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Executive functions and the self-regulation of eating behavior: A review

Simone Dohle, Katharina Diel, Wilhelm Hofmann

PII: S0195-6663(17)30160-5
DOI: 10.1016/j.appet.2017.05.041
Reference: APPET 3492

To appear in: Appetite

Received Date: 31 January 2017


Revised Date: 28 April 2017
Accepted Date: 22 May 2017

Please cite this article as: Dohle S., Diel K. & Hofmann W., Executive functions and the self-regulation of
eating behavior: A review, Appetite (2017), doi: 10.1016/j.appet.2017.05.041.

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Running head: EXECUTIVE FUNCTIONS AND EATING BEHAVIOR

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Executive Functions and the Self-regulation of Eating Behavior: A Review

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Simone Dohle, Katharina Diel, and Wilhelm Hofmann

University of Cologne
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Author Note

Simone Dohle, Katharina Diel, and Wilhelm Hofmann, Social Cognition Center

Cologne, University of Cologne. Correspondence concerning this article should be addressed

to Simone Dohle, Social Cognition Center Cologne, University of Cologne, Richard-Strauss-

Str. 2, 50931 Cologne, Germany. E-mail: simone.dohle@uni-koeln.de.


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Abstract

In order to pursue the long-term goal of losing weight, a dieter needs to resist the urge to eat

appealing, tasty foods. Beside sufficient motivation to resist these foods, dieters also need the

capacity for successful self-regulation, and this capacity is strongly related to executive

functions. Executive function is an umbrella term encompassing a number of interrelated

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higher-order cognitive processes that allow people to take goal-directed action. In this review,

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we outline how basic facets of executive functioning (updating, inhibiting, and shifting)

contribute to the successful self-regulation of eating behavior. Moreover, we identify aspects

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of the self-regulation of eating behavior that are still under-researched. We conclude by

outlining the implications of the extant research for intervention strategies and the design of

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future research studies on the role of executive functions for the self-regulation of eating
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behavior.
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Keywords: executive functions; working memory; behavioral inhibition; self-regulation; self-


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control; eating behavior


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Executive Functions and the Self-regulation of Eating Behavior: A Review

Many chronic diseases could be prevented through simple lifestyle changes. Eating healthy

foods and getting enough exercise, for example, significantly reduces the risk for obesity-

related diseases such as heart disease, stroke, cancer, and diabetes (Hill, Wyatt, Reed, &

Peters, 2003). Changing one’s eating behavior, however, is not easy: While millions of people

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diet, most of them ultimately gain weight (Burnette & Finkel, 2012; de Ridder, Adriaanse,

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Evers, & Verhoeven, 2014; Guerrieri, Stanczyk, Nederkoorn, & Jansen, 2012; Mann et al.,

2007).

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A dieter needs to resist the urge to eat palatable food in order to pursue the long-term

goal of losing weight. Thus, dieting requires self-regulation, which can be defined as goal-

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directed behavior within at least a minimum temporal perspective (Hofmann, Schmeichel, &
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Baddeley, 2012). Successful self-regulation entails that individuals not only have sufficient
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motivation to reduce the discrepancy between the actual state and the standard they are

pursuing, but also the capacity to achieve this discrepancy reduction (Hofmann et al., 2012;
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Kotabe & Hofmann, 2015). The capacity for successful self-regulation is strongly related to
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executive functions.

Executive functions
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Executive function is an umbrella term encompassing a number of interrelated higher-order

cognitive processes that allow people to take goal-directed action (Hofmann et al., 2012;
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Houben, Wiers, & Jansen, 2011; Miyake et al., 2000; Riggs, Jahromi, Razza, Dillworth-Bart,

& Mueller, 2006). The ability to update and monitor working memory representations

(“updating”), to inhibit impulses (“inhibition”), and to shift attention from one task set to

another (“task-switching/shifting”) are frequently postulated in the literature as important

executive functions (Miyake & Friedman, 2012; Miyake et al., 2000).

