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

M. Wu, Timo Brockmeyer*, M. Hartmann, M. Skunde, W. Herzog, H. C. Friederich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

140 Citations (Scopus)


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

Method. 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.

Results. 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.

Conclusions. 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.

Original languageEnglish
Pages (from-to)3365-3385
Number of pages21
JournalPsychological Medicine
Issue number16
Publication statusPublished - 6 Dec 2014


  • Anorexia nervosa
  • binge eating disorder
  • bulimia nervosa
  • cognitive flexibility
  • compulsivity
  • eating disorders
  • obesity
  • overweight
  • set-shifting


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