Review Article

The Relationship between Executive Function and Obesity in Children and Adolescents: A Systematic Literature Review

Table 1

Association between EF and obesity in childhood versus adolescence.

EF DomainParticipant ageMeasure usedFindingsSource

Childhood

2–5.5 yrsDelay of gratification task2 yrs performance predictive of 5.5 yrs obesity when considered with emotional regulationGraziano et al. (2010) [29, 40]
3–12 yrsSelf-control (age 3)
Delay of gratification (age 5)
Children’s Behavior Questionnaire (age 5)
Children with poorer performance at ages 3 and 5 had significantly higher BMI at all subsequent time points and had the most rapid gain in BMI 3–12 yrsFrancis and Susman (2009) [32]
6 yrsClassroom engagement
Social behavior questionnaire
Better performance at age 6 correlated with healthier weight in 4th gradePiché et al. (2012) [31]
(I) Inhibitory
control
5–15 yrsChild behavior questionnaireSubjects with low inhibitory control at age 7 tended to have higher BMIs at all follow-up measurements and experienced greater weight gain at age 7–15Anzman and Birch (2009) [35]
7–9 yrsGo-No Go TaskHigher BMI correlated with poorer performanceKamijo et al. (2012) [33, 41]
8-9 yrsBehavioral Rating Inventory of Executive Function (self-reporting)Highly sedentary children who were not weight conscious and consumed high fat and high sugar snacks exhibited less inhibitory control than children who were active and consumed fruits and vegetables. EF proficiency negatively correlated with substance use, high-calorie snack food intake, and sedentary behavior, while positively associate with fruit and vegetable intake as well as out-of-school physical activity Riggs et al. (2012) [30, 42]
8–11 yrsGo-No Go and Incompatibility Tasks of Attention Assessment BatteryHigh impulsivity linked to higher body weight Pauli-Pott et al. (2010) [34]
8–12 yrsDelay of Gratification Task (nonfood reward)O/OW less likely to delay gratification than HW and overweight* peersBruce et al. (2011) [27]
Go-No Go TaskO/OW had lower response accuracy for No Go component of task than healthy weight controls
Kamijo et al. (2012) [41]

(II) Attention1–6 yrsAttention span persistenceAmong boys, greater persistence at age 1 associated with reduced standardized weight gain and reduced obesity risk through age 6 Faith and Hittner (2010) [43]
4–8 yrsModified “Bavarian Model” for school entry examinationsO/OW females had greater prevalence of inability to focus attention than HW females (but not males) Mond et al. (2007) [37]

(III) Reward sensitivity6–13 yrsSensitivity to punishment and sensitivity to reward questionnaire for childrenPerformance significantly predicts BMI indirectly through overeatingVan den Berg et al. (2011) [38]

(IV) Working memory8-9 yrsBehavioral Rating Inventory of Executive Function (self-reporting)Children who were highly sedentary and consumed high fat and high sugar foods exhibited poorer working memory and poorer organizational skills than children considered active and who ate fruits and vegetables. EF proficiency negatively correlated with substance use, high-calorie snack food intake, and sedentary behavior, while positively associate with fruit and vegetable intake as well as out-of-school physical activity Riggs et al. (2012) [30, 42]

Adolescence

12–15 yrsGo-No Go and Incompatibility Tasks of Attention Assessment BatteryVariability of responses and tendency for relationship of body weight and performance to be inverse indicate attentional lapses rather than distinctly inhibitory lapses Pauli-Pott et al. (2010) [34]
12–15 yrsStop Signal TaskO/OW have less inhibitory control than HWNederkoorn et al. (2006) [44]
13–16 yrsIowa Gambling TaskO/OW performed significantly worse than HW controls Verdejo-García et al. (2010) [45]
(I) Inhibitory control12–21 yrsGo-No Go Test
Stroop Task
Five-Digit Test
Computerized Cognitive Test Battery
O/OW showed significantly more false positive responses and shorter reaction time than HW; significant association between disinhibition, OFC volume, and BMIBatterink et al. (2010) [46]; Maayan et al. (2011) [12]; Verdejo-García et al. (2010) [45]
7.5–15 yrsGo-No Go Task
Interference task
High impulsivity predicted successful weight loss in adolescents Pauli-Pott et al. (2010) [47]
10–14 yrsThe stop task
Circle drawing task
Opposite worlds task
Maudsley Index of Childhood Delay Aversionand Door-Opening Task
Association was found with overweight children and less efficient inhibitory controlVerbeken et al. (2009) [48]
12–17 yrsLetter-Number Sequencing
Stroop and Iowa Gambling Task
Greater improvement in cognitive inhibitory control skills was associated with greater reductions in BMIDelgado-Rico et al. (2012) [49]

(II) Attention/Mental flexibility12–19 yrsTrail making test
Wisconsin card sorting test
Computerized Cognitive Test Battery
Five-Digit Test-Switching
Color-Word Interference Test Stroop
D2 Attention Endurance Test
O/OW performed significantly worse than HW on all tasks; BMI inversely related to Stroop-switching performance for O/OW subjects
Lokken et al. (2009) [50]; Cserjesi et al. (2007) [51]; Verdejo-García et al. (2010) [45]; Delgado-Rico et al. (2012) [52]

(III) Reward sensitivity12–15 yrsDoor-Opening TaskO/OW were more sensitive to reward and kept gambling longer than HWNederkoorn et al. (2006) [44]

(IV) Working memory13–21 yrsWorking memory index of WRAML and Letter-Number sequencingO/OW performed worse than HW controlsMaayan et al. (2011) [12]

Obese/Overweight (O/OW) versus Healthy Weight (HW): subjects classified as overweight or obese met the criteria of BMI ≥30 kg/m2 or >95 percentile for BMI for age and gender; subjects classified as healthy weight met the criteria of BMI <25 kg/m2 or within 5–85 percentile for BMI for age and gender.
*Overweight: BMI between 85 and 95%.