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COPE Webinar Series for Health ProfessionalsJuly 8, 2020

Early Life Risk Factors for Obesity in Children with Autism Spectrum Disorder

ModeratorLisa K. Diewald MS, RD, LDNProgram ManagerMacDonald Center for Obesity Prevention and EducationM. Louise Fitzpatrick College of Nursing

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Today’s Webinar Objectives

1. Describe pregnancy-related risk factors for child obesity in children with ASD.

2. Highlight possible dietary and early life risk factors that may be underlying the increased obesity risk in children with ASD.

3. Address feeding and weight-related concerns in children with ASD and directions for future research.

Continuing Education Credit Details

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation

Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration

Continuing Education Credit Details

This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians

Suggested CDR Learning Need Codes: 5070, 5180, 5370, 9020

Level 2

CDR Performance Indicators: 6.2.5, 6.3.7, 6.3.8

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Early Life Risk Factors for Obesity in Children with Autism Spectrum Disorder

Tanja Kral, PhDProfessorSchool of Nursing & Perelman School of MedicineUniversity of Pennsylvania

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Disclosures

The planners and presenter of this program have no conflicts of interest to disclose.

Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity.

Early Life Risk Factors for Obesity in Children with

Autism Spectrum Disorder Tanja Kral, PhD

School of Nursing & Perelman School of MedicineUniversity of Pennsylvania

McDonald Center for Obesity Prevention and Education (COPE) Webinar Series

July 8, 2020

My Research Interests

Outline of Talk:

1. Obesity in children with Autism Spectrum Disorder (ASD)

2. Pregnancy-related risk factors for childhood obesity in children with ASD

3. ASD symptoms and co-occurring conditions related to obesity risk

4. Feeding difficulties in children with ASD

Obesity Risk in Children with ASD

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Obesity Risk

• In some studies, children with ASD show a 4-fold increased risk for overweight and obesity than typically developing children (TDC).

• Prevalence rates across studies:• Overweight/Obesity: 34 - 53% • Obesity: 10 - 43%

• Children with ASD are also over 3 times more likely to develop the metabolic syndrome.

Child Characteristic ASD (N = 25)[mean ± SD or N (%)] 

TDC (N = 30) [mean ± SD or N (%)]

P-value

Height (cm) 109.4 ± 6.5 112.6 ± 7.2 0.10

Weight (kg) 19.9 ± 3.7 20.1 ± 3.6 0.79

BMI z-score 0.75 ± 1.39 0.17 ± 1.07 0.088

BMI-for-age percentile 66.1 ± 29.9 55.6 ± 30.2 0.20

Waist circumference (cm) 56.2 ± 7.5 51.9 ± 4.0 0.01

Waist-to-height ratio 0.51 ± 0.06 0.46 ± 0.03 < 0.001

Weight statusUnderweight / normal-weight

Overweight / obese 14 (56%)11 (44%)

24 (80%)6 (20%) 0.055

Kral et al. (2015). Public Health Nursing, 32(5): 488-497

Cardiovascular Risk • Kral et al. (2014) showed that children with ASD, ages 4-6,

showed significantly greater abdominal waist circumference and waist-to-height ratio.

• Mean waist-to-height ratio for children with ASD: 0.51 ± 0.06

• Castro et al. (2017) reported that nearly 50% of children with ASD, ages 4-16, showed high central adiposity (waist circumference >80th percentile) and total adiposity (body fat curves >95th centile).

Early Life Risk Factors for Obesity

1. Maternal pre-pregnancy obesity2. Excess gestational weight gain

3. Rapid weight gain during infancy

Early Life Risk Factors Weight Trajectories of Children Born at Low- or High-Risk for Obesity

0.3 1 2 3 4 5 6 7 8 10 12 13 14-0.5

0.0

0.5

1.0

1.5Low-RiskHigh-Risk

* **

* ** * *

*

Child Age (yrs)

BM

I z-s

core

Stunkard et al., 2004

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Exceeding the IOM gestational weight gain recommendations was associated with a 46% increase in the odds of having a child with overweight or obesity at ages 2-5 years (Sridhar et al., 2014).

Institute of Medicine (IOM) Pregnancy Weight Gain Recommendations

Pre-pregnancy weight statusRecommended weight gain during pregnancy

Underweight (BMI < 18.5 kg/m2) 28 – 40 pounds

Normal-weight (BMI 18.5 – 24.9 kg/m2) 25 – 35 pounds

Overweight (BMI 25.0 – 29.9 kg/m2) 15 – 25 pounds

Obese (BMI > 30 kg/m2) 11 – 20 pounds

Rapid weight gain during the first year of life conferred a 2-fold higher risk of childhood obesity and a 23% higher risk of adult obesity (Druet et al., 2012).

