Neuropsychology Review

, Volume 23, Issue 2, pp 138–156 | Cite as

Systematic Review: Are Overweight and Obese Individuals Impaired on Behavioural Tasks of Executive Functioning?

  • Sian FitzpatrickEmail author
  • Sam Gilbert
  • Lucy Serpell


This review was aimed at systematically investigating the evidence suggesting that obese individuals demonstrate impaired performance on behavioural tasks examining executive functioning abilities. A systematic review of literature was carried out by searching five separate databases (PsycINFO, MEDLINE, EMBASE, CINAHL and PubMed) and a hand search of relevant journals. Twenty-one empirical papers were identified from the search criteria and the results were considered in relation to different executive functioning domains. There is little consistency of results both within and across different domains of executive functioning. The review suggests that obese individuals show difficulties with decision-making, planning and problem-solving when compared to healthy weight controls, with fewer difficulties reported on tasks examining verbal fluency and learning and memory. A lack of replication and underreporting of descriptive data is a key limitation of studies in this area and further research is needed to examine the mechanisms underpinning the relationship between obesity and executive functioning.


Executive function Obesity Planning Verbal fluency Frontal lobes Body mass index 


  1. Alvarez, J., & Emory, E. (2006). Executive function and the frontal lobes: a meta-analytic review. Neuropsychology Review, 16(1), 17–42.PubMedCrossRefGoogle Scholar
  2. Avenell, A., Broom, J., Brown, T., Poobalan, A., Aucott, L., Stearns, S., et al. (2004). Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technology Assessment, 8(21), 1–182.Google Scholar
  3. Bechara, A., Damasio, A., Damasio, H., & Anderson, S. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 7–15.PubMedCrossRefGoogle Scholar
  4. Benton, A., & Hamsher, K. (1976). Multilingual aphasia examination. Iowa City: University of Iowa.Google Scholar
  5. Boeka, A., & Lokken, K. (2008). Neuropsychological performance of a clinical sample of extremely obese individuals. Archives of Clinical Neuropsychology, 23(4), 467–474.PubMedCrossRefGoogle Scholar
  6. Bolton, H. (2010). Examining perseveration in the context of depression and starvation to inform an understanding of cognitive inflexibility. Doctoral thesis, UCL (University College London).Google Scholar
  7. Brogan, A., Hevey, D., & Pignatti, R. (2010). Anorexia, bulimia, and obesity: shared decision making deficits on the Iowa Gambling Task (IGT). Journal of the International Neuropsychological Society, 16(4), 711–715.PubMedCrossRefGoogle Scholar
  8. Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M., Pories, W., Fahrbach, K., et al. (2004). Bariatric surgery. JAMA: The Journal of the American Medical Association, 292(14), 1724–1737.Google Scholar
  9. Burgess, P., & Shallice, T. (1997). The Hayling and Brixton tests. Bury St. Edmonds: Thames Valley Test Company.Google Scholar
  10. Cserjési, R., Molnár, D., Luminet, O., & Lénárd, L. (2007). Is there any relationship between obesity and mental flexibility in children? Appetite, 49(3), 675–678.PubMedCrossRefGoogle Scholar
  11. Cserjési, R., Luminet, O., Poncelet, A., & Lénárd, L. (2009). Altered executive function in obesity. Exploration of the role of affective states on cognitive abilities. Appetite, 52(2), 535–539.PubMedCrossRefGoogle Scholar
  12. Dahl, A., Hassing, L., Fransson, E., Berg, S., Gatz, M., Reynolds, C., et al. (2010). Being overweight in midlife is associated with lower cognitive ability and steeper cognitive decline in late life. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 65(1), 1–6.Google Scholar
  13. Danner, U., Ouwehand, C., van Haastert, N., Hornsveld, H. & de Ridder, D. (2012). Decision‐making impairments in women with binge eating disorder in comparison with obese and normal weight women. European Eating Disorders Review, 20, 56–62.Google Scholar
  14. Davis, C., Levitan, R., Muglia, P., Bewell, C., & Kennedy, J. (2004). Decision-making deficits and overeating: a risk model for obesity. Obesity, 12(6), 929–935.CrossRefGoogle Scholar
  15. Davis, C., Patte, K., Curtis, C., & Reid, C. (2010). Immediate pleasures and future consequences. A neuropsychological study of binge eating and obesity. Appetite, 54(1), 208–213.PubMedCrossRefGoogle Scholar