Neurophysiological evidence has demonstrated that the brain’s frontal lobes are the

primary region involved in executive functioning (Smith & Jonides, 1999). Especially the left
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inferior frontal gyrus, among other regions, seems to play a pivotal role in the self-regulation

of eating behavior, as inferior frontal gyrus activation predicts successful restraint when

people are faced with real-world food temptations (Lopez, Hofmann, Wagner, Kelley, &

Heatherton, 2014). In addition, research has shown that some, but not all, executive functions

are related to intelligence. Friedman et al. (2006) found that updating is highly correlated with

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intelligence measures, while inhibition and task-switching are not.

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There are also considerable individual differences in the effectiveness of executive

functions (Barrett, Tugade, & Engle, 2004; Hofmann, in press; Nederkoorn, Coelho,

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Guerrieri, Houben, & Jansen, 2012), and these differences are related to a variety of health

behaviours, including dietary and exercise behaviours (Hall, 2012). In addition, evidence from

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developmental psychology suggests that executive functions show developmental changes
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over the lifespan (Hofmann, in press): While executive functioning gradually improves with
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the maturation of the frontal lobes, with full maturation being reached between 16 and

19 years of age (see Jurado & Rosselli, 2007, for a review), there is an average but not
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inevitable decline in executive functioning at the other end of the life span (Hasher & Zacks,
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1988).

To measure executive function, a number of different experimental tasks have been


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used, most commonly the Operation Span task (Turner & Engle, 1989), the Stroop task

(Stroop, 1935), the Go/NoGo task (Miller, Schäffer, & Hackley, 1991), the Trail Making test
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(Reitan, 1958), and Wisconsin Card Sorting Task (Heaton, Chelune, Talley, Kay, & Curtiss,

1993). Each of these tasks is thought to measure one or more components of executive

functioning. The Operation Span task has been found to reflect the updating function, the

Stroop task and the Go/NoGo task typically measure inhibition, the Trail Making test

indicates switching, and the Wisconsin Card Sorting Task taps into a combination of the

executive functions (Hofmann et al., 2012; Jurado & Rosselli, 2007).

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Executive Functions and Eating Behavior

In general, executive functions are strongly involved in situations requiring planning and

decision-making, error monitoring and correction, sequencing of (complex) actions, inhibition

of habitual responses, and resistance to attractive stimuli (Allan, Johnston, & Campbell, 2011;

Allan, McMinn, & Daly, 2016; Norman & Shallice, 1986). Thus, executive functions are

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likely to be involved in eating behavior, especially when people are dieting. Dieting requires

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planning of meals and diets, decisions to select and to avoid certain foods, detections of

dietary deviations, actions (such as shopping and preparing food), overcoming strong—but

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unhealthy—habits, and the resistance to attractive and tempting but goal-incongruent foods

(Allan et al., 2011; Allan et al., 2016; Dohle, Rall, & Siegrist, 2014, 2016; Hartmann, Dohle,

& Siegrist, 2013).


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On a conceptual level, executive functions can be linked to the self-regulation of
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eating behavior in theoretically meaningful ways (see Figure 1). First, eating behavior can be

a predictor of executive functioning (“EF as outcome”). Numerous studies have documented


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the protective effect of healthy lifestyles, including healthy diets, in preserving executive
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functions into old age (for a review, see Allan et al., 2016). In this review, however, we focus

mainly on evidence suggesting that executive functions play a role in determining eating
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behavior (“EF as predictor”), although we acknowledge that this relationship can be

bidirectional. Taking a more process-oriented perspective, executive functions may be


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thought of as a process moderator (“EF as moderator”); that is, they may determine the

strength of relationship between a certain determinant of behavior (such as dietary intentions,

desires, automatic attitudes) and eating behavior. Finally, executive functions themselves may

be influenced by outside variables Z, both temporarily (through situational variables such as

alcohol consumption or cognitive load) or in the long run (through training). In these cases,

EF could be seen as part of a simple mediation (i.e., an extension of the EF as predictor view;

see Panel D) or as a mediator in a mediated moderation model (i.e., an extension of the EF as


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moderator view, see addition of dotted part in Panel C). In the following section, which will

be structured along the three broad facets of executive functions (updating, inhibiting, and

shifting), we will discuss the different roles of executive functions in the self-regulation of

eating behavior in more detail.