Rapid Weight Gain During Infancy and Obesity Risk

Study to Explore Early Development (SEED)

Study to Explore Early Development (SEED) Group Classification

ASD(Autism Spectrum 

Disorder)

DD(Developmental 

Delays / Disorders)

POP(General Population 

Controls)

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Sample

Maternal pre-pregnancy BMI

Maternal gestational weight gain: Compared to IOM guidelines Recommended weight gain met (yes / no) Gestational weight gain (< / = / > than

recommendations)

Maternal Weight-Related Variables

• Child heights/lengths and weights: • Birth to 6 months: Neonatal and pediatric medical records• Ages 2-5: In-person clinic visit

• Child age- and sex-specific weight-for-age or BMI z-scores and percentiles were calculated from:

• WHO Growth Charts (birth to 24 months)• CDC Growth Charts (>24 months)

• Rapid weight gain: Change in weight-for-age z-scores from birth to 6 months >0.67 SD (Monteiro and Victora, 2005)

Child Weight-Related Variables

Demographic, Maternal, and Birth Variables

Demographic Maternal Birth

Child age Diabetes Birth weight

Child sex High blood pressure (BP) Prematurity status

Maternal education Pregnancy-related high BP (eclampsia, pregnancy-induced hypertension, HELLP syndrome)

Gestational age

Maternal race Eating disorders (bulimia nervosa, anorexia nervosa, dieting during pregnancy)

Duration of breastfeeding

Poverty status Intrauterine growthrestriction (IUGR)

Smoking during pregnancy

Co-Occurring Medical, Behavioral, and Psychiatric Conditions

Medical Conditions or Symptoms Behavioral, Developmental or Psychiatric Conditions or Symptoms

Asthma ADHD

Birth defects Behavioral problems

Cardiac diseases / disorders Cognitive delay

Endocrine diseases / disorders Feeding difficulties

Gastrointestinal diseases / disorders Motor delay

Genetic disorders Psychiatric disorders

Immune disorders Sensory disorders

Metabolic disorders Sleep problems

Neurological abnormalities / symptoms

Speech delay

Renal diseases / disorders

Respiratory diseases / disorders

Seizure disorders

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Autism Severity • Ohio State University Autism Rating Scale (OARS)

• Scores 2-3: Mild range of severity (21%)• Scores 4-5: Moderate range of severity (49%)• Scores 6-7: Severe range (22%)

• Autism Calibrated Severity Score (ACSS)

OARS ACSS

• Measures severity of global functioning

• Most impacted by adaptive abilities and expressive language skills

• Measures severity of ASD symptoms, independent of developmental factors

• May not take into account overall degree of impairment

Results: Descriptive Characteristics

Child Demographic and Anthropometric Characteristics

Characteristic ASD

Mean SD or N (%)

DDMean SD

or N (%)

POPMean SD

or N (%)P-Value

Age (months) 59.3 6.6 59.2 7.2 59.2 7.4 0.99

Sex (male/female) 82% / 18% 66% / 34% 52% / 48% <.001

Prematurity status Very preterm (< 32 weeks)

Moderate to late preterm (32 to < 37 weeks)Term (37 to < or equal 41 weeks)

Post-term (> 41 weeks)

39 (7.2%)74 (13.6%)411 (75.4%)21 (3.8%)

64 (8.6%)136 (18.3%)513 (69.1%)30 (4.5%)

25 (3.5%)76 (10.5%)591 (81.5%)33 (4.5%) <.001

BMI z-score 0.35 1.16 0.26 1.20 0.14 1.12 0.001

Weight status Underweight (BMI-for-age <5th percentile)

Normal-weight (BMI-for-age 5-84th percentile)Overweight (BMI-for-age 85-94th percentile)

Obese (BMI-for-age > or equal 95th percentile)

30 (4.5%)454 (68.0%)101 (15.1%)83 (12.4%)

44 (4.8) 642 (70.2%)125 (13.7%)103 (11.3%)

56 (6.3%)656 (74.2%)103 (11.7%)69 (7.8%) 0.007

Maternal Demographic and Weight Characteristics

Characteristic ASD

Mean SD or N (%)

