Executive function in adolescents with obesity: A systematic review and meta-analysis

The development of executive function continues in adolescence, a phase bringing independence to choose behaviors and environments. In parallel, compromised executive function may foster unhealthy eating behaviors and weight gain. However, obesity-related differences in executive function in adolescents remain poorly understood. In this systematic review and meta-analysis, we investigated whether executive function is compromised in adolescent obesity and whether any executive function domain (inhibition, cognitive flexibility, working memory, decision-making, planning and verbal fluency) shows more pronounced impairments than others. Pooled across executive function domains, results from 49 studies (n = 9648 participants) that compared adolescents with excess weight (defined as overweight or obesity) to healthy-weight peers on at least one executive function task, showed a small effect indicating worse performance in adolescents with excess weight (g = -0.314, p < .001, 95% CI [-0.413, -0.214]). To disentangle the effects of obesity and overweight, we performed separate analyses which indicated similar differences for adolescents with obesity, but not for those with overweight, compared to healthy-weight peers. We found no evidence of selective executive function impairments, as effect sizes for performance differences between weight groups did not differ between domains. Samples with higher age, BMI range and proportion of female participants showed more pronounced differences between weight groups. In conclusion, our results show that adolescents with obesity scored modestly but consistently lower on executive function tasks compared to their healthy-weight peers, with moderating effects of age, BMI and sex. Our findings raise implications for future studies and the treatment of obesity.