<p class="Pa7"><strong>Objectives: </strong>Understanding body size perceptions and discrepancies among African American women may have implications for effective weight-loss interventions. The purpose of this study is to examine body size perceptions of economically disadvantaged, overweight and obese African American women.</p><p class="Pa7"><strong>Design: </strong>Cross-sectional using baseline data from a randomized controlled trial.</p><p class="Pa7"><strong>Setting: </strong>18 census tracts in a central South Carolina city where ≥25% of residents were below poverty income.</p><p class="Pa7"><strong>Participants: </strong>147 economically disadvantaged, overweight and obese African American women.</p><p class="Pa7"><strong>Main Outcome Measures: </strong>Using Pulvers’ figure rating scale, participants chose the figure: 1) closest to their current figure; 2) they would be satisfied with; and 3) with a body weight that would be a health problem for the average person. Mean body mass indices corresponding to each figure were compared with those in a large sample of White women.</p><p class="Pa7"><strong>Results: </strong>Most participants wanted to be smaller (mean=2.6 figures smaller) than their current size. A majority (67%) chose the largest figure as representing a body size that could lead to a health problem, and most (60%) chose a current figure smaller than the figure they believed would be associated with health problems. The mean body mass index for women selecting any given figure as their current size was significantly larger (5.2-10.8 kg/m2 larger, <em>P</em><.0001) than those established in the sample of White women.</p><p><strong>Conclusions: </strong>Although women desired a smaller body size, there nonetheless were misperceptions of body size and the associated health consequences. Body size misperceptions and/or satisfaction may pose barriers for effective weight-loss. <em>Ethn Dis</em>. 2015;25(4):391-398; doi:10.18865/ ed.25.4.391</p>