Obesity common among children with medical complexity

Children with medical complexity (CMC) are significantly more likely to be overweight or obese compared with children without chronic medical conditions, according to a recent study.

CMC are characterized as those with underlying chronic health conditions, significant functional status limitations, and increased risk of hospitalization, said the researchers.

CMC represent 1–11 percent of all US children, and one in three children is overweight or obese.

“In fact, obesity may confer a ‘double disadvantage’ for children with serious chronic conditions. However, no previous study has documented the prevalence or potential mechanisms of obesity among CMC,” the researchers noted.

To assess the prevalence of overweight or obesity among CMC (≥1 serious chronic condition in ≥1 system), the researchers conducted a retrospective cohort study involving 41,905 children (aged 2–18 years). Using the CDC* standardized growth charts, overweight or obesity was defined as a body mass index (BMI) of ≥85 percentile. Obesity was further classified as class I (<120 percent of 95^th percentile BMI [BMI95]), class II (120–139 percent of BMI95), or class III (≥140 percent of BMI95). [Pediatrics 2023;doi:10.1542/peds.2022-058687]

Overall, 29.5 percent of the participants were identified as CMC.

CMC were at a significantly greater risk of being overweight (14.5 percent vs 11.0 percent; p≤0.001) or obese (17.4 percent vs 7.3 percent; p≤0.001) than those without medical complexity.

Compared with the non-CMC cohort, the CMC cohort also showed a higher prevalence of class I (11.1 percent vs 6.2 percent), class II (5.7 percent vs 0.8 percent), and class III obesity (0.6 percent vs 0.3 percent).

After adjusting for age, sex, and socioeconomic status, the prevalence of overweight or obesity remained higher among CMC than those without medical complexity (adjusted odds ratio [adjOR], 1.27).

Among CMC, the greatest risk of overweight or obesity was observed in those with metabolic conditions (adjOR, 2.09), gastrointestinal conditions (adjOR, 1.23), and malignancies (adjOR, 1.21).

Of the 3,934 CMC who were obese or overweight, 91.6 percent had no obesogenic medical condition or medication, indicating that cases of obesity and overweight may be preventable, noted the researchers.

“Our results revealed that obesity is a common and potentially preventable comorbidity among CMC, and that dietary behavioural interventions may be potential targets for early intervention to prevent weight-related comorbidities for this vulnerable population,” the researchers said.

“Further research is needed to better characterize obesity among CMC, as well as to identify potentially modifiable factors,” they noted.

*CDC: Centers for Disease Control and Prevention