Objectives: To determine: 1) the prevalence of obesity; 2) how persons perceive their body mass; 3) how they thought men perceived the body mass of women; 4) beliefs about the relationship of obesity with health, wealth, and diet; and 5) the amount and type of exercise done., Design: All eligible patients and accompanying persons present on random clinic sessions over a seven-week period., Setting: Two adjacent public primary care clinics in Barbados., Participants: 600 persons (response rate 95%) age > or = 15 years., Results: 39% (17% of males and 45% of females) were obese (body mass index [BMI] > or = 30 kg/m2), and 30% (48% of males and 24% of females) were overweight (BMI 25-29.9 kg/ m2). Satisfaction with body image declined with increasing BMI (P < .001), but 46% of obese persons were happy with how their body looked. The median image women selected from a body figure rating scale to represent their current size was not significantly different from the image they thought men preferred (P = .19) but was significantly larger than that chosen for ideal size (P < .001). Men selected a slightly smaller image compared to women (P = .04) for "the female image preferred by Barbadian men." Multivariate logistic regression showed that the likelihood of thinking that "men prefer women a little fat" was significantly increased by female sex (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.4-3.3), increasing age (OR 1.02, 95% CI 1.01-1.03), and increasing BMI (OR 1.04, 95% CI 1.01-1.07). Respondents thought obesity could be caused by overeating (74%), and by heredity (72%), and 3% associated it with wealth. Being fat and a little fat were thought to be a sign of health by 2% and 27% respectively. Only 55% of respondents exercised with walking being done by 34%., Conclusions: Females have a very high prevalence of obesity. Perceptions may be a barrier to motivation and behavior change required for weight reduction.