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Set-shifting ability across the spectrum of eating disorders and in overweight and obesity: a systematic review and meta-analysis

Published online by Cambridge University Press:  26 February 2014

M. Wu
Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
T. Brockmeyer
Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
M. Hartmann
Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
M. Skunde
Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
W. Herzog
Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
H.-C. Friederich
Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany



In this meta-analysis we review the findings from neuropsychological studies on set-shifting in people with eating disorders (EDs) or overweight/obesity.


Four databases (PubMed, PsycINFO, PSYNDEX and Web of Science) were searched for eligible studies. Effect sizes (ESs) were pooled using random-effects models. Moderator analyses were conducted for ED and overweight/obese subgroups, adult/adolescent samples and measures of set-shifting.


Sixty-four studies with a total of 1825 ED patients [1394 anorexia nervosa (AN), 376 bulimia nervosa (BN) and 55 binge eating disorder (BED)] and 10 studies with a total of 449 overweight/obese individuals were included. The meta-analysis revealed a small to medium ES for inefficient set-shifting across all three ED diagnoses (Hedges’ g = –0.45). Subgroup analyses yielded small to medium ESs for each ED subtype (g = –0.44 for AN, –0.53 for BED, –0.50 for BN), which did not differ significantly. There was a medium ES for restricting type AN (ANR; g = –0.51) but no significant ES for binge/purge type AN (AN/BP; g = –0.18). A medium ES was found across obesity studies (g = –0.61). The ES across overweight studies was not significant (g = –0.07). Adult samples did not differ from adolescent samples in either ED or overweight/obesity studies. The different set-shifting measures were associated with largely varying ESs.


The meta-analysis provides strong support that inefficient set-shifting is a salient neuropsychological phenomenon across ED subtypes and obesity, but is less prominent in AN/BP and overweight. Compulsivity seems to be a common underlying factor supporting a dimensional and transdiagnostic conceptualization of EDs and obesity.

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