DDMean SD

or N (%)

POPMean SD

or N (%)P-Value

Race / ethnicity White

African American Asian

American Indian or Pacific Islander Multiracial

Hispanic

408 (61.1%)123 (18.4%)58 (8.7%)5 (0.8%)27 (4.0%)21 (3.1%)

583 (63.8%)154 (16.9%)42 (4.6%)7 (0.1%)43 (4.7%)43 (4.7%)

646 (73.1%)94 (10.6%)39 (4.4%)5 (0.6%)36 (4.1%)19 (2.2%) <.001

Education Less than high school

High school Some college or more

43 (6.6%)92 (14.2%)515 (79.2%)

81 (9.1%)130 (14.7%)676 (76.2%)

26 (3.1%)73 (8.6%)

751 (88.4%) <.001

Below federal poverty level (% yes) 68 (10.7%) 93 (4.0%) 47 (5.7%) 0.001

Pre-pregnancy weight status Underweight / normal-weight

Overweight / obese 363 (57.2%)272 (42.8%)

470 (54.2%)397 (45.8%)

545 (64.9%)295 (35.1%) <.001

IOM GWG recommendations Above

Met Below

312 (50.7%)215 (34.9%)89 (14.5%)

393 (46.4%)295 (34.8%)159 (18.8%)

375 (45.5%)336 (40.8%)113 (13.7%) 0.005

Maternal Medical and Other Characteristics

Characteristic ASD

Mean SD or N (%)

DDMean SD

or N (%)

POPMean SD

or N (%)P-Value

Diabetes Pre-pregnancy diabetes

Gestational diabetes 9 (1.4%)47 (7.0%)

25 (2.7%)99 (10.8%)

11 (11.2%)50 (5.7%)

0.03<.001

Blood pressure conditions Hypertension

Eclampsia Pregnancy-induced hypertension

HELLP syndrome

71 (10.6%)2 (0.3%)

110 (16.5%)6 (0.9%)

92 (10.1%)13 (1.4%)

147 (16.1%)16 (1.8%)

52 (5.9%)7 (0.8%)

104 (11.8%)7 (0.8%)

0.0010.060.010.12

Eating disorder 25 (3.7%) 40 (4.4%) 29 (3.3%) 0.48

IUGR 19 (2.8%) 36 (3.9%) 19 (2.2%) 0.08

Smoking during pregnancy 76 (11.4%) 84 (9.2%) 45 (5.1%) <.01

Duration of breastfeeding Never

< 3 months 3-6 months > 6 months

111 (16.6%)167 (25.0%)108 (16.2%)282 (42.2%)

151 (16.5%)228 (25.0%)116 (12.7%)419 (45.8%)

97 (11.0%)159 (18.0%)119 (13.5%)509 (57.6%) <.01

Frequency of Child Medical Conditions

Characteristic ASD N (%)

DDN (%)

POPN (%)

P-value

Asthma 40 (6.0%) 41 (4.5%) 52 (5.9%) .308

Birth defects 37 (5.5%) 68 (7.4%) 20 (2.3%) <.001

Cardiac diseases 26 (3.9%) 42 (4.6%) 11 (1.2%) <.001

Endocrine diseases 10 (1.5%) 20 (2.2%) 4 (0.5%) .007

Gastrointestinal diseases 161 (24.1%) 165 (18.1%) 154 (17.4%) .002

Genetic disorders 24 (3.6%) 51 (5.6%) 9 (1.0%) <.001

Immune disorders 0 (0%) 4 (0.4%) 5 (0.6%) .169

Metabolic disorders 2 (0.3%) 3 (0.3%) 2 (0.2%) .917

Neurological abnormalities 47 (7.0%) 47 (5.1%) 10 (1.1%) <.001

Renal diseases 6 (0.9%) 9 (1.0%) 14 (1.6%) .369

Respiratory diseases 3 (0.5%) 1 (0.1%) 1 (0.1%) .253

Seizure disorders 24 (3.6%) 26 (2.8%) 1 (0.1%) <.001

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Frequency of Child Behavioral, Developmental or Psychiatric Conditions

Characteristic ASD N (%)

DDN (%)

POPN (%)

