey.
They wanted to know how many kids were overweight or obese and what daily habits raised the risk.
The team looked at medicine use, sleep, screen time, and whether teachers or parents used candy or chips as rewards.
What they found
Between 22 % and 40 % of the children were overweight or obese, depending on the group.
For kids with ASD, the biggest red flag was using food as a reinforcer—it quadrupled the chance of obesity.
Psychiatric medicines also added risk, but food rewards stood out above everything else.
How this fits with other research
Granich et al. (2016) saw the same high weight gain in Turkish youth with ASD, yet they blamed only the mother’s BMI.
Sezen’s team widened the lens and found the real driver inside the therapy room: edible reinforcers.
Across the ocean, Healy et al. (2019) and Heald et al. (2020) linked heavier ASD teens to lower activity, not to food rewards.
The new data do not contradict those studies—they simply point to an earlier, treatable cause: what we put in the token jar.
Why it matters
If you run DTT or ABA sessions, check how often you hand out crackers or gummies. Swap them for stickers, high-fives, or 30 seconds with a favorite toy. This single change could cut obesity risk for your clients with ASD while keeping their learning on track.
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02At a glance
03Original abstract
OBJECTIVE: To compare the prevalence and correlates of overweight (OW) and obesity (OB) between autism spectrum disorder (ASD), intellectual disability (ID), and attention deficit-hyperactivity disorder (ADHD) and to investigate which variables significantly contribute to OW/OB in each group. METHODS: Of 267 cases (96 with ASD, 80 with ID, and 91 with ADHD) aged 2-18 years, body mass index (BMI) percentiles, birth weight, food reward usage, weekly screen and physical activity time, and psychotropics used were recorded. RESULTS: OB (OB + OW) prevalence was 22.9 % (36.4 %) in ASD; 22.5 % (40 %) in ID; and 17.6 % (27.5 %) in ADHD. Although the ADHD group had the highest rate of stimulant usage (χ2 = 69.605, p < 0.001), physical activity attendance (χ2 = 49.751, p < 0.001), and the lowest anti-psychotic (χ2 = 69.142, p < 0.001), and anti-depressant usage (χ2 = 7.219, p < 0.001) than ID/DD or ASD, BMI percentile of the participants did not differ between the groups (H(2) = 1.652, p = 0.43). In hierarchical logistic regression analysis, in ASD, food reward (OR = 4.65, 95 %Cl = 1.25-17.19) and the number of psychotropics used (OR = 2.168, 95 %Cl = 1.07-4.36) were significantly related to the risk of OW/OB. In ADHD, each drugs administered and a 1-kilogram elevation in birth weight was associated with a 4.09 and 2.82 increased risk for OW/OB. CONCLUSION: OW/OB is prevalent in children with neurodevelopmental disorders regardless of their diagnosis. Our findings showed that food rewards put a higher risk for OW/OB in ASD than administering a psychotropic. It could be better to use other positive reinforcements other than edible ones to prevent OW/OB in these children.
Research in developmental disabilities, 2021 · doi:10.1016/j.ridd.2021.103992