Updating: The Role of Working memory capacity in the Self-regulation of Eating

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Behavior

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Working memory capacity is a crucial factor in the domain of eating behavior in the

way that it contributes to an individual’s capability of persisting with their long-term goals

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such as healthy eating, thus resisting short-term desires that are not in line with long-term

goals. Specifically, high working memory capacity enables individuals to efficiently represent

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a given long-term goal and thus directs attention towards this goal by maintaining goal-
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relevant information, redirecting attention away from tempting stimuli or by suppressing
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information that are not in line with the long-term goal. Thus, in a tempting situation, the

long-term goal is “shielded” and a tempting desire can be efficiently down regulated
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(Hofmann, in press; Hofmann, Gschwendner, Friese, Wiers, & Schmitt, 2008). A


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straightforward approach to test these assumptions is to relate measures of working memory

capacity with behavioral outcomes in the eating domain, assuming that people harbor
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corresponding short-term desires in conflict with an overarching long-term goal so that, on

average, working memory capacity is helpful in solving such conflicts successfully, resulting
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in better eating outcomes and a lower risk for overweight. However, a more sophisticated

moderator approach would consist of measuring desires and/or goal, to then trace their

respective impact on eating behavior as a function of high vs. low levels of working memory

capacity (see Figure 1, Panel C).

Taking a straightforward approach, Goldschmidt and colleagues (in press) investigated

the association between executive functioning, including working memory capacity, and body

weight in children. They hypothesized that that overweight children would exhibit more
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difficulties with executive functioning than normal weight children, and that this effect would

be more pronounced for overweight children who also reported loss of control eating

behavior. While a range of executive functioning constructs were measured, results revealed

only significant associations of overweight (compared to normal weight) with planning

behaviour and working memory measures. Noteworthy, working memory performance was

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only poorer among children with overweight and concomitant loss of control eating,

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suggesting that children with overweight and loss of control eating in particular would benefit

from working memory training.

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Another straightforward approach was taken by Allom and Mullan (2014), who

showed that the ability to update information in working memory associated with healthy

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long-term outcomes was related to more frequent fruit and vegetable consumption (initiatory
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behavior) but not to decreased saturated fat intake (inhibitory behavior) in individuals with
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healthy eating goals. In contrast, inhibitory control, but not working memory capacity, was

found to decrease saturated fat consumption (see also below). The influence of updating on
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initiatory health behavior - such as the consumption of fruits and vegetables - supports the
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finding that the active representation of health goals in working memory and storing

information of ways to initiate those goals may successfully facilitates the initiation and
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persistence with the associated behavior.

The positive effect of working memory on fruit and vegetable consumption was
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recently supported by Whitelock and colleagues (Whitelock, Nouwen, van den Akker, &

Higgs, in press). The authors investigated the effect of different working memory sub-

components, including the visuospatial working memory, on food intake in a healthy sample

of dieting and non-dieting female participants. The visuospatial working memory maintains

spatial and visual information, thus ensuring the formation and manipulation of mental images

(Baddeley, 2007; De Beni, Pazzaglia, Gyselinck, & Meneghetti, 2005). Whitelock et al. (in

press) argued that successful dieters may have greater visuospatial working memory capacity,
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which allows them to deal with demands on the working memory (such as food cravings)

more appropriately. The results revealed a positive association between visuospatial working

memory and percentage of low energy dense food intake in a taste test. In addition,

visuospatial working memory capacity was also found to mediate the relationship between

diet success and low energy dense food intake.