P-value

ADHD 52 (7.8%) 65 (7.1%) 5 (0.6%) <.001

Behavioral problems 104 (15.6%) 81 (8.9%) 18 (2.0%) <.001

Cognitive delay 5 (0.8%) 2 (0.2%) 2 (0.2%) .157

Feeding difficulties 48 (7.2%) 34 (3.7%) 22 (2.5%) <.001

Motor delay 127 (19.0%) 138 (15.1%) 11 (1.2%) <.001

Psychiatric disorders 25 (3.7%) 20 (2.2%) 4 (0.5%) <.001

Sensory disorders 188 (28.1%) 99 (10.8%) 9 (1.0%) <.001

Sleep problems 43 (6.4%) 24 (2.6%) 5 (0.6%) <.001

Speech delay 426 (63.8%) 525 (57.4%) 76 (8.6%) <.001

Levy et al., The Journal of Pediatrics, 205: 202-209, 2019

Results: Weight-Related Associations

Association between Maternal Pre-Pregnancy Weight Status and Child Weight Status

Kral et al., Autism, 2019

Maternal prepregn.

weight status

Unadjusted Adj. for case status

Adj. for case status, demographic

covariates

Adj. for case status, maternal covariates

Adj. for case status,

demographic, maternal

covariates

Adj. for case status,

demographic, maternal, birth

covariates

OR (95% CI)

POR

(95% CI)P

OR (95% CI)

POR

(95% CI)P

OR (95% CI) P

OR (95% CI)

P

OW/OB vs.

UW/NW

2.43 (2.00, 2.96)

<.0012.38

(1.96, 2.90)<.001

2.40 (1.95, 2.95)

<.0012.32

(1.88, 2.87)<.001

2.33(1.89, 2.87) <.001

2.00 (1.57, 2.53) <.001

After controlling for all covariates, mothers with pre-pregnancy obesity were 2 times more likely to have a child with obesity.

Association between Maternal Gestational Weight Gain (GWG) and Child Weight Status

GWGUnadjusted Adj. for case status

Adj. for case status & demographic

covariates

Adj. for case status & maternal covariates

Adj. for case status,

demographic & maternal

covariates

Adj. for case status,

demographic, maternal, & birth

covariates

OR (95% CI)

POR

(95% CI)P

OR (95% CI)

POR

(95% CI)P

OR (95% CI)

POR

(95% CI)P

< IOM vs. > IOM

0.77 (0.56, 1.05)

.0950.75

(0.55, 1.03).075

0.66 (0.47, 0.92)

.0160.78

(0.57, 1.07).118

0.69 (0.49, 0.96)

.0290.77

(0.54, 1.09) .144

< IOM vs. = IOM

1.15 (0.83, 1.60)

.3931.11

(0.80, 1.55).522

0.96 (0.67, 1.36)

.7991.14

(0.82, 1.58).452

0.98 (0.69, 1.40)

.9281.01

(0.70, 1.46) .958

> IOM vs. = IOM

1.51 (1.19, 1.90)

.0011.48

(1.17, 1.87).001

1.45 (1.14, 1.84)

.0031.46

(1.15, 1.85).002

1.43 (1.13, 1.83)

.0041.32

(1.02, 1.69) .033

When controlling for case status, mothers who exceeded the GWG recommendations were 1.5 times more likely to have a child with obesity.

Kral et al., Autism, 2019

Frequency of Rapid Weight Gain Across Groups

ASD DD POP0

10

20

30

40

50 44%

36%33%

P = 0.004Rap

id W

eig

ht

Gai

n(%

yes

)

Change in weight-for-age z-scores from birth to 6 months > 0.67 SD

Kral et al., Autism, 2019

Association between Rapid Weight Gain and Child Weight Status

Rapid weight

gain

UnadjustedAdj. for

demographic covariates

Adj. for maternal covariates

Adj. for demographic &

maternal covariates

Adj. for demographic, maternal, birth

covariates OR

(95% CI)P

OR (95% CI)

POR

(95% CI)P

OR (95% CI)

POR

(95% CI)P

ASD: Yes vs. no

2.56 (1.60, 4.08)

<0.0012.60

(1.58, 4.27)<0.001

2.54 (1.58, 4.09)

<0.0012.65

(1.60, 4.41)<0.001

3.47 (1.85, 6.51)

<0.001

DD: Yes vs. no

1.24(0.83, 1.85)

0.3021.30

(0.84, 2.00)0.232

1.25(0.83, 1.88)

0.2861.32

(0.85, 2.05)0.209

1.53(0.92, 2.55)

0.098

POP: Yes vs. no

1.38(0.88, 2.17)

0.1581.44

(0.88, 2.35)0.146

1.24(0.78, 1.98)

0.3631.26

(0.76, 2.09)0.376

2.85(1.44, 5.64)

0.003

Children w/ASD and rapid weight gain had 3.5 times greater odds of developing obesity after controlling for all covariates.

