medical complications, alcohol or drug abuse, informed consent, and

cooperation" (p. 131). Exclusion processes can be active or passive.

Patients can be actively excluded because "they do not meet the

inclusion criteria or passively because they are not referred or recom-

mended for such surgery, or because surgery is unavailable or because

they are unwilling to accept surgery out of fear or misinformation" (p.

131). Because of these and other reasons, he stated that we need "well

designed epidemiological studies to characterize the morbidly obese" (p.

132).

 Klykylo (1983) expressed doubts that neurotic conflicts necessarily

are involved in obesity. "The psychic utility of a condition or

behavior to an individual in no way establishes causality" (p. 133). He

added that because of its relation to nutrition, obesity could be a very

"utilitarian defense" (p. 133). Speaking of the possibility of

anticedents to adult obesity, he suggested comprehensive studies of

childhood obesity with the possibility of intervention and prevention.

 Stunkard (1983) referred to 11 studies that "failed to find

subgroups of morbidly obese persons" (p. 126). He pointed out that the

reason psychological assessments are done at all is to determine

suitability for surgical intervention and that this determination "is

not likely to be greatly affected by the knowledge that in general,

morbidly obese persons have more, or less, psychopathology than others"

(p. 126).

 Noppa and Hallstrom (1981) studied body weight changes and excess

weight over a 6-year period in 1,302 middle-aged Swedish women. They

found weight gain and excess weight more common among single women. The