Obesity and Overweight Among Children with Comorbidities

The goal of a recent study was to examine the prevalence of overweight or obesity in children with medical complexity (CMC) compared to those without medical complexity and to explore potential modifiable factors. 

This retrospective cohort included 41,905 children aged 2-18 years who visited a single academic medical center in 2019. The primary outcome was overweight or obesity, defined by a body mass index (BMI) ≥85% for age and sex. CMC was described as having at least one serious chronic condition in one or more systems. Obesogenic conditions and medications were deemed as those typically associated with excessive weight gain. 

It was noted that among participants, 29.5% were classified as CMC. The prevalence of overweight or obesity was higher in the CMC group compared to the non-CMC group (31.9% vs. 18.4%, p ≤ 0.001). Among the CMC group, the risk of overweight or obesity was greater for children with metabolic, gastrointestinal, and malignancies and those with Spanish-speaking parents. Interestingly, among overweight and obese CMC, 91.6% had no obesogenic conditions, and only 8.5% had received guidance from a registered dietitian in the past year.

The study emphasized that CMC are at a significantly higher risk of being overweight or obese than children without medical complexity. Many cases of overweight among CMC appear preventable, suggesting the need for further research on preventing obesity-related comorbidities in this vulnerable population.

Dietary and behavioral interventions were recommended as early intervention modalities to prevent weight-related complications. Subpopulations with CMC at the highest risk of obesity, such as those with metabolic or gastrointestinal conditions, may benefit from targeted interventions. 

More extensive observational studies in multiple institutions and prospective research are needed to generalize these findings. Improving BMI measurement techniques in the medically complex population and exploring the impact of public policies and programs on obesity and related comorbidities among CMC are also areas for future investigation.

Source: Peinado Fabregat MI, Saynina O, Sanders LM. Pediatrics. 2023;151(1):e2022058687. doi:10.1542/peds.2022-058687