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Limbers and Young (2015), however, found no relationship between working memory

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capacity (as predictor) and fruit and vegetable consumption in a healthy student population. It

should be mentioned, though, that the assessment of working memory capacity was based on

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a self-report scale that assessed everyday behaviors associated with executive functions,

whereas Allom and Mullan (2014) and Whitelock and colleagues (in press) relied on

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objective, performance-based measures of executive functions. Thus, the differences in
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methodology might account for the contradictory findings (see also Duckworth & Kern,
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2011).

Taking a moderator approach, some studies have investigated whether (a) high
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working memory capacity leads to a stronger correspondence between dietary intentions and
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eating behavior, and (b) a corresponding decrease in the link between impulsive/desire-related

determinants of behavior. For instance, when faced with the opportunity to consume tempting
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sweets, high working memory capacity individuals acted more strongly in line with the goal

to forego sweets, whereas low working memory capacity individuals acted more strongly in
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line with their automatic affective reactions toward the food (Hofmann et al., 2008; see also

Hofmann, Friese, & Roefs, 2009). These results suggest that working memory capacity may

act as an important moderator of the intention-behavior gap or attitude-behavior consistency,

helping people to translate planned behavior into action (Ajzen, 1991) while keeping

problematic, less wilful impulses and desires at bay (Hofmann, Friese, & Strack, 2009). At the

same time, these findings suggest that problematic eating behavior is most likely to result

from a combination of low commitment to a long-term dieting or health goal, strong


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impulses/desire for tempting but high-caloric food, and low trait (or state) working memory

capacity.

In sum, working memory capacity plays a major role in moderating an intention and

behaviour relationship, whereas the predicting role of working memory capacity on initiatory

health behaviours remains unclear.

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The Role of Inhibitory Control

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The ability to inhibit the impulse to eat tasty, high-calorie foods is central for the

successful self-regulation of eating behavior. Previous research has demonstrated that lower

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inhibitory control is associated with unhealthy eating habits such as overeating (Guerrieri et

al., 2007), including overeating in response to external food cues and in response to negative

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emotional states (Jasinska et al., 2012). As a result, lower inhibition places individuals at risk
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of overweight and obesity (Guerrieri, Nederkoorn, & Jansen, 2008; Hofmann, Adriaanse,
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Vohs, & Baumeister, 2014; Nederkoorn, Braet, Van Eijs, Tanghe, & Jansen, 2006;

Nederkoorn, Guerrieri, Havermans, Roefs, & Jansen, 2009; Nederkoorn, Houben, Hofmann,
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Roefs, & Jansen, 2010; Nederkoorn, Jansen, Mulkens, & Jansen, 2007).
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As in the case of working memory capacity, inhibitory control can be examined in its

direct relationship with eating behavior (“EF as predictor”, Figure 1). Using this approach,
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poorer inhibitory control has been found to be associated with increased consumption of

unhealthy foods, while the consumption of healthy foods appears to be unaffected by


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inhibitory control. For example, a study by Hall (2012) demonstrated that higher inhibitory

control was associated with lower frequency of high-fat food consumption over two weeks,

even after adjusting for demographic characteristics and general cognitive function; however,

no association with foods low in fat was found. Moreover, the above-mentioned study by

Allom and Mullan (2014) also found that inhibitory control predicted saturated fat intake, but

not fruit and vegetable consumption. This evidence suggest that inhibitory control is most

important for behaviours that require stopping a response, such as limiting the intake of high-
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calorie foods, whereas it less central for carrying out behaviours that require the initiation of a

response, such as increasing fruit and vegetable consumption (Allom & Mullan, 2014).

Noteworthy, a critical component for the successful inhibitory control of high-calorie food

intake seems to be episodic recall (i.e., the ability to encode and retrieve memories of recent

meals) as demonstrated in a recent study by Martin and colleagues (Martin, Davidson, &

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McCrory, in press). In their study of healthy adults, the researchers showed that episodic

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recall was positively associated with avoidance of fatty foods and negatively associated with

uncontrolled eating and emotional eating, suggesting that poor episodic recall might be a

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cognitive risk factor for overeating.

