Higher-order executive functions such as decision-making, cognitive flexibility and behavioural control are critical to adaptive success in all aspects of life, including the maintenance of a healthy body weight by regulating food intake. Performance on tasks designed to assess these aspects of cognition is impaired in individuals with obesity and anorexia nervosa (AN); conditions at either end of a spectrum of body weight disturbance. While the conceptualisation of obesity and AN as mirror images of each other makes some sense from a metabolic point of view, whether or not these conditions also reflect opposing states of executive function is less clear. Here, we review evidence from neurocognitive and neuroimaging studies to compare the direction and extent of executive dysfunction in subjects with obesity and AN and how these are underpinned by changes in structure and function of subregions of the prefrontal cortex (PFC). Both conditions of extreme body weight disturbance are associated with impaired decision-making and cognitive inflexibility, however, impulsive behaviour presents in opposing directions; obesity being associated with reduced behavioural control and AN being associated with elevated control over behaviour with respect to food and feeding. Accordingly, the subregions of the PFC that guide inhibitory control and valuation of action outcomes (dorsolateral prefrontal cortex and orbitofrontal cortex) show opposite patterns of activation in subjects with obesity compared to those with AN, whereas the subregions implicated in cognitive and behavioural flexibility (ventromedial prefrontal cortex and anterior cingulate cortex) show alterations in the same direction in both conditions but with differential extent of dysfunction. We synthesise these findings in the context of the utility of animal models of obesity and AN to interrogate the detail of the neurobiological contributions to cognition in patient populations and the utility of such detail to inform future treatment strategies that specifically target executive dysfunction.

决策制定、认知灵活性和行为控制等高级执行功能对于生活各个方面的适应性成功至关重要，包括通过调节食物摄入来维持健康的体重。肥胖和神经性厌食症 (AN) 患者在评估这些认知方面的任务时表现不佳；体重扰动频谱两端的条件。虽然从代谢的角度来看，将肥胖和 AN 概念化为彼此的镜像是有一定道理的，但这些条件是否也反映了执行功能的相反状态尚不清楚。这里，我们回顾了来自神经认知和神经影像学研究的证据，以比较肥胖和 AN 受试者执行功能障碍的方向和程度，以及这些是如何受到前额叶皮层 (PFC) 亚区域结构和功能变化的支持的。极端体重紊乱的两种情况都与决策受损和认知不灵活有关，然而，冲动行为呈现出相反的方向；肥胖与行为控制减少有关，而 AN 与对食物和喂养行为的控制增加有关。因此，与 AN 患者相比，指导抑制控制和评估动作结果（背外侧前额叶皮层和眶额皮层）的 PFC 子区域在肥胖患者中显示出相反的激活模式，而与认知和行为灵活性有关的子区域（腹内侧前额叶皮层和前扣带皮层）在两种情况下都显示出相同方向的改变，但功能障碍的程度不同。我们在肥胖和 AN 动物模型效用的背景下综合了这些发现，以询问神经生物学对患者群体认知的贡献的细节，以及这些细节的效用，为未来专门针对执行功能障碍的治疗策略提供信息。