MICHAEL A. FRIEDMAN
KELLY D. BROWNELL
In contrast to the concerted effort to document the physical consequences of obesity, there is much less knowledge about the psychological consequences of excess weight. Furthermore, an interesting paradox exists. Clinical impressions suggest that obesity is often associated with intense suffering, including shame, guilt, and poor body image. However, most studies comparing obese and nonobese groups on psychological variables have not found consistent differences, leading many researchers to conclude that obesity is not associated with general psychological problems (see Chapter 70). The absence of group differences in studies comparing obese and nonobese persons has led to the assumption that the obese population is homogeneous with respect to psychological functioning. It is clear, however, that the obese population is heterogeneous with respect to etiology, effects of excess weight on medical variables, and response to various treatments. An approach accounting for this heterogeneity is necessary to understand the psychological consequences of obesity.
Friedman and Brownell have proposed a generational approach, suggesting that the results of comparative studies of obese and nonobese groups are an expected, if not inevitable, outcome of the approach used. Most studies use small samples, do not represent the general obese population, and typically employ a single measure of only one aspect of psychopathology. These studies are helpful as a first generation of research in the area but may not prove a lack of psychological suffering among obese individuals. Rather, inconsistent findings reflect an inconsistent phenomenon (i.e., the effects of being obese vary across individuals). Obesity may create serious psychosocial problems in some individu-