  16. Davis, C., Tomporowski, P., McDowell, J., Austin, B., Miller, P., Yanasak, N., et al. (2011). Exercise improves executive function and achievement and alters brain activation in overweight children: a randomised controlled trial. Health Psychology, 20, 91–98.CrossRefGoogle Scholar
  17. Duchesne, M., Mattos, P., Appolinário, J., de Freitas, S., Coutinho, G., Santos, C., et al. (2010). Assessment of executive functions in obese individuals with binge eating disorder. Revista Brasileira de Psiquiatria, 32, 381–388.PubMedCrossRefGoogle Scholar
  18. Fergenbaum, J., Bruce, S., Lou, W., Hanley, A., Greenwood, C., & Young, T. (2009). Obesity and lowered cognitive performance in a Canadian First Nations population. Obesity, 17(10), 1957–1963.PubMedCrossRefGoogle Scholar
  19. Galioto, R., Spitznagel, M., Strain, G., Devlin, M., Cohen, R., Paul, R., Crosby, R., Mitchell, J. & Gunstad, J. (2012). Cognitive function in morbidly obese individuals with and without binge eating disorder. Comprehensive Psychiatry, 53, 490–495.Google Scholar
  20. Gilbert, S. J., & Burgess, P. W. (2008). Executive function. Current Biology, 18, R110–R114.PubMedCrossRefGoogle Scholar
  21. Gonzales, M., Tarumi, T., Miles, S., Tanaka, H., Shah, F., & Haley, A. (2010). Insulin sensitivity as a mediator of the relationship between BMI and working memory-related brain activation. Obesity, 18, 2131–2137.Google Scholar
  22. Grant, D., & Berg, E. (1948). A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card-sorting problem. Journal of Experimental Psychology, 38, 404–411.PubMedCrossRefGoogle Scholar
  23. Gunstad, J., Paul, R. H., Cohen, R. A., Tate, D. F., Spitznagel, M. B., & Gordon, E. (2007). Elevated body mass index is associated with executive dysfunction in otherwise healthy adults. Comprehensive Psychiatry, 48(1), 57–61.PubMedCrossRefGoogle Scholar
  24. Gunstad, J., Lhotsky, A., Wendell, C. R., Ferrucci, L., & Zonderman, A. B. (2010). Longitudinal examination of obesity and cognitive function: results from the Baltimore Longitudinal Study of Aging. Neuroepidemiology, 34(4), 222–229.PubMedCrossRefGoogle Scholar
  25. Harrison, A. (2010). Emotional Functioning in Eating Disorders: attentional bias, emotion recognition and emotion regulation. Psychological Medicine, 17, 1–11.Google Scholar
  26. Hendrick, O. M., Luo, X., Zhang, S., & Li, C. R. (2011). Saliency Processing and Obesity: A Preliminary Imaging Study of the Stop Signal Task. Obesity, 10, 1–7.Google Scholar
  27. Joseph, R., Alonso-Alonso, M., Bond, D., Pascual-Leone, A., & Blackburn, G. (2011). The neurocognitive connection between physical activity and eating behaviour. Obesity Reviews, 12, 800–812.Google Scholar
  28. Lezak, M. (1995). Neuropsychological assessment. New York: Oxford University Press.Google Scholar
  29. Logan, G. D. (1994). In D. Dagenbach & T. Carr (Eds.), Inhibitory processes in attention, memory and language (pp. 189–239). San Diego: Academic.Google Scholar
  30. Logan, G., Schachar, R., & Tannock, R. (1997). Impulsivity an inhibitory control. Psychological Science, 8, 60–64.CrossRefGoogle Scholar
  31. Lopez, C., Tchanturia, K., Stahl, D., Booth, R., Holliday, J., & Treasure, J. (2007). An examination of the concept of central coherence in women with Anorexia Nervosa. International Journal of Eating Disorders, 41, 143–152.CrossRefGoogle Scholar
  32. Maayan, L., Hoogendoorn, C., Sweat, V., & Convit, A. (2011). Disinhibited eating in obese adolescents is associated with orbitofrontal volume reductions and executive dysfunction. Obesity, 19, 1382–1387.PubMedCrossRefGoogle Scholar
  33. Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cognitive Psychology, 41, 49–100.PubMedCrossRefGoogle Scholar
  34. Mobbs, O., Iglesias, K., Golay, A., & Van der Linden, M. (2011). Cognitive deficits in obese persons with and without binge eating disorder: investigation using a mental flexibility task. Appetite, 57, 263–271.PubMedCrossRefGoogle Scholar
  35. Morgan, A., & Lilienfeld, S. (2000). A meta-analytic review of the relationship between antisocial behaviour and neuropsychological measures of executive function. Clinical Psychology Review, 20(1), 113–136.PubMedCrossRefGoogle Scholar
  36. National Institute for Health and Clinical Excellence. (2006). Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. CG043. London: National Institute for Health and Clinical Excellence.Google Scholar
  37. Nederkoorn, C., Smulders, F., Havermans, R., Roefs, A., & Jansen, A. (2006). Impulsivity in obese women. Appetite, 47(2), 253–256.PubMedCrossRefGoogle Scholar
