Obesity is a significant health problem in the US with African American (AA) women having one of the highest prevalence of obesity. Some AA women may equate a larger BMI with a positive body image. The purpose of this cross-sectional descriptive study was to examine the relationship between demographic variables, body image perception, coping behaviors and BMI with a non-probability sample of 191 AA women, 18–40 years old. Participants completed a demographic form and Pulver’s Figure Rating Scale (PFRS). Weight and height were measure and body mass index (BMI) calculated. Significant findings show that chronological age, hypertension, cigarette smoking and BMI were positively associated with body image perception. Using regression analysis, hypertension and BMI were predictors of body image perception. The study findings indicate that chronic illness and BMI impact body image perception.