This study investigated differences in the psychopathology of severely obese men and women in primary care in the North East of Ireland in comparison to clinical and community norms. One hundred thirty-eight participants (31.2% male and 68.8% female) were measured on eating disorders, depression, anxiety, self-concept and quality of life using standard self-report instruments. On the Eating Disorder Inventory, male and female scores on body dissatisfaction and female scores on bulimia were elevated to a degree that they did not differ significantly from clinical norms (P < 0.05). Female scores on the personal and social domains of self-concept fell significantly below community norms, whereas male scores on the same domains matched community levels. Significantly, more women than men scored in the severe range for depression and anxiety. Most female scores on the Eating Disorder Examination Questionnaire corresponded to clinical levels. Male participants reported higher quality of life overall. The findings suggest that gender differences should be considered regarding interventions, and that gender-specific treatment approaches might improve treatment outcomes. Moreover, screening for depression and anxiety ought to be part of obesity care for women.