  38. Pender, S. (2011). The neuropsychology of starvation: Set-shifting, central coherence, perseveration, and persistence in a nonclinical sample. Unpublished clinical psychology doctoral thesis, Department of Clinical, Educational, and Health Psychology, University College London.Google Scholar
  39. Pierobon, A., Giardini, A., Fanfulla, F., Callegari, S., & Majani, G. (2008). A multidimensional assessment of obese patients with obstructive sleep apnoea syndrome (OSAS): a study of psychological, neuropsychological and clinical relationships in a disabling multifaceted disease. Sleep Medicine, 9(8), 882–889.PubMedCrossRefGoogle Scholar
  40. Pignatti, R., Bertella, L., Albani, G., Mauro, A., Molinari, E., & Semenza, C. (2006). Decision-making in obesity: a study using the gambling task. Eating and Weight Disorders, 11(3), 126–132.PubMedGoogle Scholar
  41. Reitan, R. (1958). Validity of the trail making test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271–276.Google Scholar
  42. Shallice, T. (1982). Specific impairments of planning. Philosophical Transactions of Royal Society London B: Biological Sciences, 298, 199–209.CrossRefGoogle Scholar
  43. Smith, P., Blumenthal, J., Babyak, M., Craighead, L., Welsh-Bohmer, K., Browndyke, J., et al. (2010). Effects of the dietary approaches to stop hypertension diet, exercise, and caloric restriction on neurocognition in overweight adults with high blood pressure. Hypertension, 55(6), 1331–1338.PubMedCrossRefGoogle Scholar
  44. Spitznagel, M., Garcia, S., Miller, L., Strain, G., Devlin, M., Wing, R. et al. (2011). Cognitive Function Predicts Weight Loss Following Bariatric Surgery. Surgery for Obesity and Related Diseases, 20, 1–7.Google Scholar
  45. Spreen, O., & Strauss, E. (1998). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford: Oxford University Press.Google Scholar
  46. Stuss, D. T., & Alexander, M. P. (2007). Is there a dysexecutive syndrome? Philosophical Transactions of the Royal Society B, 362, 901–915.CrossRefGoogle Scholar
  47. Svaldi, J., Brand, M., & Tuschen-Caffier, B. (2010). Decision-making impairments in women with binge eating disorder. Appetite, 54, 84–92.PubMedCrossRefGoogle Scholar
  48. Trenerry, M. R., Crosson, B., DeBoe, J., & Leber, W. R. (1989). The stroop neuropsychological screening test. Odessa: Psychological Assessment Resources.Google Scholar
  49. Van den Berg, E., Kloppenborg, R., Kessels, R., Kappelle, L., & Biessels, G. (2009). Type 2 diabetes mellitus, hypertension, dyslipidemia and obesity: a systematic comparison of their impact on cognition. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease, 1792(5), 470–481.CrossRefGoogle Scholar
  50. Van den Eynde, F., Guillaume, S., Broadbent, H., Stahl, D., Campbell, I., Schmidt, U. et al. (2011). Neurocognition in bulimic eating disorders: a systematic review. Acta Psychiatrica Scandinavica, 124, 120–140.Google Scholar
  51. Verdejo-García, A., Pérez-Expósito, M., Schmidt-Río-Valle, J., Fernández-Serrano, M., Cruz, F., Pérez-García, M., et al. (2010). Selective alterations within executive functions in adolescents with excess weight. Obesity, 18, 1572–1578.PubMedCrossRefGoogle Scholar
  52. Volkow, N., Wang, G., Telang, F., Fowler, J., Goldstein, R., Alia-Klein, N., et al. (2008). Inverse association between BMI and prefrontal metabolic activity in healthy adults. Obesity, 17(1), 60–65.PubMedCrossRefGoogle Scholar
  53. Walsh, K. (1994). Neuropsychology: a clinical approach (3rd ed.). Edinburgh: Churchill Livingstone.Google Scholar
  54. Wechsler, D. (1997). WAIS-III, WMS-III, technical manual. San Antonio: Psychological Corporation.Google Scholar
  55. Weller, R. E., Cook, E. W., III, Avsar, K. B., & Cox, J. E. (2008). Obese women show greater delay discounting than healthy-weight women. Appetite, 51(3), 563–569.PubMedCrossRefGoogle Scholar
  56. Wilson, B., Alderman, N., Burgess, P., Emslie, H., & Evans, J. (1996). Behavioral assessment of the dysexecutive syndrome. Oxford: Thames Valley Test Company.Google Scholar
  57. World Health Organisation (WHO) (2011) Global Database on Body Mass Index. Retrieved December 4, 2011, from
  58. Zinzindohoue, F., Chevallier, J., Douard, R., Elian, N., Ferraz, J., Blanche, J., et al. (2003). Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Annals of Surgery, 237(1), 1–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
  2. 2.Institute of Cognitive NeuroscienceUniversity College LondonLondonUK

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