The role of inhibitory control can also be conceptualized as a moderator of the

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relationship between driving and restraining determinants of eating behavior. In the
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laboratory, inhibitory control as measured with the stop-signal task (Logan, Schachar, &
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Tannock, 1997) has been found to moderate the impact of automatic attitudes towards candy

on candy consumption (Hofmann, Friese, & Roefs, 2009). Also using a stop-signal task,
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Nederkoorn and colleagues (2010) found that automatic attitudes for snack food predicted
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weight gain over the period of one year more strongly for people low in inhibitory control. In

other words, people with a combination of strong impulsive tendencies towards snack food
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and low inhibitory control were most at risk of gaining weight. These results are

complemented by findings from a recent experience-sampling study using smartphone


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technology (Hofmann et al., 2014). The authors found that dieters high in inhibitory control,

as measured with a laboratory Stroop task at pretest, were more likely to attempt to resisting

food desires, to not consume desired (unhealthy) food, and objectively lost more weight over

four months compared to dieters low in inhibitory control (Hofmann et al., 2014). In concert,

the findings reported in this section suggest that inhibitory capacity may be more important

with regard to stopping (rather than initiating) behavior, that low inhibitory control may be an

important predictor of weight gain, and that, on a mechanistic level of explanation, this might
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be the case because inhibitory control may enable the effective stopping of prepotent action

tendencies (such as ripping open that bag of chips and putting them in one’s mouth while

watching TV) that may, in their aggregate, ruin people’s best dietary intentions.

The Role of Task Switching

Self-regulation always includes trade-offs between the rigid pursuit of a focal goal or

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task set (‘rigidity’ or ‘persistance’) and the possibility of switching tasks sets and being open

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to alternative courses of action (‘flexibility’). Task-switching may be related to the self-

regulation of eating behaviors in two different ways (Hofmann et al., 2012). First, task-

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switching may facilitate the ability to pursue dieting goals by allowing one to abandon

suboptimal means to pursue more effective methods to meet the dieting goal (“means-

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shifting”). For example, a dieter may realize that cutting 1000 calories a day is unrealistic and
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decides to reduce her diet by 500 calories each day and, at the same time, to exercise more.
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Second, task-switching may allow people to disengage from their dieting goal and to pursue

tempting alternatives (“goal-shifting”). Dieters who occasionally allow themselves to indulge


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without remorse in a tasty desert is a good example of such adaptive balancing of self-
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regulatory goals (Fishbach, Zhang, & Koo, 2009; Hofmann et al., 2012). In fact, it has been

demonstrated that flexible dietary restraint—a graduated approach to losing weight in which
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high-fat, energy-dense foods are permitted in limited quantities—leads to more consistent and

sustainable weight-loss than a rigid, all-or-nothing control of eating (Westenhoefer et al.,


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2013; Westenhoefer, Stunkard, & Pudel, 1999). In addition, allowing more dietary flexibility

on weekends (in contrast to weekdays) might be a more successful dieting strategy from a

long-term perspective (Orsama et al., 2014).

Compared to working memory capacity and inhibitory control, little research has been

conducted to address task-switching (Allan et al., 2011; Gunstad et al., 2007). This might be

due to the fact that task switching deficits have been demonstrated to be primarily involved in

the eating behaviour of individuals with extremely low or high BMI (Allom & Mullan, 2014;
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Roberts, Tchanturia, Stahl, Southgate, & Treasure, 2007; Wu et al., 2014). The limited

evidence in non-clinical samples, however, suggest that the role of task-switching in the self-

regulation of eating behavior appears to be a moderating one. Allan, Johnston, and Campbell

(2011) demonstrated that individuals who performed well on measures of task switching and

cognitive flexibility were more likely than others to achieve their dietary intentions (i.e.,

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eating more fruits and vegetables and less snacks). Task-switching, therefore, seems to