Kral et al., Autism, 2019

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Association between Child Weight Status and Co-Occurring Conditions

Child Classification

Unadjusted Adj. for demographic covariates

Adj. for medical, behavioral, and/or developmental / psychiatric covariates

OR (95% CI)

POR

(95% CI)P

OR (95% CI)

P

ASD vs. DD 1.14 (0.91, 1.43) .245 1.18 (0.93, 1.50) .181 1.25 (0.99, 1.59) .063

ASD vs. POP 1.57 (1.24, 2.00) <.001 1.50 (1.16, 1.94) .002 1.51 (1.14, 2.00) .004

DD vs. POP 1.38 (1.10, 1.72) .005 1.27 (1.00, 1.62) .047 1.20 (0.93, 1.56) .157

Levy et al., The Journal of Pediatrics, 205: 202-209, 2019

Prevalence of Overweight and Obesity by ASD Severity Status (OARS)

Mild Moderate Severe0

10

20

30

40

23%27%

34%

b

a, ba

ASD Severity

Ov

erw

eig

ht

and

Ob

esi

tyP

rev

ale

nce

(%

)

Discussion and Implications

• Children with ASD showed the highest frequency of rapid weight gain and those with rapid weight gain were 3.5 times as likely to develop obesity during childhood.

• Helping mothers achieve a healthy pre-pregnancy weight and adequate GWG and fostering healthy growth during infancy represent important targets for all children.

• Healthy growth patterns during infancy may carry special importance for children at increased risk for ASD.

Discussion and Implications

• Developmental disabilities, such as ASD, confer an independent risk of overweight and obesity in children.

• Children with ASD with a higher degree of impairment and more severe symptoms found to be at even great risk of developing overweight or obesity.

• Children who receive diagnosis of ASD or DD may benefit from enhanced monitoring of their weight development and anticipatory guidance for their parents.

Feeding Difficulties in Children with ASD

Feeding Difficulties• Feeding difficulties reported in as many as 89% of

children (Ledford and Gast, 2006; Ahearn et al., 2001; DeMeyer, 1979).

o Arise as early as during infancy (late acceptance of solid foods; described as ‘slow eaters’) (Emond et al., 2010).

• Potential for short- and long-term health risks.

• Source of significant caregiver stress and concern during mealtimes (Marshall et al., 2014).

• Importance of providing guidelines for clinicians for management strategies (Marshall, Hill & Dodrill, 2011).

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Picky Eating

• ~80% of children with ASD, compared to 20% of typically developing children (TDC), shown moderate to severe levels of picky eating (Williams et al., 2000; Whiteley et al., 2000; Zucker et al., 2015).

“[My child] is very picky. He has good appetite but his choices are very limited. Pancakes with chocolate chips, pizza, McDonald’s chicken nuggets, some fruits, yogurt,

applesauce, juices.”

- Quote from parent of 5 year-old child with ASD -

Food Neophobia and Rituals

• ~69% of children with ASD show (chronic) food neophobia (Lockner, Crowe & Skipper, 2008; Martins, Young & Robson, 2008).

• 46% of children with ASD showed rituals and rigid routines during mealtimes (Williams et al., 2000; Schreck & Williams, 2006).

Food Refusal Based on Food Characteristics

Food characteristicChildren

w/ASD (%)TDC (%) P-value

Consistency / texture 77.4 36.2 < .0001

Food mixed together 45.3 25.9 0.03

Temperature 30.2 24.1 0.47

Food touching other foods 20.8 17.2 0.64

Color 15.1 12.1 0.64

Brand 15.1 1.7 0.01

Shape 11.3 1.7 0.05

Adapted from Hubbard et al., J Acad Nutr Diet, 114: 1981-87, 2014

Sensory Processing Difficulties • Sensory processing and food acceptance are

related (Blissett and Fogel, 2013).

• Sensory processing difficulties may lead children with ASD to restrict their intake to foods with preferred and tolerable sensory properties (e.g., Legge et al., 2002; Field et al., 2003).

40%

44%

16%

Oral Sensory Sensitivity in Children with ASD 

Typical

Atypical

Kral et al., 2015

Quote from Parent

“Since 15 months of age [my child] has had a limited diet. He has sensory issues as far as

texture and smell. [My child] can become repetitive with certain foods and he will eat that food for months at a time. Ex: He used to only eat yogurt for lunch, nothing else. Now he only

wants peanut butter sandwiches.”

