Obesity risk and body composition among Bangkok adolescents with autism spectrum disorder: Stratification by sensory and cognitive severity using data mining

Abstract

Background: Obesity is prevalent among children with autism spectrum disorder (ASD) and may worsen core symptoms. The unique challenges faced by this population may heighten their vulnerability to both general and ASD-specific obesity risk factors. Objectives: This study examines body composition in adolescents with ASD, stratified by sensory and cognitive awareness severity and uses association rule analysis to identify key obesity-related factors for targeted intervention. Materials and methods: This cross-sectional study was conducted at an inclusive school in Bangkok, Thailand, with 39 children aged 11-17 years diagnosed with ASD and their parents. ASD severity was assessed using the Thai Autism Treatment Evaluation Checklist (Thai-ATEC), and participants were categorized by sensory and cognitive awareness scores. Anthropometric data and body composition were measured using a bioelectrical impedance analyzer (InBody 770). BMI percentiles and body composition parameters such as body fat mass, skeletal muscle mass, and visceral fat area were recorded. Family and lifestyle data were also collected. Association rule analysis using a data mining technique was applied to explore variables linked to obesity. Results: Different sensory/cognitive awareness severity levels (ATEC) had varying prevalences of obesity; the Mild group had the highest prevalence (86.67%), followed by the Moderate (66.67%) and Severe (58.33%) groups. The mild group consistently exhibited greater values for circumference, abdominal fat mass, body mass index, visceral fat area, waist-to-hip ratio, intracellular and extracellular water, skeletal muscle mass, and protein levels, indicating significant differences in anthropometric and body composition variables. Association rule analysis identified factors frequently linked to obesity, including exercise frequency, dietary behaviors, sensory/cognitive awareness severity, and digital technology use. Conclusion: This study highlights obesity as a significant concern among adolescents with ASD with distinct body composition patterns across sensory/cognitive awareness severity levels. As the first comprehensive investigation of its kind in Thailand, it identifies key contributing factors-such as physical inactivity, dietary habits, sensory processing differences, and digital media use-underscoring the need for personalized, lifestyle-based interventions in this population.