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moderate the size of dietary intention-behaviour gap (Allan et al., 2011). One possible

interpretation of the positive (rather than negative) effect of task-switching suggests that, in

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everyday life, the facet may be operating particularly at the level of means, i.e., substituting a

particular plan of action (buy healthy groceries) to achieve a given end (i.e., long-term goal to

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eat healthily) with an alternative means (shop closed –> visit friend to prepare healthy dinner
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together), rather than at the level of ends (i.e., disengaging from the long-term goal in order to
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enjoy fast food instead). Evidence for this line of reasoning comes from research on the self-

regulation of physical activity, in which task switching increased physical activity via
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substituting activities (Kelly & Updegraff, in press). That is, participants who performed well
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on measures of task switching were better able to select alternative means to pursue their

activity goal (e.g., went for a run when they missed their Zumba class). Thus, means-shifting,
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in contrast to goal-shifting, may facilitate the self-regulation of various health behaviours,

including eating behavior, but the evidence remains scarce. Future studies on task switching
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would benefit from considering means-shifting and goal-shifting simultaneously to assess

their relative contribution to the successful self-regulation of eating behavior.

Temporary Influences on Executive Functions

In addition to assessing EF as an individual difference variable, a great deal of

research has experimentally manipulated EFs such as working memory capacity. For instance,

the most widely used manipulations of working memory capacity are cognitive load

manipulations. These entail having subjects perform the primary task of interest (e.g., a
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reasoning task) while also performing a secondary task (e.g., storing a number in memory;

Baddeley & Hitch, 1974). Generally speaking, cognitive load reduces working memory

capacity temporarily (Hofmann et al., 2012), and may thus have detrimental effects on the

performance of tasks that require this executive function. For instance, Ward and Mann

(2000) have demonstrated that that chronic dieters consumed significantly more high-calorie

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food under cognitive load. Furthermore, a number of “risk” situations in which people’s

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dietary success is often at stake, among them stress or alcohol intoxication may be

functionally equivalent to cognitive load effects due to the preoccupation with task-irrelevant

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thoughts that they produce (Hofmann et al., 2012). That is, their documented detrimental

impact on the self-control of eating (e.g. Lattimore & Maxwell, 2004) may—at least

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partially—be mediated by temporary reductions in working memory capacity.
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Summary and Outlook
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As illustrated in this review, executive functions successfully contribute to the self-regulation

of eating behaviour. Beside direct influences, executive functions moderate the relationship
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between intentions, desires, or automatic attitudes and actual behaviour. In addition, executive
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functions themselves are affected by outside variables such as cognitive load. Updating,

inhibiting and shifting capacities, however, contribute to successful eating behaviour to


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different extents. WMC predicts initiatory health behaviour, such as eating fruit and

vegetables, but results vary when using different methods of assessing WMC. Objective
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performance-based measures of WMC seem be a better choice to study the influence of WMC

on eating behavior, and future studies may want to include objective-performance based

measures in combination with subjective measures for a multimethod investigation of WMC

and its relation with (un)healthy eating behaviour. As for inhibitory control, a number of

studies have revealed that poor inhibitory control leads to more unhealthy food consumption

and also moderates the relationship between automatic attitudes and candy consumption in

both short-term laboratory research and longitudinal studies. In contrast to inhibitory control,
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however, there has been only limited research on task-switching. More research is needed

especially with healthy, normal weight participants in order to gain more insight into task-

switching as a moderator between health-related intentions and behavior. These insights

would also be helpful for designing interventions promoting long-term behavioural change in

eating behavior. In particular, interventions targeting a combination of executive functions

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might be more effective than those focused on one, because the different facets of executive

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functions may facilitate different aspects of self-regulation (Hofmann et al., 2012). In sum, a

better understanding of the role of executive functions in eating behavior may decrease

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unhealthy food consumption and may push the achievement of dieting goals by allowing

flexible actions.

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Figure 1. The role of executive functions in the self-regulation of eating behavior.

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