Eating Behaviors of Children with ASD by Sensory Sensitivity Status

Kral et al., Public Health Nursing,32(5): 488-497, 2015

Food Neophobia

0

1

2

3

4

Typical OralSensory Sensitivity

Difference in OralSensory Sensitivity

P = 0.004 *

Sco

re

Food Fussiness

0

1

2

3

4

5

Typical OralSensory Sensitivity

Difference in OralSensory Sensitivity

P = 0.03*

Sco

re

Emotional Overeating

0

1

2

3

4

5

Typical OralSensory Sensitivity

Difference in OralSensory Sensitivity

P = 0.07

Sco

re

Emotional Undereating

0

1

2

3

4

5

Typical OralSensory Sensitivity

Difference in OralSensory Sensitivity

P = 0.02 *

Sco

re

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51 52

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Consequences of Feeding Difficulties in Children with ASD

• Food selectivity (Bandini et al., 2010):

• Food refusal • Limited food repertoire • High frequency of single food intake

Adapted from Bandini et al., J Pediatr, 157(2): 259-64, 2010

Domains Children w/ASD TD children P-value

Food refusal # foods will not eat

% foods will not eat of those offered45

41.7%21

18.9%< .0001< .0001

Limited repertoire (# unique foods) 19.0 22.5 0.0003

Single food intake 4 1 0.19

Limited Dietary Variety

• Progressively less varied diet from 15 months of age compared to children with typical development.

• No differences in energy and macronutrient intake.

Emond et al., Pediatrics; 126(2): e337-342, 2010

Caregiver Feeding Practices

• Little is known about feeding practices that caregivers of children with ASD use to address feeding difficulties in their children.

• Restrictive feeding practices as well as emotional and instrumental feeding, associated prospectively with obesogenic eating behaviors and increased BMI z-scores in TDC (e.g., Rodgers et al., 2013; Birch et al.

2011).

Caregiver Feeding Practices

Kral et al., Public Health Nursing,32(5): 488-497, 2015

• Caregivers of children w/ASD reported to engage in higher levels of prompting and encouragement to eat (P = .002).

• There was a non-significant trend for increased use of instrumental feeding and restriction (P < .08).

Emotional Feeding

0

1

2

3

4

5

Typical OralSensory Sensitivity

Atypical OralSensory Sensitivity

P = 0.02

*

Sco

re

Summary

• Children with ASD at higher risk for developing obesity and perhaps cardiovascular disease. Risk factors start early, before children are born.

• Despite more limited dietary variety, many children with ASD meet recommended intake for many nutrients.

• Children on restricted diets may be at higher risk for nutrient deficiencies and should be monitored closely.

Research Opportunities

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Opportunities for Interdisciplinary Collaboration

• In Science: • Nutrition • Nursing• Family studies • Pediatrics • Psychology• Public Health • Epidemiology

• In Practice: • Dietitians• Nurses • Occupational therapists • Behavioral

psychologists

Technology-Based Intervention• Develop and test

feasibility of an interactive mobile health nutrition intervention for children with ASD who are picky eaters.

• Test in 3-month RCT efficacy of intervention on changing consumption of targeted foods and beverages.

NIH / NICHD: R21 HD091330‐01A1 

Collaborators: Drs. Susan Levy, Emily Kuschner, Jennifer Pinto-Martin,Graham Thomas

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• Complete the evaluation soon after receiving it. It will expire after 3 weeks.

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Check out the COPE Fall Webinar Series

◦ 9/16/20 Katelyn Carr, PhDChoice is relative: Reinforcing value of food and activity in obesity treatment

◦ 10/14/20 Abby Braden, PhDDialectical behavior therapy and behavioral weight loss for emotional eating and obesity

◦ 11/11/20 Lauren Sastre, PhD, RD, LDNSharing the “weight” of obesity management in primary care: Integration of RDs/RDNs

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◦ A study of the experience and self-reported health and well-being of essential workers, first responders, service staff and healthcare professionals who provided support for patients, treatment sites and the community during the COVID-19 pandemic.

◦ Survey: 15-20 minutes◦ See Villanova.edu/cope for more info ◦ Pass along to colleagues

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Questions? Moderator:Lisa Diewald MS, RD, LDNcope@villanova.eduwww.villanova.edu/cope

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