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Int J Obes (Lond). 2018 Apr;42(4):655-661. doi: 10.1038/ijo.2017.270. Epub 2017 Nov 1.

The association of emotion-driven impulsiveness, cognitive inflexibility and decision-making with weight status in European adolescents.

Author information

Brain Centre Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.
Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
Research and Education Institute of Child Health, Strovolos, Cyprus.
Section for Epidemiology and Social Medicine (EPSO), University of Gothenburg, Gothenburg, Sweden.
Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Growth, Exercise, NUtrition and Development (GENUD) Research Group, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS Aragón) and Centro de Investigación Biomédica en Red de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN), Zaragoza, Spain.
Institute of Food Sciences, National Research Council, Avellino, Italy.
Department of Pediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.
Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia.



To explore the association between emotion-driven impulsiveness, cognitive inflexibility, decision-making and weight status as reflected in body mass index (BMI) z-score (zBMI) in European adolescents.


In total, 3354 adolescents aged between 12 and 18 years from the I.Family cohort completed the questionnaire-based negative urgency subscale from the UPPS-P Impulsive Behavior Scale to measure emotion-driven impulsiveness in 2013/2014. Furthermore, 1584 adolescents completed the computer-based Bergs Card Sorting Test to measure cognitive inflexibility, and 1780 adolescents completed the Hungry Donkey Test to assess decision-making ability. Anthropometric variables were measured objectively; confounding variables (age, sex, socioeconomic status and country) were assessed using a questionnaire. Mixed-effect regression analyses were conducted for each outcome of the test or questionnaire as a predictor with standardised BMI (zBMI) as the dependent variable in order to investigate association between markers of cognitive functioning and zBMI.


After controlling for confounders, results showed that emotion-driven impulsiveness (β=0.18, 95% confidence interval (CI): 0.13 to 0.24, P<0.001) and cognitive inflexibility (β=0.01, 95% CI: 0.002 to 0.02, P=0.016) were positively associated with zBMI. However, decision-making ability was not significantly related to zBMI (β=0.001, 95% CI: -0.001 to 0.003, P=0.47).


More emotion-driven impulsiveness and reduced cognitive flexibility were associated with a higher zBMI in adolescents across Europe. These results may indicate that being impulsive in negative situations and having difficulties changing mental sets increase the susceptibility for unhealthy weight development. Reducing impulsivity and training cognitive flexibility seem promising targets for the prevention and intervention programmes of obesity.


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